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Link shield - Legalization has zero federal support- treaty commitments and decades of bills getting shot down in committee empirics prove

Jackson et al 2011

Jackson et al 2011 (Ashlee Jackson, Chad Murray, Amanda C. Miralrío, Nicolas Eiden, Second-year Master’s students at the George Washington University Elliott School of International Affairs, Inter-American Drug Abuse Control Commission: Capstone Report, Mexican Drug Trafficking Organizations and Marijuana: The Potential Effects of U.S. Legalization, https://elliott.gwu.edu/sites/elliott.gwu.edu/files/downloads/acad/lahs/mexico-marijuana-071111.pdf)

Federal legalization of marijuana is unlikely. There is no indication that a complete removal of marijuana from the list of controlled substances is a politically viable option To unilaterally do so would put the United States in noncompliance with several international legal obligations the domestic process for rescheduling of marijuana makes the task seem extremely arduous both Congress and the Department of Health and Human Services have the authority to reschedule marijuana, and neither seems willing to consider the possibility Legislation has been introduced in Congress to reschedule marijuana to a Schedule II drug in order to allow for medical marijuana every year since 1997. In fourteen years of being introduced, proposals to reschedule marijuana have never moved beyond committee referral in order for this drug to be reclassified under any other schedule, it must be proven to have accepted medicinal uses However, the Drug Enforcement Administration and the National Institutes of Health have made it difficult for scientists to procure the supply of marijuana necessary to perform experiments on the medicinal properties of marijuana All of this makes for a daunting task confronting anyone who would try to go the federal route in legalizing marijuana

no indication that marijuana a politically viable option To unilaterally do so would put the United States in noncompliance with several international legal obligations Legislation has been introduced in Congress every year since 1997. , proposals have never moved beyond committee referral the Dr E A and the N I H have made it All of this makes for a daunting task confronting anyone who would try to go the federal route in legalizing marijuana.

Federal legalization of marijuana is unlikely. There is no indication that a complete removal of marijuana from the list of controlled substances is a politically viable option in the short, medium, or long term. To unilaterally do so would put the United States in noncompliance with several international legal obligations. In order to avoid this, the United States would have to convince the signatories to the international conventions discussed in Chapter 2 of this report to agree to end marijuana controls. Even ignoring the international angle, the domestic process for rescheduling of marijuana makes the task seem extremely arduous. First, both Congress and the Department of Health and Human Services have the authority to reschedule marijuana, and neither seems willing to consider the possibility.76 Legislation has been introduced in Congress to reschedule marijuana to a Schedule II drug in order to allow for medical marijuana every year since 1997. In fourteen years of being introduced, proposals to reschedule marijuana have never moved beyond the committee referral process.77 A citizen petition submitted to the DEA in 1995 to reschedule marijuana was denied in 2001. In its denial, the DEA cited the Department of Health and Human Services‟ guidance that due to marijuana‟s “high potential for abuse” and no proven medicinal value, it must remain a Schedule I drug.78 Therefore, in order for this drug to be reclassified under any other schedule, it must be proven to have accepted medicinal uses. However, the Drug Enforcement Administration and the National Institutes of Health have made it difficult for scientists to procure the supply of marijuana necessary to perform experiments on the medicinal properties of marijuana.79 All of this makes for a daunting task confronting anyone who would try to go the federal route in legalizing marijuana.

<h4><strong>Link shield - Legalization has zero federal support- treaty commitments and decades of bills getting shot down in committee empirics prove</h4><p>Jackson et al 2011</strong> (Ashlee Jackson, Chad Murray, Amanda C. Miralrío, Nicolas Eiden, Second-year Master’s students at the George Washington University Elliott School of International Affairs, Inter-American Drug Abuse Control Commission: Capstone Report, Mexican Drug Trafficking Organizations and Marijuana: The Potential Effects of U.S. Legalization, https://elliott.gwu.edu/sites/elliott.gwu.edu/files/downloads/acad/lahs/mexico-marijuana-071111.pdf)</p><p><u>Federal legalization of marijuana is unlikely. There is <mark>no indication that </mark>a complete removal of <mark>marijuana</mark> from the list of controlled substances is <mark>a politically viable option</u></mark> in the short, medium, or long term. <u><mark>To unilaterally do so would put the United States in noncompliance with several international legal obligations</u></mark>. In order to avoid this, the United States would have to convince the signatories to the international conventions discussed in Chapter 2 of this report to agree to end marijuana controls. Even ignoring the international angle, <u>the domestic process for rescheduling of marijuana makes the task seem extremely arduous</u>. First, <u>both Congress and the Department of Health and Human Services have the authority to reschedule marijuana, and neither seems willing to consider the possibility</u>.76 <u><mark>Legislation has been introduced in Congress </mark>to reschedule marijuana to a Schedule II drug in order to allow for medical marijuana<mark> every year since 1997. </mark>In fourteen years of being introduced<mark>, proposals </mark>to reschedule marijuana <mark>have never moved beyond</u></mark> the <u><mark>committee</u> <u>referral</u></mark> process.77 A citizen petition submitted to the DEA in 1995 to reschedule marijuana was denied in 2001. In its denial, the DEA cited the Department of Health and Human Services‟ guidance that due to marijuana‟s “high potential for abuse” and no proven medicinal value, it must remain a Schedule I drug.78 Therefore, <u>in order for this drug to be reclassified under any other schedule, it must be proven to have accepted medicinal uses</u>. <u>However, <mark>the Dr</mark>ug <mark>E</mark>nforcement <mark>A</mark>dministration <mark>and the N</mark>ational <mark>I</mark>nstitutes of <mark>H</mark>ealth <mark>have made it </mark>difficult for scientists to procure the supply of marijuana necessary to perform experiments on the medicinal properties of marijuana</u>.79 <u><mark>All of this makes for a daunting task confronting anyone who would try to go the federal route in legalizing marijuana</u>.</p></mark>

1nr

At: link

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

N

Ndt

1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

Yes deal – it’s close now – prefer evidence – cites Irani officials and assumes Netanyahu

Schuppe 3/5

Schuppe 3/5 (Jon, NBC News, Iran Foreign Minister: We Believe We Are 'Very Close' to Nuke Deal, http://www.nbcnews.com/news/world/iran-foreign-minister-we-believe-we-are-very-close-nuke-n317356)

Iran has no intention of building a nuclear weapon, sooner the world recognizes that, the sooner there will be a deal aimed at curbing its nuclear capabilities Foreign Minister Mohammad Javad Zarif told Once we reach that understanding, once this hysteria is out, once this fear mongering is out, then we can have a deal, and a deal that is not going to hurt anybody We are prepared to work round the clock in order to reach an agreement. We believe that we are very close, very close there are details that need to be worked out." "We are very close if the political decision can be made to get to yes, as President Obama said," minister spoke a day after Netanyahu appeared before Congress

Iran has no intention of building a weapon sooner the world recognizes that sooner deal a Foreign Minister Mohammad Javad Zarif told once this fear mongering is out, then we can have a deal, and a deal that is not going to hurt anybody We are prepared to work round the clock in order to reach an agreement. We believe that we are very close, very close there are details that need to be worked out." "We are very close if the political decision can be made to get to yes, as President Obama sai a day after Netanyahu

Iran has no intention of building a nuclear weapon, and the sooner the world recognizes that, the sooner there will be a deal aimed at curbing its nuclear capabilities in exchange for the lifting of crippling economic sanctions, Foreign Minister Mohammad Javad Zarif told NBC News. "Iran is not about building nuclear weapons," Zarif said in an exclusive interview with Ann Curry Wednesday. "We don't want to build nuclear weapons, we don't believe nuclear weapons bring security to anybody, certainly not to us." Zarif said his country's nuclear ambitions were solely in the pursuit of "scientific advancement" and boosting national pride. "Once we reach that understanding, once this hysteria is out, once this fear mongering is out, then we can have a deal, and a deal that is not going to hurt anybody," he said. He added: "We are prepared to work round the clock in order to reach an agreement. We believe that we are very close, very close and we could be very far." He said "there are details that need to be worked out." "We are very close if the political decision can be made to get to yes, as President Obama said," he said. The minister spoke a day after Israeli Prime Minister Benjamin Netanyahu appeared before the U.S. Congress, warning against a deal, which he said "paves Iran's path to the bomb."

<h4>Yes deal – it’s close now – prefer evidence – cites Irani officials and assumes Netanyahu</h4><p><strong>Schuppe 3/5</strong> (Jon, NBC News, Iran Foreign Minister: We Believe We Are 'Very Close' to Nuke Deal, http://www.nbcnews.com/news/world/iran-foreign-minister-we-believe-we-are-very-close-nuke-n317356)</p><p><u><mark>Iran has no intention of building a</mark> nuclear <mark>weapon</mark>,</u> and the <u><mark>sooner the world recognizes that</mark>, the <mark>sooner</mark> there will be a <mark>deal a</mark>imed at curbing its nuclear capabilities</u> in exchange for the lifting of crippling economic sanctions, <u><mark>Foreign Minister Mohammad Javad Zarif</mark> <mark>told</u></mark> NBC News. "Iran is not about building nuclear weapons," Zarif said in an exclusive interview with Ann Curry Wednesday. "We don't want to build nuclear weapons, we don't believe nuclear weapons bring security to anybody, certainly not to us." Zarif said his country's nuclear ambitions were solely in the pursuit of "scientific advancement" and boosting national pride. "<u>Once we reach that understanding, once this hysteria is out, <mark>once this fear mongering is out, then we can have a deal, and a deal that is not going to hurt anybody</u></mark>," he said. He added: "<u><mark>We are prepared to work round the clock in order to reach an agreement. We believe that we are very close, very close </u></mark>and we could be very far." He said "<u><mark>there are details that need to be worked out." "We are very close if the political decision can be made to get to yes, as President Obama sai</mark>d,"</u> he said. The <u>minister spoke <mark>a day after</u></mark> Israeli Prime Minister Benjamin <u><mark>Netanyahu</mark> appeared before </u>the U.S. <u>Congress</u>, warning against a deal, which he said "paves Iran's path to the bomb."</p>

1nr

AT Deal Fails/Prolif Inevitable

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

N

Ndt

1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

AND- Even if there’s no comprehensive agreement, maintaining interim deal solves our impact

Diamond 1/26

Jeremy Diamond 1/26, "Why the Iran sanctions fight is a big deal," CNN, http://www.cnn.com/2015/01/26/politics/iran-sanctions-negotiations-explainer/, DOA: 2-6-2015, y2k

what happens if talks actually collapse If talks fall apart the U.S. and the international community would lose the access it's gained to monitor Iran's facilities and Iran would no longer be constrained to a uranium enrichment threshold as it has under the terms of the current negotiations That's why even if negotiations don't result in a deal the s quo is better than the alternative Failed talks would send Iran's program underground and sound alarm bells

If talks fall apart, the U.S. and the international community would lose the access to monitor Iran's facilities Iran would no longer be constrained to enrichment threshold as it has under the terms of the current negotiations. That's why even if negotiations don't result in a deal the s quo is better than the alt Failed talks would send program underground and sound alarm bells

So what happens if talks actually collapse? If talks fall apart, the U.S. and the international community would lose the access it's gained to monitor most of Iran's nuclear facilities and Iran would no longer be constrained to a uranium enrichment threshold, as it has under the terms of the current negotiations. That's why many argue that even if negotiations don't result in a deal, the status quo is better than the alternative. Failed talks would send Iran's nuclear program underground, so to speak, and sound alarm bells in Israel, the U.S. and other Western countries.

<h4>AND- Even if there’s no comprehensive agreement, maintaining <u>interim deal</u> solves our impact</h4><p>Jeremy <strong>Diamond 1/26</strong>, "Why the Iran sanctions fight is a big deal," CNN, http://www.cnn.com/2015/01/26/politics/iran-sanctions-negotiations-explainer/, DOA: 2-6-2015, y2k</p><p>So <u>what happens if talks actually collapse</u>? <u><mark>If talks fall apart</u>, <u>the U.S. and the international community would lose the access</mark> it's gained <mark>to monitor</u></mark> most of <u><mark>Iran's</u></mark> nuclear <u><mark>facilities</u></mark> <u>and</u> <u><mark>Iran would <strong>no longer be constrained</u></strong> <u>to</mark> a uranium <mark>enrichment threshold</u></mark>, <u><mark>as it has under the <strong>terms of the current</mark> <mark>negotiations</u></strong>. <u>That's why</u></mark> many argue that <u><strong><mark>even if</u></strong> <u>negotiations <strong>don't</strong> result in a deal</u></mark>, <u><mark>the</u></mark> <u><strong><mark>s</u></strong></mark>tatus <u><strong><mark>quo is better than the</mark> <mark>alt</mark>ernative</u></strong>. <u><strong><mark>Failed talks</u></strong> <u>would</u></mark> <u><mark>send</mark> Iran's</u> nuclear <u><mark>program <strong>underground</u></strong></mark>, so to speak, <u><mark>and <strong>sound alarm bells</u></strong></mark> in Israel, the U.S. and other Western countries.</p>

1nr

AT Deal Fails/Prolif Inevitable

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

N

Ndt

1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

Iranian public is pushing for the deal, which overwhelms domestic opposition---their ev is all rhetoric and doesn’t account for internal politics---public opinion controls the nuclear agenda.

Parsi 14

Trita Parsi 14, the founder and current president of the National Iranian American Council, "Why Rouhani Could Walk Away," 9-18-2014, National Iranian American Council (NIAC), http://www.niacouncil.org/rouhani-walk-away/, DOA: 1-30-2015, y2k

hardliners face an uphill battle The negotiations remain popular with the Iranian public as polling shows. The Iranian public catapulted Rouhani to power surprising the hardliners Public opinion could do the same with the nuclear talks ensuring that efforts by the hardliners fail to weaken Rouhani. Many in the West and in Iran are skeptical that the views of the Iranian public matter to policymakers A former member of Iran’s parliament told ultimately Rouhani only needs to convince one person Khamenei the supreme leader’s office itself conducts one public opinion poll Rarely are these made public yet the supreme leader’s office carefully studies them as does the Iranian negotiating team

hardliners face an uphill battle The negotiations remain popular with the public, a polling shows. The public catapulted Rouhani to power Public opinion could do the same with the nuclear talks Many in the West are skeptical that the Iranian public matter to policymakers A former member of parliament told ultimately Rouhani only needs to convince Khamenei the supreme leader’s office conducts one public opinion poll Rarely are these made public, yet the office carefully studies them — as does the Iranian negotiating team.

But these hardliners face an uphill battle. The negotiations remain popular with the Iranian public, as recent polling shows. The Iranian public catapulted Rouhani to power in the 2013 elections — surprising the hardliners, who had otherwise managed to sideline all of their political rivals. Public opinion could do the same with the nuclear talks, ensuring that sabotage efforts by the hardliners fail to weaken Rouhani. If Rouhani and his team come back from Vienna in Novemberwith a proposed nuclear agreement, a major debate will erupt in Iran, both within Iran’s political elite and the society at large. This will be the most vital decision the Islamic Republic has faced since the Iraq-Iran cease-fire proposal in 1988. Beyond the immediate impact on the balance of power between Rouhani and his conservative political rivals, the outcome of this episode will likely determine the crucial parliamentary elections in 2016 and ultimately, the presidential elections in 2017, when Rouhani is up for re-election. The Iranian public will play an important role in this debate. While all indications show that the public supports a deal, a new poll by the University of Maryland may shed light on the thinking behind Iran’s negotiating position, but also explain why the Rouhani government may think it can live with a no-deal scenario. The poll shows that the Iranian public is resistant on two key matters: Rolling back the number of operating centrifuges and limiting Iran’s ability to conduct nuclear research. Demands for strict limitations on these issues by the P5+1, the group of six world powers negotiating with Iran, would essentially be deal breakers for the Iranian public: 70 percent oppose dismantling half of Iran’s existing centrifuges and 75 percent oppose limits on Iran’s research activity. The public’s position on these matters is likely rooted in both a longstanding narrative of the West seeking to keep Iran weak, dependent, and downtrodden by depriving it of access to advanced science, as well as the government’s own rhetoric about nuclear “red lines” on centrifuges and nuclear research. Regardless, the public’s position on these critical variables poses a major challenge for the Rouhani team. It’s not a coincidence that these are the very issues that have caused a deadlock in the talks. If the final deal forces Iran to yield significantly on research and development and dismantle its centrifuges, hardliners can turn the public against it and use it to bury the Rouhani team politically by accusing them of failing to uphold Iran’s sovereignty. The public is more likely to accept the hardliners’s rejectionism in the face of such a deal. This is critical for Rouhani because his power base is not within any of Iran’s institutions. He is most responsive to the electorate that brought him to power in 2013. Rather than return to Tehran with a deal they know will get rejected, potentially ending their political careers, Rouhani’s negotiators may opt to leave the talks without a deal at all and instead play the nationalist card: blaming the West for the collapse of the talks and declaring that while Tehran was ready for a deal, it could not accept one that violated Iranian sovereignty and rights. This is a far worse outcome for Tehran than a good deal, but several factors may cause the Rouhani team to believe it can survive walking away from the nuclear talks. First, a deal that does not have public support is not likely to last. The risk of collapse down the road would be significant. The incentives to comply with the agreement must be stronger than the incentives to cheat. If the public doesn’t trust the deal, neither Rouhani’s government nor a future government will be able to adhere to it. As such, Rouhani and his allies would not be willing to spend political capital for a deal that would fall apart shortly after being signed. Second, the Rouhani government appears to believe that the sanctions regime cannot be further ramped up — and may even collapse soon — regardless of whether or not a nuclear deal is reached. The last few months of diplomacy has simply taken the wind out of the sails of the sanctions proponents.Rebuilding the international will to intensify sanctions on Iran will be a tall order. Leaders in Europe and Asia hope that Iran will be open for business again soon, and the government in Tehran knows that. Combined with geopolitical changes in the region and beyond — in particular, U.S.-Russia tensions and the rise of the Islamic State in neighboring Iraq — Tehran also believes the United States’ military options to strike a nuclear Iran are even more limited than they were in 2012. Washington cannot afford to be at war with the Islamic State, where Tehran’s help is needed (if covertly), while also being at war with Iran. This has given Rouhani’s team — and the hardliners — more flexibility in their calculations. Simply put, Iran can afford to say no to a deal that doesn’t meet its bottom line requirements. Many in the West and in Iran are skeptical that the views of the Iranian public matter to policymakers. A former member of Iran’s parliament told me that, ultimately, Rouhani only needs to convince one person in order to make a deal work: Supreme Leader Ayatollah Ali Khamenei. That may seem well known, but even the former MP also acknowledged that the supreme leader’s office itself conducts at least one public opinion poll a month. Rarely are these made public, yet the supreme leader’s office carefully studies them — as does the Iranian negotiating team.

<h4>Iranian public is pushing for the deal, which overwhelms domestic opposition---their ev is all rhetoric and doesn’t account for internal politics---public opinion <u>controls</u> the nuclear agenda.</h4><p>Trita <strong>Parsi 14</strong>, the founder and current president of the National Iranian American Council, "Why Rouhani Could Walk Away," 9-18-2014, National Iranian American Council (NIAC), http://www.niacouncil.org/rouhani-walk-away/, DOA: 1-30-2015, y2k</p><p>But these <u><strong><mark>hardliners face an uphill battle</u></strong></mark>. <u><mark>The negotiations remain <strong>popular with the</mark> Iranian <mark>public</u></strong>, <u>a</mark>s</u> recent <u><strong><mark>polling shows.</mark> </strong><mark>The</u></mark> <u>Iranian <mark>public <strong>catapulted Rouhani to power</u></strong></mark> in the 2013 elections — <u>surprising the hardliners</u>, who had otherwise managed to sideline all of their political rivals. <u><strong><mark>Public opinion could do</mark> <mark>the same with the nuclear talks</u></strong></mark>, <u>ensuring that</u> sabotage <u>efforts by the hardliners <strong>fail</strong> to weaken Rouhani. </u>If Rouhani and his team come back from Vienna in Novemberwith a proposed nuclear agreement, a major debate will erupt in Iran, both within Iran’s political elite and the society at large. This will be the most vital decision the Islamic Republic has faced since the Iraq-Iran cease-fire proposal in 1988. Beyond the immediate impact on the balance of power between Rouhani and his conservative political rivals, the outcome of this episode will likely determine the crucial parliamentary elections in 2016 and ultimately, the presidential elections in 2017, when Rouhani is up for re-election. The Iranian public will play an important role in this debate. While all indications show that the public supports a deal, a new poll by the University of Maryland may shed light on the thinking behind Iran’s negotiating position, but also explain why the Rouhani government may think it can live with a no-deal scenario. The poll shows that the Iranian public is resistant on two key matters: Rolling back the number of operating centrifuges and limiting Iran’s ability to conduct nuclear research. Demands for strict limitations on these issues by the P5+1, the group of six world powers negotiating with Iran, would essentially be deal breakers for the Iranian public: 70 percent oppose dismantling half of Iran’s existing centrifuges and 75 percent oppose limits on Iran’s research activity. The public’s position on these matters is likely rooted in both a longstanding narrative of the West seeking to keep Iran weak, dependent, and downtrodden by depriving it of access to advanced science, as well as the government’s own rhetoric about nuclear “red lines” on centrifuges and nuclear research. Regardless, the public’s position on these critical variables poses a major challenge for the Rouhani team. It’s not a coincidence that these are the very issues that have caused a deadlock in the talks. If the final deal forces Iran to yield significantly on research and development and dismantle its centrifuges, hardliners can turn the public against it and use it to bury the Rouhani team politically by accusing them of failing to uphold Iran’s sovereignty. The public is more likely to accept the hardliners’s rejectionism in the face of such a deal. This is critical for Rouhani because his power base is not within any of Iran’s institutions. He is most responsive to the electorate that brought him to power in 2013. Rather than return to Tehran with a deal they know will get rejected, potentially ending their political careers, Rouhani’s negotiators may opt to leave the talks without a deal at all and instead play the nationalist card: blaming the West for the collapse of the talks and declaring that while Tehran was ready for a deal, it could not accept one that violated Iranian sovereignty and rights. This is a far worse outcome for Tehran than a good deal, but several factors may cause the Rouhani team to believe it can survive walking away from the nuclear talks. First, a deal that does not have public support is not likely to last. The risk of collapse down the road would be significant. The incentives to comply with the agreement must be stronger than the incentives to cheat. If the public doesn’t trust the deal, neither Rouhani’s government nor a future government will be able to adhere to it. As such, Rouhani and his allies would not be willing to spend political capital for a deal that would fall apart shortly after being signed. Second, the Rouhani government appears to believe that the sanctions regime cannot be further ramped up — and may even collapse soon — regardless of whether or not a nuclear deal is reached. The last few months of diplomacy has simply taken the wind out of the sails of the sanctions proponents.Rebuilding the international will to intensify sanctions on Iran will be a tall order. Leaders in Europe and Asia hope that Iran will be open for business again soon, and the government in Tehran knows that. Combined with geopolitical changes in the region and beyond — in particular, U.S.-Russia tensions and the rise of the Islamic State in neighboring Iraq — Tehran also believes the United States’ military options to strike a nuclear Iran are even more limited than they were in 2012. Washington cannot afford to be at war with the Islamic State, where Tehran’s help is needed (if covertly), while also being at war with Iran. This has given Rouhani’s team — and the hardliners — more flexibility in their calculations. Simply put, Iran can afford to say no to a deal that doesn’t meet its bottom line requirements. <u><strong><mark>Many in the West</strong></mark> and in Iran <mark>are skeptical that the</mark> views of the <mark>Iranian public <strong>matter to policymakers</u></strong></mark>. <u><strong><mark>A</mark> <mark>former member</u></strong> <u>of</mark> Iran’s</u> <u><mark>parliament told</u></mark> me that, <u><strong><mark>ultimately</u></strong></mark>, <u><mark>Rouhani only needs to convince </mark>one person</u> in order to make a deal work: Supreme Leader Ayatollah Ali <u><strong><mark>Khamenei</u></strong></mark>. That may seem well known, but even the former MP also acknowledged that <u><strong><mark>the supreme leader’s office</mark> itself <mark>conducts</u></strong></mark> at least <u><strong><mark>one public opinion poll</u></strong></mark> a month. <u><mark>Rarely</mark> <mark>are these made public</u>, <u><strong>yet the</mark> supreme leader’s <mark>office carefully studies them</u></strong> — <u>as does</u> <u><strong>the Iranian negotiating team</u></strong>.</p></mark>

1nr

AT Deal Fails/Prolif Inevitable

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

N

Ndt

1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

No uniqueness—winning now ______insert legislation that Obama recently pushed through___

<h4><u><strong>No uniqueness—winning now ______insert legislation that Obama recently pushed through___</h4></u></strong>

1nr

at winners win

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

N

Ndt

1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

Even if a confrontational strategy is key, that doesn’t mean the plan’s singular win spills-over—it’s more likely to undermine Obama’s careful strategy

Lizza 13

Ryan Lizza, 1/7/13, Will Hagel Spike the G.O.P.’s Fever?, www.newyorker.com/online/blogs/newsdesk/2013/01/how-much-will-the-nomination-of-chuck-hagel-hurt-obamas-second-term-agenda.html

Obama’s victory has made almost no difference in changing the psychology or incentives of the members of the G.O.P. who matter most breaking the fever” was the wrong metaphor There is no one event that can change a political party overnight A better metaphor for the coming battles with Congress may be three yards and a cloud of dust”: a series of grinding plays where small victories are earned only after lots of intense combat While the fiscal-cliff showdown demonstrated that there’s potential for bipartisan deal-making in the Senate, passing any Obama priority through the House of Representatives is nearly impossible unless the political pressure is extremely intense The fiscal-cliff bill offers the White House a general template for the coming fights over spending issues where there is very little consensus between Obama and most House Republicans. Deals will have to be negotiated in the Senate and gain the imprimatur of some high-profile Republicans. Then a pressure campaign will have to be mounted to convince Boehner to move the legislation to the floor of the House under rules that allow it to pass with mostly Democratic votes. It’s easier to see how this could happen with the coming budgetary issues, which have deadlines that force action, than for the rest of Obama’s agenda, which is more likely than not to simply die in the House.

