United States vs. the world Saturday, Dec 26 2009 

It wasn’t very long ago that I saying President Obama would probably be a centrist president. (Maybe not on this blog, but my comments are elsewhere on the Web.) The wild claims about socialism and radical shifts in policy were just that—wild claims. Most of the Republicans are scared out of their boots and most Democrats seem dissatisfied. He’s continued Bush’s Patriot Act, FISA, illegal spying, destruction of the Fourth Amendment, and so on. He’s continued the unwise bailouts of those responsible for our current financial crisis. And perhaps worst of all, he has kept the hawkish policy of his predecessor, now recently expanding the war in Afghanistan and has continued the illegal policy of extraordinary rendition, black sites (including the black jail), and ignoring Israeli crimes. All of this was expected, of course. Putting aside all the wonderful rhetoric (“Hope!” and “Change!”), Obama’s policies were recognized as nothing more than underwhelming. He’s a centrist president. (Here I am keeping myself, of course, to the American political lexicon. In American politics—where Democrats represent the “left” and Republicans represent the “right”—he is “centrist.” To the rest of the world, he remains a rightist.)

(Click for larger image. Author unknown.)

On a more specific level, Obama has continued his racist and imperial policies as they relate to Latin America. I wish to specifically talk about Honduras and the recent military coup that occurred there. For those unaware (which would be unsurprising, given the American educational culture), there was an illegal coup d’รฉtat in June of 2009 that ousted the democratically-elected president of Honduras, Manuel “Mel” Zelaya. After the military coup had removed Zelaya from the country, the Honduran congress voted to put Roberto Micheletti in power, with no other government in the world recognizing his presidency.

Naturally, of course, the neoconservative right hailed this military coup as a “defense of democracy,” a “democratic coup,” and so on. Janet from SCSU Scholars acclaimed it as a “legal election.” The rest of the world had no illusions and harshly condemned the illegal takeover of the country. This shouldn’t come as a surprise, as the historical role of scholars has been to acquiesce to power, authority, state doctrine, and so on.

The rest of the world, that is, with the exception of the United States. While Obama certainly mimicked what the OAS and the UN were saying regarding the illegal coup, he was the only one to keep his ambassador, Hugo Llorens, in the country. This is the same Llorens who called the elections under the illegal coup as “a great celebration of democracy.” Meanwhile, the U.S. Ambassador to the OAS at the time declared Zelaya’s return to his country “foolish and irresponsible.” The British scholar Gordon Connell-Smith aptly points out, “While paying lip-service to the encouragement of representative democracy in Latin America, the United States has a strong interest in just the reverse,” apart from “procedural democracy, especially the holding of elections—which only too often have proved farcical.” While it’s certainly true there were procedural elections, which the U.S. supported in contrast to much of the rest of the world, the U.S. continued to refuse to demand Zelaya’s return to power and still refuses to speak even one word about the human rights abuses occurring under Micheletti.

This isn’t to say the precedent isn’t there. The countless Latin Americans murdered, tortured, or disappeared speaks volumes to the U.S.’s long and historic role in intervening in the region for its own (read: business’s) interests through dismantling left-wing democracies and installing right-wing dictatorships. The history is clear enough that it does not bear repeating here. Thus, it comes as no surprise that the Obama administration has opted to support (and played an important role in) the illegal overthrow of the left-wing Zelaya, ignore the atrocities of the current government, and support the right-wing “election” occurring just recently.


Avatar Wednesday, Dec 23 2009 

I just saw Avatar—in 3D. This is a pretty awesome movie. The movie itself was great, but the wonderful visual effects put the movie over the top. It was the icing on the cake, so to speak. It was beautiful, indeed; but don’t let this distract you from the story! Without wanting to spoil much for any of you who have yet to see the film (I suggest you do), I’m making this post because the movie deals with many of the themes that I also discuss on this blog. It explores war, environmental destruction, individualism and collectivism, the egoistic pursuit of profit maximization, and human rights—and does so brilliantly, I might add. Perhaps I’ll discuss the film’s use of these themes in the future. For now, suffice it to say this is a wonderful movie. Go see it.

A crime against that which does not exist Saturday, Dec 19 2009 

Global warming is a crime against that which not exist, namely future people. Of course, it is still a crime against people who do exist in the present, e.g. the poor in Bolivia whose glacial water sources are quickly disappearing.

