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Organ Donors and Imprisoned People

photograph of jail cell with man's hands hanging past bars

Should people who are in prison – even on death row – be allowed to donate their organs? Sally Satel has recently made the case. After all, there is a “crying need” for organs, with people dying daily because they do not receive a transplant. But, as Satel points out, the federal prison system does not allow for posthumous donations and limits living donations to immediate family members.

Imprisoned people, whether they want to donate a kidney whilst alive or all their organs after an execution, are rarely able to do so.

There seem to be a couple of practical justifications for this. For one, it might interfere with the date of execution; secondly, the prison system might have to bear some of this cost. I want to address these two issues before moving on to some of the other ethical issues involved.

It’s important to see that the actual date of execution has no ethical significance – it is not a justice-driven consideration. If it turns out that an execution is delayed two weeks to enable a kidney transplant, so what? Executions are delayed by stays all the time, and if there is some good to come out of changing the date then keeping it fixed doesn’t seem particularly important.

Secondly, there may well be costs to the prison system in, say, medical care for a patient who has donated a kidney (or for the removal of organs post-execution). But the prison system is part of the state. Given there is a nationwide shortage of organs, we might expect the state to play a role in addressing this, and if it has to bear some cost, why should it matter that the prison system – not the health system – must pay? After all, the criminal justice system is meant to help broader society. (That is not to mention that there might be other ways of funding these transplants that don’t increase costs for the prison system.)

There are further explanations for why states do not permit donations. Christian Longo – who sits on death row in Oregon for murdering his wife and children – asked to posthumously donate his organs and was told that the drugs used in executions destroy the organs. But Longo points out that other states use drugs that do not cause such destruction. Still, the specific drugs used in executions brings up an ethical concern: how painful these drugs are is not clear, and there seem to be some incredibly distressing executions.

Fiddling around with these drug cocktails in order to ensure the viability of organs may introduce major risks to the condemned.

Longo asked to donate his organs, so too did Shannon Ross, who is serving a long prison sentence. The fact that people are requesting to donate means that there seems to be more than mere consent here, there is an eagerness to donate. But this might hide some deeper worries, and to see this we need to investigate why inmates wish to donate.

We might also worry that Longo wants to get some “extra privileges” or to somehow improve his own situation. Perhaps an appeals or parole board would look more favorably upon somebody who has given up a kidney. But that doesn’t seem to be the case for Longo, who is resigned to death (though he has not yet been killed, Oregon has a moratorium in place). Yet others might volunteer to donate in the mistaken belief that this will help their case. This might make the expressed consent less voluntary than it seems, since they don’t fully understand the risks and benefits of what they are consenting to.

And this leads to what I think the most difficult moral issue here is: whether prisoners can autonomously consent. Longo points out that consent can sometimes be exploited: prisoners in the 60s and 70s were paid to volunteer for “research into the effects of radiation on testicular cells.”

That, even if it is seemingly voluntary, is unacceptable – prisoners are in a vulnerable position and we shouldn’t exploit them for medical research.

Both for prisoners who will be released and those on death row, I think we can find a useful parallel with cases of voluntary euthanasia. The key similarity is that both are in a desperate situation and are offered a chance that seems to help them improve their position.

David Velleman, for example, poses this challenge to defenders of voluntary euthanasia: perhaps even offering somebody the choice to die is coercive. To simplify a very complex argument, if someone thinks they might be a drain on their family, then offering them the chance to be euthanized might not actually help them do what they would autonomously choose. They want to carry on living, and they regret that this burdens their family. But once confronted with the option to die, they are called upon to provide a justification for continued existence and might, then, feel compelled to take an option they might otherwise not. And we can see how a prisoner on death row might similarly feel compelled to donate – lacking a suitable justification to refuse – once confronted by the choice.

In addition to these concerns about mistaken beliefs and the coerciveness of choice, there might be another deep temptation to donate. Longo notes that he has little opportunity to give back to society in any way – a society that he recognizes he has wronged and harmed. Giving away his organs seems to be a way of giving back. Donation, then, provides a way of atoning, if only to a limited extent.