Obama’s victory made no difference in changing the psychology or incentives of members of the G.O.P. who matter that “breaking the fever” was the wrong metaphor There is no one event that can change a political party overnight A better metaphor for coming battles three yards and a cloud of dust a series of grinding plays where victories are earned only after intense combat fiscal-cliff demonstrated there’s potential for bipartisan deal-making passing the House is impossible unless pressure is extremely intense Deals will have to be negotiated and gain imprimatur of Republicans

But Obama’s victory has made almost no difference in changing the psychology or incentives of the members of the G.O.P. who matter most: the House Republicans. The idea that a bloc of conservative, mostly Southern, Republicans would start to coöperate with the President on issues like tax policy and immigration may have rested on a faulty assumption. The past few weeks of fiscal-cliff drama have taught us that “breaking the fever” was the wrong metaphor. There is no one event—even the election of a President—that can change a political party overnight. Congress is a co-equal branch of government, and House Republicans feel that they have as much of a mandate for their policies as Obama does for his. Shouldn’t House Republicans care that their views on Obama’s priorities, like tax cuts for the rich and immigration, helped cost Romney the White House and will make it difficult for their party’s nominee to win in 2016? In the abstract, many do, but that’s not enough to change the voting behavior of the average House Republican, who represents a gerrymandered and very conservative district. A better metaphor for the coming battles with Congress may be what Woody Hayes, the college-football coach, famously called “three yards and a cloud of dust”: a series of grinding plays where small victories are earned only after lots of intense combat. While the fiscal-cliff showdown demonstrated that there’s potential for bipartisan deal-making in the Senate, passing any Obama priority through the House of Representatives is nearly impossible unless the political pressure is extremely intense. The fiscal-cliff bill passed the House only when Speaker John Boehner’s members realized that their only alternative was blowing up the settlement negotiated by Joe Biden and Mitch McConnell—and accepting all the blame and consequences. That episode offers the White House a general template for the coming fights over spending, immigration, and gun control—three issues where there is very little consensus between Obama and most House Republicans. Deals will have to be negotiated in the Senate and gain the imprimatur of some high-profile Republicans. Then a pressure campaign will have to be mounted to convince Boehner to move the legislation to the floor of the House under rules that allow it to pass with mostly Democratic votes. It’s easier to see how this could happen with the coming budgetary issues, which have deadlines that force action, than for the rest of Obama’s agenda, which is more likely than not to simply die in the House.

<h4>Even if a confrontational strategy is key, that doesn’t mean the plan’s singular win spills-over—it’s more likely to undermine Obama’s careful strategy </h4><p>Ryan <strong>Lizza</strong>, 1/7/<strong>13</strong>, Will Hagel Spike the G.O.P.’s Fever?, www.newyorker.com/online/blogs/newsdesk/2013/01/how-much-will-the-nomination-of-chuck-hagel-hurt-obamas-second-term-agenda.html</p><p>But <u><strong><mark>Obama’s victory</mark> has <mark>made </mark>almost <mark>no difference in changing the psychology or incentives of </mark>the <mark>members of the G.O.P. who matter</mark> most</u></strong>: the House Republicans. The idea that a bloc of conservative, mostly Southern, Republicans would start to coöperate with the President on issues like tax policy and immigration may have rested on a faulty assumption. The past few weeks of fiscal-cliff drama have taught us <mark>that “<u><strong>breaking the fever” was the wrong metaphor</u></strong></mark>. <u><strong><mark>There is no one event</u></strong></mark>—even the election of a President—<u><strong><mark>that can change a political party overnight</u></strong></mark>. Congress is a co-equal branch of government, and House Republicans feel that they have as much of a mandate for their policies as Obama does for his. Shouldn’t House Republicans care that their views on Obama’s priorities, like tax cuts for the rich and immigration, helped cost Romney the White House and will make it difficult for their party’s nominee to win in 2016? In the abstract, many do, but that’s not enough to change the voting behavior of the average House Republican, who represents a gerrymandered and very conservative district. <u><strong><mark>A better metaphor for </mark>the <mark>coming battles </mark>with Congress may be</u></strong> what Woody Hayes, the college-football coach, famously called “<u><strong><mark>three yards and a cloud of dust</mark>”: <mark>a series of grinding plays where </mark>small <mark>victories are earned only after </mark>lots of <mark>intense combat</u></strong></mark>. <u><strong>While the <mark>fiscal-cliff</mark> showdown <mark>demonstrated </mark>that <mark>there’s potential for bipartisan deal-making </mark>in the Senate, <mark>passing </mark>any Obama priority through <mark>the House </mark>of Representatives <mark>is </mark>nearly <mark>impossible unless </mark>the political <mark>pressure is extremely intense</u></strong></mark>. <u><strong>The fiscal-cliff bill</u></strong> passed the House only when Speaker John Boehner’s members realized that their only alternative was blowing up the settlement negotiated by Joe Biden and Mitch McConnell—and accepting all the blame and consequences. That episode <u><strong>offers the White House a general template for the coming fights over spending</u></strong>, immigration, and gun control—three <u><strong>issues where there is very little consensus between Obama and most House Republicans. <mark>Deals will have to be negotiated</mark> in the Senate <mark>and gain </mark>the <mark>imprimatur of</mark> some high-profile <mark>Republicans</mark>. Then a pressure campaign will have to be mounted to convince Boehner to move the legislation to the floor of the House under rules that allow it to pass with mostly Democratic votes. It’s easier to see how this could happen with the coming budgetary issues, which have deadlines that force action, than for the rest of Obama’s agenda, which is more likely than not to simply die in the House.</p></u></strong>

1nr

at winners win

PC Key

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Ndt-Round1.docx

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1

Georgia Boyce-Feinberg

Bricker, Holland, McElhinny

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The ban on organ sales for transplant has created a large and growing shortage

Williams 14

Williams 14 Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute; University of Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott & White Health Center for Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31, 2014 American Journal of Law and Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for Cadaver

Organ transplantation saves thousands of lives every year. However, many individuals die waiting for transplants due to an insufficiency of organs Currently, more than 122,000 individuals are waitlisted for organs in the U S Due to financial and other barriers to becoming waitlisted, the actual number requiring organs is likely higher This gap between available organs and the need for organs continues to widen The supply of organs is limited as only a small number of individuals die in circumstances medically eligible for organ donation, The current organ donation system in the United States relies on the altruism of donors. The (NOTA) prohibits the receipt of any form of valuable consideration in exchange for organs to be used for transplantation other methods have been employed in attempts to increase donations Despite the implementation of these strategies, a severe organ shortage remains

many individuals die waiting for transplants due to an insufficiency of organ more than 122,000 individuals are waitlisted Due to financial and other barriers to becoming waitlisted, the actual number is higher The current organ donation system in the United States relies on the altruism of donors. NOTA) prohibits the receipt of any form of valuable consideration in exchange for organs other methods have been employed in attempts to increase donations a severe organ shortage remains.

Organs Instituted http://ssrn.com/abstract=2418514 Organ transplantation saves thousands of lives every year. However, many individuals die waiting for transplants due to an insufficiency of organs.1 Currently, more than 122,000 individuals are waitlisted for organs in the United States.2 Due to financial and other barriers to becoming waitlisted, the actual number of Americans requiring organs is likely higher.3 This gap between available organs and the need for organs continues to widen.4 The supply of organs is limited as only a small number of individuals die in circumstances medically eligible for organ donation, and less than sixty-eight percent of eligible individuals donate.5 As a result of those long waitlists and limited supply there is a substantial need to increase organ donations. This paper will focus on increasing consent rates for cadaveric organ donation in the Unites States by repealing current law prohibiting cadaveric donors and their estates from being financially compensated.6 The current organ donation system in the United States relies on the altruism of donors. The National Organ Transplantation Act (NOTA) prohibits the receipt of any form of valuable consideration in exchange for organs to be used for transplantation.7 State statutes also prohibit the sale of certain organs and tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for organs is prohibited, other methods have been employed in attempts to increase donations.9 Despite the implementation of these strategies, a severe organ shortage remains.

<h4>The ban on organ sales for transplant has created a large and growing shortage</h4><p><strong>Williams 14</strong> Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute; University of Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott & White Health Center for Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31, 2014 American Journal of Law and Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for Cadaver </p><p>Organs Instituted http://ssrn.com/abstract=2418514</p><p><u>Organ transplantation saves thousands of lives every year. However, <mark>many individuals die waiting for transplants due to an insufficiency of organ</mark>s</u>.1 <u>Currently, <mark>more than 122,000 individuals are waitlisted</mark> for organs in the U</u>nited <u>S</u>tates.2 <u><mark>Due to financial and other barriers to becoming waitlisted, the actual number</mark> </u>of Americans <u>requiring organs <mark>is</mark> likely <mark>higher</u></mark>.3 <u>This gap between available organs and the need for organs continues to widen</u>.4 <u>The supply of organs is limited as only a small number of individuals die in circumstances medically eligible for organ donation, </u>and less than sixty-eight percent of eligible individuals donate.5 As a result of those long waitlists and limited supply there is a substantial need to increase organ donations. This paper will focus on increasing consent rates for cadaveric organ donation in the Unites States by repealing current law prohibiting cadaveric donors and their estates from being financially compensated.6 <u><mark>The current organ donation system in the United States relies on the altruism of donors.</mark> The</u> National Organ Transplantation Act <u>(<mark>NOTA) prohibits the receipt of any form of valuable consideration in exchange for organs</mark> to be used for transplantation</u>.7 State statutes also prohibit the sale of certain organs and tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for organs is prohibited, <u><mark>other methods have been employed in attempts to increase donations</u></mark>.9 <u>Despite the implementation of these strategies, <mark>a severe organ shortage remains</u>.</p></mark>

Contention 1 – Organ sales will save lives

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Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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Varied efforts to increase voluntary donations fail – individually and in combination

Beard 8

Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics, Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy

the transplant industry has examined and adopted a series of policy options ostensibly designed to improve the system’s performance. All of these, however, continue to maintain the basic zero-price property of the altruistic system. As a result, the likelihood that any of them, even in combination, will resolve the organ shortage is remote At least seven such actions have been implemented INCREASED EDUCATIONAL EXPENDITURES incorporating organ donor cards on states’ driver licenses. federal legislation requiring all hospitals to request organ donation additional legislation to refer potential organ donors the Organ Donation Breakthrough Collaborative,” ■ KIDNEY EXCHANGES Finally, i legislation authorizing reimbursement of any direct costs incurred by onors We must conclude that none of the policies should be expected to resolve the transplant organ shortage. . Rather, every time another one of these marginalist policies is devised, it delays the only real reform that is capable of fully resolving the organ shortage

a series of policy options ostensibly designed to improve the system’s performance. however, continue to maintain the basic zero-price property of the altruistic system. the likelihood any of them will resolve the organ shortage is remote At least seven such actions have been implemented EDUCATIONAL EXPENDITURES incorporating organ donor cards on driver licenses requiring all hospitals to request organ donation the Organ Donation Breakthrough Collaborative Finally legislation authorizing reimbursement of any direct costs incurred by donors We must conclude that none of the policies should be expected to resolve the transplant organ shortage every time another one of these marginalist policies is devised, it delays the only real reform that is capable of fully resolving the organ shortage

http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf Aware of the increasingly dire consequences of continued reliance on the existing approach to cadaveric organ procurement and alarmed at the figures shown above, the transplant industry has examined and adopted a series of policy options ostensibly designed to improve the system’s performance. All of these, however, continue to maintain the basic zero-price property of the altruistic system. As a result, the likelihood that any of them, even in combination, will resolve the organ shortage is remote. At least seven such actions have been implemented over the last two decades or so: ■ INCREASED EDUCATIONAL EXPENDITURES In the absence of financial incentives, moral suasion becomes the principal avenue through which additional supply may be motivated. Consequently, the organ procurement organizations (opos) created under the 1984 Act have launched substantial promotional campaigns. The campaigns have been designed to both educate the general public about the desperate need for donated organs and educate physicians and critical care hospital staff regarding the identification of potential deceased donors. Over the years, a substantial sum has been spent on these types of educational activities. Recent empirical evidence, however, suggests that further spending on these programs is unlikely to increase supply by a significant amount. ■ ORGAN DONOR CARDS A related activity has been the process of incorporating organ donor cards on states’ driver licenses. The cards can be easily completed and witnessed at the time the licenses are issued or renewed. They serve as a pre-mortem statement of the bearer’s wish to have his or her organs removed for transplantation purposes at the time of death. Their principal use, in practice, is to facilitate the opos’ efforts to convince surviving family members to consent to such removal by revealing the decedant’s wishes. The 1968 Uniform Anatomical Gift Act gave all states the authority to issue donor cards and incorporate them in drivers’ licenses. Moreover, a few states have recently begun to rely entirely on donor cards to infer consent without requiring the surviving family’s permission when such cards are present. Survey evidence indicates that less than 40 percent of U.S. citizens have signed their donor cards. ■ REQUIRED REQUEST Some survey evidence published in the late 1980s and early 1990s found that in a number of cases families of potential deceased donors were not being asked to donate the organs. As a result, donation was apparently failing to occur in some of those instances simply because the request was not being presented. In response to this evidence, federal legislation was passed in 1987 requiring all hospitals receiving any federal funding (which, of course, is virtually all hospitals) to request organ donation in all deaths that occur under circumstances that would allow the deceased’s organs to be used in transplantation. It appears that this legal obligation is now being met in most, if not all, cases. Yet, the organ shortage has persisted and the waiting list has continued to grow. ■ REQUIRED REFERRAL While required-request legislation can compel hospitals to approach the families of recently deceased potential organ donors with an appeal for donation, it cannot ensure that the request will be made in a sincere, compassionate manner likely to elicit an agreement. Following implementation of the required-request law, there were a number of anecdotes in which the compulsory organ donation requests were presented in an insincere or even offensive manner that was clearly intended to elicit a negative response. The letter of the law was being met but not the spirit. As a result, additional legislation was passed that requires hospitals to refer potential organ donors to the regional opo so that trained procurement personnel can approach the surviving family with the donation request. This policy response has resulted in no perceptible progress in resolving the shortage. ■ COLLABORATION A fairly recent response to the organ shortage has been the so-called “Organ Donation Breakthrough Collaborative,” which was championed by then-secretary of health and human services Tommy Thompson. The program was initiated shortly after Thompson took office in 2001 and is currently continuing. The program’s basic motivation is provided by the observation of a considerable degree of variation in performance across the existing opos. Specifically, the number of deceased organ donors per thousand hospital deaths has been found to vary by a factor of almost five across the organizations. The presumption, then, is that the relatively successful opos employ superior procurement techniques and/or knowledge that, if shared with the relatively unsuccessful organizations, would significantly improve their performance. Thus, diffusion of “best practice” techniques is seen as a promising method through which cadaveric donation rates may be greatly improved. A thorough and objective evaluation of the Thompson initiative has not, to our knowledge, been conducted. Figure 1, in conjunction with a recent econometric study of observed variations in opo efficiency, suggests that such an evaluation would yield both good news and bad news. The good news is that the program appears to have had a positive (and potentially significant) impact on the number of donations. In particular, it appears that, after 2002, the growth rate of the waiting list has slowed somewhat. Whether this effect will permanently lower the growth rate of the waiting list or simply cause a temporary intercept shift remains to be seen. The bad news, however, is unequivocal— the initiative is not going to resolve the organ shortage. Even if, contrary to reasonable expectations, all opo relative inefficiencies were miraculously eliminated (i.e., if al organizations’ performance were brought up to the most efficient unit), the increase in donor collection rates would still be insufficient to eliminate the shortage. ■ KIDNEY EXCHANGES Another approach that has received some attention recently involves the exchange of kidneys between families who have willing but incompatible living donors. Suppose, for example, a person in one family needs a kidney transplant and a sibling has offered to donate the needed organ. Further suppose that the two siblings are not compatible — perhaps their blood types differ. If this family can locate a second, similarly situated family, then it may be possible that the donor in the first family will match the recipient in the second, and vice versa. A relatively small number of such exchanges have recently occurred and a unos-based computerized system of matching such interfamily donors has been proposed to facilitate a larger number of these living donor transactions. Two observations regarding kidney exchanges are worth noting. First, such exchanges obviously constitute a crude type of market in living donor kidneys that is based upon barter rather than currency. Like all such barter markets, this exchange will be considerably less efficient than currency-based trade. Puzzlingly, some of the staunchest critics of using financial incentives for cadaveric donors have openly supported expanded use of living donor exchanges. Apparently, it is not market exchange per se that offends them but, rather, the use of money to facilitate efficient market exchange. This combination of positions merely highlights the critics’ lack of knowledge regarding the operation of market processes. It is quite apparent that living donor kidney exchanges are not going to resolve the organ shortage. Opportunities for such barter-based exchanges are simply too limited. ■ REIMBURSEMENT OF DONOR COSTS Finally, in another effort to encourage an increase in the number of living (primarily kidney) donors, several states have passed legislation authorizing reimbursement of any direct (explicit) costs incurred by such donors (e.g., travel expenses, lost wages, and so on). Economically, this policy action raises the price paid to living kidney donors from a negative amount to zero. As such, it should be expected to increase the quantity of organs supplied from this source. Because the explicit, out-of-pocket expenses associated with live kidney donation are unlikely to be large relative to the longer-term implicit costs of potential health risks, however, such reimbursement should not be expected to bring forth a flood of new donors. Moreover, recent empirical evidence suggests that an increase in the number of living donors may have a negative impact on the number of deceased donors because of some degree of supply-side substitutability. Again, this policy is not a solution to the organ shortage. We must conclude that none of the above-listed policies should be expected to resolve the transplant organ shortage. We say this not because we oppose any of these policies; indeed, each appears sensible in its own right and some have unquestionably succeeded in raising the number of organ donors by some (perhaps nontrivial) amount. Rather, our concern is that every time another one of these marginalist policies is devised, it delays the only real reform that is capable of fully resolving the organ shortage.

