In The Netherlands a similar bill has been submitted to our upper house for approval last September. I hope it passes, although there is vocal opposition against this issue.
From a society's perspective opt-out makes perfect sense. If you are really against organ donation, just register yourself as such; it takes all of five minutes. I don't even care why you would want to keep all your organs after death, it's not my call.
The reason to go for opt-out rather than opt-in is because a lot of people simply don't register their preference, even when they are, rationally speaking, all for organ donation — that's the critical point. Thinking about your own mortality sucks, and visiting the website where you can register yourself as a donor (necessary for the opt-in model) is something that hovers somewhere on the eternal to-do list, but somehow they never get around to it. Because it is never you that suddenly dies in a freak accident.
If you are against organ donation, you will however register that preference the moment such a bill is passed into law.
That's it. Statistics and psychology (and saving lives) are the reason states consider opt-out over opt-in. The state isn't invading your corporeal sovereignty, you are not being harvested for organs the moment you enter a hospital (well, not in France or The Netherlands at least), and you still get to decide.
"I don't even care why you would want to keep all your organs after death"
I don't, but I also want every measure to be taken to ensure I survive. With the corruption and dishonesty we've seen from the police all the way to the highest levels of government, I no longer believe my best interests will be honored. I used to be a donor, but I've lost faith in our institutions, especially when it comes to Healthcare. Do you trust insurance companies? If so, why?
Why is this downvoted? I think it's a valid concern.
How do you know that in some small village somewhere the local government isn't so corrupt as to make sure the organ donation process gets 'speeded up' to serve the need of some wealthy/influential organ recipient in waiting?
I didn't downvote, but I've got to say I don't think it is a valid concern.
If you honestly have so little faith in local government that you believe they would change the care options of a patient to "speed up" organ donation, what makes you think they wouldn't disregard the patients preferences on organ donation and just remove the relavent item after death and before handing the body over to the family?
Aren't you effectively saying that it's pointless to lock your house, because if a thief is immoral enough to enter and steal your TV, they'd be immoral enough to break the lock as well?
nope I'm saying that one is as easy or indeed easier than another. Once you assume an immoral authority has control over patient care it's frankly easier and less risky for them just to remove organs without patient consent after death, than deliberately give poor care to hasten the patient's demise.
a) My patient might be dead by the time the donor dies, less profit for me.
b) "deliberately poor care" or "generous amounts of painkillers"? The alternative phrasing is exactly how assisted suicide works in societies where it is not legal.
There is a paper trail, at least in developed countries with a formal waiting list. So a corrupt authority harvesting organs without consent cannot just use it without informing the registry about where the organ came from.
These corrupt doctors are willing to kill people and/or steal their organs, but they insist on notifying the registry before they put the stolen organs in the recipient? Sounds absurd, man.
If we've moved from opt-in to opt-out, what do you think is the next logical step in that path if not mandatory donation? And if the argument is that we should move to opt-out because "greater good", then what's the argument against mandatory donations?
This is slippery slope fallacy. The argument against mandatory donations is exactly that - it's makes donations mandatory, while opt-out gives you choice and just changes the default.
If you seriously fear for your life as a registered donor, it should be not too much work to check one box.
If there is mandatory donation, or even if there is opt-out, wouldn't that increase the supply to meet the demand, thereby reducing any incentive for profit on the sale of organs and eliminating any motive for corruption?
If the end justifies the means, then I think it's irrelevant whether the change causes demand to be met so long as more people get the organs they need. On the other hand, if you don't believe that the end justifies the means, then it's completely irrelevant because you have to respect people's choices over their bodies (even posthumously) even if you think they are misguided or 'selfish'.
"From a society's perspective opt-out makes perfect sense." It's very troubling to follow that line of thought. It's also arguably in societies interest to make all your private medical data publicly available for research and all your private communications, purchases and movements available to any government agency to prevent crime etc. How many people would be comfortable with what are considered by many to be fundamental rights being opt-in all of a sudden?
"The state isn't invading your corporeal sovereignty". It is, in the most fundamental and intimate way possible. If you support opt-out at least be honest about what it is. I carry an organ donation card but this is a line I think should not be crossed. There are alternative which don't make your body ownership opt-in (like doctors guidelines about approaching families etc).
