The Faculty Lounge

Normalize Answering “For Money”

And do it for the repugnant jobs too.

 

Normalize answering "Why do you want this job?" with "Because I don’t currently have a job."

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— John Holbein (@johnholbein1.bsky.social) June 6, 2025 at 9:41 AM

Doctors Were Preparing To Remove Their Organs. Then They Woke Up.

This disheartening story comes from The New York Times, via Al Roth’s Market Design Blog. As Roth notes on BlueSky: “Organ donation from deceased donors relies on the assurance that the donor's death was in no way hastened by the subsequent donation. Today's NYT has a report suggesting that careful guidelines were sometimes almost breached.”

From the article:

Four years ago, an unconscious Kentucky man began to awaken as he was about to be removed from life support so his organs could be donated. Even though the man cried, pulled his legs to his chest and shook his head, officials still tried to move forward.

Now, a federal investigation has found that officials at the nonprofit in charge of coordinating organ donations in Kentucky ignored signs of growing alertness not only in that patient but also in dozens of other potential donors. . . .

Although the surgeries didn’t happen, the investigation said multiple patients showed signs of pain or distress while being readied for the procedure. (emphasis mine)

And also:

But the investigation found that the organization’s employees repeatedly pressured families to authorize donation, improperly took over cases from doctors and tried to push hospital staff to remove life support and allow for surgery even if there were indications of growing awareness in patients.

To emphasize (again), none of these organ retrievals went forward. The report is obviously disturbing, nevertheless.

 

Organ donation from deceased donors relies on the assurance that the donor's death was in no way hastened by the subsequent donation. Today's NYT has a report suggesting that careful guidelines were sometimes almost breached. #medicine #transplants #death

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— Al Roth (@alroth.bsky.social) June 6, 2025 at 10:45 AM

Pat Oglesby Appointed to Marijuana Legalization Commission

The governor of NC, Josh Stein, has come out in favor of marijuana legalization and formed a commission, on which my co-teacher, Pat Oglesby, has been tapped to serve, to study the issue and make recommendations.

This is an outstanding choice! Pat knows more about marijuana legalization, taxation, licensing, and related issues than anyone I know. We co-taught a course, Cannabis Legalization, at UVA Law that was a huge success, due to Pat’s knowledge and connections to industry experts, regulators, and researchers (and to our excellent students, of course).

The official press release is here, which includes the full list of commission appointees.

MAID In France

Via Al Roth's Market Design Blog comes news of a proposed French law that "has some familiar and some novel features." Reuters has the story: 

PARIS, May 27 (Reuters) - French lower house lawmakers approved a bill on Tuesday to legalise assisted dying, paving the way for France to become the latest European nation to allow terminally ill people to end their lives. . . the legislation is expected to pass, with polls showing more than 90% of French people in favour of laws that give people with terminal diseases or interminable suffering the right to die.

The proposed bill:

provides the right to assisted dying to any French person over the age of 18 suffering from a serious or incurable condition that is life-threatening, advanced or terminal. The person . . . must also have constant physical or psychological suffering that cannot be alleviated. Lawmakers stipulated that psychological suffering alone would not be enough to end one's life.

The patient can administer the lethal dose themselves or by an accredited medical professional if they are physically unable. Healthcare workers who object to doing so are free to opt out. Anyone found to have obstructed someone's right to die can face a two-year prison sentence and a 30,000 euro fine.

Read the full story here. 

Fair Compensation For Research Participants

I was very happy to see this guest editorial: Pursuing Fair and Just Compensation for Research Participants: An Open Letter to the Research Ethics Community. From the paper:

Concerns over undue influence often arise in discussions of payment to research participants, and many research ethics oversight bodies default to “payment conservatism,” preferring minimal compensation to participants (or none at all) out of an abundance of caution (Largent and Fernandez Lynch Citation2017). This practice, however, is unfair and does not convincingly protect against harm or undue influence. . . .