<h4>Varied efforts to increase voluntary donations fail – individually and in combination </h4><p><strong>Beard 8</strong> T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics, Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy</p><p>http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf</p><p>Aware of the increasingly dire consequences of continued reliance on the existing approach to cadaveric organ procurement and alarmed at the figures shown above, <u>the transplant industry has examined and adopted <mark>a series of policy options ostensibly designed to improve the system’s performance.</mark> All of these, <mark>however, continue to maintain the basic zero-price property of the altruistic system.</mark> As a result, <mark>the likelihood</mark> that <mark>any of them</mark>, even in combination, <mark>will resolve the organ shortage is remote</u></mark>. <u><mark>At least seven such actions have been implemented</u></mark> over the last two decades or so: ■ <u>INCREASED <mark>EDUCATIONAL EXPENDITURES</u></mark> In the absence of financial incentives, moral suasion becomes the principal avenue through which additional supply may be motivated. Consequently, the organ procurement organizations (opos) created under the 1984 Act have launched substantial promotional campaigns. The campaigns have been designed to both educate the general public about the desperate need for donated organs and educate physicians and critical care hospital staff regarding the identification of potential deceased donors. Over the years, a substantial sum has been spent on these types of educational activities. Recent empirical evidence, however, suggests that further spending on these programs is unlikely to increase supply by a significant amount. ■ ORGAN DONOR CARDS A related activity has been the process of <u><mark>incorporating organ donor cards on</mark> states’ <mark>driver licenses</mark>.</u> The cards can be easily completed and witnessed at the time the licenses are issued or renewed. They serve as a pre-mortem statement of the bearer’s wish to have his or her organs removed for transplantation purposes at the time of death. Their principal use, in practice, is to facilitate the opos’ efforts to convince surviving family members to consent to such removal by revealing the decedant’s wishes. The 1968 Uniform Anatomical Gift Act gave all states the authority to issue donor cards and incorporate them in drivers’ licenses. Moreover, a few states have recently begun to rely entirely on donor cards to infer consent without requiring the surviving family’s permission when such cards are present. Survey evidence indicates that less than 40 percent of U.S. citizens have signed their donor cards.<u> </u>■ REQUIRED REQUEST Some survey evidence published in the late 1980s and early 1990s found that in a number of cases families of potential deceased donors were not being asked to donate the organs. As a result, donation was apparently failing to occur in some of those instances simply because the request was not being presented. In response to this evidence, <u>federal legislation</u> was passed in 1987 <u><mark>requiring all hospitals</u></mark> receiving any federal funding (which, of course, is virtually all hospitals) <u><mark>to request organ donation</u></mark> in all deaths that occur under circumstances that would allow the deceased’s organs to be used in transplantation. It appears that this legal obligation is now being met in most, if not all, cases. Yet, the organ shortage has persisted and the waiting list has continued to grow. ■ REQUIRED REFERRAL While required-request legislation can compel hospitals to approach the families of recently deceased potential organ donors with an appeal for donation, it cannot ensure that the request will be made in a sincere, compassionate manner likely to elicit an agreement. Following implementation of the required-request law, there were a number of anecdotes in which the compulsory organ donation requests were presented in an insincere or even offensive manner that was clearly intended to elicit a negative response. The letter of the law was being met but not the spirit. As a result, <u>additional legislation</u> was passed that requires hospitals<u> to refer potential organ donors </u>to the regional opo so that trained procurement personnel can approach the surviving family with the donation request. This policy response has resulted in no perceptible progress in resolving the shortage. ■ COLLABORATION A fairly recent response to the organ shortage has been <u><mark>the</mark> </u>so-called “<u><mark>Organ Donation Breakthrough Collaborative</mark>,” </u>which was championed by then-secretary of health and human services Tommy Thompson. The program was initiated shortly after Thompson took office in 2001 and is currently continuing. The program’s basic motivation is provided by the observation of a considerable degree of variation in performance across the existing opos. Specifically, the number of deceased organ donors per thousand hospital deaths has been found to vary by a factor of almost five across the organizations. The presumption, then, is that the relatively successful opos employ superior procurement techniques and/or knowledge that, if shared with the relatively unsuccessful organizations, would significantly improve their performance. Thus, diffusion of “best practice” techniques is seen as a promising method through which cadaveric donation rates may be greatly improved. A thorough and objective evaluation of the Thompson initiative has not, to our knowledge, been conducted. Figure 1, in conjunction with a recent econometric study of observed variations in opo efficiency, suggests that such an evaluation would yield both good news and bad news. The good news is that the program appears to have had a positive (and potentially significant) impact on the number of donations. In particular, it appears that, after 2002, the growth rate of the waiting list has slowed somewhat. Whether this effect will permanently lower the growth rate of the waiting list or simply cause a temporary intercept shift remains to be seen. The bad news, however, is unequivocal— the initiative is not going to resolve the organ shortage. Even if, contrary to reasonable expectations, all opo relative inefficiencies were miraculously eliminated (i.e., if al organizations’ performance were brought up to the most efficient unit), the increase in donor collection rates would still be insufficient to eliminate the shortage. <u>■ KIDNEY EXCHANGES</u> Another approach that has received some attention recently involves the exchange of kidneys between families who have willing but incompatible living donors. Suppose, for example, a person in one family needs a kidney transplant and a sibling has offered to donate the needed organ. Further suppose that the two siblings are not compatible — perhaps their blood types differ. If this family can locate a second, similarly situated family, then it may be possible that the donor in the first family will match the recipient in the second, and vice versa. A relatively small number of such exchanges have recently occurred and a unos-based computerized system of matching such interfamily donors has been proposed to facilitate a larger number of these living donor transactions. Two observations regarding kidney exchanges are worth noting. First, such exchanges obviously constitute a crude type of market in living donor kidneys that is based upon barter rather than currency. Like all such barter markets, this exchange will be considerably less efficient than currency-based trade. Puzzlingly, some of the staunchest critics of using financial incentives for cadaveric donors have openly supported expanded use of living donor exchanges. Apparently, it is not market exchange per se that offends them but, rather, the use of money to facilitate efficient market exchange. This combination of positions merely highlights the critics’ lack of knowledge regarding the operation of market processes. It is quite apparent that living donor kidney exchanges are not going to resolve the organ shortage. Opportunities for such barter-based exchanges are simply too limited. ■ REIMBURSEMENT OF DONOR COSTS <u><mark>Finally</mark>, i</u>n another effort to encourage an increase in the number of living (primarily kidney) donors, several states have passed <u><mark>legislation authorizing reimbursement of any direct</mark> </u>(explicit) <u><mark>costs incurred by</u></mark> such <mark>d<u>onors</mark> </u>(e.g., travel expenses, lost wages, and so on). Economically, this policy action raises the price paid to living kidney donors from a negative amount to zero. As such, it should be expected to increase the quantity of organs supplied from this source. Because the explicit, out-of-pocket expenses associated with live kidney donation are unlikely to be large relative to the longer-term implicit costs of potential health risks, however, such reimbursement should not be expected to bring forth a flood of new donors. Moreover, recent empirical evidence suggests that an increase in the number of living donors may have a negative impact on the number of deceased donors because of some degree of supply-side substitutability. Again, this policy is not a solution to the organ shortage. <u><mark>We must conclude that none of the</u></mark> above-listed <u><mark>policies should be expected to resolve the transplant organ shortage</mark>.</u> We say this not because we oppose any of these policies; indeed, each appears sensible in its own right and some have unquestionably succeeded in raising the number of organ donors by some (perhaps nontrivial) amount<u>. Rather,</u> our concern is that <u><mark>every time another one of these marginalist policies is devised, it delays the only real reform that is capable of fully resolving the organ shortage</u></mark>.</p>

Contention 1 – Organ sales will save lives

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

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The shortage means many die

Beard 8

Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics, Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy

our failure to adapt our organ procurement policy suggests that more than 80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In addition, the unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis, unemployment, and declining health must also be reckoned along with the growing despair of family members who must witness all of this. Nonetheless, the pain, suffering, and death imposed on the innocents thus far pales in comparison to what lies ahead if more fundamental change is not forthcoming we are able to produce forecasts of the expected size of future waiting lists We run the forecasts out 10 years a cumulative total of 196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing shortage.

more than 80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. the pain, suffering, and death imposed on the innocents pales in comparison to what lies ahead if more fundamental change is not forthcoming we are able to produce forecasts of future waiting lists 196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing shortage

http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf WAITING LISTS YET TO COME The consequences of our failure to adapt our cadaveric organ procurement policy to the changed technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests that more than 80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In addition, the unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis, unemployment, and declining health must also be reckoned along with the growing despair of family members who must witness all of this. Nonetheless, the pain, suffering, and death imposed on the innocents thus far pales in comparison to what lies ahead if more fundamental change is not forthcoming. In order to illustrate the severe consequences of a continuation of the altruistic system, we use the data presented in Figures 1 and 2 above to generate forecasts of future waiting lists and deaths. The forecasts represent our best guess of what the future holds if fundamental change continues to be postponed. The results should serve as a wake-up call for those who argue that we should continue tinkering with the existing procurement system while further postponing the implementation of financial incentives. The costs of such a “wait and see” approach are rapidly becoming intolerable. CHANGING VARIABLE To produce reasonable forecasts of future waiting lists and deaths, we must first confront an apparent anomaly in the reported data that could cast doubt on the accuracy of some of the more recent figures. Specifically, the reported number of deaths of patients on the waiting list (plus those too sick to receive a transplant) follows a consistently upward trend that is very close to a constant proportion of the size of the waiting list over most of the sample period. Beginning in 2002, however, the number of deaths levels off and even starts to decline, despite continued growth of the waiting list. It is not clear why there is an abrupt change in the observed trend in this variable. Our investigation of this issue yielded several plausible explanations but no definitive answer. For example, it may be the case that recent advances in medical care, such as the left ventricular assist device, have extended some patients’ lives and, thereby, reduced the number of deaths on the list. Alternatively, it may be the case that because of rising criticism of the current system, unos has taken steps to remove some of the relatively higher-risk patients from the list before they die. For example, the meld/peld program, which was introduced in February 2002, removed a number of liver patients (who have a comparatively high death rate) from the waiting list. Additionally, the increasing use of so-called “extended criteria” donor organs may have a similar effect, getting the most critically ill patients off the list prior to their deaths. Clearly, the implications of these alternative explanations for reliance on the data are not the same. For example, if patients are, in fact, simply living longer and the data accurately reflect that reality, then our analysis should incorporate the observations. But if the more recent figures are, instead, a manifestation of strategic actions taken by the reporting agency, then they should be excluded. Because we have been unable to identify a single, convincing explanation for the observed phenomenon, we elected to perform our analysis both ways — including and excluding the post-2002 observations on the number of deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to generate our forecasts is as follows: First, because the number of deaths appears to be causally driven by the number of patients on the waiting list, we begin by estimating a simple linear regression model of the former as a function of the latter. The results of that estimation are reported in Table 1 for the two sample periods described above. Next, we estimate a second linear model with the number of patients on the waiting list regressed against time, again using the two alternative sample periods. Those results are reported in Table 2. From the results, we are able to produce forecasts of the expected size of future waiting lists for each of our sample periods. We run the forecasts out 10 years from the end of our longer sample period, to 2015. Given the forecasted waiting list values, we are then able to use the regression results in Table 1 to generate our forecasts of the number of deaths over the same period. The two alternative sets of forecasts are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the results show the waiting list reaching 145,691 to 152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642 are expected to die that year. Even more tragically, over the entire period of both actual and predicted values, a cumulative total of 196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing shortage. Figure 5 illustrates the results. In that figure, we incorporate several historical reference points in order to put the numbers in perspective. No one directly involved in the transplant industry is likely to be surprised by our results. Thirty years of experience consistently point to a continuation of the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect a sudden reversal. But our purpose is not to surprise the parties who are already knowledgeable about this increasingly severe problem. Rather, our intent is to awaken the sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no longer continue to postpone meaningful reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve. They will not.

<h4>The shortage means many die</h4><p><strong>Beard 8</strong> T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics, Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy</p><p>http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf</p><p>WAITING LISTS YET TO COME</p><p>The consequences of <u>our failure to adapt our</u> cadaveric <u>organ procurement policy</u> to the changed technological realities of the transplant industry have been unconscionable. Figure 2, above, <u>suggests that <mark>more than 80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system.</mark> In addition, the unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis, unemployment, and declining health must also be reckoned along with the growing despair of family members who must witness all of this. Nonetheless, <mark>the pain, suffering, and death imposed on the innocents</mark> thus far <mark>pales in comparison to what lies ahead if more fundamental change is not forthcoming</u></mark>. In order to illustrate the severe consequences of a continuation of the altruistic system, we use the data presented in Figures 1 and 2 above to generate forecasts of future waiting lists and deaths. The forecasts represent our best guess of what the future holds if fundamental change continues to be postponed. The results should serve as a wake-up call for those who argue that we should continue tinkering with the existing procurement system while further postponing the implementation of financial incentives. The costs of such a “wait and see” approach are rapidly becoming intolerable. CHANGING VARIABLE To produce reasonable forecasts of future waiting lists and deaths, we must first confront an apparent anomaly in the reported data that could cast doubt on the accuracy of some of the more recent figures. Specifically, the reported number of deaths of patients on the waiting list (plus those too sick to receive a transplant) follows a consistently upward trend that is very close to a constant proportion of the size of the waiting list over most of the sample period. Beginning in 2002, however, the number of deaths levels off and even starts to decline, despite continued growth of the waiting list. It is not clear why there is an abrupt change in the observed trend in this variable. Our investigation of this issue yielded several plausible explanations but no definitive answer. For example, it may be the case that recent advances in medical care, such as the left ventricular assist device, have extended some patients’ lives and, thereby, reduced the number of deaths on the list. Alternatively, it may be the case that because of rising criticism of the current system, unos has taken steps to remove some of the relatively higher-risk patients from the list before they die. For example, the meld/peld program, which was introduced in February 2002, removed a number of liver patients (who have a comparatively high death rate) from the waiting list. Additionally, the increasing use of so-called “extended criteria” donor organs may have a similar effect, getting the most critically ill patients off the list prior to their deaths. Clearly, the implications of these alternative explanations for reliance on the data are not the same. For example, if patients are, in fact, simply living longer and the data accurately reflect that reality, then our analysis should incorporate the observations. But if the more recent figures are, instead, a manifestation of strategic actions taken by the reporting agency, then they should be excluded. Because we have been unable to identify a single, convincing explanation for the observed phenomenon, we elected to perform our analysis both ways — including and excluding the post-2002 observations on the number of deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to generate our forecasts is as follows: First, because the number of deaths appears to be causally driven by the number of patients on the waiting list, we begin by estimating a simple linear regression model of the former as a function of the latter. The results of that estimation are reported in Table 1 for the two sample periods described above. Next, we estimate a second linear model with the number of patients on the waiting list regressed against time, again using the two alternative sample periods. Those results are reported in Table 2. From the results, <u><mark>we are able to produce forecasts of </mark>the expected size of <mark>future waiting lists</u></mark> for each of our sample periods. <u>We run the forecasts out 10 years</u> from the end of our longer sample period, to 2015. Given the forecasted waiting list values, we are then able to use the regression results in Table 1 to generate our forecasts of the number of deaths over the same period. The two alternative sets of forecasts are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the results show the waiting list reaching 145,691 to 152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642 are expected to die that year. Even more tragically, over the entire period of both actual and predicted values, <u>a cumulative total of<mark> 196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing shortage</mark>.</u> Figure 5 illustrates the results. In that figure, we incorporate several historical reference points in order to put the numbers in perspective. No one directly involved in the transplant industry is likely to be surprised by our results. Thirty years of experience consistently point to a continuation of the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect a sudden reversal. But our purpose is not to surprise the parties who are already knowledgeable about this increasingly severe problem. Rather, our intent is to awaken the sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no longer continue to postpone meaningful reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve. They will not.</p>

Contention 1 – Organ sales will save lives

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Waitlist underestimates the need for kidney transplants

Goodwin 9

Goodwin 9 MICHELE GOODWIN Everett Fraser Professor of Law and Professor of Medicine and Public Health, University of Minnesota Law School. SAINT LOUIS UNIVERSITY JOURNAL OF HEALTH LAW & POLICY [Vol. 2:327 2009] CONFRONTING THE LIMITS OF ALTRUISM: A RESPONSE TO JAKE LINFORD

three quarters of the transplant waitlist consists of patients needing kidneys. At the end of February 2009, there were 83,447 registrants waiting for kidneys. that figure undercounts the actual number of patients that would benefit from a kidney transplant, because it does not account for the 485,000 Americans with end-stage renal disease, or the more than 341,000 who are on dialysis, those who are registered on Internet websites, like matchingdonor.com, or those who decided that the market might be far more expedient than waiting in the U.S

the waitlist does not account for the 485,000 Americans with end-stage renal disease, or the more than 341,000 who are on dialysis, those who are registered on Internet websites r those who decided that the market might be far more expedient than waiting in the U.S

Of the patients in line for organs, most need kidneys.29 In fact, three quarters of the transplant waitlist consists of patients needing kidneys. At the end of February 2009, there were 83,447 registrants waiting for kidneys.30 But that number tells us less than what we really need to know. For example, that figure undercounts the actual number of patients that would benefit from a kidney transplant, because it does not account for the 485,000 Americans with end-stage renal disease, or the more than 341,000 who are on dialysis, those who are registered on Internet websites, like matchingdonor.com, or those who decided that the black market might be far more expedient than waiting in the U.S. To be sure, the gains in organ donation pale in comparison with the number of registered patients who can expect to die before ever receiving a transplant.

<h4>Waitlist underestimates the need for kidney transplants</h4><p><strong>Goodwin 9</strong> MICHELE GOODWIN Everett Fraser Professor of Law and Professor of Medicine and Public Health, University of Minnesota Law School. SAINT LOUIS UNIVERSITY JOURNAL OF HEALTH LAW & POLICY [Vol. 2:327 2009] CONFRONTING THE LIMITS OF ALTRUISM: A RESPONSE TO JAKE LINFORD</p><p>Of the patients in line for organs, most need kidneys.29 In fact, <u>three quarters of <mark>the</mark> transplant <mark>waitlist</mark> consists of patients needing kidneys. At the end of February 2009, there were 83,447 registrants waiting for kidneys.</u>30 But that number tells us less than what we really need to know. For example, <u>that figure undercounts the actual number of patients that would benefit from a kidney transplant, because it <mark>does not account for the 485,000 Americans with end-stage renal disease, or the more than 341,000 who are on dialysis, those who are registered on Internet websites</mark>, like matchingdonor.com, o<mark>r those who decided that the</u></mark> black <u><mark>market might be far more expedient than waiting in the U.S</u></mark>. To be sure, the gains in organ donation pale in comparison with the number of registered patients who can expect to die before ever receiving a transplant.</p>

Contention 1 – Organ sales will save lives

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Organs from cadavers don’t solve

Fry-Revere 14

Fry-Revere 14 Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014

The Kidney Sellers: A Journey of Discovery in Iran p 6 Today the number of kidneys provided from cadavers could never be enough, even if every organ from every potential qualified donor could be harvested. This is true because not every death results in useable organs. Organs can be diseased or injured, or the body can be dead too long before it reaches the hospital. no matter how the process for retrieving organs from the dead improves, there will never be enough kidneys to meet the ever-growing demand.

kidneys provided from cadavers could never be enough, even if every organ from every potential qualified donor could be harvested. because not every death results in useable organs. Organs can be diseased or injured, or the body can be dead too long before it reaches the hospital no matter how the process for retrieving organs improves there will never be enough

The Kidney Sellers: A Journey of Discovery in Iran p 6 At the time, what Congress did seemed reasonable, but over the following three decades, no matter how efficient the U.S. cadaver organ procurement sys- tem became, it could not satisfy the demand. Medical innovations keep people alive longer, and the ever-growing diabetes and hypertension epidemics contin- ually increased the number of people who could benefit from a kidney transplant. Today the number of kidneys provided from cadavers could never be enough, even if every organ from every potential qualified donor could be harvested. This is true because not every death results in useable organs. Organs can be diseased or injured, or the body can be dead too long before it reaches the hospital. Patients who die in the hospital after a car accident or similar trauma are the best potential organ donors because the appropriate medical equip- ment is at hand to switch gears from saving the patient to preserving organs for transplantation. Nevertheless, given what we know now, no matter how the process for retrieving organs from the dead improves, there will never be enough kidneys to meet the ever-growing demand.

<h4>Organs from cadavers don’t solve</h4><p><strong>Fry-Revere 14</strong> Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014 </p><p><u>The Kidney Sellers: A Journey of Discovery in Iran p 6</p><p></u>At the time, what Congress did seemed reasonable, but over the following three decades, no matter how efficient the U.S. cadaver organ procurement sys- tem became, it could not satisfy the demand. Medical innovations keep people alive longer, and the ever-growing diabetes and hypertension epidemics contin- ually increased the number of people who could benefit from a kidney transplant. <u>Today the number of <mark>kidneys provided from cadavers could never be enough, even if every organ from every potential qualified donor could be harvested. </mark>This is true <mark>because not every death results in useable organs. Organs can be diseased or injured, or the body can be dead too long before it reaches the hospital</mark>.</u> Patients who die in the hospital after a car accident or similar trauma are the best potential organ donors because the appropriate medical equip- ment is at hand to switch gears from saving the patient to preserving organs<u> </u>for transplantation. Nevertheless, given what we know now,<u> <mark>no matter how the process for retrieving organs</mark> from the dead <mark>improves</mark>, <mark>there will never be enough</mark> kidneys to meet the ever-growing demand.</p></u>

Contention 1 – Organ sales will save lives

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Artificial organs don’t work

Adhikari 14

Adhikari 14 Richard Adhikari has written about high-tech for leading industry publications since the 1990s

http://www.technewsworld.com/story/80198.html According to Jordan Miller at Rice "Parts of the body which require human cells to perform biomechanical functions, such as the liver or kidney, are still several decades away from reaching human patients," . "We are still in the feasibility stage -- not sure how to keep cells alive at high cell density and adequate size needed to match human organs." A 3D structure will require nearly 1 billion functioning cells to approximate the function of a liver or kidney, and "there are dozens of cell types in these organs," . "We are typically only looking at one or two cell types being put into a 3D printed structure."

Parts of the body which require human cells to perform biomechanical functions, such as the liver or kidney, are several decades away from reaching human patients We are still in the feasibility stage -- not sure how to keep cells alive at high cell density and adequate size needed to match human organs there are dozens of cell types in these organs We are typically only looking at one or two cell types being put into a 3D printed structure

03/26/14 Bioprinting, Part 1: The Promise and the Pitfalls http://www.technewsworld.com/story/80198.html [According to Jordan Miller, assistant professor of bioengineering at Rice University]. "Parts of the body which require human cells to perform biomechanical functions, such as the liver or kidney, are still several decades away from reaching human patients," Miller said. "We are still in the feasibility stage -- not sure how to keep cells alive at high cell density and adequate size needed to match human organs." A 3D structure will require nearly 1 billion functioning cells to approximate the function of a liver or kidney, and "there are dozens of cell types in these organs," Miller pointed out. "We are typically only looking at one or two cell types being put into a 3D printed structure." NOTE SOURCE WITH QUALS EDITED INTO BEGINNING OF CARD

<h4>Artificial organs don’t work</h4><p><strong>Adhikari 14</strong> Richard Adhikari has written about high-tech for leading industry publications since the 1990s </p><p>03/26/14 Bioprinting, Part 1: The Promise and the Pitfalls <u>http://www.technewsworld.com/story/80198.html</p><p></u>[<u>According to Jordan Miller</u>, assistant professor of bioengineering <u>at Rice</u> University]. <u>"<mark>Parts of the body which require human cells to perform biomechanical functions, such as the liver or kidney, are </mark>still <mark>several decades away from reaching human patients</mark>," </u>Miller said<u>. "<mark>We are still in the feasibility stage -- not sure how to keep cells alive at high cell density and adequate size needed to match human organs</mark>." A 3D structure will require nearly 1 billion functioning cells to approximate the function of a liver or kidney, and "<mark>there are dozens of cell types in these organs</mark>," </u>Miller pointed out<u>. "<mark>We are typically only looking at one or two cell types being put into a 3D printed structure</mark>."</p><p></u><strong>NOTE SOURCE WITH QUALS EDITED INTO BEGINNING OF CARD</p></strong>

Contention 1 – Organ sales will save lives

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And they’re too expensive

Gopar 14

Gopar 14 Jennifer Julisa Gopar ans Dr. Rance LeFebvre 28 July 2014 COSMOS Cluster 7: Biomedical Sciences The Moral and Ethical Debate Regarding Artificial Organ Growth http://cosmos.ucdavis.edu/archives/2014/Cluster7/Gopar_Jennifer_EthicsofGrowingOrgans.pdf

The Scientist elaborated on this possible problem, stating Platt thinks that organ engineering is too costly to meet the needs of everyone waiting for a transplant. ‘You’d have to turn over the entire GDP of a country to accomplish that,’ he says. So it is still unclear whether the cost of these artificial organs will allow them to be within the reach of patients in need of an organ transplant.

organ engineering is too costly to meet the needs of everyone waiting for a transplant. ‘You’d have to turn over the entire GDP of a country to accomplish that,’ it is unclear whether the cost of these artificial organs will allow them to be within the reach of patients in need of an organ transplant.