> From a society's perspective opt-out makes perfect sense." It's very troubling to follow that line of thought. It's also arguably in societies interest to make all your private medical data publicly available for research and all your private communications, purchases and movements available to any government agency to prevent crime etc. How many people would be comfortable with what are considered by many to be fundamental rights being opt-in all of a sudden?
Straw man argument. People don't die with immediate effect for lack of public data.
> "The state isn't invading your corporeal sovereignty". It is, in the most fundamental and intimate way possible. If you support opt-out at least be honest about what it is. I carry an organ donation card but this is a line I think should not be crossed. There are alternative which don't make your body ownership opt-in (like doctors guidelines about approaching families etc).
You are dead. What rights do you really need and how are they violated?
While i support opt out, you do have rights after you're dead, otherwise your wills would have no power and you would not be able to leave inheritance.
> You are dead. What rights do you really need and how are they violated?
I see two possibilities. One, the state of my body affects what will happen to me. Two, I am mostly dead, and cryonics (and some future tech) could save me.
The first requires something supernatural. My probability: "no way in hell". The second requires cryonics to work. In theory, in practice, economically, and for me in particular. My probability: "one hell of a long shot".
Even if my organs do matter to my dead being, doctors still have lives to save…
Anyone who beliefs cryogenics will save them will surely make the proper arrangements, and will certainly register themself as a non-donor in any opt-out system. This is a non-issue if your mind is made up; you can opt-out, by design.
One may register for cryonics, and still donate organs.
I'm not sure I need my heart, kidneys etc. for future reconstruction. Important information might be located in the gut, but I'm sure we can extract many organs without touching those neurons.
Even then, I may be willing to sacrifice my hope of resuscitation to save lives today. And that's if I even bother registering for cryonics —as tempting as it is.
Once you're dead, there's no longer a "you" for your organs to belong to. At worst, they're violating the property rights of your next of kin, and even that is basically irrelevant in a place where selling organs is illegal.
I hope it doesn't pass, it's a move in a very wrong direction.
> The state isn't invading your corporeal sovereignty
Basically, that IS what's happening. The obvious sane solution would be to force people to make a choice, for example, when you request a new ID card you must register your preference. But now the default choice is already made for you. And that's of course exactly what they're aiming for, just as software vendors do with opt-out schemes.
It's a classic dark pattern. I think many of the people supporting opt-out know that people would say no if confronted with the question so they support what I would call an an underhand and sinister approach. See the OP's response below "I would fear that for many people being confronted with this choice when you are renewing your driver's licence means defaulting for the 'safe' option of non-donor."
On the one hand we have this underhanded, sinister manipulation. On the other hand, we have lives to save.
Personally, I side with the supervillain on this one. Hurt feelings (including religious delusions) are nothing compared to the good you can make with a person's organs.
That said, I still (reluctantly) support the possibility to opt out. Forcing people to give up their body after their death is likely to have consequences I don't want to deal with.
In the US in 2012 94% "strongly support" organ donation and 61% are actually donors[0], so at most we can expect to double the number of registered donors -- although depending on demographics of non donors that might mean a lot more actual donors since 2.5 million die annually but there are only 30,000 organ donations. The waitlist grows by a few thousand each year (was 117,000 in 2012), so doubling the number of organ donors would solve the problem in like a decade, assuming rates stay the same -- although I bet more people would get organ transplants if it was more readily available [1].
I don't know the number of people who don't want to donate their organs but even more strongly don't want to be on the "Selfish Assholes List" (which will inevitably be leaked (increasing distrust between citizens is a nice "cyberwarfare" play)), but I suspect it's non negligible. Maybe social pressure is for the greater good, but it is a tradeoff you should be honest about.
The "nudge" effect has had significant positive results [1] where it got introduced. It basically is the difference between a many year organ waiting list and getting a rapid transplant.
One never knows that they might eventually need an organ transplant. Two years ago I was feeling reasonably healthy for my age but internally a uncommon auto immune disease are fighting a battle and my kidney were losing it with hardly any symptoms of the damage. In a manner of months I had some joint pains that wouldn't go away and my weight started ballooning. I went to the doctor and he didn't take it seriously until tests indicated that I was stage 4 kidney disease. Generally at this point is it too late and kidney function may slowly degrade further over time.