The worry here is that the prospect of atonement is a bit like the worry of being a burden on your family.

When you’re given the option – donate your organs in the one case, end your life in another – this prospect burns too brightly.

It might be that the prospect of atonement blots out an individual’s proper concern with, say, their own future health (or, if they are on death row, with objections they might have to organ donation).

Yet I think that – powerful and troubling as this concern might be – this is only a worry. In offering his argument, Velleman notes that he isn’t opposed to a right to die, just that this is a (perhaps defeasible) argument against an institutional right to die. Likewise, the argument in our domain only goes so far. Many people have no objection to organ donation, so there is no such concern that they, if on death row, are making the wrong choice for themselves. Plenty of people who are under no pressure at all choose to donate a kidney – why can’t we allow prisoners to make that choice, too?

If we worry too much about the possibility of letting prisoners make a bad choice, we might be paternalistic and also take away from them the free choice to selflessly help others.

Unions and Worker Agency

photograph of workers standing together, arms crossed

The past few years have seen a resurgence of organized labor in the United States, with especially intense activity in just the past few months. This includes high profile union drives at Starbucks, Amazon, the media conglomerate Condé Nast, and even MIT.

Parallel to this resurgence is the so-called “Great Resignation.” As the frenetic early days of the pandemic receded into the distance, workers began quitting at elevated rates. According to the Pew Research Center, the three main reasons for quitting were low pay, a lack of opportunity for advancement, and feeling disrespected. Former U.S. Secretary of Labor Robert Reich even analogized it to a general strike, in which workers across multiple industries stop work simultaneously.

Undoubtedly, the core cause of both the Great Resignation and growing organized labor are the same – dissatisfaction with working conditions – but they are also importantly different. The aim of quitting is to leave the workplace, the aim of unions and strikes are to change it. They do this by trying to shift the balance of power in the workplace and give more voice and agency to workers.

Workplaces are often highly hierarchical with orders and direction coming down from the top, controlling everything from mouse clicks to uniforms. This has even led some philosophers, like the noted political philosopher Elizabeth Anderson, to refer to workplaces as dictatorships. She contends that the workplace is a blind spot in the American love for democracy, with the American public confusing free markets with free workers, despite the often autocratic nature of the workplace. Managers may hold almost all the power in the workplace, even in cases where the actual working conditions themselves are good.

Advocates of greater workplace democracy emphasize “non-domination,” or that at the very least workers should be free from arbitrary exercises of managerial power in the workplace. While legal workplace regulations provide some checks on managerial power, the fact remains that not everything can or should be governmentally regulated. Here, worker organizations like unions can step in. This is especially important in cases where, for whatever reasons, workers cannot easily quit.

Conversations about unionization generally focus on wages and benefits. Unions themselves refer to the advantage of unionization as the “union difference,” and emphasize the increases in pay, healthcare, sick leave, and other benefits compared to non-unionized workplaces. But what causes this difference? Through allowing workers to bargain a contract with management, unions enable workers to be part of a typically management-side discussion about workplace priorities. Employer representatives and union representatives must sit at the same table and come to some kind of agreement about wages, benefits, and working conditions. That is, for good or for ill, unions at least partially democratize the workplace – although it is far from full workplace democracy, in which workers would democratically exercise managerial control.

Few would hold that, all things being equal, workers should not have more agency in the workplace. More likely, their concern is either that worker collectives like unions come at the cost of broader economic interests, or that unions specifically do not secure worker agency but in fact saddle workers with even more restrictions.

The overall economic effect of unions is contentious, but there is little evidence that they hobble otherwise productive industries. A 2019 survey of hundreds of studies on unionization found that while unionization did lower company profits, it did not negatively impact company productivity and decreased overall societal inequality.

More generally, two assumptions must be avoided. The first is that the interests of the workers are necessarily separate from the interests of the company. No doubt company interests do sometimes diverge from union interests, but at a minimum unionized workers still need the company to stay in business. This argument does not apply to public sector unions (government workers), but even there, unions can arguably lead to more invested workers and stronger recruitment.