Research participation generates immense social value, and generous compensation can reflect this value and serve as an important sign of respect and appreciation for participants

Read the whole thing here. I hope that more researchers in this area begin to see the errors of attempts to maintain compensation to medical research subjects at low rates. I have long maintained, both in this setting and in the case of compensation to egg donors, that the ability of any sum to "coerce" or "induce" participation is a function of individual financial need. As I argued in Sunny Samaritans and Egomaniacs: Price Fixing In The Gamete Market:

Ironically, the most likely effect of the ASRM price cap is to drive from the market the most highly desired egg donors, who tend to be better-educated and of a higher socioeconomic status. '' These donors are arguably in a better position to evaluate the risks of egg donation against the monetary benefits and should be less susceptible to the "coercive" effects of monetary compensation because they are more likely to have other income opportunities to choose from.

And in the recently-posted "Repugnant Work": 

Phase I subjects thus can, and do, register for multiple trials each year and many consider Phase I trial participation their profession. Though pharmaceutical researchers refer to Phase I research subjects as “paid volunteers,” Phase I test subjects themselves reject that term, embracing instead the label “professional guinea pig.”14 This contrasts with the articulated views of researchers, IRB boards, and ethicists, who worry that financial compensation undermines judgement or voluntariness. These parties thus urge limitations on the amounts paid to guinea pigs and frame their efforts in non-commercial terms—as subjects or volunteers, for example, rather than as workers or contractors.

Related Posts: 

Egg Donor Antitrust Suit In Today’s WSJ

• Sunny Samaritans’ Suit Survives
• ASRM Seeks Dismissal of Egg Donor Suit
• Kamakahi v. ASRM et al. — Updates
• Politics And Profits in The Egg Business (When Sunny Samaritans Sue, IV)
• When Sunny Samaritans Sue, Part III
• When Sunny Samaritans Sue, Continued
• When Sunny Samaritans Sue
• The Value of Smart Eggs

Congestion And The Deceased Donor Waiting List

From Al Roth's Market Design Blog:

The deceased donor waiting list for kidneys to transplant is congested: offers, which take time to evaluate, are often rejected, while cold ischemia time accumulates.

 Here's a paper just published in Transplantation, in which we suggest new ways to detect organs that will be hard to match, and which might therefore be expedited through the allocation process (to get more quickly to patients who will accept them).

Insights From Refusal Patterns for Deceased Donor Kidney Offers, by Guan, Grace MS1; Neelam, Sanjit MS2; Studnia, Joachim MS2; Cheng, Xingxing S. MD, MS3; Melcher, Marc L. MD, PhD4; Rees, Michael A. MD, PhD5,6; Roth, Alvin E. PhD7; Somaini, Paulo PhD8; Ashlagi, Itai PhD1
Author Information
Transplantation ():10.1097/TP.0000000000005434, May 21, 2025 

No IVF For Single Women

In Italy. The FT has the story:

Italy’s constitutional court has upheld a long-standing ban on single women undergoing treatment for in vitro fertilisation, dealing a big setback to many who aspire to have babies amid the country’s deepening demographic crisis. Under existing rules, only heterosexual married couples are eligible for IVF in Italy, including in private clinics. This has forced many women who are single or in a same-sex partnership to travel to Spain or the UK for fertility treatments, a much costlier and more complicated endeavour.

But the constitutional court, in a separate ruling on Thursday, delivered a major victory to women in same-sex partnerships who have had children through IVF abroad, often with one partner providing the egg and the other carrying the pregnancy. Until now, Italy has recognised only the birth mother as legal parent, denying the other partner any rights over their own genetic children, or forcing them to go through a lengthy adoption process.  The court called such an approach unconstitutional and ruled that two women who undergo IVF together abroad, with each other’s consent, must both be recognised as the child’s legal parents.

 

“Under existing rules, only heterosexual married couples are eligible for IVF in Italy, including in private clinics. This has forced many women who are single or in a same-sex partnership to travel to Spain or the UK for fertility treatments, a much costlier and more complicated endeavour.”