I found my diagnosis at that point and even if discovered early the auto immune disease I have still doesn't have a cure to stop it other than treat the symptoms. My short term hopes are to stay healthy as possible and when required switch to dialysis and try to live a long normal life until I get a transplant. But in most places in the US, a kidney transplant takes 3-5 years on a list due to organ shortage. In many parts of the EU the wait is just under a year. Also organ transplant is not a cure in any way since one needs a lifetime of drugs to keeps prevent rejection but it is better than dialysis in trying to live a normal life.
On the question of organ donation being opt-in/out I certainly would like a shorter wait time but I would like people to be informed as much as possible to make a decision. I think much of it is people believing it will never happen to them that they need it. But just remember that on a roll of dice things can change for you without even knowing it.
The title of the article is misleading. France has had an opt-out sytem for organ donation for years. The only thing that has changed is that it is no longer required to consult relatives for a second opinion.
> Until 1 January, when the legislation took effect, unless the person who had died had previously expressed a clear wish for or against donation, doctors were required to consult relatives who, in almost a third of cases, refused.
You had to consult relatives and ask them: "do you know if the deceased was opposed to this"? This meant the way to opt out was to tell your relatives. It has been the case for 40 years. [1]
There were posters in most hospital waiting rooms telling people to do this (which I found creepy as I found myself there a few months ago, waiting for news on whether a relative would live or die, by the way). See [2] for an example.
Now the only way to opt out is to send snail mail (!) to be added to a nationwide file. It should become possible to do it over the Internet someday.
Fun fact - we have a pin card that has been designed to store that information since 2006, but the feature has never been made accessible to the public. [3]
Yes, I added a source (the first one) which confirms that. 32.5 % of the time the relatives said no, but polls showed that it should only have been 21 %.
Lying is a rather strong word, perhaps they thought that their relative was inclined to refuse donation. And default has no meaning here because they know that their answer decides the outcome; letting it fall to a “default” option decided by others seems to be rather irresponsible to the deceased relative.
Death is a rather traumatic event. Many people won't think straight in this situation. Some may just blurt out "no" because they're in no state to respond to any kind of request.
Wales has relatively recently moved to "opt-out". It appears to have already made a huge positive difference.
I was disgusted at how many people opted out though. The Welsh aren't generally thought of as selfish.
I had opted in long before the change, why would I hoard my meat bits when I die?
I should stress, in Wales at least, it is still worth explicitly opting in. The presumed consent only applies if you die in Wales. If you died on the wrong side of the Severn, like a trip to Cribbs Causeway over the border in England had a tragic twist, the presumed consent doesn't apply.
Defaults are an extremely powerful policy lever--sometimes worryingly powerful.
FWIW, Richard Thaler, who played a big role in creating the field of behavioral economics, has argued in favor of "mandated choice" for organ donations at the time people renew their drivers license [1]. His concern with default opt-in, as I recall from one of his books, is that defaults are so powerful that they may not really create implied consent.
Mandated choice sounds like a very useful mechanism, but I would fear that for many people being confronted with this choice when you are renewing your driver's licence means defaulting for the 'safe' option of non-donor.
The tricky thing about organ donation is that the default choice tends to be 'postpone deciding'. For society at large this is harmful. Hypothetically, if you could ask someone's ghost after they've died on the hospital table, I bet most people would gladly donate their organs (perhaps with the occasional “Oh but can you please leave my face untouched?” thrown in) after accepting their untimely demise. But we can't. So with opt-in and a with a mandated binary choice at a set time you go for the safe option, which is 'non-donor' (“I'll change it after I've thought it through.”).
Hypothetically, if you could ask someone's ghost [...]
I bet most people would gladly donate their organs
Don't you think it's a bit of a stretch to imagine you know someone's preferences better than they do when they've explicitly stated their preferences through a forced choice mechanism?
"Mandated choice sounds like a very useful mechanism, but I would fear that for many people being confronted with this choice when you are renewing your driver's licence means defaulting for the 'safe' option of non-donor."
But at that point, they have made a choice (as ill-informed as it may be) as opposed to one being made for them.
I'm an organ donor. I encourage others to do the same. That said, when a government makes choices about your body for you -- even if the choice seems "right" -- I find it a bit unsettling.
Freedom is measured best when the "wrong" option is chosen. It also illuminates those who just give such freedom lip service.
