January 14, 2008
Presumed consent
Gordon Brown is considering introducing a system of "presumed consent" for organ donations: unless you opt out, you’re in. I dislike the idea of presumed consent intensely. Were I to "presume consent" for publicly exposing myself (I’ll put it away if you tell me to, of course) I doubt the judge would be amused.
The obvious - and sadly unacceptable - solution is a market for organ donations. I discussed moral objections to that here, and Al Roth’s clever quasi market of "matched donations" here.
Andrew Oswald has a proposal that is likely to have very similar effect to GB’s, but much more respectful of liberty: a tax deduction for anyone who agrees to be on the organ donation register. Just tick a box on your tax return. Oswald suspects the sums involved would have to be fairly small; he may be right. I’d rather find out than shift to a system of presumed consent.
This is true of Singapore as well. Citizens can opt out if they want, but by default, the organs will be donated after their death.
Posted by: Divya | January 14th, 2008 at 8:57 am | Report this commentNZ has for decades had a system of indicating organ donor consent when signing up for a driver’s licence - it’s on the licence card and the driver database. Guess what? That consent is totally ignored. When a likely donor turns up in A&E, the doctors go through the whole rigmarole of seeking next of kin approval, with the usual lack of success in a time of grief and trauma. The rationale: the doctors are looking after the family’s well-being. The wishes of the deceased are ignored. What was the point of the pre-consent? Bizarre.
Your comment about markets for organs echoes a Harvard study on cadavers, which I’ve just commented on. http://jimdonovan.net.nz/2008/01/14/the-market-for-dead-bodies/
Posted by: Jim Donovan | January 14th, 2008 at 9:27 am | Report this commentMust be something maudlin in the business/economics blogosphere tonight!
In as much as presumed consent may violate your rights, at the end of the day it saves more lives than the opt-in model in status quo, without being subject to the same kind of moral objections an organ market creates.
After all, what’s more important, one’s right to “presumed disconsent”, or another person’s life?
The problem with your public exposure example is that it is not analogous: there are no socially perceived legitimate benefits from indecent exposure. An opt out organ donation program does possess legitimate benefits.
Posted by: Carlo | January 14th, 2008 at 9:42 am | Report this commentAnything involving a quid pro quo, such as a tax deduction, runs two risks (in different directions). The first is that it will put poorer people under pressure, rather than allowing them to make what is a very personal choice simply on a personal level.
The second is the risk, seen with paying for blood donations in other countries, that people no longer see it as an altruistic thing to do but as something grubbier than that, and that is so bad they need to be compensated for it, and therefore are actually *less* likely to do it.
Considering that a presumption of consent that can be easily rebutted - most likely even by simply informing your next of kin of your wishes, as they will still be consulted - imposes very little restriction on anyone’s liberty, Andrew Oswald’s solution seems to increase cost while carrying significant risks. To me it looks like he’s suffering from an all too frequent economist’s problem: when all you have is a hammer, everything looks like a nail…
Posted by: Tom | January 14th, 2008 at 11:20 am | Report this commentTom’s comment might have some bite at a £1000 deduction. Oswald thinks £10 would be enough of a deduction. I think that’s probably right.
Posted by: Tim Harford | January 14th, 2008 at 11:25 am | Report this commentIf it isn’t right, and people really, really do not want to be on the organ donation register, all the more reason for concerns over presumed consent.
When I’m dead, I’m dead. If my relatives don’t get my bits chopped out to save as many others as possible and there is some sort of afterlife, when they get there they’ll get glowered at. Same applies to anyone I have the facility to sign for.
I don’t understand the objection, I own my body, but when I’m dead, I no longer own anything, an opt-out system is fine by me.
Posted by: MatGB | January 14th, 2008 at 12:45 pm | Report this commentI personally have no problem with presumed consent, because it does not infringe on anyone’s liberty: you still can opt out easily. But given that many people, like Tim, have reservations about this, I propose a simple solution that presumes neither consent nor disconsent.
Here’s how it works: When you get a driver’s license, you have to check either the opt-in or the opt-out box. If you check no or both boxes, the license is not valid, just like if you don’t sign it.
Problem solved.
Any objections?
Posted by: LemmusLemmus | January 14th, 2008 at 1:12 pm | Report this commentIt seems to me presumed consent is a very economical decision. In this context at least.
The dead person loses nothing except of course organs they have no use for and the person that receives the organ now has at worst an increased quality of life and at best gets to keep their life.
It is also an economical mode of distribution as the people giving the organs would generally be in the place that the organs were required when they were in a position to give them.
I agree with the comment above that the analogy of public exposure doesn’t carry - even if the person doing the exposing truly believes it is in the public’s interest I think we could agree it is not. Whereas the consent here is solely to provide benefit.
I’d be interested to see what the economic cost of the additional years of life for those receiving the organs was. I wonder if we’d be worse off financially? I suppose it depends how many of them would return to work…
Posted by: Paul D'Ambra | January 15th, 2008 at 12:59 pm | Report this commentAs far as I’m concerned the principle counts more than whether or not this individual instance is beneficial. If they have the power to default you to opting in for organ donation, what else do they have the power to default you to opting in for? In getting your license will you have to opt out of donating your whole estate to the government as well? Opt out of automatically volunteering to have your vehicle searched without probable cause?
Posted by: David Peterson | January 15th, 2008 at 5:30 pm | Report this commentMaybe the scenarios are not likely, but I do think it can open a door that a crafty enough politician could exploit in the name of “the general welfare” (or British constitutional equivalent)
I am not sure I understand what the fuss is all about in the first place. Like so many things that are now the subject of debate in the UK (ID cards, anyone?), many continental European countries have had careful and sensible ‘presumed consent’ policies on organs for years, and the list of adopting countries has been growing. First of all, since many of these countries are culturally even more conservative than the UK - neither Catholics nor Calvinist Protestants have been among the carriers of the Enlightenment, let’s face it - the usually unspoken ‘that’s the way we do things here’ argument doesn’t quite cut it (I will not deign the ‘thin end of the wedge’ argument with a comment). Secondly, everyone who thinks this through for a moment realises that the cost-benefit ratio should make all opponents turn their head in shame. Unless the donor believes in an afterlife that will only allow them in if they’re in one piece - frankly, a constraint they could have considered when driving the 30 miles over the speed limit that got them into A&E in the first place - the cost of the organ donation to them is zero. And if they believe in that afterlife, they can always check the ‘leave me alone’ (or better, the ‘please put me back together at great cost to society so that I can get where I need to be in one piece’ box). While individual costs are close to zero, the benefits of presumed consent to society are immense. Taxes might certainly help, but why go through bribing people to do the morally right thing when simple regulation gets you there as well?
Posted by: Bob Hancké | January 20th, 2008 at 6:46 pm | Report this comment