This is a point I just thought about in a discussion about global warming on some other forum. It’s worth mentioning that global warming (read anthropogenic climate change) is a classic example of externalities. Neoclassical economics tells us that when people (which includes corporations) don’t have to pay the price for the consequences of their actions, there is market failure. Resources are not being allocated efficiently—one reason why any claim about markets being efficient should be taken with a grain of salt. For examples, producers of pollution do not take into consideration the harmful effects of pollution—i.e. the true cost of pollution is ignored—and so pollution is overproduced (because the price does not reflect the cost). However, not only is global warming a classic example of market failure, it is the “greatest market failure” ever, in the words of Nicholas Stern:

The science tells us that GHG emissions are an externality; in other words, our emissions affect the lives of others. When people do not pay for the consequences of their actions we have market failure. This is the greatest market failure the world has seen. It is an externality that goes beyond those of ordinary congestion or pollution, although many of the same economic principles apply for its analysis.

This externality is different in 4 key ways that shape the whole policy story of a rational response. It is: global; long term; involves risks and uncertainties; and potentially involves major and irreversible change.

As it happens, there is a solution to fix the problem of when prices do not reflect true costs. The solution is to make the price reflect cost. In this case, you increase the price. That’s what some people have called the carbon tax (i.e. a Pigouvian tax). The externality goes away and resources are being allocated more efficiently. Now, we know the cost of our pollution and activity on this planet is enormous. It is several magnitudes larger than any cost associated with mitigating it, in fact. The rational human being should therefore be opting to mitigate it. The real question becomes whether or not we’re rational.

But let us think about the four key ways that Stern says global warming is distinct from other typical externalities. It’s global, long-term, risky and involves uncertainties, and is irreversible (within reasonable amounts of time, that is). What this means is that we’re condemning future populations of humans to live with the adverse effects of our actions. When we think about it for just a moment or two, we quickly realize that this is fundamentally wrong. It is morally wrong. Yet, many of these people do not even exist yet. They haven’t been born. At the same time, when they do come into existence, they will have to live in a much worse environment because of the actions we are committing in the present. It is in this sense that we are committing a crime against that which does not yet exist (namely future generations).

This is very peculiar indeed. The non-harm and non-aggression principles of libertarianism tells us not to harm other people. But it says nothing of people who do not exist (in that they have yet to exist). In a sense, I think many people in the present feel undisturbed about the effects of human activity on future generations because it’s a rather intangible idea, somewhat abstract. It’s hard to connect. If we are able to so brazenly ignore the plight of suffering Africans in the present, surely it is almost impossible for us to feel anything for generations of humans who are yet to exist. The effects of what goes on in our neighborhood, our cities, our states, or even our nation are much more immediate than that which goes on halfway around the world. So I think there is a problem of immediacy here. What happens to future generations is not immediate to us. This allows us to do what we do without even so much as batting an eyelid. Again, though, this is because we aren’t having to pay for the costs. Future generations will have to pay for it, and they will pay greatly. This is an externality. We can fix it by making the price of our actions reflect the true cost, and in this way we will also make the problems associated with our actions more immediate to us.

An appeal to skepticism Wednesday, Dec 16 2009 

As I note in my “About” page, I sometimes deal with the topic of philosophy. In this sense, I usually mean moral philosophy (or perhaps also political philosophy, but I usually label that under politics). My fascination with philosophy began with my intro to reasoning (i.e. logic) class with Dr. Williford (no longer at SCSU) in my first year here at the university, and continued with my business ethics course with Dr. Shaffer in my third year here. It now continues with my course in epistemology (i.e. the philosophical study of knowledge) with Dr. Mirza. One of the central topics dealt with was what constituted knowledge. In this sense, the philosophical question is much different than the other philosophical questions that I have dealt with in the past on this blog. In any case, I find it fascinating (even if irrelevant), and the label of “philosophy” in my About page does not preclude it, so I’ll explore the topic below in further detail. If you are not interested in the philosophical question of knowledge, then this would be a good time to stop reading (and keep in mind this is not one my ordinary posts on this blog, as I usually deal with politics or economics; see the categories in the box on the left). If, on the other hand, you are interested in the epistemic question of knowledge, then please bear with me as I explore the concept of philosophical skepticism. ๐Ÿ™‚