With these possible outcomes taken consideration, it is now becoming clear that money will play an important role in artificial organ growth. If we begin producing artificial organs, will these be available to everyone? Or will these be only available to the wealthy? The whole purpose of artificial organ growth is to give hope to those waiting for an organ transplant. How would this fulfill that purpose if only the wealthy will be able to afford it? The Scientist elaborated on this possible problem, stating, “[Jeffrey] Platt thinks that organ engineering is too costly to meet the needs of everyone waiting for a transplant. ‘You’d have to turn over the entire GDP of a country to accomplish that,’ he says. On the other hand, ‘I could get a pig for a couple of hundred dollars.’ But [Paolo] Macchiarini argues that organ engineering is in its infancy, and every advance improves efficiency and lowers cost. ‘What we did in 2008 in 6 months, we can now do in a few weeks,’ he says. ‘We do care about getting this to every patient.’ [Joseph] Vacanti adds that mass-producing artificial scaffolds will make organ engineering even more cost-effective. ‘When you scale them up, the bulk materials and manufacturing tech are extremely cheap,’ he says. ‘I think it’s going to be cheaper than growing lots of pigs.’” So it is still unclear whether the cost of these artificial organs will allow them to be within the reach of patients in need of an organ transplant.

<h4><strong>And they’re too expensive</h4><p>Gopar 14</strong> Jennifer Julisa Gopar ans Dr. Rance LeFebvre 28 July 2014 COSMOS Cluster 7: Biomedical Sciences The Moral and Ethical Debate Regarding Artificial Organ Growth</p><p><u>http://cosmos.ucdavis.edu/archives/2014/Cluster7/Gopar_Jennifer_EthicsofGrowingOrgans.pdf</p><p></u>With these possible outcomes taken consideration, it is now becoming clear that money will play an important role in artificial organ growth. If we begin producing artificial organs, will these be available to everyone? Or will these be only available to the wealthy? The whole purpose of artificial organ growth is to give hope to those waiting for an organ transplant. How would this fulfill that purpose if only the wealthy will be able to afford it? <u>The Scientist elaborated on this possible problem, stating</u>, “[Jeffrey] <u>Platt thinks that <mark>organ engineering is too</u> <u>costly to meet the needs of everyone waiting for a transplant. ‘You’d have to turn over <strong>the entire GDP of a country</strong> to accomplish that,’</mark> he says.</u> On the other hand, ‘I could get a pig for a couple of hundred dollars.’ But [Paolo] Macchiarini argues that organ engineering is in its infancy, and every advance improves efficiency and lowers cost. ‘What we did in 2008 in 6 months, we can now do in a few weeks,’ he says. ‘We do care about getting this to every patient.’ [Joseph] Vacanti adds that mass-producing artificial scaffolds will make organ engineering even more cost-effective. ‘When you scale them up, the bulk materials and manufacturing tech are extremely cheap,’ he says. ‘I think it’s going to be cheaper than growing lots of pigs.’” <u>So <mark>it is</mark> still <mark>unclear whether the cost of these artificial organs will allow them to be within the reach of patients in need of an organ transplant.</p></u></mark>

Contention 1 – Organ sales will save lives

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Crowd-out studies are based on Titmuss, who’s wrong

Economist 11

Economist 11 The Economist Feb 16th 2011 Blood, not money http://www.economist.com/blogs/blighty/2011/02/volunteering_and_profiteering

In a classic 1970 study called "The Gift Relationship: From Human Blood to Social Policy" Titmuss compared the voluntary British system with the American one in which payments were then widely made. Titmuss reckoned such a market was inefficient and wasteful, that it created shortages and surpluses, he was wrong, and such arguments have since been widely discredited

In a classic study Titmuss compared the voluntary system with the American one in which payments were made. Titmuss reckoned such created shortages and surpluses, he was wrong, and such arguments have since been widely discredited

Blood donors are also unpaid, in Britain and elsewhere. A debate over whether or not they should be compensated for their efforts has raged for at least four decades. In a classic 1970 study called "The Gift Relationship: From Human Blood to Social Policy" Richard Titmuss compared the voluntary British system favourably with the American one in which payments were then widely made. Titmuss reckoned such a market was inefficient and wasteful, that it created shortages and surpluses, and led eventually to a contaminated product. Although he was wrong, and such arguments have since been widely discredited, Americans mostly no longer receive payment for giving blood. Too many people in poor health lied about their medical histories in order to make a few bucks, endangering those who were to receive the blood. As the World Health Organisation notes, people who give blood voluntarily and for altruistic reasons have a lower prevalence of HIV, hepatitis viruses and other blood-borne infections than do those who seek monetary reward. Presumably that is because being rich is a great protection against disease.

<h4>Crowd-out studies are based on Titmuss, who’s wrong</h4><p><strong>Economist 11</strong> The Economist Feb 16th 2011 Blood, not money</p><p>http://www.economist.com/blogs/blighty/2011/02/volunteering_and_profiteering</p><p>Blood donors are also unpaid, in Britain and elsewhere. A debate over whether or not they should be compensated for their efforts has raged for at least four decades. <u><mark>In a classic </mark>1970 <mark>study </mark>called "The Gift Relationship: From Human Blood to Social Policy"</u> Richard <u><mark>Titmuss compared the voluntary </mark>British</u> <u><mark>system</u></mark> favourably <u><mark>with the American one in which payments were </mark>then widely <mark>made. Titmuss reckoned such </mark>a market was inefficient and wasteful, that it <mark>created shortages and surpluses,</u></mark> and led eventually to a contaminated product. Although <u><mark>he was wrong, and such arguments have since been widely discredited</u></mark>, Americans mostly no longer receive payment for giving blood. Too many people in poor health lied about their medical histories in order to make a few bucks, endangering those who were to receive the blood. As the World Health Organisation notes, people who give blood voluntarily and for altruistic reasons have a lower prevalence of HIV, hepatitis viruses and other blood-borne infections than do those who seek monetary reward. Presumably that is because being rich is a great protection against disease.</p>

Contention 1 – Organ sales will save lives

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New empirical data proves no altruism crowd out

Gordon 15

Elisa J Gordon 15, PhD/MPH-Research Associate Professor in Center for Healthcare Studies - Institute for Public Health and Medicine, Medical Education-Medical Humanities and Bioethics and Surgery-Organ Transplantation at Northwestern University, “Does Financial Compensation for Living Kidney Donation Change Willingness to Donate?,” American Journal of Transplantation, Volume 15, Issue 1, pages 265–273, January 2015

This study assessed public perceptions about the impact of compensation on willingness to donate, The majority of the public surveyed perceived financial compensation for living donors acceptable in general. the majority (70%) would not change their willingness to donate if offered financial compensation and 74% found an offer of compensation to others acceptable, which undermines the positive crowding out hypothesis that the offer of compensation reduces a desired behavior in those already disposed to pursuing the desired behavior. Bryce similarly found 71–76% maintaining the same willingness to be a deceased donor, depending on the type of compensation

This study assessed public perceptions The majority surveyed perceived financial compensation acceptable 70%) would not change their willingness to donate if offered financial compensation 74% found an offer of compensation to others acceptable, which undermines the positive crowding out hypothesis Bryce similarly found 71 % maintaining the same willingness

This study assessed public perceptions about the impact of compensation on willingness to donate, the amount of compensation that would begin motivating individuals to donate, and the amount that starts to be perceived as undue inducement.¶ The majority of the public surveyed perceived financial compensation for living donors acceptable in general. However, fewer respondents considered financial compensation to themselves to donate acceptable. Moreover, the majority (70%) would not change their willingness to donate if offered financial compensation, and 74% found an offer of compensation to others acceptable, which, together, undermines the positive crowding out hypothesis that the offer of compensation reduces a desired behavior in those already disposed to pursuing the desired behavior. Bryce et al similarly found 71–76% maintaining the same willingness to be a deceased donor, depending on the type of compensation [28]. Our finding suggests that respondents were against personally receiving financial compensation. In other words, this disconnection between tolerance for compensating others and less support for personal compensation suggests that financial compensation would make little difference in individuals' decisions to donate, and that in practice, policies in support of financial compensation would have relatively little traction in increasing living donation rates.

<h4>New empirical data proves no altruism crowd out</h4><p>Elisa J <strong>Gordon 15</strong>, PhD/MPH-Research Associate Professor in Center for Healthcare Studies - Institute for Public Health and Medicine, Medical Education-Medical Humanities and Bioethics and Surgery-Organ Transplantation at Northwestern University, “Does Financial Compensation for Living Kidney Donation Change Willingness to Donate?,” American Journal of Transplantation, Volume 15, Issue 1, pages 265–273, January 2015</p><p><u><mark>This study assessed public perceptions</mark> about the impact of compensation on willingness to donate,</u> the amount of compensation that would begin motivating individuals to donate, and the amount that starts to be perceived as undue inducement.¶ <u><mark>The majority</mark> of the public <mark>surveyed perceived financial compensation</mark> for living donors <mark>acceptable</mark> in general. </u>However, fewer respondents considered financial compensation to themselves to donate acceptable. Moreover, <u>the majority (<strong><mark>70%) would not change their willingness to donate if offered financial compensation</u></strong></mark>, <u>and <mark>74% found an offer of compensation to others acceptable, which</u></mark>, together, <u><strong><mark>undermines the positive crowding out hypothesis</strong></mark> that the offer of compensation reduces a desired behavior in those already disposed to pursuing the desired behavior. <mark>Bryce</u></mark> et al <u><mark>similarly found 71</mark>–76<mark>%</mark> <mark>maintaining the same willingness</mark> to be a deceased donor, depending on the type of compensation</u> [28]. Our finding suggests that respondents were against personally receiving financial compensation. In other words, this disconnection between tolerance for compensating others and less support for personal compensation suggests that financial compensation would make little difference in individuals' decisions to donate, and that in practice, policies in support of financial compensation would have relatively little traction in increasing living donation rates.</p>

Contention 1 – Organ sales will save lives

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

Ma.....

Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

No crowd out – donations are primarily for friends and relatives

Gill 2

Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care, Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45

In the early 1970s, Titmuss and Singer argued that the existence of financial incentives for blood products would decrease the amount of blood products overall, and some people might believe that the same argument can be extended to financial incentives for kidneys, first the available evidence does not support the conclusion that payment for blood products has reduced blood supply in the U S secondly, because live kidney donations are usually between family members, there is a significant difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's conclusions to the kidney debate. We do, however, remain open to the possibility that future evidence may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey (1999, p. 119).

evidence does not support the conclusion that payment for blood has reduced blood supply in the U St secondly, because live kidney donations are usually between family members, there is a significant difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's conclusions to the kidney debate.

Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_ of_ethics_journal/v012/12.1gill.html 3. In the early 1970s, Titmuss (1971) and Singer (1973) argued that the existence of financial incentives for blood products would decrease the amount of blood products overall, and some people might believe that the same argument can be extended to financial incentives for kidneys, leading to the conclusion that payment for kidneys will decrease the overall number of kidneys available for transplant. Singer and Titmuss's criticisms of payment for blood products are consequentialist—they argue that such payment is wrong because it would reduce the amount of blood for people who needed it. We believe, first of all, that their consequentialist arguments against payment for blood products have turned out to be inconclusive at best—that the available evidence does not support the conclusion that payment for blood products has reduced blood supply in the United States. And we believe, secondly, that because live kidney donations are usually between family members, there is a significant difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's conclusions to the kidney debate. We do, however, remain open to the possibility that future evidence may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey (1999, p. 119).

<h4>No crowd out – donations are primarily for friends and relatives</h4><p><strong>Gill 2</strong> Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care, Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45</p><p>Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_ of_ethics_journal/v012/12.1gill.html</p><p>3. <u>In the early 1970s, Titmuss</u> (1971) <u>and Singer</u> (1973) <u>argued that the existence of financial incentives for blood products would decrease the amount of blood products overall, and some people might believe that the same argument can be extended to financial incentives for kidneys,</u> leading to the conclusion that payment for kidneys will decrease the overall number of kidneys available for transplant. Singer and Titmuss's criticisms of payment for blood products are consequentialist—they argue that such payment is wrong because it would reduce the amount of blood for people who needed it. We believe, <u>first </u>of all, that their consequentialist arguments against payment for blood products have turned out to be inconclusive at best—that <u>the available <mark>evidence does not support the conclusion that payment for blood </mark>products<mark> has reduced blood supply in the U</u></mark>nited <u><mark>S</u>t</mark>ates. And we believe, <u><mark>secondly,</mark> </u>that<u> <mark>because live kidney donations are usually between family members, there is a significant difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's conclusions to the kidney debate.</mark> We do, however, remain open to the possibility that future evidence may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey (1999, p. 119). </p></u>

Contention 1 – Organ sales will save lives

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

KrMa

Dartmouth KrMa

Da.....

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Jo.....

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Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

Even if some crowd out occurred, sales would still provide an adequate supply of organs

Study by Becker and Elias 14

Study by Becker and Elias 14 Gary S. Becker, Nobel Prize-winning professor of economics at the University of Chicago and a senior fellow at the Hoover Institution; and Julio J. Elias, economics professor at the Universidad del CEMA in Argentina. Updated Jan. 18, 2014 Wall Street Journal Cash for Kidneys: The Case for a Market for Organs http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_hpp_MIDDLENexttoWhatsNewsFifth

Finding a way to increase the supply of organs would reduce wait times and deaths, and it would greatly ease the suffering that many sick individuals now endure while they hope for a transplant. The most effective change would be to provide compensation to people who give their organs—that is, we recommend establishing a market for organs. Paying donors for their organs would finally eliminate the supply-demand gap sufficient payment to kidney donors would increase the supply of kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant. We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants. Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney. Iran permits the sale of kidneys by living donors. waiting times to get kidneys have been largely eliminated Since the number of kidneys available at a reasonable price would be far more than needed to close the gap between the demand and supply of kidneys, there would no longer be any significant waiting time to get a kidney transplant. The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear. the claim that payments would be ineffective in eliminating the shortage of organs isn't consistent with what we know about the supply of other parts of the body for medical use. Paying for organs would save the cost of dialysis for people waiting for kidney transplants and other costs to individuals waiting for other organs. More important, it would prevent thousands of deaths and improve the quality of life among those who now must wait years before getting the organs they need.

The most effective change would be to provide compensation to people who give their organs Paying donors for their organs would finally eliminate the supply-demand gap. , sufficient payment to kidney donors would increase the supply of kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney Iran permits the sale of kidneys by living donors waiting times have been largely eliminated The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear the claim that payments would be ineffective isn't consistent with what we know about the supply of other parts of the body for medical use Paying for organs would save the cost of dialysis for people waiting for kidney transplants and other costs to individuals waiting for other organs.

Finding a way to increase the supply of organs would reduce wait times and deaths, and it would greatly ease the suffering that many sick individuals now endure while they hope for a transplant. The most effective change, we believe, would be to provide compensation to people who give their organs—that is, we recommend establishing a market for organs. Organ transplants are one of the extraordinary developments of modern science. They began in 1954 with a kidney transplant performed at Brigham & Women's hospital in Boston. But the practice only took off in the 1970s with the development of immunosuppressive drugs that could prevent the rejection of transplanted organs. Since then, the number of kidney and other organ transplants has grown rapidly, but not nearly as rapidly as the growth in the number of people with defective organs who need transplants. The result has been longer and longer delays to receive organs. Many of those waiting for kidneys are on dialysis, and life expectancy while on dialysis isn't long. For example, people age 45 to 49 live, on average, eight additional years if they remain on dialysis, but they live an additional 23 years if they get a kidney transplant. That is why in 2012, almost 4,500 persons died while waiting for kidney transplants. Although some of those waiting would have died anyway, the great majority died because they were unable to replace their defective kidneys quickly enough. Enlarge Image The toll on those waiting for kidneys and on their families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis. Most of those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself. Individuals can live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live donors. The majority of transplant kidneys come from parents, children, siblings and other relatives of those who need transplants. The rest come from individuals who want to help those in need of transplants. In recent years, kidney exchanges—in which pairs of living would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would be compatible for transplants, cutting their wait time—have become more widespread. Although these exchanges have grown rapidly in the U.S. since 2005, they still account for only 9% of live donations and just 3% of all kidney donations, including after-death donations. The relatively minor role of exchanges in total donations isn't an accident, because exchanges are really a form of barter, and barter is always an inefficient way to arrange transactions. Exhortations and other efforts to encourage more organ donations have failed to significantly close the large gap between supply and demand. For example, some countries use an implied consent approach, in which organs from cadavers are assumed to be available for transplant unless, before death, individuals indicate that they don't want their organs to be used. (The U.S. continues to use informed consent, requiring people to make an active declaration of their wish to donate.) In our own highly preliminary study of a few countries—Argentina, Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed consent or vice versa, we found that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have found more positive effects from switching to implied consent, but none of the effects would be large enough to eliminate the sizable shortfall in the supply of organs in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even when they use different methods to procure organs and have different cultures and traditions. Paying donors for their organs would finally eliminate the supply-demand gap. In particular, sufficient payment to kidney donors would increase the supply of kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant. We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants. These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction in the quality of life. Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney. That estimate isn't exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn't increase the total cost of kidney transplants by a large percentage. Few countries have ever allowed the open purchase and sale of organs, but Iran permits the sale of kidneys by living donors. Scattered and incomplete evidence from Iran indicates that the price of kidneys there is about $4,000 and that waiting times to get kidneys have been largely eliminated. Since Iran's per capita income is one-quarter of that of the U.S., this evidence supports our $15,000 estimate. Other countries are also starting to think along these lines: Singapore and Australia have recently introduced limited payments to live donors that compensate mainly for time lost from work. Since the number of kidneys available at a reasonable price would be far more than needed to close the gap between the demand and supply of kidneys, there would no longer be any significant waiting time to get a kidney transplant. The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear. Today, finding a compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of six proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs would result in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be arranged to suit the health of recipients (and donors) because surgeons would be confident that compatible kidneys would be available. The system that we're proposing would include payment to individuals who agree that their organs can be used after they die. This is important because transplants for heart and lungs and most liver transplants only use organs from the deceased. Under a new system, individuals would sell their organs "forward" (that is, for future use), with payment going to their heirs after their organs are harvested. Relatives sometimes refuse to have organs used even when a deceased family member has explicitly requested it, and they would be more inclined to honor such wishes if they received substantial compensation for their assent. The idea of paying organ donors has met with strong opposition from some (but not all) transplant surgeons and other doctors, as well as various academics, political leaders and others. Critics have claimed that paying for organs would be ineffective, that payment would be immoral because it involves the sale of body parts and that the main donors would be the desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for organs would be repugnant. But the claim that payments would be ineffective in eliminating the shortage of organs isn't consistent with what we know about the supply of other parts of the body for medical use. For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes time, involves great discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000. Another illuminating example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable volunteers by offering them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S., even during wars, and the cost of these recruits hasn't been excessive. Whether paying donors is immoral because it involves the sale of organs is a much more subjective matter, but we question this assertion, given the very serious problems with the present system. Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the present system? Under the type of system we propose, safeguards could be created against impulsive behavior or exploitation. For example, to reduce the likelihood of rash donations, a period of three months or longer could be required before someone would be allowed to donate their kidneys or other organs. This would give donors a chance to re-evaluate their decisions, and they could change their minds at any time before the surgery. They could also receive guidance from counselors on the wisdom of these decisions. Though the poor would be more likely to sell their kidneys and other organs, they also suffer more than others from the current scarcity. Today, the rich often don't wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in several states or other means. The sale of organs would make them more available to the poor, and Medicaid could help pay for the added cost of transplant surgery. The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those in need of organs could increase to help them pay for the cost of organ transplants. Paying for organs would lead to more transplants—and thereby, perhaps, to a large increase in the overall medical costs of transplantation. But it would save the cost of dialysis for people waiting for kidney transplants and other costs to individuals waiting for other organs. More important, it would prevent thousands of deaths and improve the quality of life among those who now must wait years before getting the organs they need.

<h4>Even if some crowd out occurred, sales would still provide an adequate supply of organs<u><strong> </h4><p></u>Study by Becker and Elias 14 </strong>Gary S. Becker, Nobel Prize-winning professor of economics at the University of Chicago and a senior fellow at the Hoover Institution; and Julio J. Elias, economics professor at the Universidad del CEMA in Argentina.<strong> </strong>Updated Jan. 18, 2014 Wall Street Journal Cash for Kidneys: The Case for a Market for Organs</p><p><u>http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_hpp_MIDDLENexttoWhatsNewsFifth</p><p>Finding a way to increase the supply of organs would reduce wait times and deaths, and it would greatly ease the suffering that many sick individuals now endure while they hope for a transplant. <mark>The most effective change</u></mark>, we believe, <u><mark>would be to provide compensation to people who give their organs</mark>—that is, we recommend establishing a market for organs. </u>Organ transplants are one of the extraordinary developments of modern science. They began in 1954 with a kidney transplant performed at Brigham & Women's hospital in Boston. But the practice only took off in the 1970s with the development of immunosuppressive drugs that could prevent the rejection of transplanted organs. Since then, the number of kidney and other organ transplants has grown rapidly, but not nearly as rapidly as the growth in the number of people with defective organs who need transplants. The result has been longer and longer delays to receive organs. Many of those waiting for kidneys are on dialysis, and life expectancy while on dialysis isn't long. For example, people age 45 to 49 live, on average, eight additional years if they remain on dialysis, but they live an additional 23 years if they get a kidney transplant. That is why in 2012, almost 4,500 persons died while waiting for kidney transplants. Although some of those waiting would have died anyway, the great majority died because they were unable to replace their defective kidneys quickly enough. Enlarge Image The toll on those waiting for kidneys and on their families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis. Most of those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself. Individuals can live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live donors. The majority of transplant kidneys come from parents, children, siblings and other relatives of those who need transplants. The rest come from individuals who want to help those in need of transplants. In recent years, kidney exchanges—in which pairs of living would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would be compatible for transplants, cutting their wait time—have become more widespread. Although these exchanges have grown rapidly in the U.S. since 2005, they still account for only 9% of live donations and just 3% of all kidney donations, including after-death donations. The relatively minor role of exchanges in total donations isn't an accident, because exchanges are really a form of barter, and barter is always an inefficient way to arrange transactions. Exhortations and other efforts to encourage more organ donations have failed to significantly close the large gap between supply and demand. For example, some countries use an implied consent approach, in which organs from cadavers are assumed to be available for transplant unless, before death, individuals indicate that they don't want their organs to be used. (The U.S. continues to use informed consent, requiring people to make an active declaration of their wish to donate.) In our own highly preliminary study of a few countries—Argentina, Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed consent or vice versa, we found that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have found more positive effects from switching to implied consent, but none of the effects would be large enough to eliminate the sizable shortfall in the supply of organs in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even when they use different methods to procure organs and have different cultures and traditions. <u><mark>Paying donors for their organs would finally eliminate the supply-demand gap</u>.</mark> In particular<mark>, <u>sufficient payment to kidney donors would increase the supply of kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant</mark>. We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants. </u>These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction in the quality of life. <u><mark>Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney</mark>.</u> That estimate isn't exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn't increase the total cost of kidney transplants by a large percentage. Few countries have ever allowed the open purchase and sale of organs, but <u><mark>Iran permits the sale of kidneys by living donors</mark>.</u> Scattered and incomplete evidence from Iran indicates that the price of kidneys there is about $4,000 and that <u><mark>waiting times</mark> to get kidneys <mark>have been largely eliminated</u></mark>. Since Iran's per capita income is one-quarter of that of the U.S., this evidence supports our $15,000 estimate. Other countries are also starting to think along these lines: Singapore and Australia have recently introduced limited payments to live donors that compensate mainly for time lost from work. <u>Since the number of kidneys available at a reasonable price would be far more than needed to close the gap between the demand and supply of kidneys, there would no longer be any significant waiting time to get a kidney transplant. <mark>The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear</mark>. </u>Today, finding a compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of six proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs would result in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be arranged to suit the health of recipients (and donors) because surgeons would be confident that compatible kidneys would be available. The system that we're proposing would include payment to individuals who agree that their organs can be used after they die. This is important because transplants for heart and lungs and most liver transplants only use organs from the deceased. Under a new system, individuals would sell their organs "forward" (that is, for future use), with payment going to their heirs after their organs are harvested. Relatives sometimes refuse to have organs used even when a deceased family member has explicitly requested it, and they would be more inclined to honor such wishes if they received substantial compensation for their assent. The idea of paying organ donors has met with strong opposition from some (but not all) transplant surgeons and other doctors, as well as various academics, political leaders and others. Critics have claimed that paying for organs would be ineffective, that payment would be immoral because it involves the sale of body parts and that the main donors would be the desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for organs would be repugnant. But <u><mark>the claim that payments would be ineffective</mark> in eliminating the shortage of organs <mark>isn't consistent with what we know about the supply of other parts of the body for medical use</mark>.</u> For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes time, involves great discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000. Another illuminating example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable volunteers by offering them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S., even during wars, and the cost of these recruits hasn't been excessive. Whether paying donors is immoral because it involves the sale of organs is a much more subjective matter, but we question this assertion, given the very serious problems with the present system. Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the present system? Under the type of system we propose, safeguards could be created against impulsive behavior or exploitation. For example, to reduce the likelihood of rash donations, a period of three months or longer could be required before someone would be allowed to donate their kidneys or other organs. This would give donors a chance to re-evaluate their decisions, and they could change their minds at any time before the surgery. They could also receive guidance from counselors on the wisdom of these decisions. Though the poor would be more likely to sell their kidneys and other organs, they also suffer more than others from the current scarcity. Today, the rich often don't wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in several states or other means. The sale of organs would make them more available to the poor, and Medicaid could help pay for the added cost of transplant surgery. The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those in need of organs could increase to help them pay for the cost of organ transplants. <u><mark>Paying for organs</mark> </u>would lead to more transplants—and thereby, perhaps, to a large increase in the overall medical costs of transplantation. But it <u><mark>would save the cost of dialysis for people waiting for kidney transplants and other costs to individuals waiting for other organs.</mark> More important, it would prevent thousands of deaths and improve the quality of life among those who now must wait years before getting the organs they need.</p></u>

Contention 1 – Organ sales will save lives

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

KrMa

Dartmouth KrMa

Da.....

