I think it’s interesting to ask whether people in the opt-out countries are really consenting. Can you really say someone has consented if you never actually made the request?
This is sloppy, but it's what I have time for atm:
In fact, the truth is surprisingly simple: much depends merely on what happens if people don’t make a decision, something called a no-action default, or simply a default. The countries on the left of the graph ask you to choose to be an organ donor, and those on the right ask you to choose not to be a donor. If you do not make an active choice, you are, by default, a nondonor in Germany and a donor in Austria.
Dan and I wanted to understand this. We started by asking a sample of Americans whether they would be donors or not by presenting them with a choice on a webpage. One group, the opt-in condition, was told that they had just moved to a new state where the default was not to be an organ donor, and they were given a chance to change that status with a simple click of a mouse. A second group, the opt-out condition, saw an identical scenario, except the default was to be a donor. They could indicate that they did not want to be a donor with a mouse click. The third group was simply required to choose; they needed to check one box or the other to go on to the next page. This neutral ques-tion, with nothing prechecked, is a mandated-choice condi-tion; it’s important, because it shows what people do when they are forced to choose.
The effect of the default was remarkably strong: when they had to opt in, only 42 percent agreed to donate, but when they had to opt out, 82 percent agreed to donate. The most interesting result was from those forced to make a choice: 79 percent said they would be a donor, almost the same percentage of donors as in the opt-out condition. The only difference between the group that was asked to opt out and those who were forced to make a choice was that we forced the respondents in the mandated-choice condition to pick either box before they could go forward. It shows that if forced to make a choice, most participants would become donors. Otherwise, if they were given a default, most simply took it, whatever it was.
From The Elements of Choice by Eric Johnson
It’s more complicated than the one example, and he covers it further, but as a rough guideline, it looks like forced choice and opt out are similar in this case. Which would make sense because the opposition is mostly religious and strict religious people are more motivated to opt out.
Personally, I don’t really see that much value in the affirmative consent of the dead. Viable organs are hard to get, and save lives. I think it’s worth it to keep it opt-out.
I agree, but it raises an interesting argument regarding the definition of consent. I don’t necessarily believe in free will so I like to mention it in situations where you can easily see that people are more accurately described as reacting to their environment than making any kind of conscious choice.
Simply by changing from opt-in to opt-out, you mostly reverse the observed behavior of a population. Lots of applications for this sort of thinking, like voting for instance.
Germany is currently considering a third way: they ask you.
Everyone in Germany has health insurance, so the idea is that the health insurance simply asks you directly to decide. Most people are in favor of organ donation, but never actually get an organ donor card or talk to their relatives. Asking them to decide won’t get anywhere near the donor rates of an opt-out scheme, but it could drastically increase them.
In Ontario, Canada people can opt in when renewing their health card (a card used to access public healthcare) or driver’s license, and it probably does positively impact the rate of opting in, but it really doesn’t seem to address the need. I’ve been a registered organ donor since I was 16, but most people I’ve brought it up with aren’t.
I suppose if choosing an option is mandatory instead of voluntary then that would change things for the better. Is that what Germany is doing?
Yeah, the formulation is a bit off here. With opt-out, you have no way to measure consent, because you can’t discern between people who actually consent and those who just haven’t opted out, for lack of knowledge or other reasons.
These societies have simply weighed up the two options and decided that saving lives is more important than leaving personal freedom intact at all costs.
Ok but for most people it doesnt really matter with a dead body. If you opt out because of religion its okay have it your way but other than that its not like it matters, youre dead.
We don’t get their consent to be buried or cremated or whatever else people do with the remaining bodies of their loved ones. It’s just opt out. Why should organ donation, which provides a societal and personal benefit be different?
I’m pretty sure people do make their wishes clear regarding their funeral preparations. You can put that kind of stuff in your last will and I would assume it holds some legal weight.
I actually agree that organ donation should be opt-out, but there is an unavoidable argument against that. Namely, the fact that people have the right to opt-out at all implies that you have a responsibility to verify their informed consent before enrolling them in the procedure. At least, that would be the conventional wisdom according to the field of medical ethics.
Yes, you can choose to lay out your wishes. Many do, just like opt in or opt out organ donation. However, if you don’t lay out your wishes, you will still end up buried or cremated or something similar without consent.
I’m not saying that’s wrong. We can’t just leave dead bodies where they lie. It also provides comfort to families to practice burial rites. My point is that technically you are still making decisions about what to do with somebodies body parts without consent, as they can no longer consent. Is there really a difference? If they care that much, will they just opt out?