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— Kim Krawiec (@kimkrawiec.bsky.social) May 22, 2025 at 8:00 PM

Massachusetts Reins In Trafficking Creep

At least for now. I had not been following Commonwealth v. Garafalo, but it is an interesting case in the latest battles over "trafficking creep" and the  Massachusetts Supreme Court recently weighed in. As Janie Chuang explained trafficking creep (along with exploitation creep) back in 2014:

The vagaries of this expansive definition have allowed diverse advocates to
opportunistically appropriate the “trafficking” label, such that what
trafficking is – is very much in the eye of the beholder. The definitional
muddle has also inspired promiscuous conflation of legal concepts, heated
battles over how best to address the problem, and an ever-changing
landscape of actors sharing in the fervor to abolish that thing we call
“trafficking.” 

The defendants in Garafalo responded to an online advertisement ostensibly offering sexual services for a fee (the advertisements were actually part of a sting operation). Interestingly, the advertisements went to great pains to depict the offerors as adult women not being trafficked. For example, the ads contained photos of adult women and described the women as "independent", "meaning -- as clarified in one text message exchange between the ostensible sex worker and one of the defendants -- that the woman was not affiliated with a "pimp" or "boyfriend."

More on "Joe Donor," Alleged "Father" of 180

The BBC has the story here:

An unregulated sperm donor, who claims to have fathered more than 180 children around the world, has been denied increased parental rights for a child he fathered as a donor through natural insemination. . . .

The judge questioned the donor's motives and asked: "Is he compelled to reproduce?
"Does he enjoy gratification from knowing that there are scores of his children on the earth?"
The judge also said Mr Albon, who is originally from the United States, had tried to control five of the six women in England and Wales who had his children, including using litigation.

You can hear more about Joe Donor and other "super donors" in two podcasts I did with the University of Chicago's Mary Anne Case on the Taboo Trades podcast. I've also written several papers on sperm markets including the motives (real or presumed) of donors, usually in comparison to the egg market, all posted to SSRN: 

Altruism and Intermediation in the Market for Babies, 66 Washington & Lee Law Review 203–258 (2009).

 

Sunny Samaritans and Egomaniacs: Price-Fixing in the Gamete Market, 72 Law and Contemporary Problems 59–90 (2009).

 

Lessons from Law About Incomplete Commodification in the Egg Market, 33 Journal of Applied Philosophy 160–177 (2016).

 

Markets, Morals, and Limits in the Exchange of Human Eggs, 13 Georgetown Journal of Law & Public Policy 349–366 (2015).

 

My Good Luck In England

As I noted in an earlier post, I had a number of conferences, lectures, and workshops this semester. All of them were really wonderful and I felt extremely grateful to have been invited. But every once in a while you attend an event that is really special. I was fortunate to be a part of two this year, both in England (coincidence? Maybe not).

The first was the annual Baron de Lancey Lecture at the University of Cambridge hosted by the Centre for Law, Medicine and Life Sciences. To be honest, law school lectures can be a mixed bag. Large law schools just have a lot going on at any given time -- general workshops, specialty workshops, student events, fed soc debates, conferences, etc. So lectures sometimes (not universally, of course) often feel forced and not something the faculty are excited about. The Cambridge folk were absolutely fabulous, however -- welcoming, inquisitive, engaged, etc. 

The second event was the fourth annual Normative Foundations of the Market conference at Oxford. The workshop was organized by Professor Tsilly Dagan, Emeritus Professor Colin Mayer, Professor Hanoch Dagan (Berkeley), and Professor Amy Sepinwall (Penn). Hanoch and Amy have been the primary organizers of all four iterations of this conference and it has only gotten better each time. They managed to attract an all star and multi-disciplinary line-up. And everyone was engaged and enthusiastic throughout the two days of papers, despite the jet lag of the participants, since everyone had come from various timezones, including the US east and west coasts, Israel, China, and more. 