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Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

The US ban on sales has created an international illegal market

Hughes 9

Hughes 9 J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.

U.S. organ procurement policy has consequences beyond a domestic organ shortage. A thriving global market in human organs has resulted from U.S. policy banning organ sales The illegality of the organ trade is insufficient to discourage many of those faced with the possibility of dying on an organ waiting list, and "transplant tourism" has become its own industry. U.S. doctors perform illegal transplants, too, often under hospitals' "don't ask, don't tell" policy regarding transplants involving foreigners who claim to be related The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the world. In short, U.S. policy and its ban on organ sales have produced some of the same immoral and unethical consequences the ban was designed to avoid

. A thriving global market in human organs has resulted from U.S. policy banning organ sales The illegality of the organ trade is insufficient to discourage many of those faced with the possibility of dying on an organ waiting list, and "transplant tourism" has become its own industry U.S. doctors perform illegal transplants, too, The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the world

Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351 Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models U.S. organ procurement policy has consequences beyond a domestic organ shortage. A thriving global black market in human organs has resulted from U.S. policy banning organ sales. n78 While nearly all developed nations have banned the sale and purchase of human organs, many countries do not strictly enforce these laws. n79 The illegality of the organ trade is insufficient to discourage many of those faced with the possibility of dying on an organ waiting list, and "transplant tourism" has become its own industry. n80 In Bombay in 2001, nearly US$ 10 million were exchanged for kidney transplants. n81 Patients use kidney brokers to locate sellers, who circumvent a ban on kidney sales by signing an affidavit swearing that they are not being paid. n82 Before the U.S. invaded Iraq in 2003, that country was known as "one of [the] world's best black marketplaces for human organs." n83 The lack of effective prosecution of these transactions extends beyond Asia and the Middle East to Europe, as recent cases in Estonia and Germany suggest. n84 U.S. doctors perform illegal transplants, too, often under hospitals' "don't ask, don't tell" policy regarding transplants involving foreigners who claim to be related. n85 U.S. hospitals set their own rules for who can be a live organ donor, and organ brokers can locate hospitals that do not question a purported familial relationship between "donors" and "donees." n86 The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the world. n87 Organ sellers often face debt, unemployment, and serious health problems; as such, they are easy targets for abuse. n88 Prisoners and the homeless are among those exploited. n89 Sellers of organs on the black market are often paid less than what they were initially promised, while their financial situations and health often grow worse after the transplants. n90 Data from the Indian black market trade in kidneys [*363] support the concern about sellers' lack of adequate information about the risks involved. In one study, 86% of the sellers there reported that their health had "deteriorated substantially" after their organ sales, and "four out of five sellers would not recommend that others follow their lead in selling organs." n91 In short, U.S. policy and its ban on organ sales have produced some of the same immoral and unethical consequences the ban was designed to avoid. n92

<h4>The US ban on sales has created an international illegal market</h4><p><strong>Hughes 9</strong> J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.</p><p>Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351</p><p>Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models</p><p><u>U.S. organ procurement policy has consequences beyond a domestic organ shortage<mark>. A thriving global</u> </mark>black <u><mark>market in human organs has resulted from U.S. policy banning organ sales</u></mark>. n78 While nearly all developed nations have banned the sale and purchase of human organs, many countries do not strictly enforce these laws. n79 <u><mark>The illegality of the organ trade is insufficient to discourage many of those faced with the possibility of dying on an organ waiting list, and "transplant tourism" has become its own industry</mark>.</u> n80 In Bombay in 2001, nearly US$ 10 million were exchanged for kidney transplants. n81 Patients use kidney brokers to locate sellers, who circumvent a ban on kidney sales by signing an affidavit swearing that they are not being paid. n82 Before the U.S. invaded Iraq in 2003, that country was known as "one of [the] world's best black marketplaces for human organs." n83 The lack of effective prosecution of these transactions extends beyond Asia and the Middle East to Europe, as recent cases in Estonia and Germany suggest. n84 <u><mark>U.S. doctors perform illegal transplants, too,</mark> often under hospitals' "don't ask, don't tell" policy regarding transplants involving foreigners who claim to be related</u>. n85 U.S. hospitals set their own rules for who can be a live organ donor, and organ brokers can locate hospitals that do not question a purported familial relationship between "donors" and "donees." n86 <u><mark>The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the world</mark>.</u> n87 Organ sellers often face debt, unemployment, and serious health problems; as such, they are easy targets for abuse. n88 Prisoners and the homeless are among those exploited. n89 Sellers of organs on the black market are often paid less than what they were initially promised, while their financial situations and health often grow worse after the transplants. n90 Data from the Indian black market trade in kidneys [*363] support the concern about sellers' lack of adequate information about the risks involved. In one study, 86% of the sellers there reported that their health had "deteriorated substantially" after their organ sales, and "four out of five sellers would not recommend that others follow their lead in selling organs." n91 <u>In short, U.S. policy and its ban on organ sales have produced some of the same immoral and unethical consequences the ban was designed to avoid</u>. n92</p>

Contention 2 is the Illegal market

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

Jo.....

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Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

“Experts” suffer from multiple sources of bias. The ruse of objectivity emerges from a culture of politicized threat inflation that produces ill-advised policies.

Oppenheimer 12

Oppenheimer 12 [Michael F. Oppenheimer is Clinical Professor in the Global Affairs Masters program at the New York University Center for Global Affairs. His courses include International Relations, International Political Economy, U.S. Foreign Policy, and Future International Systems. He is the originator and director of the Carnegie Corporation funded project on alternate futures for pivotal countries, which has published China 2020, Russia 2020, Turkey 2020, Ukraine 2020, and Pakistan 2020. He has done extensive consulting, specializing in futures oriented policy analysis for the U.S. foreign policy and intelligence communities and think tanks. He is a life member of the Council on Foreign Relations.SAIS Review > Volume 32, Number 1, Winter-Spring 2012 From Prediction to Recognition: Using Alternate Scenarios to Improve Foreign Policy Decisions]

Policymakers bring unrecognized assumptions assumptions derived from recent experience (which produce misleading historical analogies or trend extrapolations), value preferences, (rewarding assumptions “good enough” t theoretical or cultural biases, group-think, the risks of dissent debates proceed within a context of insecurity which encourages threat inflation and self-fulfilling prophecies. The magnitude of U.S. power blind us to perspectives of others Washington policy makers realized that the post-Cold War environment created the opportunity for the United States, which has forthrightly described itself as the world's only superpower, to domi¬nate the East Asia-Pacific region. To this end, it has aggressively sought Tokyo's assistance Washington reasons the demise of the alliance would instantly invite other nations to attempt to dominate East Asia, or at the very least, create unacceptable regional instability Tokyo has accepted these U.S. assumptions, concluding that it is easier to continue with the security paradigm that has presumably maintained regional stability for decades than to change it. Washington and Tokyo have been constantly evoking the theme of regional instability. Washington maintains that North Ko¬rea is still an unpredictable security threat, and because Russia and China are the nations most likely to challenge the military power of the United States in the future, they too are suspect. Washington maintains that China is aspiring to be the dominant regional power while Beijing believes that the U.S. objective is to contain China Washing-ton recognizes that the strengthened U.S.-Japan security relationship has created angst in Beijing and that Chinese leaders are working to counter this alliance, while expressing opposition to what they see as a resurgence of Japanese militarism Thus, Washington and Tokyo have found reasons to rationalize the continuation of the bilateral security arrangement. The centerpiece of this rationalization is the putative instability of East Asia and therefore the continuing need for America's military presence and a strengthened bilateral alliance However, this enduring and strengthened security arrangement is problematic First, because it is a Cold War alliance, it still presupposes that the be-havior of some nations is blatantly hostile, surreptitious, and intended to upset the stability of East Asia and perhaps even usurp regional power it is built on distrust and suspicion. Second, because it is built on distrust and suspicion, it produces regional tension. The exist-ence of the U.S.---Japan security alliance does this because of its purpose and because of the reciprocation that it prompts from other countries. These enduring problems even cause the genuine efforts by Washington and Tokyo to improve regional relations to be minimized, since their overall objective is interpreted as hegemonic

Policymakers bring unrecognized assumptions assumptions derived from recent experience (which produce misleading historical analogies or trend extrapolations), value preferences, (rewarding assumptions “good enough” t theoretical or cultural biases, group-think, the risks of dissent debates proceed within a context of insecurity which encourages threat inflation and self-fulfilling prophecies. The magnitude of U.S. power blind us to perspectives of others Washington and Tokyo have been constantly evoking the theme of regional instability Washington maintains North Ko¬rea Russia and China are suspect enduring and strengthened security arrangement is problematic it presupposes the be-havior of some nations is hostile, surreptitious, and intended to upset stability because it is built on distrust it produces regional tension the U.S.---Japan security alliance does this because reciprocation that it prompts These even cause genuine efforts by Washington to improve regional relations to be minimized since their objective is interpreted as hegemonic

Policymakers often bring unrecognized or unarticulated assumptions about the future into policy debates.2 These assumptions are derived from recent experience (which can produce misleading historical analogies or trend extrapolations), value preferences, time pressure (rewarding assumptions that are “good enough” to permit closure), mindsets based on theoretical or cultural biases, group-think, the political risks of dissent and demands of building a case for change (which create strong incentives to wring the greatest possible value out of current policy). Foreign policy debates proceed within a context of insecurity and uncertainty, which often encourages threat inflation and actions that produce self-fulfilling negative prophecies. U.S. policymakers are particularly susceptible to these tendencies, given multiple U.S. interests and the consequent thinning of intelligence and increased uncertainty. The magnitude of relative U.S. power in the world—which multiplies perceived threats—can blind us to the interests and perspectives of others and, when deployed carelessly, can produce massive unintended consequences. Their notion of East Asian instability is based on obsolete assumptions and makes war inevitable DiFilippo 2 Anthony DiFilippo, professor of sociology at Lincoln University in Pennsylvania, 2002 East Gate (Longon), The Challenges of the U.S.-Japan Military Arrangement, pg. 54-5 The end of the Cold War and the very visible diminution of super-power tensions briefly rekindled the idea that the United Nations would be able to provide international security. This view not only reemerged in Japan, but there has also been increased discussion about the elimina¬tion of nuclear weapons, another historically strong Japanese sentiment. However, Washington policy makers realized that the post-Cold War environment created the opportunity for the United States, which has forthrightly described itself as the world's only superpower, to domi¬nate the East Asia-Pacific region. To this end, it has aggressively sought Tokyo's assistance. Ending the bilateral security arrangement therefore would not be a prudent choice, Washington reasons, since the demise of the alliance or even the loss of a physical American presence in Japan would instantly invite other nations to attempt to dominate East Asia, or at the very least, create unacceptable regional instability. Tokyo has accepted these U.S. assumptions, concluding that it is easier to continue with the security paradigm that has presumably maintained regional stability for decades than to change it. Tokyo has felt that it is in Japan's best interests to work with the United States, not just to main¬tain the bilateral security alliance but also to strengthen it. While doing this since 1996, Washington and Tokyo have been constantly evoking the theme of regional instability. Washington maintains that North Ko¬rea is still an unpredictable security threat, and because Russia and China are the nations most likely to challenge the military power of the United States in the future, they too are suspect. Washington maintains that China is aspiring to be the dominant regional power in East Asia, while Beijing believes that the U.S. objective is to contain China.97 Washing-ton recognizes that the strengthened U.S.-Japan security relationship has created angst in Beijing and that Chinese leaders are working to counter this alliance, while expressing opposition to what they see as a resurgence of Japanese militarism.98 Tokyo continues to assert that be sides the missile threat that it poses to Japan, North Korea has "rekindled suspicions over nuclear weapons.''99 The Japanese Defense Agency's 2000 white paper suggests that China is a latent security threat to Japan and to East Asia. The white paper makes specific reference to China's new efforts in the development of intercontinental land and submarine ballistic missiles and stresses that Chinese naval vessels have more fre¬quently been observed near Japanese waters.1° For Tokyo, exacerbat¬ing its frustration relating to Russian reluctance to settle the northern islands disagreement was the alleged September 2000 spying incident, since it helped to justify lingering suspicions of Moscow's intentions. Thus, Washington and Tokyo have found reasons to rationalize the continuation of the bilateral security arrangement. The centerpiece of this rationalization is the putative instability of East Asia and therefore the continuing need for America's military presence and a strengthened bilateral alliance to forestall regional problems. However, this enduring and strengthened security arrangement is problematic for two reasons. First, because it is a Cold War alliance, it still presupposes that the be-havior of some nations is blatantly hostile, surreptitious, and intended to upset the stability of East Asia and perhaps even usurp regional power. In other words, it is built on distrust and suspicion. Second, because it is built on distrust and suspicion, it produces regional tension. The exist-ence of the U.S.---Japan security alliance does this because of its purpose and because of the reciprocation that it prompts from other countries. These enduring problems even cause the genuine efforts by Washington and Tokyo to improve regional relations to be minimized, since their overall objective is interpreted as hegemonic

<h4>“Experts” suffer from multiple sources of bias. The ruse of objectivity emerges from a culture of politicized threat inflation that produces ill-advised policies.</h4><p><u><strong>Oppenheimer 12</u></strong> [Michael F. Oppenheimer is Clinical Professor in the Global Affairs Masters program at the New York University Center for Global Affairs. His courses include International Relations, International Political Economy, U.S. Foreign Policy, and Future International Systems. He is the originator and director of the Carnegie Corporation funded project on alternate futures for pivotal countries, which has published China 2020, Russia 2020, Turkey 2020, Ukraine 2020, and Pakistan 2020. He has done extensive consulting, specializing in futures oriented policy analysis for the U.S. foreign policy and intelligence communities and think tanks. He is a life member of the Council on Foreign Relations.SAIS Review > Volume 32, Number 1, Winter-Spring 2012 From Prediction to Recognition: Using Alternate Scenarios to Improve Foreign Policy Decisions]</p><p><u><mark>Policymakers</u></mark> often <u><mark>bring unrecognized </u></mark>or unarticulated<u> <mark>assumptions </u></mark>about the future<mark> </mark>into<u> </u>policy<u><mark> </u></mark>debates.2 These<u><mark> assumptions </u></mark>are<u><mark> derived from <strong>recent experience</strong> (which </u></mark>can<u><mark> produce misleading historical analogies or trend extrapolations), <strong>value preferences, </u></strong></mark>time pressure <u><mark>(rewarding assumptions </u></mark>that are<u> <mark>“good enough” t</u></mark>o permit closure), mindsets based on<u><strong> <mark>theoretical or cultural biases, group-think, the </u></strong></mark>political<u><strong><mark> risks of dissent </u></strong></mark>and demands of building a case for change (which create strong incentives to wring the greatest possible value out of current policy). Foreign policy<u><mark> debates proceed <strong>within a context of insecurity</u></strong></mark> and uncertainty, <u><mark>which</u></mark> often <u><mark>encourages <strong>threat inflation</strong> and </u></mark>actions that produce<u><strong><mark> self-fulfilling </u></strong></mark>negative<u><strong><mark> prophecies.</u></strong></mark> U.S. policymakers are particularly susceptible to these tendencies, given multiple U.S. interests and the consequent thinning of intelligence and increased uncertainty. <u><mark>The magnitude of</u></mark> relative <u><mark>U.S. power </u></mark>in the world—which multiplies perceived threats—can<u><mark> blind us to </u></mark>the interests and<u><mark> perspectives of others </u></mark>and, when deployed carelessly, can produce massive unintended consequences.</p><p><strong>Their notion of East Asian instability is based on obsolete assumptions and makes war inevitable</p><p>DiFilippo 2</p><p></strong>Anthony DiFilippo, professor of sociology at Lincoln University in Pennsylvania, 2002 East Gate (Longon), The Challenges of the U.S.-Japan Military Arrangement, pg. 54-5</p><p>The end of the Cold War and the very visible diminution of super-power tensions briefly rekindled the idea that the United Nations would be able to provide international security. This view not only reemerged in Japan, but there has also been increased discussion about the elimina¬tion of nuclear weapons, another historically strong Japanese sentiment. However, <u>Washington policy makers realized that the post-Cold War environment created the opportunity for the United States, which has forthrightly described itself as the world's only superpower, to domi¬nate the East Asia-Pacific region. To this end, it has aggressively sought Tokyo's assistance</u>. Ending the bilateral security arrangement therefore would not be a prudent choice, <u>Washington reasons</u>, since <u>the demise of the alliance</u> or even the loss of a physical American presence in Japan <u>would instantly invite other nations to attempt to dominate East Asia, or at the very least, create unacceptable regional instability</u>.</p><p><u>Tokyo has accepted these U.S. assumptions, concluding that it is easier to continue with the security paradigm that has presumably maintained regional stability for decades than to change it. </u>Tokyo has felt that it is in Japan's best interests to work with the United States, not just to main¬tain the bilateral security alliance but also to strengthen it. While doing this since 1996, <u><mark>Washington and Tokyo have been</mark> <mark>constantly evoking the theme of regional instability</mark>. <mark>Washington</mark> <mark>maintains</mark> that <mark>North Ko¬rea</mark> is still an unpredictable security threat, and because <mark>Russia and China are</mark> the nations most likely to challenge the military power of the United States in the future, they too are <mark>suspect</mark>. Washington maintains that China is aspiring to be the dominant regional power</u> in East Asia, <u>while Beijing believes that the U.S. objective is to contain China</u>.97 <u>Washing-ton recognizes that the strengthened U.S.-Japan security relationship has created angst in Beijing and that Chinese leaders are working to counter this alliance, while expressing opposition to what they see as a resurgence of Japanese militarism</u>.98 Tokyo continues to assert that be sides the missile threat that it poses to Japan, North Korea has "rekindled suspicions over nuclear weapons.''99 The Japanese Defense Agency's 2000 white paper suggests that China is a latent security threat to Japan and to East Asia. The white paper makes specific reference to China's new efforts in the development of intercontinental land and submarine ballistic missiles and stresses that Chinese naval vessels have more fre¬quently been observed near Japanese waters.1° For Tokyo, exacerbat¬ing its frustration relating to Russian reluctance to settle the northern islands disagreement was the alleged September 2000 spying incident, since it helped to justify lingering suspicions of Moscow's intentions. <u>Thus, Washington and Tokyo have found reasons to rationalize the continuation of the bilateral security arrangement. The centerpiece of this rationalization is the putative instability of East Asia and therefore the continuing need for America's military presence and a strengthened bilateral alliance</u> to forestall regional problems. <u>However, this <mark>enduring and strengthened security arrangement is problematic</u></mark> for two reasons. <u>First, because it is a Cold War alliance, <mark>it</mark> still <mark>presupposes</mark> that <mark>the be-havior of some nations is</mark> blatantly <mark>hostile, surreptitious, and intended to upset</mark> the <mark>stability</mark> of East Asia and perhaps even usurp regional power</u>. In other words, <u>it is built on distrust and suspicion. Second, <mark>because it is built on distrust</mark> and suspicion, <mark>it produces regional tension</mark>. The exist-ence of <mark>the U.S.---Japan</mark> <mark>security</mark> <mark>alliance</mark> <mark>does this because</mark> of its purpose and because of the <mark>reciprocation that it prompts</mark> from other countries. <mark>These</mark> enduring problems <mark>even cause</mark> the <mark>genuine efforts</mark> <mark>by Washington</mark> and Tokyo <mark>to improve</mark> <mark>regional</mark> <mark>relations to be minimized</mark>, <mark>since</mark> <mark>their</mark> overall <mark>objective is interpreted as hegemonic</p></u></mark>

K

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Navy-Round8.docx

N

Navy

8

Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Neg-Navy-Round8.docx

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Dartmouth

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college

Trafficking is increasing now—global legislation is ineffective—most recent trends prove

Da Silva and Frontera 15

Da Silva and Frontera 15 (Ivan Rocha Ferreira Da Silva, MD1; Jennifer A. Frontera, MD2 Neurocritical Care Unit and Stroke Department, Hospital Copa D’Or, Rio de Janeiro, Brazil 2Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, Ohio “Worldwide Barriers to Organ Donation” JAMA Neurol. 2015;72(1):112-118. doi:10.1001/jamaneurol.2014.3083. http://archneur.jamanetwork.com/article.aspx?articleid=1934718)