I know some countries, they used to let you specify which organs, but then people opted out of eyes. So they removed the option and it was just donor or not. People still consented, without opting out of eyes. Is that better, or is that manipulating consent?
My point is that technically you are still making decisions about what to do with some odors body parts without consent, as they can no longer consent. Is there really a difference?
That’s a good point, you’re right.
That’s interesting about the eyes, I’m honestly not sure what to say about that.
In most (all) European states you actually get a state mandated ID card, which has an expiration date. So the consent can be formed while filling out the formular to get a new ID.
I think it’s interesting to ask whether people in the opt-out countries are really consenting. Can you really say someone has consented if you never actually made the request?
This is sloppy, but it's what I have time for atm:
From The Elements of Choice by Eric Johnson
It’s more complicated than the one example, and he covers it further, but as a rough guideline, it looks like forced choice and opt out are similar in this case. Which would make sense because the opposition is mostly religious and strict religious people are more motivated to opt out.
Wow, good source. 82% donor rate for the opt-out group versus 79% for the forced-choice is a smaller difference than I would have guessed.
It’s a decent book overall. If you’re interested in the theory behind choice architecture it’s worth a read.
But yeah, read it a couple months ago and remembered it specifically addressed this question.
Personally, I don’t really see that much value in the affirmative consent of the dead. Viable organs are hard to get, and save lives. I think it’s worth it to keep it opt-out.
I agree, but it raises an interesting argument regarding the definition of consent. I don’t necessarily believe in free will so I like to mention it in situations where you can easily see that people are more accurately described as reacting to their environment than making any kind of conscious choice.
Simply by changing from opt-in to opt-out, you mostly reverse the observed behavior of a population. Lots of applications for this sort of thinking, like voting for instance.
Germany is currently considering a third way: they ask you.
Everyone in Germany has health insurance, so the idea is that the health insurance simply asks you directly to decide. Most people are in favor of organ donation, but never actually get an organ donor card or talk to their relatives. Asking them to decide won’t get anywhere near the donor rates of an opt-out scheme, but it could drastically increase them.
In Ontario, Canada people can opt in when renewing their health card (a card used to access public healthcare) or driver’s license, and it probably does positively impact the rate of opting in, but it really doesn’t seem to address the need. I’ve been a registered organ donor since I was 16, but most people I’ve brought it up with aren’t.
I suppose if choosing an option is mandatory instead of voluntary then that would change things for the better. Is that what Germany is doing?
That sounds promising, I think you’re right that it would be a significant improvement in donor rates over the opt-in system.
Necrophilia has entered the chat
How do I opt-out?
Cremation
How do I opt in?
Yeah, the formulation is a bit off here. With opt-out, you have no way to measure consent, because you can’t discern between people who actually consent and those who just haven’t opted out, for lack of knowledge or other reasons.
These societies have simply weighed up the two options and decided that saving lives is more important than leaving personal freedom intact at all costs.
Ok but for most people it doesnt really matter with a dead body. If you opt out because of religion its okay have it your way but other than that its not like it matters, youre dead.
We don’t get their consent to be buried or cremated or whatever else people do with the remaining bodies of their loved ones. It’s just opt out. Why should organ donation, which provides a societal and personal benefit be different?
I’m pretty sure people do make their wishes clear regarding their funeral preparations. You can put that kind of stuff in your last will and I would assume it holds some legal weight.
I actually agree that organ donation should be opt-out, but there is an unavoidable argument against that. Namely, the fact that people have the right to opt-out at all implies that you have a responsibility to verify their informed consent before enrolling them in the procedure. At least, that would be the conventional wisdom according to the field of medical ethics.
Yes, you can choose to lay out your wishes. Many do, just like opt in or opt out organ donation. However, if you don’t lay out your wishes, you will still end up buried or cremated or something similar without consent.
I’m not saying that’s wrong. We can’t just leave dead bodies where they lie. It also provides comfort to families to practice burial rites. My point is that technically you are still making decisions about what to do with somebodies body parts without consent, as they can no longer consent. Is there really a difference? If they care that much, will they just opt out?
I know some countries, they used to let you specify which organs, but then people opted out of eyes. So they removed the option and it was just donor or not. People still consented, without opting out of eyes. Is that better, or is that manipulating consent?
That’s a good point, you’re right.
That’s interesting about the eyes, I’m honestly not sure what to say about that.
In most (all) European states you actually get a state mandated ID card, which has an expiration date. So the consent can be formed while filling out the formular to get a new ID.