Anyway, as I wrap up another academic year I am tired, but definitely counting my blessings! Congrats to all for surviving yet another academic year!

Child Trade or Adoption? South Korea Halts Fraud Investigation

NPR has the story, here:

South Korea's government investigation into human rights violations in past international adoptions, which led to a landmark admission of government responsibility in March, has ground to a halt. . . .

South Korea is one of the leading countries that sends children abroad for adoption. According to official data, nearly 170,000 babies have been adopted from South Korea since 1955, while experts suspect the actual number is higher. Sixty-five percent of them went to the United States. . . .

The commission found that adoption agencies sent away babies as "abandoned children" when they in fact they were missing children or had parents. The South Korean government gave the agencies a free hand, through legislation and neglect, to collect adoption fees and donations in what the commission called a "child trade."

Read the whole thing here. 

“South Korea is one of the leading countries that sends children abroad for adoption. According to official data, nearly 170,000 babies have been adopted from South Korea since 1955, while experts suspect the actual number is higher. Sixty-five percent of them went to the United States.”

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— Kim Krawiec (@kimkrawiec.bsky.social) May 6, 2025 at 2:00 PM

Telman on NIL and the Iamaleava Brothers

Over at ContractsProfBlog, Jeremy Telman has an interesting post on the current state of NIL concluding that "the center cannot hold" and urging a move to a development league model:

If we were to move to the Development League model, following every other country on the planet, young athletes can still get a college education while playing, but they will be actual, professional athletes, earning a living wage or better. And when they are not professional athletes during the off-season, they will be students, subject to the same expectations as other students, enriching both education and athletics without enriching the people who for decades have been exploiting college athletes and taxpayer dollars. A man can dream.

Read the whole post here. 

Selling Buddha

The BBC has the story, here: 

"Are the relics of the Buddha a commodity that can be treated like a work of art to be sold on the market?" wonders Naman Ahuja, a Delhi-based art historian. "And since they aren't, how is the seller ethically authorised to auction them?
"Since the seller is termed the 'custodian', I would like to ask – custodian on whose behalf? Does custodianship permit them now to sell these relics?"

Chris Peppé, great-grandson of William, told the BBC the family looked into donating the relics, but all options presented problems and an auction seemed the "fairest and most transparent way to transfer these relics to Buddhists".

 

“"Are the relics of the Buddha a commodity that can be treated like a work of art to be sold on the market?" wonders Naman Ahuja, a Delhi-based art historian. "And since they aren't, how is the seller ethically authorised to auction them?”

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— Kim Krawiec (@kimkrawiec.bsky.social) May 6, 2025 at 3:38 AM

"Repugnant Work" just posted

I posted a new article to SSRN, Repugnant Work. Here is the abstract:

This chapter discusses the repugnant income generating activities ("RIGA") of phase I medical research ("guinea pigging"), sex work, and plasma donation. Though each is a robust industry and substantial source of income and professional identity for many providers, significant debate surrounds whether participants in these industries are engaged in work, despite the subjective attitudes of participants themselves and objective similarities to other jobs. The continued invocation of false distinctions between RIGA and other work is thus best explained by discomfort with "dirty work" than to any unique concerns about effort, excellence, meaningfulness, or community. Whether RIGA is work carries consequences, albeit not the ones that many observers believe. But recognizing RIGA as work could impact the stigma faced by RIGA participants and subtly empower them to advocate for fair treatment by acknowledging their important role in the economy and society.

Download the whole thing here. Comments welcome!

Sally Satel Endorses The End Kidney Deaths Act

In this moving piece, Sally Satel, a two time kidney transplant patient argues in favor of The End Kidney Deaths Act. One thing I always appreciate about Sally is her focus on the wellbeing (including the emotional and psychological struggle) of those with end stage renal disease. Debates about incentivizing organ donation are appropriately focused on the welfare of potential donors, but it's also important to remember that the recipients of organs are very sick patients who have often exhausted other treatment options (such as they are).  Read "I Had Two Kidney Transplants. I Want Donors To Get Paid" here. 