I don't disagree with any of that. The alternative though with opt out is that you're effectively not giving many people a choice because they don't get around to making one. Maybe that's ok as a matter of policy but it has both philosophical and practical issues.
Mandated choice is good when consent (implied or not) is more important than the outcome. Organ donations are different. I'd rather save lives first and ask questions later.
To avoid rocking the boat too much. There is a difference between the opt-out ruse and open coercion. The latter is more likely to cause problems I don't want to deal with.
Its an emotional subject. Doesn't it boil down to "I'm uneasy about thinking about what happens to my body after I'm dead" versus "Don't let living people die". One is, in my opinion, a much stronger argument.
That's not what the debate is. It's about the dark pattern of opt-out in which other people make the choice for you and being forced to opt out of it. Many people, myself included, are for organ donation but oppose opt-out as unethical and dangerous.
There's an equally compelling argument that 'opt-in' is a dark pattern, that 'makes the choice for you' and forces you to do paperwork. Its equally troubling to imagine your organs go to waste after you die because of incomplete paperwork. Why are not those concerned about that, given equal time?
In my case, it's "I'm not uneasy about thinking about what happens to my body after I'm dead, but I'm uneasy about 'tricking' people who might actually be uneasy about it". Where I think "I'm uneasy" is understating a feeling of which you might not understand the intensity if you're not feeling it that way.
The real and serious problem with this is that the organ donation process biases the medical profession into declaring you "dead" as soon as possible, and ideally even sooner, so that your organs are as fresh as possible.
Does this actually happen? I see this concern mentioned several times here, but always as a hypothetical. Has there been any research done to see if donors do indeed receive inferior care?
It's been like that in Poland for many years now, but in reality this doesn't really work since families are always asked before the donation and they usually refuse and the law doesn't really expect the doctors to ask the families but they still do it anyway, just to be on the safe side and not have to deal with repercussions like the family suing the doctor.
This seems like a perfectly sensible thing to do, honestly. If I were designing the system, I'd say that the default option is opt-out and that if you make an affirmative choice (yes or no) during your lifetime, that choice overrides your family's wishes, but otherwise your family gets a "veto" over your organ donation.
The whole problem that "opt-in" organ donation is that most people just do whatever the default is and no actual human decisionmaking takes place, so it's preferable to have sensible defaults. If a human is overriding the default, that's the desired behavior.
Families are typically out of their depth in these situations and completely dependent on medical staff to guide them in decisions regarding their loved one. Medical staff may confront the family with the question of organ donation before they have been able to internalize the decision to withdrawl life support. Without time to internalize the decision to withdraw life support families may feel that allowing organ donation may be bias medical staff and, even subconsciously, tip the scales.
Families may be uncomfortable with yielding control of their loved ones body to the medical establishment. The question of organ donation is presented as a binary choice to families (all or nothing) and requires a significant degree of trust in the medical community. They may worry that they are unwittingly consenting to donations of germ cells; that part of their loved one may end up in a student lab or that organ donation may delay a funeral.
Families may worry that donation will incur additional costs or that someone will profit from the deceased organs (see Henrietta Lacks and HeLa).
Also making an opt-in decision in any complex situation that requires unanimous consent of what is essentially a committee is typically going to result in no-action.
This would render the whole point moot. Why have a default in the first place if you always require an affirmative choice, either from the person or from the family?
That is basically the practical problem with an opt out system. Defaults are sufficiently powerful that lack of an opt out can't really (and really shouldn't) be taken as an affirmative choice.
Well, ideally yes you'd just enforce an affirmative choice here, but I think the whole point of having an organ donor registry is for time-critical situations like when you can't find someone to ask or when there is not clear person to ask.
The problem is verification. As things are today, you have to verify that a person has registered as a donor. If they are and you can't confirm it then nothing happens as far as that person is concerned. In the new system if you can't confirm someone is a non-donor they'll take all your usable parts.
I propose a compromise where every person is "supposed" to register their preference one way or the other. That would probably increase the number of registered donors, and if you can't find someone in the database you don't assume a default choice for them.
This has been the case in Belgium for about 20 years. The law does make it possible for the family to _refuse_ in case they have objections against it.
It is the default, but the family is still considered.
You can register your opt-out with a simple signed letter to the government.