For well over two millennia, philosophers have dealt with the question of what knowledge is. Plato gave, but did not necessarily commit to, the basic description as “justified true belief.” That is, knowledge is justified true belief. More formally, subject, S, knows proposition, p, if and only if p is true, S believes that p, and S is justified in believing that p. It is easier to read if formulated like this:

S knows that p, iff (if and only if):
1. p is true
2. S believes that p
3. S is justified in believing that p

Thus, the three necessary and sufficient conditions for knowledge are truth, belief, and justification. This has become known as the justified true belief analysis of knowledge. The purpose is to find the conditions for knowledge such that when these conditions are met, one can be said to have knowledge (sufficiency) and that every case of knowledge meets these conditions (necessity). Put differently, if I meet these three conditions I have knowledge; and if I have knowledge, I meet these three conditions.

Thus, the justified true belief analysis of knowledge was generally accepted as the correct analysis for knowledge since Plato crudely formulated it. And it seems correct on the surface. I cannot be said to know something that is false. I cannot “know” it is raining outside currently if it is, in fact, not currently raining outside. Further, I also cannot be said to know something if I don’t actually believe it. If it is raining outside, but I do not believe it to be raining outside, I cannot be said to know that it is raining outside. Moreover, it seems I cannot “know” something if I am not properly justified. I may have the true belief that I will win the lottery tonight. That is, I might actually win the lottery tonight and I believed I would. However, if I simply formulated my belief on conjecture, some supernatural explanation, etc., I am not ordinarily said to have knowledge. If I merely make a lucky guess about some proposition, it’s not really knowledge. Thus, I need some justification for my beliefs. If I am properly justified in my belief that is true, then I can be said to have knowledge. For example, I observe that it is raining outside and I therefore formulate the belief that it is raining outside. Since it is true that is it raining outside (and I believe it and am justified in believing it), I can be said to know it’s raining outside.

In 1963, one Edmund Gettier turned this two-thousand-year-old analysis on its head with his single three-page paper. In it, he describes cases in which a person has a justified true belief but cannot be said to have knowledge (i.e. the three conditions are not sufficient for knowledge). Such counterexamples to the traditional analysis have come to be known as “Gettier problems” or “Gettier counterexamples.” Let us explore such a counterexample. The following case is one similar to the original Gettier presented in his seminal paper. Suppose Smith is a close friend of Jones. Smith formulates the belief that Jones owns a Ford, for Smith has always seen Jones drive his Ford, has seen the documentation for Jones’ ownership of Ford, has no reason to suspect Jones does not in fact own the Ford he drives around, and so on. Smith is entirely justified in believing Jones owns a Ford. However, Smith has been deceived. The documentation Smith saw was authentic-looking but was in fact fraudulent; in reality, Jones did not own the Ford he was driving around and was merely deceiving Smith. Thus, Smith’s justified belief that Jones owns the Ford is false. Smith does not have knowledge because he failed to satisfy all three of the previous conditions for knowledge (namely, the condition that the proposition believed is true). However, Smith is in a room with Jones and another man whom he has never met before, Jake. At the same time, Smith deduces from his (untrue) belief about Jones’ ownership of Ford that “Someone in this room owns a Ford.” Smith believes this proposition based on his false belief that Jones owns a Ford. As it just happens, however, Jake does own a Ford (but Jones does not). As we see, then, Smith has the justified true belief that “Someone in this room owns a Ford.” Smith was justified in believing “Someone in this room owns a Ford” because he validly deduced it from the justified belief that Jones owned a Ford. However, Jones did not own a Ford, but it still remains true that “Someone in this room owns a Ford” because Jake, by sheer circumstance, does in fact own a Ford. Since Smith had no previous knowledge of Jake (much less what car he drove), then it seems Smith’s belief that “Someone in this room owns a Ford” is only made true by the lucky circumstance that someone he with whom he is unfamiliar owns a Ford. Intuitively, we do not say lucky circumstances amount to knowledge. Gettier showed the justified true belief of knowledge to be insufficient, because all three conditions were met but knowledge was not obtained.

