Showing posts with label compensation for donors. Show all posts
Showing posts with label compensation for donors. Show all posts

Friday

Legal brothels in Germany

The Telegraph has the story: Welcome to Paradise (Paradise is the name of a brothel in Stuttgart.). It's an unusually good article, so here is an unusually long set of excerpts.  One of the reasons I follow this kind of debate is because of the similar, ongoing debate about whether the sale of kidneys should be legal.


"When Germany legalised prostitution in 2002 it triggered an apparently unstoppable growth in the country’s sex industry. It’s now worth 15 billion euros a year and embraces everything from 12-storey mega-brothels to outdoor sex boxes. Nisha Lilia Diu visits some of them to find out who won and who lost...
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"Paradise is a chain, like Primark or Pizza Hut, with five branches and three more on the way.
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"People think Amsterdam is the prostitution capital of Europe but Germany has more prostitutes per capita than any other country in the continent, more even than Thailand: 400,000 at the last count, serving 1.2 million men every day. Those figures were released a decade ago, soon after Germany made buying sex, selling sex, pimping and brothel-keeping legal in 2002. Two years later, prostitution in Germany was thought to be worth 6 billion euros – roughly the same as Porsche or Adidas that year. It’s now estimated to be 15 billion euros.
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"The idea of the law, passed by Chancellor Gerhard Schröder’s Social Democrat-Green coalition, was to recognise prostitution as a job like any other. Sex workers could now enter into employment contracts, sue for payment and register for health insurance, pension plans and other benefits. Exploiting prostitutes was still criminal but everything else was now above board. Two female politicians and a Berlin madam were pictured clinking their champagne glasses in celebration.

"It didn’t work. “Nobody employs prostitutes in Germany,” says Beretin. None of the authorities I spoke to had ever heard of a prostitute suing for payment, either. And only 44 prostitutes have registered for benefits.

"What did happen was the opening of Europe’s biggest brothel – the 12-storey, neon-wrapped Pascha in Cologne. Not to mention a rash of FKK, or “naked”, clubs where men can spend the evening drifting between the sauna, the bar and the bedrooms. Bargain-hunters might try the “flat rate” brothels, where an entry fee of between 50-100 euros buys you unlimited sex with as many women as you want, or cruise the caravans at motorway truck stops, or the drive-through “sex boxes” in the street-walking zones. (They look like stables and are known as “verrichtungsboxen” - “getting things done boxes”.)

"The Netherlands legalised prostitution two years before Germany, just after Sweden had gone the other way and made the purchase of sex a criminal offence. Norway adopted the Swedish model - in which selling sex is permitted but anyone caught buying it is fined or imprisoned - in 2009. Iceland has followed suit, and France and Ireland look set to do the same.

"The Home Office insists Britain’s byzantine prostitution laws (in brief: you can buy and sell sex indoors under certain circumstances) are not up for review. But that might not be the case for long.

"Mary Honeyball, the Labour MEP, has been leading the charge to have the Swedish model adopted across Europe. Her bill was voted through by the European Parliament on 26 February, formally establishing the EU’s position on the issue. A few days later, on Monday, a cross-party report in Britain also recommended the model.

"Pressure to review prostitution laws is coming from an EU anti-trafficking directive that obliges member states to “reduce demand” for human trafficking. Given that at least 70 per cent of trafficking in Europe is into forced prostitution, a lot of people are arguing that the best way to reduce demand for trafficking is to reduce demand for prostitution. And one way to do that is to criminalise the buyer.
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"More than 55,000 men come to Paradise every year. Everyone – punter and prostitute – pays a 79 euro entry fee. That includes food (there is a buffet right by the Jacuzzi into which a naked middle-aged man is lowering himself) but the sex is extra. That’s negotiated between the men and the women and all of the money from that activity is kept by her. The going rate at Paradise is about 50 euros for half an hour, slightly cheaper than the hammam – another extra – which is offered at 53 euros for 30 minutes.
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"The law leaves [Saarbrücken’s mayor, Charlotte] Britz with her hands tied. “It’s easier to open a brothel in Germany than a chip shop,” she says. That’s actually true: while premises serving food need special licences there are no restrictions on brothels. That’s because all they do, technically, is rent rooms. The prostitutes are their customers just as much as the punters are. Sometimes, more so.
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"Most [prostitutes] are in a similar situation to Suzi: her family has no idea what she’s doing and she has no desire to have an official record of her years in prostitution. “This work is not for a long time,” she says. “Very soon I will stop.” Once she’s saved up enough money, she plans to get a job in a hotel or a restaurant. Kristina Marlen, a tantric dominatrix in Berlin and a spokeswoman for Germany’s Trade Association for Erotic and Sexual Services, agrees. “A lot of people just do it for a short period in their lives. They don’t want to have in their CV, ‘I was a whore from 2007 to 2009’.”
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"“People don’t employ prostitutes in Germany because it’s complicated,” says Beretin...
"Actually, says Knop, managing prostitutes is completely legal. The problem is making sure you don’t cross the line between “managing” them and “exploiting” them.
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"Forced prostitution comes in many guises. Some women are kidnapped, others are tricked with the promise of jobs as nannies or waitresses. Others choose to work as prostitutes but have no idea of the conditions that await them. Often, a woman’s pimps or traffickers are people from her own town. They know where her family lives and aren’t afraid of harming them in order to control her. Sometimes it’s the families who pressure girls into prostitution in the first place - unable, or unwilling, to think of another way for a woman to earn a living.
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"All the sex workers I spoke to, in Britain and in Germany, told me it’s “not for everyone.” Kristina Marlen, the Berlin dominatrix, sees her work in terms of “celebrating the sexual part of the person” (though “sometimes people come in and I am like ‘Ew’. But I can work with them.”) She’s bisexual and currently in an open relationship with a woman. She thinks of prostitution as its own kind of “sexual orientation”.