You can also listen to this episode of the Taboo Trades podcast, featuring Satel: 

 

 

Steven Levitt & Ruby Rorty argue for the End Kidney Deaths Act in Chicago Tribune

 "The EKDA, a 10-year pilot program proposed by the Coalition to Modify NOTA, offers a sensible, moderate approach to valuable consideration in the form of refundable tax credits of $50,000 for nondirected living donors. The credit would be paid out over the course of five years, at $10,000 each year, and mirror the support we already extend to other public servants, such as veterans, firefighters and adoptive parents." HT: Frank McCormick

 

Steven Levitt & Ruby Rorty argue for the End Kidney Deaths Act in Chicago Trib "The EKDA, a 10-year pilot program proposed by the Coalition to Modify NOTA, offers a sensible, moderate approach to valuable consideration in the form of refundable tax credits of $50,000 for nondirected living donors."

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— Kim Krawiec (@kimkrawiec.bsky.social) April 30, 2025 at 3:42 PM

Bernstein on semen as a potentially toxic substance

This abstract, with an interesting title, from an always-interesting author, came across my desk recently. Anita Bernstein, Are You There Law? It's Me Semen. Here's the abstract from SSRN:

Abstract
Joining a conversation about menstruation and the law, this Essay interprets “law” to mean regulation––a source of burden, constraint, and interference justified by reason. The object of my regulatory agenda is a substance perceived by Western thinkers at least since Aristotle as the superior counterpart to menstrual fluid. Traditions that celebrate semen as vital or affirmative, while recoiling from and controlling the other gendered emission that hurts no one, get reality backward. Law as burden, constraint, and interference ought to regulate semen and leave menstrual fluid alone. Contrast the two substances. One of them started out with the potentially useful function of building a uterine lining. That possibility concluded, menstrual fluid is benign. The other effluvium started out with the potentially useful function of launching a pregnancy. Pregnancy is a good thing when it is desired by the person who has to live with the bulk of pregnancy’s detriments. Along with its capacity to do an important job, semen causes quite the array of harms. A statute on point for this purpose, the Federal Hazardous Substances Act, regulates material that “may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use.” Because semen “has the capacity to produce personal injury or illness to man through ingestion, inhalation, or absorption through any body surface,” it also aligns with the definition of “toxic” in the statute. Judges, policymakers, litigants, and ordinary people can all learn from well-established legal labels to understand semen as a stark example of an externality. Nothing in this statute impedes the characterization I propose: The FHSA lists substances that lie outside its purview, and semen is not among them. Labeling, containment, and emergency protocols—splash protection, if you like—are the hazardous-substance safety impositions I would apply to semen.

 

Kessler and Roth on organ donor registration

This long-awaited paper from Kessler and Roth was just published last week. As Roth notes, they began work on the project in 2010, when Kessler was "just a kid." In fact, I saw Kessler present this paper around that time and can confirm that he (and I!) were much younger then. 

Here's the abstract:

Abstract: The United States has a severe shortage of organs for transplant. Recently—inspired by research based on hypothetical choices—jurisdictions have tried to increase organ donor registrations by changing how the registration question is asked. We evaluate these changes with a novel "field-in-the-lab" experiment, in which subjects change their real organ donor status, and with new donor registration data collected from US states. A "yes/no" frame is not more effective than an "opt-in" frame, contradicting conclusions based on hypothetical choices, but other question wording can matter, and asking individuals to reconsider their donor status increases registrations.

As a bit of background, some early work using hypothetical donor registrations provided evidence that choice frame-- specifically, requiring subjects to say either "yes" or no"no" to organ donation, as opposed to an opt-in framework --  could dramatically increase organ donor registration rates. For example,  

Johnson and Goldstein (2003; 2004) found that 42% of their experimental subjects reported a willingness to register as an organ donor when asked to opt-in to a donor registry but that the rate was a dramatically higher 79% when subjects were required to say either “yes” or “no” to organ donation, a staggering 37 percentage point treatment effect.