The second assumption to avoid is that management interests are necessarily company interests. Just as workers may sometimes pursue their personal interests over broader company interest, so too can management. This concern is especially acute when investment groups, like hedge funds, buy a company. Their incentive is to turn a profit on their investment, whether that is best achieved by the long-term health of the company or by selling it for parts. Stock options were historically proposed as a strategy to tie the personal compensation of management to the broader performance of a company. This strategy is limited however, as what it does more precisely is tie management compensation to the value of stock, which can be manipulated in various ways, such as stock buybacks.

Beyond these economic considerations, a worker may also question whether their individual agency in the workplace is best represented by a union. Every organization is going to bring some strictures with it, and this can include union regulations and red tape. The core argument on behalf of unions as a tool for workplace agency is that due to asymmetries of power in the workplace, the best way for workers to have agency is collective agency. This is especially effective for goals that are shared widely among workers, such as better pay. Hypothetically, something like a fully democratic workplace (or having each individual worker well positioned to be part of company decision making) would be better for worker agency than unions. The question of whether these alternatives would work is more practical than ethical.

There can be other tensions between individual and collective agency. In America specifically, unions have been viewed as highly optional. The most potent union relationship is a “closed shop,” in which a union and company agree to only hire union workers. Slightly less restrictive is a “union shop,” under which all new workers must join the union. Both are illegal in the United States under the 1947 Taft Hartley Act, which restricted the power of unions in several ways. State-level  “right to work” laws go even further, forbidding unions from negotiating contracts that automatically deduct union representation fees from employees. The argument is one of personal freedom – that if someone is not in the union they should not have to pay for it. The challenge is that the union still has to represent this individual, who benefits from the union they are not paying for. This invites broader questions about the value of individual freedoms, and how they must be calibrated with respect to the collective good.

 

The author is a member of Indiana Graduate Workers Coalition – United Electrical Workers, which is currently involved in a labor dispute at Indiana University Bloomington.

COVID-19 and Systemic Racism

photograph of "No Justice No Peace" sign at protest

As more information about COVID-19 and its effects comes to light, it is clear that the impacts of the disease are not the same everywhere or for everyone. Some communities are hit harder than others. In many cases, COVID-19 hot spots highlight systemic problems that existed before “coronavirus” was a household word. The public action that a society takes when things get rough reflects its values, in this case, its judgments about who and what is really important. Unsurprisingly, the circumstances of marginalized groups are not sufficiently taken into account in the construction of social programs and systems. When these social programs serve as the circulatory system of a nation during a pandemic, marginalized groups are the hardest hit. One lesson that this great tragedy should teach us is that we must recognize and embrace the diversity in our communities. Respect and appreciation for our cultural differences can help us to construct preemptive, life-saving policies.

If we’re willing to collectively put forth the work, the multiple tragedies we’ve recently gone through as a nation could give rise to transformative action. The murder of George Floyd and the subsequent protests to amplify the message that Black Lives Matter have cast the issue of racial justice onto center stage. The disproportionate effect of COVID-19 on communities of color can and should help people to understand what it means for racism to be systemic. One barrier to meaningful dialogue about racism is that some people think that for an action to be racist, it must be done with an explicit, hateful, discriminatory intention. Certainly, there are cases in which these conditions are met—some people are explicit, hateful racists. Systemic racism, however, has the potential to be even more pernicious and impactful. Understanding systemic racism requires us to think more holistically. We need to ask ourselves: How do we design our cities? Where do we put institutions that generate pollution and waste and why do we put them where we do? What social programs do we provide and to whom? What steps are we taking to see to it that upward mobility and human flourishing are attainable for all members of society? When answers to these questions suggest that people of color are consistently more negatively impacted by our practices, we have problems of systemic racism to fix. We find ourselves in just that situation when it comes to our response to COVID-19.