I don't have the time to dig up the statistics right now, but the percentage of donors is considerably higher than, for example, in Germany, which is opt-in.
You don't have to be brain dead in Australia anymore either.. only your heart has to stop.
"Identify cessation of circulation (absence of circulation for a period of not less than 2 minutes and not more than 5 minutes)"
While the plain English information sheet cherry picks some severe cases..
"Generally they are patients with very severe brain injury from which they cannot recover. Less often, they are patients with terminal heart or lung failure, or have suffered a very severe spinal injury where they cannot breathe unassisted"
The actual protocol says...
"resuscitative attempts are either contraindicated on medical grounds, given that it has been determined that meaningful recovery of the patient is unlikely, or the patient (or the person with legal authority to make his or her medical decisions) has decided that resuscitative measures would be unduly burdensome."
Which pretty much gives the green light no matter what.
From an episode of "House", why not expand the pool of donors by accepting organs from old people or otherwise more marginal organs? If it's a matter of life & death for the recipient, wouldn't a more marginal organ be better than none?
Many will benefit from this change, but France should not force anyone to opt into what is a very personal and emotional decision. The government should not tell you what to do with your body even after death.
The online opt-out registry and opt-out form options will give people a chance to express their wishes to avoid donation. However, there will be a sizable portion of the population who do not fill these out due to ignorance, especially in the less advantaged fringes of society. What is the government going to do to make sure everyone knows about the change and the ability to opt-out?
In this case I respectfully disagree. If it's opt-in, many, many fewer people opt-in. The data on this is a striking and huge difference between opt-in and opt-out countries. All countries should change to opt-out because it would save a lot of lives - and that's exactly the kind of trade off between personal freedom and the greater good that governments are in the best position to make. That's why we have seat-belt laws and helmet laws and government vaccination programs, etc.
The tragedy in this is actually how long countries are taking to wake up to the data and take action. In Canada (BC anyway) it's still opt-in.
> If anything the opt out should be further restricted. You may opt out, but you'd need a valid reason. Any held superstition should not be grounds.
This is insane and a reason why some people would be against "opt-in by default" is fear of it expanding into something draconian like you are describing.
You don't respect religious beliefs(which you were clearly referring to derisively as "superstition"). Fine. But please don't advocate for your contempt to be codified into laws that discriminate against people different than you.
I'm all for making organ donation opt-in by default since I believe that accurately reflects most people's actual preference. But I'm not for tricking or forcing anyone into it. The default should be made clear and people should be able to easily opt-out for any reason they see fit or even no reason at all.
Is it? Is it really more insane than believing you need your organs after you are dead?
> But please don't advocate for your contempt to be codified into laws
Why not? People do it all the time :) At least my agenda benefits society by any objective measure.
> discriminate against people different than you.
How does it discriminate when it's the same for everybody?
> The default should be made clear and people should be able to easily opt-out for any reason they see fit or even no reason at all.
Isn't this the case in France?
I don't really care that much if people opt out, but I do think it should be harder to opt-out. Akin to conscientious objection in the face of a mandatory draft. Not that I wouldn't mind that the opt-out would be available only on very selective criteria.
On the one hand, we're weighting supernatural beliefs against real life-saving treatments. On the other hand, the backlash we can get from some religious people is just as real. God will never smite me, but his followers might.
More generally, I'd say this is not the right way to combat religion. There are reasons why we still have religions, some of them worth copying (helping your neighbour and such), some of them worth combating (such as fear and poverty). Going directly against he will of religious people is only going to get ugly.
Well, I feel that by the time a government can take decisions that are oblivious to any sort of superstition, religion included, the society will have matured so much than donating your organs after you die will be so obvious to be a non-issue.
> How do you know? Have you ever been dead? Do you know any people who have died?
As soon as anybody comes back from the dead to object, I'll reconsider my opinion. Until then I have no cause to believe that I or anybody else will need their body after we are dead. The living, however, most certainly do.
>> This is good for society.
> You don't know that either, unless you know the future. In this particular case, you can't rely on the past either.
Of course I know it's good for society: less people die due to donor organs. That's not up for debate. This will not change in the future either, until we can grow our own spare parts.
The government already has a say in what happens to one's corpse after death. There are rules and regulations, and procedures to deal with the corpse in the lack of other instructions or interventions.