Globally, legislation guiding organ transplant varies widely. Only 20% of African nations report having a transplant organ coordinating structure Even fewer countries have a mechanism for collection and analysis of data related to donation, donor safety, and transplantation activities transplants are performed despite a lack of legislation promulgate illegal transplantation and organ trafficking Even in countries that have legislation regulating organ trafficking there is weak enforcement and few international regulations that can effectively police the problem illicit organ trade generates 1.2 billion per yea this market is fueled not only by profit but also by long waiting lists for organs A growing number of countries report patients have traveled to countries to buy organs on the black (illicit) market known as transplant tourism. American citizens received foreign transplants in 35 countries, led by China, the Philippines, and India

Globally, legislation guiding organ transplant varies widely.1 Only 20% of African nations report having a coordinating structure Even fewer have a mechanism for c analysis of data related to transplantation activities transplants are performed despite a lack of legislation promulgate organ trafficking Even in countries that have legislation regulating organ trafficking, there is weak enforcement illicit organ trade generate 1.2 billion per year this market is fueled not only by profit but also by long waiting lists for organs growing number report patients traveled to buy organs on the illicit) market American citizens received f transplants in 35 countries

Globally, legislation guiding organ donation and transplant varies widely.1 Only 20% of African nations report having a transplant and organ donation coordinating structure, while 95% of countries in the Americas have such a system in place. Even fewer countries have a mechanism for collection and analysis of data related to donation, donor safety, and transplantation activities. Some countries report that liver and/or kidney transplants are performed despite a lack of legislation. Such lack of oversight may promulgate illegal transplantation and organ trafficking. Even in countries that have legislation regulating organ trafficking, there is weak enforcement and few international regulations that can effectively police the problem.43 A recent report by Global Financial Integrity estimates that the illicit organ trade generates illegal profits between $600 million and $1.2 billion per year.44 It is hypothesized that this market is fueled not only by profit but also by cultural and religious barriers to organ donation and transplantation in some countries, long waiting lists for organs, precarious infrastructure for transplants in the country of origin, and difficult access to chronic life support (in the case of renal replacement therapy).45 A growing number of countries report that patients have allegedly traveled to countries to buy organs on the black (illicit) market, a practice known as transplant tourism. The World Health Organization estimates that 5% to 10% of kidney transplants worldwide occur as a result of commercial transactions.46,47 A study of American citizens who received organ transplants abroad showed that roughly 90% were kidney transplants and that male sex, Asian race, resident and nonresident alien status, and college education were significantly and independently associated with foreign transplant.48 In 2006, patients from 34 states, plus the District of Columbia, received foreign transplants in 35 countries, led by China, the Philippines, and India.48

<h4>Trafficking is increasing now—global legislation is <u>ineffective</u>—most recent <u>trends</u> prove</h4><p><strong>Da Silva and Frontera 15 </strong>(Ivan Rocha Ferreira Da Silva, MD1; Jennifer A. Frontera, MD2 Neurocritical Care Unit and Stroke Department, Hospital Copa D’Or, Rio de Janeiro, Brazil 2Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, Ohio “Worldwide Barriers to Organ Donation” JAMA Neurol. 2015;72(1):112-118. doi:10.1001/jamaneurol.2014.3083. http://archneur.jamanetwork.com/article.aspx?articleid=1934718)</p><p><u><mark>Globally, legislation guiding organ</mark> </u>donation and <u><mark>transplant <strong>varies widely.</u></strong>1 <u>Only <strong>20% of African nations</strong> report having a</mark> transplant</u> and <u>organ</u> donation <u><mark>coordinating structure</u></mark>, while 95% of countries in the Americas have such a system in place. <u><mark>Even</u> <u>fewer</mark> countries <mark>have a mechanism for c</mark>ollection and <mark>analysis of data related to</mark> donation, donor safety, and <mark>transplantation activities</u></mark>. Some countries report that liver and/or kidney <u><mark>transplants are performed despite a lack of legislation</u></mark>. Such lack of oversight may <u><mark>promulgate</mark> <strong>illegal transplantation and <mark>organ trafficking</u></strong></mark>. <u><mark>Even in countries that have legislation regulating organ trafficking</u>, <u>there is <strong>weak enforcement</strong></mark> and few international regulations</u> <u>that can effectively police the problem</u>.43 A recent report by Global Financial Integrity estimates that the <u><mark>illicit organ trade generate</mark>s</u> illegal profits between $600 million and $<u><strong><mark>1.2 billion</strong> per yea</u>r</mark>.44 It is hypothesized that <u><mark>this</u> <u>market is fueled not only by profit but also by</u></mark> cultural and religious barriers to organ donation and transplantation in some countries, <u><mark>long waiting lists for organs</u></mark>, precarious infrastructure for transplants in the country of origin, and difficult access to chronic life support (in the case of renal replacement therapy).45 <u>A <strong><mark>growing number</strong></mark> of countries</u> <u><mark>report</u></mark> that <u><mark>patients</u></mark> <u>have</u> allegedly <u><mark>traveled</mark> to countries <mark>to buy organs on the</mark> black (<mark>illicit) market</u></mark>, a practice <u>known as transplant tourism.</u> The World Health Organization estimates that 5% to 10% of kidney transplants worldwide occur as a result of commercial transactions.46,47 A study of <u><mark>American citizens</u></mark> who received organ transplants abroad showed that roughly 90% were kidney transplants and that male sex, Asian race, resident and nonresident alien status, and college education were significantly and independently associated with foreign transplant.48 In 2006, patients from 34 states, plus the District of Columbia, <u><mark>received f</mark>oreign <mark>transplants in 35 countries</mark>, led by China, the Philippines, and India</u>.48</p>

Contention 2 is the Illegal market

./documents/ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

ndtceda14/Dartmouth/KrMa/Dartmouth-Kreus-Martin-Aff-Ndt-Round2.docx

KrMa

Dartmouth KrMa

Da.....

Kr.....

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Dartmouth

Dartmouth

ndtceda14

NDT/CEDA 2014-15

cx

college

Their discourse of short term economic collapse papers over massive ongoing structural violence

Shannon and Volcano 12

Shannon and Volcano (editor of the Routledge journal Contemporary Anarchist Studies; member of the Workers Solidarity Alliance and Queers without Borders) 12 (Deric and Abby, Capitalism in the 2000s in The Accumulation of Freedom, pg. 87-88)

capitalism is prone to periodic "crises yet we declare capitalism in "crisis" now, For children working in sweatshops, for entire countries struggling with food insecurity and hunger, for continents grappling with an AIDS crisis that disproportionately affects our most marginalized populations, for trafficked women and children, for queer youth struggling to obtain basic resources and kicked out of their homes by fundamentalist parents, for those people living with the legacy of colonization and the discourse surrounding crises themselves seem to uphold that capitalism is more or less functioning the rest of the time

capitalism is prone to periodic "crises." yet we declare capitalism in "crisis" now, For children in sweatshops entire countries struggling with food insecurity grappling with an AIDS crisis that disproportionately affects marginalized populations, for trafficked women for queer youth struggling to obtain basic resources for those living with the legacy of colonization the discourse surrounding crises seem to uphold that capitalism is functioning the rest of the time

As Asimakopoulos explains in this collection, capitalism is prone to periodic "crises." This isn't necessarily a new insighta. system based on capital investments creates "bubbles" in expanding industries (i.e., housing, the "dot corn boom," etc.) that cannot last, but that investors want to make a quick buck off (or a few million, for that matter). When these bubbles "burst" (when they are no longer profitable), investors stop raking in profits and this can lead to economic downturnsto recessions or, in the case of the current crisis, depressions. But what do we mean with this discourse of"crisis?" A quick look at the ultrarich doesn't show a drastic reduction in comfort and lifestyle. And while unemployment, poverty; precarity, and privation are affecting larger sections of the world's population, those problems are business as usual for a significant portion of the world. And yet we declare capitalism in "crisis" now, For children working in sweatshops, for entire countries struggling with food insecurity and hunger, for continents grappling with an AIDS crisis that disproportionately affects our most marginalized populations, for trafficked women and children, for queer youth struggling to obtain basic resources and kicked out of their homes by fundamentalist parents, for those people living with the legacy of colonization and slaveryfor the majority of the world's inhabitants capitalism IS the crisis. But the discourse of "crisis" isn't employed until it starts hurting the collective bottom line of the wealthy. 'This, in and of itself, can be used as an opportunity to discuss the need for socialist alternatives. And the truth is that capitalism requires these "crises" to function. People talk about events like the 1987 stock market crash, the Asian financial crisis of 1997, and the dotcorn and housing bubbles and bursts as though they are anomalies. These things are regular features of capitalism. And those not at the top tiers of our global class system (about 95 percent of the world) are experiencing crisis every single daya constant crisis of sorts. So the discourse surrounding crises themselves seem to uphold that capitalism is more or less functioning the rest of the time. More and more people are coming to the realization that this is not the caseand we need to be pressing this point as we battle against austerity. If we want to avoid "austerity," we need to smash capitalism to pieces. No amount of goodhearted reform or Keynesian policy is going to substantively address the social crisis that is capitalism.

<h4>Their discourse of short term economic collapse papers over massive ongoing structural violence</h4><p><u><strong><mark>Shannon and Volcano</u></strong></mark> (editor of the Routledge journal Contemporary Anarchist Studies; member of the Workers Solidarity Alliance and Queers without Borders) <u><strong><mark>12</p><p></u></strong></mark>(Deric and Abby, Capitalism in the 2000s in The Accumulation of Freedom, pg. 87-88)</p><p>As Asimakopoulos explains in this collection, <u><mark>capitalism is prone to periodic "crises</u>."</mark> This isn't necessarily a new insighta. system based on capital investments creates "bubbles" in expanding industries (i.e., housing, the "dot corn boom," etc.) that cannot last, but that investors want to make a quick buck off (or a few million, for that matter). When these bubbles "burst" (when they are no longer profitable), investors stop raking in profits and this can lead to economic downturnsto recessions or, in the case of the current crisis, depressions.</p><p>But what do we mean with this discourse of"crisis?" A quick look at the ultrarich doesn't show a drastic reduction in comfort and lifestyle. And while unemployment, poverty; precarity, and privation are affecting larger sections of the world's population, those problems are business as usual for a significant portion of the world. And <u><mark>yet we declare</mark> <mark>capitalism in "crisis" now, For children</mark> working <mark>in sweatshops</mark>, for <mark>entire countries struggling with food insecurity</mark> and hunger, for continents <mark>grappling with an AIDS crisis that</mark> <mark>disproportionately affects</mark> our most <mark>marginalized populations, for trafficked women</mark> and children, <mark>for queer youth struggling to obtain basic resources</mark> and kicked out of their homes by fundamentalist parents, <mark>for those</mark> people <mark>living with the legacy of colonization</mark> and </u>slaveryfor the majority of the world's inhabitants capitalism IS the crisis. But the discourse of "crisis" isn't employed until it starts hurting the collective bottom line of the wealthy. 'This, in and of itself, can be used as an opportunity to discuss the need for socialist alternatives. And the truth is that capitalism requires these "crises" to function. People talk about events like the 1987 stock market crash, the Asian financial crisis of 1997, and the dotcorn and housing bubbles and bursts as though they are anomalies. These things are regular features of capitalism. And those not at the top tiers of our global class system (about 95 percent of the world) are experiencing crisis every single daya constant crisis of sorts. So <u><mark>the discourse surrounding crises</mark> themselves <mark>seem to uphold that capitalism is</mark> more or less <mark>functioning the rest of the time</u></mark>. More and more people are coming to the realization that this is not the caseand we need to be pressing this point as we battle against austerity. If we want to avoid "austerity," we need to smash capitalism to pieces. No amount of goodhearted reform or Keynesian policy is going to substantively address the social crisis that is capitalism.</p>

K

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Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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People sell organs out of economic desperation, but the illicit market leaves them worse off

Jaycox 12

Jaycox 12 Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at Boston College, Developing World Bioethics Volume 12 Number 3 2012 pp 135–147 COERCION, AUTONOMY, AND THE PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION

Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study He found that almost all of these organ vendors were in significant debt to wealthy landlords at the time they sold their kidneys; Although the vendors were promised by third-party brokers an average price of 160,000 rupees per kidney, the amount actually received by the vendors was an average of 103,000 rupees. As a result, a majority of them were ‘either still in debt or had accumulated new debts’ a majority of the vendors experienced long-term physical and psychological malady as a result of their nephrectomies, and a majority also expressed regret or shame for their decision because they were not freed from their debts and/or felt they had committed a morally wrong act. Moazam summarizes his findings with the conclusion that the sale of kidneys functions to reinforce the poverty of those who sell them:

almost all organ vendors were in significant debt to wealthy landlords at the time they sold their kidneys Although vendors were promised an average price of 160,000 rupees per kidney, the amount actually received was an average of 103,000 . As a result, a majority ( ) of them were ‘either still in debt or had accumulated new debts’ a majority of the vendors experienced long-term physical and psychological malady and expressed regret the sale of kidneys functions to reinforce the poverty of those who sell them

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study in which he interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14 He found that almost all of these organ vendors were in significant debt to wealthy landlords at the time they sold their kidneys; the average debt of each was 130,000 rupees at the time of sale. Although the vendors were promised by third-party brokers an average price of 160,000 rupees per kidney, the amount actually received by the vendors was an average of 103,000 rupees. As a result, a majority (17) of them were ‘either still in debt or had accumulated new debts’ at the time of their interviews. 15 Moreover, a majority of the vendors experienced long-term physical and psychological malady as a result of their nephrectomies, and a majority also expressed regret or shame for their decision because they were not freed from their debts and/or felt they had committed a morally wrong act. When asked why they had made the decision, ‘the most common [Urdu] words they used were majboori (a word that arises from the root jabr, which means a state that is beyond one’s control) and ghurbat (extreme poverty).’16,Moazam summarizes his findings with the conclusion that the sale of kidneys functions to reinforce the poverty of those who sell them: In the words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward immediate and extended families in which they are inextricably embedded, and within systems of social and economic inequalities which they can neither control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical expenses or to meet the responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most the debts rapidly accumulate again, even if they have been partially or completely paid back with the money from selling a kidney. 17 4 F. Moazam, R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.Hastings Cent Rep 2009; 39: 29–44. Due to recent legislation (18 March 2010), the sale of human organs is now illegal in Pakistan, although the social effects of this new legislation remain to be studied; see T.M. Pope. Legal Briefing: Organ Donation and Allocation. J Clin Ethics 2010; 21: 243–263: 254.

<h4>People sell organs out of economic desperation, but the illicit market leaves them worse off</h4><p><strong>Jaycox 12</strong> Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at Boston College,</p><p>Developing World Bioethics Volume 12 Number 3 2012 pp 135–147 COERCION, AUTONOMY, AND THE PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION</p><p>http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf</p><p><u>Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study </u>in which he interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14 <u>He found that <mark>almost all </mark>of these <mark>organ vendors were in significant debt to wealthy landlords at the time they sold their kidneys</mark>;</u> the average debt of each was 130,000 rupees at the time of sale. <u><mark>Although </mark>the <mark>vendors were promised </mark>by third-party brokers<mark> an average price of 160,000 rupees per kidney, the amount actually received</mark> by the vendors <mark>was an average of 103,000 </mark>rupees<mark>. As a result, a majority </u>(</mark>17<mark>) <u>of them were ‘either still in debt or had accumulated new debts’</mark> </u>at the time of their interviews. 15 Moreover, <u><mark>a majority of the vendors experienced long-term physical and psychological malady</mark> as a result of their nephrectomies, <mark>and</mark> a majority also <mark>expressed regret</mark> or shame for their decision because they were not freed from their debts and/or felt they had committed a morally wrong act.</u> When asked why they had made the decision, ‘the most common [Urdu] words they used were majboori (a word that arises from the root jabr, which means a state that is beyond one’s control) and<u> </u>ghurbat (extreme poverty).’16,<u><strong>Moazam summarizes his findings with the conclusion that<mark> the sale of kidneys functions to reinforce the poverty of those who sell them</mark>:</strong> </u>In the words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward immediate and extended families in which they are inextricably embedded, and within systems of social and economic inequalities which they can neither control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical expenses or to meet the responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most the debts rapidly accumulate again, even if they have been partially or completely paid back with the money from selling a kidney. 17 4 F. Moazam, R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.Hastings Cent Rep 2009; 39: 29–44. Due to recent legislation (18 March 2010), the sale of human organs is now illegal in Pakistan, although the social effects of this new legislation remain to be studied; see T.M. Pope. Legal Briefing: Organ Donation and Allocation. J Clin Ethics 2010; 21: 243–263: 254.</p>

Contention 2 is the Illegal market

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Ndt

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Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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For many, the coercion is more violent

Bowden 13

Bowden 13 Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law. Intercultural Human Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451 ARTICLE: FEELING EMPTY? ORGAN TRAFFICKING & TRADE: THE BLACK MARKET FOR HUMAN ORGANS lexis

Organ trafficking has been depriving innocent people of their fundamental right to life for decades Imagine living in a poor country As you walk peacefully you are grabbed and thrown into the back of an unmarked truck. a surgeon slices through your flesh to remove your kidney no anesthesia is administered and no medication is given to prevent infection Your body is then dumped on a side street, and you are extremely lucky if you live , there are reported accounts suggesting that abduction of organs is a harsh reality of organ trafficking. Furthermore, there is evidence of governmental involvement, which contributes to and exacerbates the problem.

Organ trafficking has been depriving innocent people of their fundamental right to life for decades Imagine living in a poor country you are grabbed and thrown into the back of an unmarked truck a surgeon slices through your flesh to remove your kidney no anesthesia is administered and no medication is given to prevent infection Your body is then dumped on a side street, and you are extremely lucky if you live there are reported accounts suggesting that abduction of organs is a harsh reality

[*452] Introduction Organ trafficking has been depriving innocent people of their fundamental right to life for decades. n1 Imagine living in a poor country, where you wake up in the morning and set out to find work and food for the day. As you walk peacefully to your home at the end of the day, you are grabbed and thrown into the back of an unmarked truck. n2 You wake up, screaming from excruciating pain, as a surgeon slices through your flesh to remove your kidney. Due to the costs associated with such a procedure, no anesthesia is administered and no medication is given to prevent infection. n3 In the event that the surgery does not go as planned, no forms of emergency assistance are available. Your body is then dumped on a side street, and you are extremely lucky if you live. Should you report the incident to government officials? What if the government is actually involved in this inhumane activity? n4 [*453] There are conflicting views on whether people are actually kidnapped for their organs. n5 In fact, many believe these stories are just myths. n6 However, there are reported accounts suggesting that abduction of organs is a harsh reality of organ trafficking. n7 Reports indicate organ trafficking is so prevalent that there is a surplus of organs available for transplantation. n8 Furthermore, there is evidence of governmental involvement, which contributes to and exacerbates the problem. n9 Fortunately, most countries have enacted laws to prevent and prohibit organ trafficking from occurring. n10

<h4>For many, the coercion is more violent</h4><p><strong>Bowden 13</strong> Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law. Intercultural Human Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451 ARTICLE: FEELING EMPTY? ORGAN TRAFFICKING & TRADE: THE BLACK MARKET FOR HUMAN ORGANS lexis</p><p> [*452] Introduction</p><p><u><mark>Organ trafficking has been depriving innocent people of their fundamental right to life for decades</u></mark>. n1 <u><mark>Imagine living in a poor country</u></mark>, where you wake up in the morning and set out to find work and food for the day. <u>As you walk peacefully</u> to your home at the end of the day, <u><mark>you are grabbed and</mark> <mark>thrown into the back of an unmarked truck</mark>. </u>n2 You wake up, screaming from excruciating pain, as <u><mark>a surgeon slices through your flesh to remove your kidney</u></mark>. Due to the costs associated with such a procedure, <u><mark>no anesthesia is administered and no medication is given to prevent infection</u></mark>. n3 In the event that the surgery does not go as planned, no forms of emergency assistance are available. <u><mark>Your body is then dumped on a side street, and you are extremely lucky if you live</u></mark>. Should you report the incident to government officials? What if the government is actually involved in this inhumane activity? n4 [*453] There are conflicting views on whether people are actually kidnapped for their organs. n5 In fact, many believe these stories are just myths. n6 However<u>, <mark>there are reported accounts suggesting that abduction of organs is a harsh reality</mark> of organ trafficking.</u> n7 Reports indicate organ trafficking is so prevalent that there is a surplus of organs available for transplantation. n8 <u>Furthermore, there is evidence of governmental involvement, which contributes to and exacerbates the problem. </u>n9 Fortunately, most countries have enacted laws to prevent and prohibit organ trafficking from occurring. n10</p>

Contention 2 is the Illegal market

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A

Ndt

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Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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Inequality=multiple structural trends towards extinction

Szentes ‘8

Szentes ‘8 Tamás Szentes, a Professor Emeritus at the Corvinus University of Budapest. “Globalisation and prospects of the world society” 4/22/08 http://www.eadi.org/fileadmin/Documents/Events/exco/Glob.___prospects_-_jav..pdf

arms race and militarisation have not ended but escalated and continued many “invisible wars” are suffered by the poor , manifested in mass misery, poverty, unemployment, homelessness, starvation , exploitation and oppression, and in the degradation of human environment, ”, Behind “invisible wars” we find striking international and intrasociety inequities and distorted development patterns , which tend to generate social as well as international tensions paving the way for unrest and “visible” wars peace cannot be safeguarded in one part of the world when some others suffer visible or invisible wars no ecological balance can be ensured, unless the deep international development gap and intra-society inequalities are substantially reduced The narrow-minded, election-oriented, selfish behaviour motivated by thirst for power and wealth, paves the way for the final, last catastrophe Nevertheless, . Under the circumstances provided by rapidly progressing science and technological revolutions, human society cannot survive unless such profound intra-society and international inequalities prevailing today are soon eliminated. The real choice for the world society is between continuation of visible and “invisible wars” and transformation of the world order

arms race and militarisation have not ended but escalated and continued invisible wars are suffered by the poor Behind invisible wars” we find striking international inequities which tend to generate tensions paving the way for unrest and “visible” wars peace cannot be safeguarded in one part when some others suffer no ecological balance can be ensured, unless the deep international development gap are substantially reduced selfish behaviour paves the way for the final catastrophe human society cannot survive unless profound international inequalities are eliminated