One critical component of emergency response is the transmission of information. Across the country, there have been huge challenges to information dissemination, created by a cluster of assumptions. Chief among these assumptions is the idea that everyone can speak English or is in regular contact with someone who can. For instance, meatpacking plants have been among the hardest hit institutions worldwide. As I have written in a previous article, conditions in slaughterhouses create a perfect storm for the spread of coronavirus. People work shoulder-to-shoulder doing strenuous activities that cause them to sweat and breathe heavily. Many employees at these facilities are immigrants and refugees who don’t speak English. Even if health and safety materials about COVID-19 are being created and widely disseminated, if a person can’t understand that material, they are in a poor position to help themselves or those around them. In crafting public health policy, we need to take into account the diverse nature of our communities. We need to provide information in more than one language. What’s more, we need to find ways of being proactive with these communities. We shouldn’t assume that everyone has access to television or the internet.

Florida governor Ron DeSantis made headlines last week for blaming his state’s spiking COVID-19 cases on migrant farm workers. This is a common move from the emerging coronavirus playbook—blame an outbreak on one event or group of people and imply that the spike is, therefore, somehow not real. Far from being exculpatory, increased cases among migratory farm workers is evidence of failure in governmental strategy. Florida public policy officials are aware that migrant farm workers exist in their state. However, in thinking about public health and the economy, concern for what might be happening on the margins came much too little and too late.

Racial injustice often leads to a snowball effect of harms. Consider the case of Louisiana’s infamous “Cancer Alley,” an 85-mile stretch of land along the Mississippi River that is home both to a majority black population and to roughly 150 petrochemical plants. The pollution in this area causes a range of health issues for those who live there. According to the EPA’s 2014 National Air Toxics Assessment, residents of this area are 95% more likely than most Americans to develop cancer from air pollution. These communities were already disenfranchised; pollution makes it worse. Pollution also causes pre-existing conditions, so, unsurprisingly COVID-19 has ravaged communities in Cancer Alley. At one point in April, a community in the area had the highest per capita COVID-19 death rate in the country.

The Navajo Nation has also been disproportionately affected by COVID-19—at one point it had the unfortunate distinction of having the highest per capita infection rate in the United States. The Navajo community has enacted strict lockdown and prevention measures, which have appeared to flatten the curve, at least for now. Help was slow to arrive. The CARES Act set aside 600 million to assist the Navajo Nation in its fight. To combat such an infectious disease, assistance is needed urgently. However, in order to receive the money to which they were entitled, the Navajo Nation had to sue the U.S. Treasury. By this point, people were already dead. Given the position in which the United States government stands to native people, swift assistance should have been a top priority.

When we say that Black Lives Matter and when we say that the lives of people of color matter, we take on responsibilities. We need to be reflective and active not just about our criminal justice system, but about the broad social and economic systems that give rise to inequity and injustice.

Stories of Vulnerability: COVID-19 in Slaughterhouses

photograph of conveyor line at meat-packing plant

Cases of famous people who have contracted COVID-19 have made headlines. Tom Hanks and Rita Wilson tested positive and later recovered. U.K. Prime Minister Boris Johnson wound up in intensive care. Many professional athletes have contracted the disease. More often than not, however, when we zoom in on coronavirus hotspots, we find that stories about vulnerability come into focus. Many of these stories go unheard unless they cause hardship or inconvenience for groups with more power.

One such case has to do with the production and slaughter of animals that people consume for food. Across the country, there are meat shortages caused by coronavirus. For example, nearly 1 in 5 Wendy’s restaurants has run out of beef, and at many locations other meat products such as pork and chicken are unavailable as well. Supermarkets are also facing shortages. The reason is that the conditions in slaughterhouses are particularly conducive to the spread of coronavirus. Hot spots are popping up at many such sites. 700 employees at a Tyson factory in Perry, Iowa tested positive. At a Tyson plant in Indiana, 900 employees tested positive. According to a CDC report, across 19 states there have been 4,913 cases of coronavirus among slaughterhouse employees. So far, there have been 20 deaths.

Slaughterhouses, also known as meat packing plants, are the next stop for most farm animals after their time in factory farms. When mammals like pigs and chickens arrive, they are put on conveyor belts, stunned, then killed. Their bodies are then sent to a series of “stations” where people carve them up for packaging and, later, consumption.

Work in a slaughterhouse is both physically and psychologically strenuous. Carving flesh and bone requires real effort, and many employees sweat profusely while doing it. The sheer volume of animals that need to be carved up to satisfy the American appetite for meat ensures that employees work together, standing shoulder to shoulder, in spaces that are often poorly ventilated.