I apologize if the foregoing case was not very clear. Gettier probably explains it much better than I can, and you can read his paper here. The actual car example comes from Keith Lehrer, in this paper. Of course, Wikipedia explains it pretty well. A much simpler version that I like is that of a broken clock. Let’s say I purchase a brand new clock, set it up, and observe it for some time and ascertain that it is telling time accurately. I am justified in believing the time it displays because clocks are generally reliable sources for telling time. Several days later, however, I come home and observe the clock displays the time of 6:07. Based on this, I formulate the justified belief that it is 6:07. Unbeknownst to me, the clock stopped working 12 hours earlier. By sheer luck, though, the actual time is 6:07. Thus, my justified belief is true. However, we would not ordinarily say I “know” that it is 6:07 because of my reliance on a broken clock. Had I looked at it at any other time, my belief about the time would be false. Therefore, I was lucky and luck does not count for knowledge.

There have been many attempts to solve this puzzle. Some have said we need to find a fourth condition that eliminates the possibility of Gettier problems (called “JTB+G”). Others have decided to throw out the justification condition and find other conditions in its stead. (It is almost universally agreed that truth and belief are necessary but insufficient conditions for knowledge. That “justification” is necessary for knowledge has been argued against, for example by Robert Nozick.) The literature on this is quite vast so I will not review it in this post. The Wikipedia article I linked to does a satisfactory job in explaining the various approaches, if you are interested, as does this site.

Suffice it to say that one response has been that the justification condition on which we rely is not strong enough. It is possible that even completely justified beliefs are in fact wrong. If the premises on which I rely are always (logically) possibly wrong, then any account that relies on “justification” will always be susceptible to a Gettier-like problem. This line of thinking is referred to as fallibilism. Kirkham has a good defense of fallibilism here.

Fallibilism rests on the idea of skepticism. Epistemic skepticism says that any belief based on empiricism (that is, empirical evidence or reliance on sensory perception) could logically possibly be false. The arguments for this are quite nuanced and detailed. That I am seeing a computer before me could conceivably be false. To wit, there could be a conceivable world where my senses are being deceived perhaps because I am hallucinating or because some evil genius scientists is controlling my thoughts and is merely giving me the false belief that I see a computer before me. Thus it is logically possible that I am wrong in my perceptual beliefs. In fact, claims the skeptic, it is logically possible that all beliefs based on empiricism are false (see, e.g. the brain in a vat theory). If it is logically possible that all our beliefs based on perception are false, then we cannot be said to know anything for sure. That is the argument of skepticism. Again, though, the arguments for and against skepticism are nuanced and will not be reviewed in this post. (If you are really interested, this book has a good overview.)

In conclusion, since it appears it is logically possible that any (or every) empirical belief we have about things could be wrong, the case for knowledge should be stronger. That is, it is only possible for us to “know” when it is not logically possible that our belief is fallible (that is, there is no conceivable or possible world where it is wrong). Again, see the Kirkham paper I linked to for a further exposition of this argument.

This is a powerful argument, and it is one I appeal to. Of course many people reject this argument on many grounds and I do not mean to imply that Dr. Mirza endorses such an argument. It is merely one I have decided is the most convincing of those provided. Keep in mind, please, that I have also just condensed an entire semester of lecture, discussion, argument, and thought into about 1,500 words. The issue is much more complex and nuanced than this. I merely offer a rough overview of this topic that I find fascinating. I admit I probably did a rather poor exposition here, as my purpose was simply to formulate my thoughts about this subject in some words and I apologize if it is not exactly coherent. I would be pleased to clarify if anyone is interested.

If you were at all put off by this post, I won’t take it against you, but you should not worry because these types of philosophical posts probably will not be the norm for this blog. Cheers. ๐Ÿ™‚

The people speak Sunday, Dec 13 2009 

Sorry for the relative inactivity as of late. I’ve been busy with finals, and still am, so this will be a short post. I just got finished watching The People Speak shown on the History channel. If you have a chance to watch it, I suggest you do. It was a very moving show of what real and ordinary people have said throughout American history. It wasn’t about what politicians, the elites, or the business class have thought. It was what people who were being affected by the nation’s policies spoke about. And I think it shows just how much Americans have been anti-war, for participatory democracy, social change, equality, and solidarity. It has always been this way and it runs deep in American life, outside of the perverse culture of Washington and Wall Street.