It’ s a common place that human society can survive and develop only in a lasting real peace. Without peace countries cannot develop. Although since 1945 there has been no world war, but --numerous local wars took place, --terrorism has spread all over the world, undermining security even in the most developed and powerful countries, --arms race and militarisation have not ended with the collapse of the Soviet bloc, but escalated and continued, extending also to weapons of mass destruction and misusing enormous resources badly needed for development, --many “invisible wars” are suffered by the poor and oppressed people, manifested in mass misery, poverty, unemployment, homelessness, starvation and malnutrition, epidemics and poor health conditions, exploitation and oppression, racial and other discrimination, physical terror, organised injustice, disguised forms of violence, the denial or regular infringement of the democratic rights of citizens, women, youth, ethnic or religious minorities, etc., and last but not least, in the degradation of human environment, which means that --the “war against Nature”, i.e. the disturbance of ecological balance, wasteful management of natural resources, and large-scale pollution of our environment, is still going on, causing also losses and fatal dangers for human life. Behind global terrorism and “invisible wars” we find striking international and intrasociety inequities and distorted development patterns , which tend to generate social as well as international tensions, thus paving the way for unrest and “visible” wars. It is a commonplace now that peace is not merely the absence of war. The prerequisites of a lasting peace between and within societies involve not only - though, of course, necessarily - demilitarisation, but also a systematic and gradual elimination of the roots of violence, of the causes of “invisible wars”, of the structural and institutional bases of large-scale international and intra-society inequalities, exploitation and oppression. Peace requires a process of social and national emancipation, a progressive, democratic transformation of societies and the world bringing about equal rights and opportunities for all people, sovereign participation and mutually advantageous co-operation among nations. It further requires a pluralistic democracy on global level with an appropriate system of proportional representation of the world society, articulation of diverse interests and their peaceful reconciliation, by non-violent conflict management, and thus also a global governance with a really global institutional system. Under the contemporary conditions of accelerating globalisation and deepening global interdependencies in our world, peace is indivisible in both time and space. It cannot exist if reduced to a period only after or before war, and cannot be safeguarded in one part of the world when some others suffer visible or invisible wars. Thus, peace requires, indeed, a new, demilitarised and democratic world order, which can provide equal opportunities for sustainable development. “Sustainability of development” (both on national and world level) is often interpreted as an issue of environmental protection only and reduced to the need for preserving the ecological balance and delivering the next generations not a destroyed Nature with overexhausted resources and polluted environment. However, no ecological balance can be ensured, unless the deep international development gap and intra-society inequalities are substantially reduced. Owing to global interdependencies there may exist hardly any “zero-sum-games”, in which one can gain at the expense of others, but, instead, the “negative-sum-games” tend to predominate, in which everybody must suffer, later or sooner, directly or indirectly, losses. Therefore, the actual question is not about “sustainability of development” but rather about the “sustainability of human life”, i.e. survival of mankind – because of ecological imbalance and globalised terrorism. When Professor Louk de la Rive Box was the president of EADI, one day we had an exchange of views on the state and future of development studies. We agreed that development studies are not any more restricted to the case of underdeveloped countries, as the developed ones (as well as the former “socialist” countries) are also facing development problems, such as those of structural and institutional (and even system-) transformation, requirements of changes in development patterns, and concerns about natural environment. While all these are true, today I would dare say that besides (or even instead of) “development studies” we must speak about and make “survival studies”. While the monetary, financial, and debt crises are cyclical, we live in an almost permanent crisis of the world society, which is multidimensional in nature, involving not only economic but also socio-psychological, behavioural, cultural and political aspects. The narrow-minded, election-oriented, selfish behaviour motivated by thirst for power and wealth, which still characterise the political leadership almost all over the world, paves the way for the final, last catastrophe. One cannot doubt, of course, that great many positive historical changes have also taken place in the world in the last century. Such as decolonisation, transformation of socio-economic systems, democratisation of political life in some former fascist or authoritarian states, institutionalisation of welfare policies in several countries, rise of international organisations and new forums for negotiations, conflict management and cooperation, institutionalisation of international assistance programmes by multilateral agencies, codification of human rights, and rights of sovereignty and democracy also on international level, collapse of the militarised Soviet bloc and system-change3 in the countries concerned, the end of cold war, etc., to mention only a few. Nevertheless, the crisis of the world society has extended and deepened, approaching to a point of bifurcation that necessarily puts an end to the present tendencies, either by the final catastrophe or a common solution. Under the circumstances provided by rapidly progressing science and technological revolutions, human society cannot survive unless such profound intra-society and international inequalities prevailing today are soon eliminated. Like a single spacecraft, the Earth can no longer afford to have a 'crew' divided into two parts: the rich, privileged, wellfed, well-educated, on the one hand, and the poor, deprived, starving, sick and uneducated, on the other. Dangerous 'zero-sum-games' (which mostly prove to be “negative-sum-games”) can hardly be played any more by visible or invisible wars in the world society. Because of global interdependencies, the apparent winner becomes also a loser. The real choice for the world society is between negative- and positive-sum-games: i.e. between, on the one hand, continuation of visible and “invisible wars”, as long as this is possible at all, and, on the other, transformation of the world order by demilitarisation and democratization. No ideological or terminological camouflage can conceal this real dilemma any more, which is to be faced not in the distant future, by the next generations, but in the coming years, because of global terrorism soon having nuclear and other mass destructive weapons, and also due to irreversible changes in natural environment.

<h4><u><strong>Inequality=multiple structural trends towards extinction</h4><p>Szentes ‘8</p><p></u></strong>Tamás Szentes, a Professor Emeritus at the Corvinus University of Budapest. “Globalisation and prospects of the world society” 4/22/08 http://www.eadi.org/fileadmin/Documents/Events/exco/Glob.___prospects_-_jav..pdf</p><p>It’ s a common place that human society can survive and develop only in a lasting real peace. Without peace countries cannot develop. Although since 1945 there has been no world war, but --numerous local wars took place, --terrorism has spread all over the world, undermining security even in the most developed and powerful countries, --<u><mark>arms race and militarisation have not ended</u></mark> with the collapse of the Soviet bloc, <u><mark>but escalated and continued</u></mark>, extending also to weapons of mass destruction and misusing enormous resources badly needed for development, --<u>many “<mark>invisible wars</mark>” <mark>are suffered by the poor</mark> </u>and oppressed people<u>, manifested in<strong> mass misery, </strong>poverty,<strong> unemployment, homelessness, starvation</strong> </u>and malnutrition, epidemics and poor health conditions<u>, exploitation and oppression, </u>racial and other discrimination, physical terror, organised injustice, disguised forms of violence, the denial or regular infringement of the democratic rights of citizens, women, youth, ethnic or religious minorities, etc.,<u> <strong>and</strong> </u>last but not least,<u> <strong>in the degradation of human environment</strong>, </u>which means that --the “war against Nature<u>”,</u> i.e. the disturbance of ecological balance, wasteful management of natural resources, and large-scale pollution of our environment, is still going on, causing also losses and fatal dangers for human life. <u><mark>Behind<strong></mark> </u></strong>global terrorism and<u> “<mark>invisible wars” we find striking international </mark>and intrasociety <mark>inequities</mark> and distorted development patterns , <mark>which tend to generate</mark> social as well as international <mark>tensions</u></mark>, thus <u><mark>paving the way for unrest and “visible” wars</u></mark>. It is a commonplace now that peace is not merely the absence of war. The prerequisites of a lasting peace between and within societies involve not only - though, of course, necessarily - demilitarisation, but also a systematic and gradual elimination of the roots of violence, of the causes of “invisible wars”, of the structural and institutional bases of large-scale international and intra-society inequalities, exploitation and oppression. Peace requires a process of social and national emancipation, a progressive, democratic transformation of societies and the world bringing about equal rights and opportunities for all people, sovereign participation and mutually advantageous co-operation among nations. It further requires a pluralistic democracy on global level with an appropriate system of proportional representation of the world society, articulation of diverse interests and their peaceful reconciliation, by non-violent conflict management, and thus also a global governance with a really global institutional system. Under the contemporary conditions of accelerating globalisation and deepening global interdependencies in our world, <u><mark>peace<strong></mark> </u></strong>is indivisible in both time and space. It cannot exist if reduced to a period only after or before war, and<u> <mark>cannot be safeguarded in one part</mark> of the world <mark>when some others suffer</mark> visible or invisible wars</u>. Thus, peace requires, indeed, a new, demilitarised and democratic world order, which can provide equal opportunities for sustainable development. “Sustainability of development” (both on national and world level) is often interpreted as an issue of environmental protection only and reduced to the need for preserving the ecological balance and delivering the next generations not a destroyed Nature with overexhausted resources and polluted environment. However,<u> <mark>no ecological balance can be ensured, unless the deep international development gap</mark> and intra-society inequalities <mark>are substantially reduced</u></mark>. Owing to global interdependencies there may exist hardly any “zero-sum-games”, in which one can gain at the expense of others, but, instead, the “negative-sum-games” tend to predominate, in which everybody must suffer, later or sooner, directly or indirectly, losses. Therefore, the actual question is not about “sustainability of development” but rather about the “sustainability of human life”, i.e. survival of mankind – because of ecological imbalance and globalised terrorism. When Professor Louk de la Rive Box was the president of EADI, one day we had an exchange of views on the state and future of development studies. We agreed that development studies are not any more restricted to the case of underdeveloped countries, as the developed ones (as well as the former “socialist” countries) are also facing development problems, such as those of structural and institutional (and even system-) transformation, requirements of changes in development patterns, and concerns about natural environment. While all these are true, today I would dare say that besides (or even instead of) “development studies” we must speak about and make “survival studies”. While the monetary, financial, and debt crises are cyclical, we live in an almost permanent crisis of the world society, which is multidimensional in nature, involving not only economic but also socio-psychological, behavioural, cultural and political aspects. <u>The narrow-minded, election-oriented, <mark>selfish behaviour</mark> motivated by thirst for power and wealth,</u> which still characterise the political leadership almost all over the world, <u><mark>paves the way for</mark> <strong><mark>the final</mark>, last <mark>catastrophe</u></strong></mark>. One cannot doubt, of course, that great many positive historical changes have also taken place in the world in the last century. Such as decolonisation, transformation of socio-economic systems, democratisation of political life in some former fascist or authoritarian states, institutionalisation of welfare policies in several countries, rise of international organisations and new forums for negotiations, conflict management and cooperation, institutionalisation of international assistance programmes by multilateral agencies, codification of human rights, and rights of sovereignty and democracy also on international level, collapse of the militarised Soviet bloc and system-change3 in the countries concerned, the end of cold war, etc., to mention only a few. <u>Nevertheless, </u>the crisis of the world society has extended and deepened, approaching to a point of bifurcation that necessarily puts an end to the present tendencies, either by the final catastrophe or a common solution<u>. Under the circumstances provided by rapidly progressing science and technological revolutions, <mark>human society cannot survive unless</mark> such <mark>profound</mark> intra-society and <mark>international inequalities</mark> prevailing today <mark>are</mark> soon <mark>eliminated</mark>.</u> Like a single spacecraft, the Earth can no longer afford to have a 'crew' divided into two parts: the rich, privileged, wellfed, well-educated, on the one hand, and the poor, deprived, starving, sick and uneducated, on the other. Dangerous 'zero-sum-games' (which mostly prove to be “negative-sum-games”) can hardly be played any more by visible or invisible wars in the world society. Because of global interdependencies, the apparent winner becomes also a loser. <u>The real choice for the world society is between</u> negative- and positive-sum-games: i.e. between, on the one hand, <u>continuation of visible and “invisible wars”</u>, as long as this is possible at all, <u>and</u>, on the other, <u><strong>transformation of the world order</u> by demilitarisation and democratization. No ideological or terminological camouflage can conceal this real dilemma any more, which is to be faced not in the distant future, by the next generations, but in the coming years, because of global terrorism soon having nuclear and other mass destructive weapons, and also due to irreversible changes in natural environment.</p></strong>

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The illegal market is also a threat to public health – spreads antibiotic-resistant bacteria

Kelly 13

Kelly 13 Emily Kelly, Executive Comment Editor for the Boston College International & Comparative Law Review. Boston College International and Comparative Law Review Spring, 2013 36 B.C. Int'l & Comp. L. Rev. 1317 NOTE: INTERNATIONAL ORGAN TRAFFICKING CRISIS: SOLUTIONS ADDRESSING THE HEART OF THE MATTER lexis

Because governmental disease control agencies do not monitor underground organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV Transplant tourism harms global public health policies Additionally, transplant tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria. Because such bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique strains across borders upon returning to their home countries

Because governmental disease control agencies do not monitor underground organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV Transplant tourism harms global public health policies transplant tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria Because such bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique strains across borders

[*1324] With regard to recipients, the dangers of receiving medical care in developing countries can outweigh the benefits of life-saving transplant tourism. n66 Because governmental disease control agencies do not monitor underground organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV. n67 Tragically, transplant tourists also have "a higher cumulative incidence of acute [organ] rejection in the first year after transplantation." n68 Transplant tourism also harms global public health policies. n69 Most notably, the underground market impedes the success of legal organ donation frameworks. n70 For example, Thai patients have difficulty accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant tourists. n71 In 2007, China banned transplant tourism because wealthy foreigners--rather than the 1.5 million Chinese on the waiting list--received an overwhelming amount of organ transplants. n72 Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death out of fear that their bodies may be exploited. n73 This further contributes to the global organ shortage and exacerbates the underlying causes of OTC trafficking. n74 Additionally, transplant tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria. n75 Because such bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique strains across borders upon returning to their home countries. n76 As a result of these effects, transplant tourism has drawn increasing attention to the root of the problem: organ shortages. n77

<h4>The illegal market is also a threat to public health – spreads antibiotic-resistant bacteria</h4><p><strong>Kelly 13</strong> Emily Kelly, Executive Comment Editor for the Boston College International & Comparative Law Review. Boston College International and Comparative Law Review Spring, 2013 36 B.C. Int'l & Comp. L. Rev. 1317 NOTE: INTERNATIONAL ORGAN TRAFFICKING CRISIS: SOLUTIONS ADDRESSING THE HEART OF THE MATTER lexis</p><p> [*1324] With regard to recipients, the dangers of receiving medical care in developing countries can outweigh the benefits of life-saving transplant tourism. n66 <u><mark>Because governmental disease control agencies do not monitor underground organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV</u></mark>. n67 Tragically, transplant tourists also have "a higher cumulative incidence of acute [organ] rejection in the first year after transplantation." n68 <u><mark>Transplant tourism</u></mark> also <u><mark>harms global public health policies</u></mark>. n69 Most notably, the underground market impedes the success of legal organ donation frameworks. n70 For example, Thai patients have difficulty accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant tourists. n71 In 2007, China banned transplant tourism because wealthy foreigners--rather than the 1.5 million Chinese on the waiting list--received an overwhelming amount of organ transplants. n72 Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death out of fear that their bodies may be exploited. n73 This further contributes to the global organ shortage and exacerbates the underlying causes of OTC trafficking. n74 <u>Additionally, <mark>transplant tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria</mark>.</u> n75 <u><mark>Because such bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique strains across borders</mark> upon returning to their home countries</u>. n76 As a result of these effects, transplant tourism has drawn increasing attention to the root of the problem: organ shortages. n77</p>

Contention 2 is the Illegal market

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Leap, McBride, Stables

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Our alternative is to demilitarize the public sphere, bottom up rejection of security politics allows us to move beyond an unsustainable system that leads to inevitable threat escalation

Lal, 2007

national security is an antonym for human security the state should not be the referent object of security: “states are unreliable as primary referents because while some are in the business of security some are not; even those which are producers of security represent the means and not the ends; and states are too diverse in their character to serve as the basis for a comprehensive theory of security.” the national security state is merely an elite tool, which causes human insecurity at home and abroad. The state treats security as a problem that comes from the outside, rather than as a problem that can arise from domestic issues. The end result of state-centric security is that humans are alienated from discussions about their own security and welfare. “economic collapse, political oppression, scarcity, overpopulation, ethnic rivalry, the destruction of nature, terrorism, crime and disease provide more serious threats to the well-being of individuals and the interest of nations.” Thus, to millions of people, it is not the existence of the Other across the border that poses a security problem, but their own state that is a threat to security. put theory into practice Critical theory does not offer simple one-shot solutions to the problems created by the neo-realist state and elitist conception of security. To give simple answers would be a performative contradiction, especially after criticizing realism for being intellectually rigid for believing in objective truth. there are no alternatives; just alternative modes of understanding. However, using the poststructuralist analysis that discourse is power, we can move towards deconstructing the power of the state and elites to securitize using their own tool: discourse. we are colonized through discursive practices and subjected to the reality that the state wants us to see. However, definitions belong to the definer, and it is high time that we questioned and defined our own reality. citizen action is critical to questioning and deconstructing the national security state and taking away its power to define our security a grassroots statecraft that is defined as “challenging foreign policy of government through contending discursive and speech acts.” calls for pitting the values of civil society against the state establishment and challenging the American statecraft’s freedom to cast issues and events in a security or militarized framework. The U S has not always been a national security state and neither does it have to maintain that hegemonic and oppressive status in order to exist. It is critical to remember that fundamental changes in our institutions and structures of power do not occur from the top; they originate from the bottom. History is case in point. Citizen action was critical to ending the Red Scare and the Vietnam War grassroots citizen action performatively makes individuals the referent subject of security as people would call for the demilitarization and desecuritization of issues that are contrary and irrelevant to human security. There is hope for the future and practical application of critical theory in international relations. “it was the existence of the Other across the border that gave national security its power and authority; it is the disappearance of the border that has vanquished that power.” Britain, France and Germany set aside their historical enmities and became part of a European community, which has formed a new collective identity and security across borders. Cold War rivals that almost annihilated the world are now friends in the “war against terror.” The apartheid regime in South Africa did collapse eventually. India and Pakistan have been moving towards a more peaceful future While nation-states that were previously hostile to each other have united to be hostile towards other states, it is not overly idealist to suggest that with each new friendship and alliance, there is one less foe and one less Other. The world is not stable and stagnant, existing in an anarchic, nasty and brutish framework in which states have to endlessly bargain for their self-interest, as realists would like us to believe. On the contrary, international relations and the boundaries constructed by the state are subject to change and ever-transitioning, which presents a compelling case for critical theory as a more realistic framework through which we can view international relations. our ultimate search for security does not lie in securing the state from the threat of the enemy across the border, but in removing the state as the referent object of security and moving towards human emancipation. questioning and changing structures that oppress us Emancipation and security become two sides of the same coin as humans must be freed from their oppressive structures and overthrow physical and human constraints that prevent them from reaching their true potential. However, emancipation is not the end-all solution but a project that can never be fully realized. This may lead some to question the practicality of the concept that we can see in the horizon, but the closer we get to it, the further away it seems. Yet, when we look back, we see how far we have come. human emancipation serves practical purpose as an immanent critique, which can be utilized as a philosophical anchorage for tactical goal setting.

discourse is power, we can deconstruct the power of elites using their own tool: discourse. we are through discursive practices subjected to the reality the state wants us to see. it is time we defined our own reality citizen action is critical grassroots statecraft challenging policy through contending discursive acts calls for pitting values of society against the state The U S has not always been a national security state and neither does it have to maintain hegemonic and oppressive status to exist changes do not occur from the top; they originate from the bottom. . Citizen action was critical to ending the Red Scare and Vietnam grassroots action makes individuals the referent of security as people call for demilitarization of issues contrary to human security Britain, France and Germany set aside historical enmities and became a community Cold War rivals are now friends The apartheid regime did collapse India and Pakistan have been moving towards peace with each new friendship , there is one less foe and one less Other The world is not stable in a , nasty brutish framework which presents a compelling case for critical theory as a realistic framework

(Prerna P., Master of Arts in International Relations @ San Francisco State University, Senior Graduate Thesis, Critical Security Studies, “Deconstructing the National Security State: Towards a New Framework of Analysis,” http://prernalal.com/wp-content/uploads/2008/10/css-deconstructing-the-nat-sec-state.pdf) Throughout this paper, we have seen cases of how national security is an antonym for human security. With this essential realization, Booth (2005, 33) gives three reasons for why the state should not be the referent object of security: “states are unreliable as primary referents because while some are in the business of security some are not; even those which are producers of security represent the means and not the ends; and states are too diverse in their character to serve as the basis for a comprehensive theory of security.” Additionally, the cases of South Africa and Afghanistan prove how the national security state is merely an elite tool, which causes human insecurity at home and abroad. The state treats security as a problem that comes from the outside, rather than as a problem that can arise from domestic issues. The end result of state-centric security is that humans are alienated from discussions about their own security and welfare. The most compelling reason is provided by Hayward Akler (2005, 191) in Critical Security Studies and World Politics, in which he states that “economic collapse, political oppression, scarcity, overpopulation, ethnic rivalry, the destruction of nature, terrorism, crime and disease provide more serious threats to the well-being of individuals and the interest of nations.” Thus, to millions of people, it is not the existence of the Other across the border that poses a security problem, but their own state that is a threat to security. The question that arises next is how to put critical theory into practice and deconstruct the national security state. Critical theory does not offer simple one-shot solutions to the problems created by the neo-realist state and elitist conception of security. To give simple answers would be a performative contradiction, especially after criticizing realism for being intellectually rigid for believing in objective truth. In other words, there are no alternatives; just alternative modes of understanding. However, using the poststructuralist Foucaultian analysis that discourse is power, we can move towards deconstructing the power of the state and elites to securitize using their own tool: discourse. The elites who control the meaning of security and define it in terms that are appropriate to their interests hold tremendous power in the national security state. As Foucault astutely observed, “the exercise of power is always deeply entwined with the production of knowledge and discourse” (Dalby 1998, 4). For too long, language has been used against us to create our reality, thereby obfuscating our lens of the world, depriving us from an objective search for truth and knowledge. The history of colonized people shows how the construction of language defined and justified their oppressed status. In a way, we are colonized through discursive practices and subjected to the reality that the state wants us to see. However, definitions belong to the definer, and it is high time that we questioned and defined our own reality. Thus, citizen action is critical to questioning and deconstructing the national security state and taking away its power to define our security. In On Security, Pearl Alice Marsh (1995, 126) advances the idea of a grassroots statecraft that is defined as “challenging foreign policy of government through contending discursive and speech acts.” This calls for pitting the values of civil society against the state establishment and challenging the American statecraft’s freedom to cast issues and events in a security or militarized framework. The United States has not always been a national security state and neither does it have to maintain that hegemonic and oppressive status in order to exist. It is critical to remember that fundamental changes in our institutions and structures of power do not occur from the top; they originate from the bottom. History is case in point. Citizen action was critical to ending the Red Scare and the Vietnam War, as the American people realized the ludicrousness of framing Vietnam as a security issue, which led to the fall of the Second New Deal, the deaths of thousands of American soldiers and a financial cost that we are still shouldering. In the end, what they need to be secured from and how, is a question best left up to individual Americans and subsequently, civil society. Thus, grassroots citizen action performatively makes individuals the referent subject of security as people would call for the demilitarization and desecuritization of issues that are contrary and irrelevant to human security. There is hope for the future and practical application of critical theory in international relations. As Robert Lipschutz (2000, 61) concludes in After Authority: War, Peace, and Global Politics in the 21st Century, “it was the existence of the Other across the border that gave national security its power and authority; it is the disappearance of the border that has vanquished that power.” Britain, France and Germany set aside their historical enmities and became part of a European community, which has formed a new collective identity and security across borders. Cold War rivals that almost annihilated the world are now friends in the “war against terror.” The apartheid regime in South Africa did collapse eventually. In the past two years, India and Pakistan have been moving towards a more peaceful future that also includes fighting the “war against terror” together. While nation-states that were previously hostile to each other have united to be hostile towards other states, it is not overly idealist to suggest that with each new friendship and alliance, there is one less foe and one less Other. The world is not stable and stagnant, existing in an anarchic, nasty and brutish framework in which states have to endlessly bargain for their self-interest, as realists would like us to believe. On the contrary, international relations and the boundaries constructed by the state are subject to change and ever-transitioning, which presents a compelling case for critical theory as a more realistic framework through which we can view international relations. Therefore, our ultimate search for security does not lie in securing the state from the threat of the enemy across the border, but in removing the state as the referent object of security and moving towards human emancipation. Human emancipation is often cited as the ultimate goal of the CSS project. Kenneth Booth (2005, 181) defines human emancipation as “the theory and practice of inventing humanity, with a view of freeing people, as individuals and collectivities, from contingent and structural oppressions...the concept of emancipation shapes strategies and tactics of resistance, offers a theory of progress for society, and gives a politics of hope for common humanity.” For Booth then, human emancipation is a concern with questioning and changing structures and institutions that oppress us and prevent us from reaching our true potential, a seemingly Marxist and poststructuralist concern. Emancipation and security become two sides of the same coin for Booth (2005, 191), as humans must be freed from their oppressive structures and overthrow physical and human constraints that prevent them from reaching their true potential. However, emancipation is not the end-all solution but a project that can never be fully realized. This may lead some to question the practicality of the concept. Here, I will draw an analogy from Karl Marx, whose idea of human emancipation was communism, a goal that we can see in the horizon, but the closer we get to it, the further away it seems. Yet, when we look back, we see how far we have come. Therefore, human emancipation serves practical purpose as an immanent critique, which can be utilized as a philosophical anchorage for tactical goal setting.