This kind of work is not highly sought after for obvious reasons. It is unpleasant. As is so often the case in the United States, unpleasant work is done by those who struggle to find employment—often undocumented immigrants and people living in low-income communities. This complicates the problems with coronavirus spread in several ways. First, employees often do not speak English fluently, so conveying critical information about the virus is difficult. Second, it is common for members of these communities to live in large families or groups. Third, low-income communities are frequently places that are densely populated. All of these factors contribute to more rapid spread of the virus.

In response to the meat shortage, President Trump signed an executive order declaring that meat processing plants are critical infrastructure in the United States. There is disagreement among legal experts about what this means. Some argue that the president doesn’t have the authority to require that slaughterhouses remain open when their continued operation puts employees’ health in jeopardy. One interpretation is that the order simply exempts slaughterhouses from shutdown orders issued by governors. Despite the executive order, plenty of slaughterhouses have closed because they simply don’t have the healthy staff required to carry on.

Those who are supportive of the order are pleased that it provides support to companies that sell meat. Many Americans also approve because it appears that they can continue to put meat on their plates to feed their families and to satisfy their own gustatory preferences. Others approve of the order because they are concerned about the well-being of animal agriculture more broadly. Factory farms raise astonishing numbers of animals every year. The owners of these facilities are not breeding and raising them because they love animals and want thousands of pigs for pets. In these facilities, animals are treated as products to be bought and sold. During the pandemic, new animals are being born and there is no place to put them. The response, in many cases, has been to kill the older animals en masse. For example, Iowa politicians sent a letter to the Trump administration asking for assistance with the disposal of the 700,000 pigs that must now be euthanized each week across the country. The same problem exists for all species of farm animals. People are concerned that this might mean devastation for animal agriculture.

On the other side, many say “good riddance!” Animal agriculture is a cruel and inhumane industry. The pandemic has few silver linings, but one of them is that it brings injustices that might previously have been hidden into the public eye. Our system of animal agriculture could not exist without exploitation of the most vulnerable members of our communities. Slaughterhouses employ vulnerable workers in unsafe working conditions. Factory farms and slaughterhouses abuse and kill animals that cannot defend themselves. Maybe it is finally time for all of this cruelty and suffering to end. In his executive order, President Trump identified slaughterhouses as critical infrastructure. This means that such places are essential, necessary for the proper functioning of our communities. Since consuming the bodies of slaughtered animals is not necessary for human survival, this designation doesn’t seem appropriate.

What’s more, the conditions present in factory farms are exactly the kind that lead to the spread of zoonotic diseases. It appears that the coronavirus jumped from pangolin to human in a wet market in Wuhan. On other occasions, however, diseases spread in factory farms and slaughterhouses—diseases like the swine flu and mad cow disease. Other flus, like the avian flu, are believed to have originated in wet markets in China, but involved animals, chickens and ducks, that we regularly farm for food in the United States. One way that we can help to prevent the transmission and spread of zoonotic diseases is to stop consuming meat.

For those that love the taste of meat, there are alternatives. Beyond Meat and Impossible, plant based products that are engineered to strongly resemble meat in taste, texture, and appearance, are thriving in general, but are doing exceedingly well during the pandemic in particular. In vitro meat, a cellular cultured product that is produced by taking a biopsy of an animal, is a product that is produced in laboratory conditions rather than slaughterhouse conditions and is, therefore, likely to be much safer.

The pandemic shines a light on some of the ways in which our systems of food production exploit the vulnerable—both employees at risk for disease and the animals people put on their plates. Rather than issuing executive orders protecting this industry, perhaps it’s time to dismantle it altogether.

Pandemic Sacrifices: It Matters Who Dies and Why

photograph of small liferaft at sea

Political leaders, faux medical experts, and pundits are advocating for a stop to isolation policies despite the real loss of life that would result from doing so.