Roth and Kessler use a controlled experiment (giving Massachusetts residents the opportunity to change their organ donor registration status) that tests whether the choice frame affects organ donor registration. They then present results from newly collected data on registration decisions from state DMVs, leveraging state-level changes in question wording as natural experiments. "Both sets of empirical work find consistent, near zero impacts of choice frame on organ donor registration, suggesting that prior estimates using hypothetical data do not accurately describe behavior under actual incentives."

Read the whole thing here.

 

Papers can take a long time to publish, but the problems they address can last even longer. #econsky #transplantation marketdesigner.blogspot.com/2025/04/newo...

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— Al Roth (@alroth.bsky.social) April 30, 2025 at 8:12 AM

Philosophy of Contract Law Now Available!

The new Research Handbook on the Philosophy of Contract Law, edited by Mindy Chen-Wishart and Prince Saprai, and published by Edward Elgar Publishing is now out. From the publisher:

With contributions from experts in the field, this comprehensive Research Handbook provides a systematic overview of debates at the cutting edge of the philosophy of contract law.

The Research Handbook engages closely with general theories of contract law, entering into detailed theoretical discussions surrounding its principles, rules and doctrines, as well as its moral foundations. Chapters explore key themes such as the limits of freedom of contract; debates about monistic and pluralistic theories of contract law; and the philosophical challenges associated with resolving hard cases. The Research Handbook on the Philosophy of Contract Law suggests paths for future studies, emphasising the need to bridge the gap between theory and practice.

Wide-ranging in scope, this Research Handbook is an essential resource for scholars and students in contract law theory, moral and political philosophy, jurisprudence and law and economics. Legal practitioners and policy experts seeking an overview of current theoretical debates will also benefit greatly from this book.

The book leaflet as well as screen shots of the table of contents are below. My contribution, The Ethical Limits of Markets: Market Inalienability, is here. Here is the abstract:

Although ethical critiques of markets are longstanding, modern academic debates about the “moral limits of markets” (MLM) tend to be fairly limited in scope. These disputes center, not on the dangers of markets per se, but on the dangers of exchanging particular items and activities through the marketplace. Proponents of MLM theories thus do not want to eliminate markets entirely, but instead seek to identify the moral and ethical boundaries of the marketplace by considering which goods and services are inappropriate for market trading. This chapter summarizes and categorizes some of the more important arguments within this debate, with a focus on recent research, controversies, and applications. The goal is to provide an overview of these debates, highlighting some of the topics that have generated robust discussion, particularly when relatively recent empirical or theoretical work may shed new light on a topic. Specifically, I focus on crowding out, corruption, leaving a space for altruism, equality, and a trio of related debates regarding paternalism (coercion, unjust inducement, and exploitation).

Dutch Sperm "Calamity"

The Guardian has the news in this story: ‘Medical calamity’: dozens of Dutch sperm donors fathered at least 25 children. (HT: Al Roth's Market Design Blog)

According to the article: “At least 85 sperm donors in the Netherlands have fathered 25 or more children, the national gynaecology and obstetrics organisation has said, after a new registration system showed fertility clinics have been breaking existing rules on sperm donation for decades.”

These revelations are important because countries like the Netherlands are often held up as regulatory role models, in contrast to the US, which has a fractured and largely unregulated system. But enforcement matters too, it turns out, and here there was none. 

The information became available only once donor anonymity laws were lifted: “Since 2004, when donors’ right to anonymity was lifted, the data showed there had been at least 85 “mass donors” (defined as at least 25 conceptions).”

“Most were biological father to between 26 and 40 children, Schoonenberg said, although several had between 50 and 75. Among them were at least 10 fertility doctors” (emphasis mine)