<h4><strong>Our alternative is to demilitarize the public sphere, bottom up rejection of security politics allows us to move beyond</strong> an unsustainable system that leads to inevitable threat escalation</h4><p><u>Lal, 2007</p><p></u>(Prerna P., Master of Arts in International Relations @ San Francisco State University, Senior Graduate Thesis, Critical Security Studies, “Deconstructing the National Security State: Towards a New Framework of Analysis,” http://prernalal.com/wp-content/uploads/2008/10/css-deconstructing-the-nat-sec-state.pdf)</p><p>Throughout this paper, we have seen cases of how <u><strong>national security is an antonym for human security</u></strong>. With this essential realization, Booth (2005, 33) gives three reasons for why <u><strong>the state should not be the referent object of security: “states are unreliable as primary referents because while some are in the business of security some are not; even those which are producers of security represent the means and not the ends; and states are too diverse in their character to serve as the basis for a comprehensive theory of security.”</u></strong> Additionally, the cases of South Africa and Afghanistan prove how <u><strong>the national security state is merely an elite tool, which causes human insecurity at home and abroad. The state treats security as a problem that comes from the outside, rather than as a problem that can arise from domestic issues. The end result of state-centric security is that humans are alienated from discussions about their own security and welfare. </u></strong>The most compelling reason is provided by Hayward Akler (2005, 191) in Critical Security Studies and World Politics, in which he states that <u><strong>“economic collapse, political oppression, scarcity, overpopulation, ethnic rivalry, the destruction of nature, terrorism, crime and disease provide more serious threats to the well-being of individuals and the interest of nations.” Thus, to millions of people, it is not the existence of the Other across the border that poses a security problem, but their own state that is a threat to security.</u></strong> The question that arises next is how to <u><strong>put</u></strong> critical <u><strong>theory into practice</u></strong> and deconstruct the national security state. <u><strong>Critical theory does not offer simple one-shot solutions to the problems created by the neo-realist state and elitist conception of security. To give simple answers would be a performative contradiction, especially after criticizing realism for being intellectually rigid for believing in objective truth.</u></strong> In other words, <u><strong>there are no alternatives; just alternative modes of understanding. However, using the poststructuralist</u></strong> Foucaultian <u><strong>analysis that <mark>discourse is power, we can </mark>move towards <mark>deconstruct</mark>ing<mark> the power of </mark>the state and <mark>elites</mark> to securitize <mark>using their own tool: discourse.</u></strong></mark> The elites who control the meaning of security and define it in terms that are appropriate to their interests hold tremendous power in the national security state. As Foucault astutely observed, “the exercise of power is always deeply entwined with the production of knowledge and discourse” (Dalby 1998, 4). For too long, language has been used against us to create our reality, thereby obfuscating our lens of the world, depriving us from an objective search for truth and knowledge. The history of colonized people shows how the construction of language defined and justified their oppressed status. In a way, <u><strong><mark>we are </mark>colonized <mark>through discursive practices </mark>and <mark>subjected to the reality </mark>that <mark>the state wants us to see.</mark> However, definitions belong to the definer, and <mark>it is </mark>high <mark>time</mark> that <mark>we</mark> questioned and <mark>defined our own reality</mark>.</u></strong> Thus, <u><strong><mark>citizen action is critical</mark> to questioning and deconstructing the national security state and taking away its power to define our security</u></strong>. In On Security, Pearl Alice Marsh (1995, 126) advances the idea of <u><strong>a <mark>grassroots statecraft</mark> that is defined as “<mark>challenging</mark> foreign <mark>policy </mark>of government <mark>through contending discursive</mark> and speech <mark>acts</mark>.”</u></strong> This <u><strong><mark>calls for pitting</mark> the <mark>values of </mark>civil <mark>society against the state </mark>establishment and challenging the American statecraft’s freedom to cast issues and events in a security or militarized framework. <mark>The U</u></strong></mark>nited <u><strong><mark>S</u></strong></mark>tates <u><strong><mark>has not always been a national security state and neither does it have to maintain</mark> that <mark>hegemonic and oppressive status</mark> in order <mark>to exist</mark>. It is critical to remember that fundamental <mark>changes </mark>in our institutions and structures of power <mark>do not occur from the top; they originate from the bottom.</mark> History is case in point<mark>. Citizen action was critical to ending the Red Scare and </mark>the <mark>Vietnam </mark>War</u></strong>, as the American people realized the ludicrousness of framing Vietnam as a security issue, which led to the fall of the Second New Deal, the deaths of thousands of American soldiers and a financial cost that we are still shouldering. In the end, what they need to be secured from and how, is a question best left up to individual Americans and subsequently, civil society. Thus, <u><strong><mark>grassroots </mark>citizen <mark>action </mark>performatively <mark>makes individuals the referent </mark>subject <mark>of security as people </mark>would <mark>call for</mark> the <mark>demilitarization</mark> and desecuritization <mark>of issues </mark>that are <mark>contrary</mark> and irrelevant <mark>to</mark> <mark>human security</mark>. There is hope for the future and practical application of critical theory in international relations. </u></strong>As Robert Lipschutz (2000, 61) concludes in After Authority: War, Peace, and Global Politics in the 21st Century, <u><strong>“it was the existence of the Other across the border that gave national security its power and authority; it is the disappearance of the border that has vanquished that power.” <mark>Britain, France and Germany set aside </mark>their <mark>historical enmities and became </mark>part of <mark>a </mark>European <mark>community</mark>, which has formed a new collective identity and security across borders. <mark>Cold War rivals </mark>that almost annihilated the world <mark>are now friends </mark>in the “war against terror.” <mark>The apartheid regime</mark> in South Africa <mark>did collapse</mark> eventually.</u></strong> In the past two years, <u><strong><mark>India and Pakistan have been moving towards </mark>a more <mark>peace</mark>ful future</u></strong> that also includes fighting the “war against terror” together. <u><strong>While nation-states that were previously hostile to each other have united to be hostile towards other states, it is not overly idealist to suggest that <mark>with each new friendship </mark>and alliance<mark>, there is one less foe and one less Other</mark>. <mark>The world is not stable </mark>and stagnant, existing <mark>in a</mark>n anarchic<mark>, nasty </mark>and <mark>brutish framework</mark> in which states have to endlessly bargain for their self-interest, as realists would like us to believe. On the contrary, international relations and the boundaries constructed by the state are subject to change and ever-transitioning, <mark>which presents a compelling case for critical theory as a </mark>more <mark>realistic framework </mark>through which we can view international relations.</u></strong> Therefore, <u><strong>our ultimate search for security does not lie in securing the state from the threat of the enemy across the border, but in removing the state as the referent object of security and moving towards human emancipation.</u></strong> Human emancipation is often cited as the ultimate goal of the CSS project. Kenneth Booth (2005, 181) defines human emancipation as “the theory and practice of inventing humanity, with a view of freeing people, as individuals and collectivities, from contingent and structural oppressions...the concept of emancipation shapes strategies and tactics of resistance, offers a theory of progress for society, and gives a politics of hope for common humanity.” For Booth then, human emancipation is a concern with <u><strong>questioning and changing structures</u></strong> and institutions <u><strong>that oppress us</u></strong> and prevent us from reaching our true potential, a seemingly Marxist and poststructuralist concern. <u><strong>Emancipation and security become two sides of the same coin</u></strong> for Booth (2005, 191), <u><strong>as humans must be freed from their oppressive structures and overthrow physical and human constraints that prevent them from reaching their true potential. However, emancipation is not the end-all solution but a project that can never be fully realized. This may lead some to question the practicality of the concept</u></strong>. Here, I will draw an analogy from Karl Marx, whose idea of human emancipation was communism, a goal <u><strong>that we can see in the horizon, but the closer we get to it, the further away it seems. Yet, when we look back, we see how far we have come.</u></strong> Therefore, <u><strong>human emancipation serves practical purpose as an immanent critique, which can be utilized as a philosophical anchorage for tactical goal setting.</u></strong> </p>

K

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Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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Vote neg on presumption—the Aff is epistemologically bankrupt. Their evidence is manufactured and distorted by the threat industry.

Pieterse 7

Pieterse 7 (Jan, Professor of Sociology – University of Illinois (Urbana), “Political and Economic Brinkmanship”, Review of International Political Economy, 14(3), p. 473)

The American military represents a vast growing establishment this large security establishment is a bipartisan project makes it politically immune That it is a completely hierarchical world onto itself makes it relatively unaccountable a military seeks career advancement through role expansion expansion through threat inflation and in inflated threats finds rationales for ruthless action subject to feedback from its own echo chambers Misinformation broadcast by part of the intelligence apparatus blows back Inhabiting a hall of mirrors this apparatus operates in a perpetual state of self hypnosis

military politically immune makes it relatively unaccountable military seeks career advancement through role expansion expansion through threat inflation, and in inflated threats finds rationales for ruthless action Inhabiting a hall of mirrors this apparatus operates in a perpetual state of self hypnosis

Brinkmanship and producing instability carry several meanings. The American military spends 48% of world military spending (2005) and represents a vast, virtually continuously growing establishment that is a world in itself with its own lingo, its own reasons, internecine battles and projects. That this large security establishment is a bipartisan project makes it politically relatively immune. That for security reasons it is an insular world shelters it from scrutiny. For reasons of ‘deniability’ the president is insulated from certain operations (Risen, 2006). That it is a completely hierarchical world onto itself makes it relatively unaccountable. Hence, to quote Rumsfeld, ‘stuff happens’. In part this is the familiar theme of the Praetorian Guard and the shadow state (Stockwell, 1991). It includes a military on the go, a military that seeks career advancement through role expansion, seeks expansion through threat inflation, and in inflated threats finds rationales for ruthless action and is thus subject to feedback from its own echo chambers. Misinformation broadcast by part of the intelligence apparatus blows back to other security circles where it may be taken for real (Johnson, 2000). Inhabiting a hall of mirrors this apparatus operates in a perpetual state of self hypnosis with, since it concerns classified information and covert ops, limited checks on its functioning.

<h4>Vote neg on presumption—the Aff is epistemologically bankrupt. Their evidence is <u>manufactured</u> and <u>distorted</u> by the threat industry.</h4><p><strong>Pieterse 7</strong> (Jan, Professor of Sociology – University of Illinois (Urbana), “Political and Economic Brinkmanship”, Review of International Political Economy, 14(3), p. 473)</p><p>Brinkmanship and producing instability carry several meanings. <u>The American <mark>military</u></mark> spends 48% of world military spending (2005) and <u>represents a vast</u>, virtually continuously <u>growing establishment</u> that is a world in itself with its own lingo, its own reasons, internecine battles and projects. That <u>this large security establishment is a bipartisan project makes it <mark>politically</u></mark> relatively <u><mark>immune</u></mark>. That for security reasons it is an insular world shelters it from scrutiny. For reasons of ‘deniability’ the president is insulated from certain operations (Risen, 2006). <u>That it is a completely hierarchical world onto itself <mark>makes it relatively unaccountable</u></mark>. Hence, to quote Rumsfeld, ‘stuff happens’. In part this is the familiar theme of the Praetorian Guard and the shadow state (Stockwell, 1991). It includes a military on the go, <u>a <mark>military</u></mark> that <u><mark>seeks <strong>career advancement</strong> through role expansion</u></mark>, seeks <u><mark>expansion</u> <u>through <strong>threat inflation</u></strong>, <u>and in inflated threats finds <strong>rationales for ruthless action</u></strong></mark> and is thus <u>subject to feedback</u> <u>from its own echo chambers</u>. <u>Misinformation broadcast by part of the intelligence apparatus blows back</u> to other security circles where it may be taken for real (Johnson, 2000). <u><mark>Inhabiting <strong>a hall of mirrors</strong> this apparatus operates in a perpetual state of <strong>self hypnosis</u></strong></mark> with, since it concerns classified information and covert ops, limited checks on its functioning.</p>

K

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Navy

8

Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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The availability of organs in the US would dry up demand in the illegal market

Upchurch 12

Upchurch 12 Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The Man who Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a Re-Examination of The National Organ Transplantation Act of 1984" (2012). http://erepository.law.shu.edu/student_scholarship/18

By increasing the supply of available organs in the U S through compensation, citizens would have less reason to travel elsewhere to pay for an organ If demand dried up transplant tourism in these countries would take a major hit presumably American citizens make up a substantial percentage of the tourist patients seeking a new organ they cannot attain domestically. As one report stated, “Most of those organs ended up transplanted into American citizens If those American citizens with the means to purchase were not forced abroad to find an organ, it is very

By increasing the supply of available organs in the U S citizens would have less reason to travel elsewhere If demand dried up , transplant tourism in these countries would take a major hit presumably American citizens make up a substantial percentage of the tourist patients Most of those organs ended up transplanted into American citizens

By increasing the supply of available organs in the United States through compensation, American citizens would have less reason to travel elsewhere to pay for an organ. For example, Aadil Hospital in Lahore, Pakistan advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and $16,000 for the second if the first organ fails.118 If demand dried up from foreign citizens, transplant tourism in these countries would take a major hit because brokers would fetch lower sums for organs they procure. Statistical information is difficult to come by for obvious reasons, but presumably American citizens make up a substantial percentage of the tourist patients seeking a new organ they cannot attain domestically. As one report about impoverished Bangladeshi villagers taken advantage of for their organs succinctly stated, “Most of those organs ended up transplanted into American citizens.”119 The black market for organs in other countries is not fueled by local patients. Rather, it is driven upwards and out of control by those American as well as European citizens who cannot acquire what they need domestically.120 One estimate is that the black market accounts for as high as twenty percent of all kidney transplants worldwide.121 Nadley Hakim, transplant surgeon for St. Mary’s Hospital in London, offered an interesting take on this problem of the black market when he said, “this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer.”122 Within the past month, an indigent Chinese teenager sold his kidney so that he could purchase an iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124 Sadly, the boy received roughly ten percent of what the buyer paid, with the rest going to the surgeon and others involved in coordinating the operation.125 If those American citizens with the means to purchase were not forced abroad to find an organ, it is very possible that stories like this would become much less commonplace.

<h4>The availability of organs in the US would dry up demand in the illegal market</h4><p><strong>Upchurch 12<u></strong> Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The Man who Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a Re-Examination of The National Organ Transplantation Act of 1984" (2012). http://erepository.law.shu.edu/student_scholarship/18</p><p><mark>By increasing the supply of available organs in the U</u></mark>nited<u> <mark>S</u></mark>tates<u> through compensation, </u>American<u> <mark>citizens would have less reason to travel elsewhere</mark> to pay for an organ</u>. For example, Aadil Hospital in Lahore, Pakistan advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and $16,000 for the second if the first organ fails.118 <u><mark>If demand dried up</u> </mark>from foreign citizens<mark>, <u>transplant tourism in these countries would take a major hit</u></mark> because brokers would fetch lower sums for organs they procure. Statistical information is difficult to come by for obvious reasons, but <u><mark>presumably American citizens make up a substantial percentage of the tourist patients</mark> seeking a new organ they cannot attain domestically. As one report </u>about impoverished Bangladeshi villagers taken advantage of for their organs<u> </u>succinctly <u>stated, “<mark>Most of those organs ended up transplanted into American citizens</u></mark>.”119 The<u> </u>black market for organs in other countries is not fueled by local patients. Rather, it is driven<u> </u>upwards and out of control by those American as well as European citizens who cannot acquire<u> </u>what they need domestically.120 One estimate is that the black market accounts for as high as twenty percent of all kidney transplants worldwide.121 Nadley Hakim, transplant surgeon for St. Mary’s Hospital in London, offered an interesting take on this problem of the black market when he said, “this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer.”122 Within the past month, an indigent Chinese teenager sold his kidney so that he could purchase an iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124 Sadly, the boy received roughly ten percent of what the buyer paid, with the rest going to the surgeon and others involved in coordinating the operation.125 <u>If those American citizens with the means to purchase were not forced abroad to find an organ, it is very </u>possible that stories like this would become much less commonplace.</p>

Contention 2 is the Illegal market

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Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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State budgets internal link is a joke

<h4>State budgets internal link is a joke</h4>

Econ

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N

Navy

8

Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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Legalizing sales in the US would take down the illegal market

Calandrillo 4

Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D., Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall, 2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage lexis

if we cannot prevent the black markets in human organs that continue to thrive worldwide today, a thoughtful and responsible regulatory solution in America might be the best response a well-regulated legalized market in the U.S. may not completely eliminate black markets worldwide However, it is reasonable to suspect that an American market would significantly reduce the demand for black market organs, especially given the ability of a regulated market to better ensure the quality of its product. Furthermore, a legalized market in the U.S. (with appropriate safeguards to prevent abuse of sellers) may lead to similar structures abroad.

a thoughtful and responsible regulatory solution in America might be the best response it is reasonable to suspect that an American market would significantly reduce the demand for black market organs, especially given the ability of a regulated market to better ensure the quality of its product. Furthermore, a legalized market in the U.S. may lead to similar structures abroad

Moreover, if we cannot prevent the black markets in human organs that continue to thrive worldwide today, a thoughtful and responsible regulatory solution in America might be the best response. Many scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no follow-up health care, and generally exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for misrepresentation and fraud against both buyers and sellers today, as prices spiral out of control for organs that are of dubious quality. n181 Gloria Banks decries the exploitation of society's most vulnerable individuals in the organ sale trade, and urges legal and ethical safeguards for their protection. n182 Susan Hankin Denise adds that a properly regulated organ market may therefore be a better solution to the problem of scarcity than the outright ban we witness today. n183 FOOTNOTE ATTACHED n183 See Denise, supra note 72, at 1035-36 (arguing that regulated markets are superior to the existing ban on organ sales in the U.S.). Of course, even a well-regulated legalized market in the U.S. may not completely eliminate black markets worldwide if patients can still find organs more cheaply abroad. However, it is reasonable to suspect that an American market would significantly reduce the demand for black market organs, especially given the ability of a regulated market to better ensure the quality of its product. Furthermore, a legalized market in the U.S. (with appropriate safeguards to prevent abuse of sellers) may lead to similar structures abroad. On the other hand, one might argue that competing markets might lead to a "race to the bottom" in terms of regulatory standards, as each country tries to gain more market share.

<h4>Legalizing sales in the US would take down the illegal market </h4><p><strong>Calandrillo 4</strong> Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D., Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall, 2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage lexis</p><p>Moreover, <u>if we cannot prevent the black markets in human organs that continue to thrive worldwide today, <mark>a thoughtful and responsible regulatory solution in America might be the best response</u></mark>. Many scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no follow-up health care, and generally exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for misrepresentation and fraud against both buyers and sellers today, as prices spiral out of control for organs that are of dubious quality. n181 Gloria Banks decries the exploitation of society's most vulnerable individuals in the organ sale trade, and urges legal and ethical safeguards for their protection. n182 Susan Hankin Denise adds that a properly regulated organ market may therefore be a better solution to the problem of scarcity than the outright ban we witness today. n183 FOOTNOTE ATTACHED n183 See Denise, supra note 72, at 1035-36 (arguing that regulated markets are superior to the existing ban on organ sales in the U.S.). Of course, even <u>a well-regulated legalized market in the U.S. may not completely eliminate black markets worldwide </u>if patients can still find organs more cheaply abroad. <u>However, <mark>it is reasonable to suspect that an American market would <strong>significantly reduce the demand for black market organs</strong>, especially given the ability of a regulated market to better ensure the quality of its product. Furthermore, a legalized market in the U.S.</mark> (with appropriate safeguards to prevent abuse of sellers) <strong><mark>may lead to similar structures abroad</strong></mark>.</u> On the other hand, one might argue that competing markets might lead to a "race to the bottom" in terms of regulatory standards, as each country tries to gain more market share. </p>

Contention 2 is the Illegal market

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A

Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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a—gambling taxation is a 3 billion contribution to the economy every year—their author

Gainsbury 12

Gainsbury 12 (Sally, Centre for Gambling Education and Research, Southern Cross University, 2012, “Internet Gambling: Current Research Findings and Implications”///TS)

McDermott estimated that US $72 (US$42 billion federally and $30 billion for state governments) could be raised over 10 years through taxing online operators and gambling winnings.

McDermott estimated that and $30 billion for state governments) could be raised over 10 years

McDermott estimated that US $72 (US$42 billion federally and $30 billion for state governments) could be raised over 10 years through taxing online operators and gambling winnings.

<h4>a—gambling taxation is a 3 billion contribution to the economy every year—their author</h4><p><strong>Gainsbury 12</strong> (Sally, Centre for Gambling Education and Research, Southern Cross University, 2012, “Internet Gambling: Current Research Findings and Implications”///TS)</p><p><u><mark>McDermott estimated that <strong></mark>US $72</strong> (US$42 billion federally <mark>and $30 billion for state governments) could be raised <strong>over 10 years</strong></mark> through taxing online operators and gambling winnings.</p></u>

Econ

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N

Navy

8

Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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The United States Federal Government should amend the National Organ Transplant Act to permit regulated sale of human organs. A government agency should be established to purchase organs from those living in the United States, with payment in vouchers with a cash value set at an adjusted market-clearing price. Organs should be placed in the Organ Procurement and Transplantation Network.

<h4>The United States Federal Government should amend the National Organ Transplant Act to permit regulated sale of human organs. A government agency should be established to purchase organs from those living in the United States, with payment in vouchers with a cash value set at an adjusted market-clearing price. Organs should be placed in the Organ Procurement and Transplantation Network.</h4>

Plan

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Ndt

2

Puget Sound Brittenham-Queirolo

Leap, McBride, Stables

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b—That’s .015% of the US economy and .003% of the global economy—that isn’t sufficient to cause global war

<h4>b—That’s .015% of the US economy and .003% of the global economy—that isn’t sufficient to cause global war</h4>

Econ

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N

Navy

8

Wake Forest Nasar-Raudenbush

Ridley

1AC OG (WTO Banks) 1NC Security K

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