They are weighing the impact that isolation is having on the economy. The longer we isolate, the more businesses will suffer, and the more corporations will not be able to benefit from the labor that previously was performed. Further, we are facing a catastrophic rise in unemployment—22 million due to the pandemic. Instead of looking towards social benefits and supporting those most affected from losing their jobs and health, these leaders are suggesting ending isolation and further exposing the workforce in the name of an economy that, experts warn, will just need to be shut down again—next time with further dead, made up of those apparently expendable and worth sacrificing for the economy.

These calculations stand in for rhetorical frameworks for moral analysis. We do have approaches for dealing with massive losses when they are the result of, say, natural disasters. These can be blunt instruments that weigh the impact of saving each individual human life against the resources that could otherwise be spent on the good of “society.”

Imagine you were on a lifeboat in a stormy sea. There is no way for everyone to survive, and the experts estimate that a certain percentage must be sacrificed for the survival of the majority. What is the ethical method for making this decision?

The stipulations here force us into “consequentialist” thinking—we would like to maximize the number of people alive at the end of the hellish scenario. However, most would find the “pure” consequentialist reasoning abhorrent. In other words, maximizing the number of people alive at the end is not where our ethical duties end. When stuck on a lifeboat and in a position where 20% of those on board will die, there is a moral difference in this 20% being determined randomly or at the will of a corrupt captain. (Or as a result of the previous decisions of the corrupt captain.)

Our current situation is, and isn’t, parallel to the lifeboat analogy. There isn’t an inevitable number of people that must be sacrificed. There isn’t a storm forcing us to weigh human life against a “greater good”—in this case, the economy. We could, in fact, stay on our boat and take the measures that experts are suggesting at avoiding the sacrifice the leaders are saying are “necessary.”

However, when there is inevitable harm, the procedure for allocating that harm matters morally. Say we do face a scenario where there is a percentage of human lives that will be lost given the pandemic, and a need to end isolation for the greater good of the economy. COVID-19 is the great equalizer we must endure, and while we will lose some, our country/lifeboat will endure.

It’s important to note that even with that stipulation, the metaphor breaks down. That isn’t even the position we are in, either. The actions of the leadership of our lifeboat continue to ensure that the amount of harm increases, and becomes more unavoidable, more inevitable. By defunding the WHO and pandemic response teams, but counteracting state efforts and absolving the federal government from its responsibility for action, the situation continues to be made worse.

Further, they’re able to do this by invoking the notion that it is just like the inevitability of a natural disaster while asking people to unequally bear the burdens of the harm. They’re banking on the support from those they don’t think will accrue the harm. As in the lifeboat analogy, the ones who survive will likely be grateful. But the decision-making for who will be sacrificed is not morally neutral.

Treating these losses as distant and abstract statistics is a strategy. There is force in calling the impact of the coronavirus the great equalizer, as celebrities and politicians alike have claimed. It evokes the frameworks of natural disasters or warfare where there is a limit to what we can do to intervene—lives will “just be lost.” Trump’s message has shifted from denial and buck-passing to attempts to frame casualties under 100,000 as a victory.

This is not an equalizer and is structurally and reliably affecting some groups of people more than others. Black Americans are dying at a much higher rate than non-Black Americans—33%, while only making up 14% of the areas analyzed. Thirty percent of COVID-19 patients are black despite representing only 13% of the population (the different data is the result of varying availability of data). These stark differences become more dire in some cities: In Wisconsin, for example, African Americans represent 6 percent of the population, but nearly 40 percent of COVID-19 fatalities.

Other over-represented vulnerable populations include those living in care facilities, such as disabled people and the elderly, and the incarcerated. Meanwhile, the rich are much safer than others.

This makes a moral difference. Just like on a lifeboat, the captain is not absolved of making every attempt to avoid circumstances where sacrifices must be made, and is responsible for ensuring that just burden-sharing is in place. Sacrifices cannot be justified for false reasons—saving the economy isn’t even a true reason in the sense that sacrificing people may not actually achieve the intended aim.

Anyone suggesting sacrificing 2-3% of the population needs to name family members and loved ones they are willing to sacrifice. They then need to indicate a further segment of their loved ones to live with the effects of a serious illness and extended ICU stay. Because if this is an inevitable sacrifice we all must make, treat it as the great equalizer they claim it is. This will affect us all.