It shows how much American history has been built on the backs of ordinary people who strove for nothing more than a better life. It shows that opposition to state violence and oppression has a long and strong history, and the struggles of people like Frederick Douglass, Susan B. Anthony, Eugene Debs, Martin Luther King Jr., J. W. Loguen, Bartolomeo Vanzetti, Emma Goldman, and others to fight against it. American history is a history of dissent and resistance and activism. Society has become more civilized due to their contributions. What liberty we have is because of these people who rose up. That is to say, democracy and liberty comes from the bottom up, from the people. When you look at the activist history of the sixties, the seventies, and the eighties, you see that it has a civilizing effect on society. And it continues straight through today, and we see it in the opposition to our fundamentally wrong wars, in the fight to give rights to gays, in the advancement of environmental protection, in the anti-sweatshop movements, and the solidarity with the suppressed in Palestine. That is the source of social progress. That is message I think Howard Zinn is trying to put out in The People Speak (and his A People’s History of the United States). So when we talk about what lies ahead, well, it’s largely up to us.

Organ capitalism revisted Wednesday, Dec 2 2009 

A couple of months ago, I wrote a piece supporting the sale and purchase of organs. I argued that allowing for a market for organs would get rid of the lack of supply of organs that are desperately needed to save the lives of those in need of an organ transplant (the literature tends to agree, as does empirical evidence from Iran). Every year, tens of thousands of people (about 100,000 in the U.S. alone) in need of new organs must wait because there lacks a supply of healthy organs available to them, and thousands more die because of this shortage. Every year the shortage continues to rise (demand is increasing faster than supply is). Healthy organs abound, but the shortage arises from the fact that it is a crime to sell or purchase organs. The altruistic donation of organs, while undoubtedly saving many lives, simply does not come close to supplying the necessary amount of organs. The logical conclusion seems to suggest there ought to be a market for organs.

Some people, however, detest this notion. In a recent post on his blog, Dr. Filip Spagnoli makes several nuanced arguments against free organ trade. The main arguments he makes, insofar as I understand them, are that the poor, qua the poor, will be desperate for money and therefore forced to sell their organs; the wealthy, qua the wealthy, will be able to disproportionately afford the organs and therefore be unfairly benefited; organ transplants are dangerous; solid organs donation is nonrenewable and therefore decidedly and relevantly different from blood donation; organ trade is tantamount to commodification of the body; and an opt-out system is the best solution to our problem.

King Banaian, a professor and chairman of the economics department at SCSU, made an argument similar to first listed above, back in 2005. The poor are desperate, goes the argument, and so it’s unfair they would end up selling organs (i.e. they lack informed consent). The basic underlying premise of this argument is that the poor are irrational, incapable of thinking for themselves. The government, therefore, knows what’s better for them than they themselves do. That is, they have to be protected from themselves (because they’re poor). I reject that argument. If the premise is true for the sale of organs, then it would be equally true of other economic decisions they make, including the sale of their labor or their purchase of goods. That doesn’t seem to be the case and, if it is, we certainly don’t restrict completely their involvement in the market (and even more certainly not the involvement of others).

So the argument seems to be that, if it weren’t for the money incentive being offered, the poor wouldn’t choose to donate their organs. But that’s true of basically all people. Economic agents would not do many things if it were not for the money incentive. Dell wouldn’t sell me computers if they weren’t being compensated for it. Is that exploitation (of their want for money)? I don’t think so. That’s called trade, and both the seller and buyer are made better off by it. So what the detractors have failed to explain is how the poor are made better off by ensuring they are not able to receive money that would help alleviate their predicament.

The second argument is that the wealthy, because they obtain more wealth, “will be able to benefit disproportionately from the market because prices will be high …” Dr. Spagnoli says this is true because society is aging, but admits prices will fall because of competition among suppliers, particularly from poor places like Africa. Still, the fact that the wealthy can disproportionately afford things does not suggest to me there ought not to be trade. So long as the distribution of wealth is unequal (which seems to always be the case), some people will be able to afford more than others. That doesn’t mean we outlaw trade. (The wealthy can afford more food and labor than the poor; do we therefore outlaw the sale of food or labor?) That seems to be punishing the rich merely by fact that they’re rich. And in this case, the punishment is death. Detractors of organ trade fail to explain how outlawing trade benefits the less-than-wealthy who are in need of an organ. It seems to me that as the wealthy begin to demand less organs, prices will begin to fall (allowing even the poor to afford to buy organs). By outlawing organ trade, detractors are (at best) disallowing some people from buying lifesaving organs merely because of their wealth.