If someone keels over and dies on the streets in Paris, the body doesn't just get left there to rot.
If there are arrangements in place, or if the next of kin get involved then those determine what happens to the corpse. Otherwise, it's the "default" option. I assume that's cremation, but I've not checked.
It takes a sensible default for organ donation too, and it takes explicit action to change the default. In the lack of explicit instructions otherwise from the deceased, they do the sensible default with regards to organ donation.
I carry an organ donation card and have taken part in organ donation signup drives. I find this appalling as well. It's equivalent to the government giving itself ownership of your body. How can't it change the relationship between patients and doctors? It's insane. People have also quickly forgotten the organ theft scandals of the last 40 years where hospitals stole organs from bodies for research and profit.
I suggest you do some research about the organ retention scandals in the UK and Ireland and how it affected grieving families. It's horrifying and would make any rational person seriosuly question opt-out organ donation given the unethical behaviour of hospitals for decades.
"According to Colgan, babies' bodies were filled with sand, so they would be the correct weight when loved ones held them for the last time. Pituitary glands of thousands of children (and some adults) were sold to pharmaceutical companies unbeknownst to their families."[1]
1)Ownership is a bit of a moot point at that point, because you are already dead.
2)Your wishes will still be respected assuming you took the relevant steps before you died. The difference now is that the default assumption is that you aren't selfish enough to deny life and quality of life to those who are left behind. It's not likely you need your heart, lungs, liver, corneas etc. You are, at this stage, already dead.
3)If one is sufficiently selfish to doom those in need of a transplant, there's a register for that.
4)Your body probably isn't going to just stay wherever you died anyway. The responsibility for dealing with it is transferred to others regardless, what with you being dead and all.
Sorry, you mean some critical organs used to save others lives after you die?
Or where you planning to use that lovely healthy heart after you die, when a patient in the next room is dying because they cant find a suitable transplant.
Living in any modern society means taking on some duties and obligations for the benefit of the society. This will bother you for five minutes in France before clicking 'submit' and getting on with your (hopefully long lasting) life. You would wish dealing with taxes was as easy that.
Besides, what are you going to do with your body? It'll be gone sooner or later.
The difference being, there's not much use for your heart once you're dead.
Not only that, but it's useless even for your family, since they can't simply sell it or profit in any way as they would with most things (unless you're also advocating for the family right to sell your organs).
Sure! Driving while stoned/drunk should be illegal so someone else's drug use doesn't kill me, and the draft has a place for true national emergencies like another world war or something like Yellowstone cooking off. I like being part of a society that doesn't look like a MMA free-for-all.
There's an angle to organ transplants that I've not heard discussed. We are who we are to a certain extent through DNA, when you receive a transplant you're receiving someone else's DNA, you receive all their genetic dispositions.
There's lots of cases of people undergoing personality changes after a transplant, as far as I know no-one has ever studied this in depth but it's real.
> Transplants don't save lives, they violate it in the worst possible way.
How? The recipient is consenting to receive. As for the donor, here's a tale about Diogenes of Sinope:
> When asked how he wished to be buried, he left instructions to be thrown outside the city wall so wild animals could feast on his body. When asked if he minded this, he said, "Not at all, as long as you provide me with a stick to chase the creatures away!" When asked how he could use the stick since he would lack awareness, he replied "If I lack awareness, then why should I care what happens to me when I am dead?"
From a society's perspective opt-out makes perfect sense. If you are really against organ donation, just register yourself as such; it takes all of five minutes. I don't even care why you would want to keep all your organs after death, it's not my call.
The reason to go for opt-out rather than opt-in is because a lot of people simply don't register their preference, even when they are, rationally speaking, all for organ donation — that's the critical point. Thinking about your own mortality sucks, and visiting the website where you can register yourself as a donor (necessary for the opt-in model) is something that hovers somewhere on the eternal to-do list, but somehow they never get around to it. Because it is never you that suddenly dies in a freak accident.
If you are against organ donation, you will however register that preference the moment such a bill is passed into law.
That's it. Statistics and psychology (and saving lives) are the reason states consider opt-out over opt-in. The state isn't invading your corporeal sovereignty, you are not being harvested for organs the moment you enter a hospital (well, not in France or The Netherlands at least), and you still get to decide.