"But, she says, “there are some people working in the sex industry who shouldn’t be there.” Sex workers can find themselves in “very precarious positions and not all the women can articulate themselves as I can.” Even she has had “moments in which it wasn’t clear to me how to communicate boundaries.” You need to be thick-skinned and good at negotiating with strong boundaries and high self-esteem. There isn’t much of what’s been called “willing supply”.

Tuesday

Pros and cons of paying for kidneys, in the Journal of Medical Ethics

Some pros and cons on paying for kidneys in the Journal of Medical Ethics, March 2014, Volume 40, Issue 3

From the editors' summary in the first article ("The concise argument")"

"For over half a century the subject of organ transplantation has attracted ethical debate. One such ongoing debate, provoked by the severe scarcity of organs for transplantation and a concern to increase their supply, has been about why willing live donors should continue to be prohibited from offering their own organs for sale. Against allowing this, it has often been argued that prohibition protects people in poverty from being driven to, and then harmed by, this desperate last resort. But is that how such people in poverty themselves see it? From their point of view, it has been suggested, wouldn't it be reasonable to see prohibition as depriving them of their best option, leaving them worse off than if they had been able to exercise it? Isn't the claim to protect people in poverty therefore ‘misplaced paternalism’, providing no ethical justification for prohibition?

"In this month's feature article, Simon Rippon (see page 145, Editor's choice) mounts a serious and sustained challenge to that conclusion. He argues that while it would be reasonable for people in poverty to sell their organs if given the option, it would be equally reasonable, given the ‘significant and unavoidable’ harms of a live organ donor market, for them to prefer not to have this option at all. In her commentary on Rippon's paper, Janet Radcliffe-Richards (see page 152) acknowledges that ‘a plausible case for prohibition would probably take this form’, but goes on to argue that ‘although in principle prohibition need not be paternalistic, in practice it is’, since it ‘has been imposed on everyone irrespective of any consultation’. To this, and two further commentaries, by Gerald Dworkin (see page 151) and by Adrian Walsh (see page 153), Rippon responds (see page 155) in a significant contribution to a debate that nevertheless seems likely to continue unabated as long as the need for whole organs continues so greatly to exceed their supply."

The concise argument

Feature article

Commentaries

Clinical ethics

Thursday

WSJ: "I gave away a kidney, would you sell one?"

Dimitri Linde, a non-directed donor who started a kidney exchange chain writes in the WSJ yesterday:

I Gave Away a Kidney. Would You Sell One?

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"To obviate the kidney shortage, we should heed the recommendation of Nobel Prize-winning economist Gary Becker and others by making it legal to compensate donors. Currently, the National Organ Transplant Act bans the "sale" of any human organs in the U.S. Those who oppose compensation object to its ramifications for donors and society. They argue that the poor will be exploited, and that people should give out of the goodness of their hearts.

But these lofty sentiments ignore the fact that 18 transplant candidates die each day. As the legal scholar Richard Epstein has put it: "Only a bioethicist could prefer a world in which we have 1,000 altruists per annum and over 6,500 excess deaths over one in which we have no altruists and no excess deaths."

Yet absent such policy changes, which have little traction in Washington, right now transplant chains are the best tool to facilitate donations. Chains begin with a would-be recipient identifying a donor—say, a man with polycystic kidney disease and his wife. In most cases, a potential donor doesn't have a compatible blood and tissue type with the intended recipient, so this spousal pair would likely be a poor match. (Incompatibility can marginalize the life span of the transplant, or preclude the body from accepting it at all.)

That's where organizations like the National Kidney Registry, a nonprofit computerized matching service, come in. The NKR and similar nonprofits work with hospitals across the U.S. to create large national exchanges, linking incompatible and poorly compatible pairs to highly compatible counterparts elsewhere. Additionally, by working with living donors, these matching services furnish kidneys that endure, on average, twice as long as equally compatible cadaver transplants.

Through groups like NKR, altruistic donors—people willing to donate to an anonymous person—initiate "donor chains," catalyzing multiple donations. Inspired by reading about a 60-person chain begun by such a donor, I entrusted the NKR to select my recipient. Their software churned up a highly compatible match for me more than a thousand miles away. Concurrent with receiving a kidney, my recipient's incompatible donor gave to a commensurately strong match. A courier delivered this donor's organ to a third hospital in yet another region of the country, completing the exchanges."

Perfect Strangers: kidney donation movie

I went to see Perfect Strangers last night at Stanford, by Stanford's documentary filmmaker Jan Krawitz.
It was followed by a panel discussion by Krawitz, Stanford philosopher Debra Satz, and two non-directed kidney donors, one of whom was the main character in the film. Both initiated non-directed donor chains.

The other donor was the subject of this 2011 blog post A kidney donor argues that selling kidneys should be legal.

Tuesday

More on the market for kidneys in Iran

Here's an article on the market for kidneys in Iran that I missed when it came out, recently pointed out to me by Mohammad Akbarpour

Kidney International (2012) 82, 627–634; doi:10.1038/ki.2012.219; published online 6 June 2012

The Iranian model of living renal transplantation

Mitra Mahdavi-Mazdeh1
1Iranian Tissue Bank Research & Preparation Center, Tehran University of Medical Sciences, Tehran, Iran
Correspondence: Mitra Mahdavi-Mazdeh, Iranian Tissue Bank Research & Preparation Center, Tehran University of Medical Sciences, Tehran, Iran. E-mail: mmahdavi@sina.tums.ac.ir
Received 6 March 2012; Revised 28 March 2012; Accepted 5 April 2012
Advance online publication 6 June 2012
Top

Abstract

Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the ‘Achilles heel of the model’.