The next argument is organ transplants are dangerous, so they should not be allowed. It’s true that all surgery, even the most benign, carry risk (including death). That reason alone is not enough to outlaw transplantation of organs. If it’s dangerous to sell organs for money, then it’s equally dangerous to donate organs altruistically. But we allow the altruistic kind. Clearly, danger is not the underlying factor here. Moreover, the dangers are overplayed, I think. The death rate for liver transplantation in Japan is at 0%, and 0.3% in the United States. These rates will continue to decline as advances in medicine continue and as surgeons progress along the learning curve. Kidney transplantation is even safer (people who donate kidneys live longer than those who don’t). Remember, it was Joseph Murray who won the Nobel Prize in medicine for completing the first kidney allograft in 1954. The patient in that case is still alive. While there is serious risk in many activities, including surgery (or timber cutting or smoking, which are both legal), that’s not enough to outlaw the practice.

Another argument is that blood (or sperm perhaps) is okay to sell because it’s renewable. The only defense here is that the distinction between renewable and nonrenewable is “relevant,” but without any further explanation. How is the distinction important? The fact that some goods are scarce doesn’t tell me a lot (other than that their price is going to be higher). Furthermore, modern liver transplantation in live patients consists of removing only a portion of the liver from the donor, which will regenerate and return to full functionality within a matter of a few weeks. Does the detractor now accept the trade of livers? (Similarly, the sale of bone marrow, which is just as renewable as blood, is a serious crime in the United States.)

A very common argument that also comes up is that the trade of organs is tantamount to the commodification of the body. I say, So what? It saves the lives of real human beings. That’s what matters. “Commodification is dehumanization,” they say. I counter that there is nothing more dehumanizing than simply letting people die, which is precisely what you do when you outlaw the trade of organs. So what is worse: that people might sell parts of their body or that hundreds of thousands of people are unable to get organs that could save their lives? Supporters of this argument also fail to explain how blood, bone marrow, sperm, ovarian eggs, or bearing children (all of which have markets) do not constitute commodification. Or, if they do, do they believe these practices ought to be outlawed? It’s also worth mentioning that even in altruistic donations, people are still profiting from it: the doctor, the nurses, the hospital, and so on. That is, everyone except the donor.

They might respond, We’re not letting them die because we have a solution, which is the op-out system. Opt-out, also called presumed consent, begins with the assumption that all people wish to donate their organs upon death. If you do not consent, you must specifically tell this to the state. (My contention is that this is akin to saying the state owns your body by assumption.) This is opposed to the opt-in system, like in the United States, where the assumption is that people do no wish to donate their organs upon death, unless it is otherwise specified. In that way, the hope of opt-out supporters is that people are not altruistic, but rather lazy or ignorant. I find that deeply unethical, but Dr. Spagnoli points to several studies from his country, Belgium, which show opt-out is providing an ample amount of organs (that is, people seem to be lazy or ignorant). (The rate of “donation” is marginally higher than that of the U.S.) A lot of the scholarly literature, however, does indeed seem to suggest opt-out provides higher rates of organ “donations” than opt-in. If this were necessarily true, though, Sweden and Israel (opt-out states) would not have such low donation rates. A study published in 2005 further shows that opt-out systems do not guarantee higher donation rates. The authors find that, when correcting for mortality rates, the apparent efficacy of opt-out disappears. Perhaps better than opt-in or opt-out, a better choice would be mandatory choice. All competent adults must choose whether or not they wish to donate their organs or not. Family decisions (which negatively affect the efficacy of both opt-in and opt-out) must not override the individual’s choice.

Still, it seems giving enough of an incentive to potential donors is the key to finally getting rid of organ shortages, which cause unnecessary deaths each year. As I explained earlier, Iran has been successful in accomplishing this. If detractors are unwavering, however, then perhaps markets are not necessarily the correct solution. Instead, I might propose a system wherein the government pays for the organs and then distributes these as equitably as possible. This removes a lot of the fears detractors have of unfair market allocations. Others, unfortunately, might reflexively bash the idea because it relies on (*moan*) the government. But I ask these people the same question as before: What is worse—that the government might be involved in the trade of organs or that thousands must die needlessly each year because they are unable to procure necessary organs?