It’s a scary time to be a liberal, isn’t it? In the past month alone, a business tycoon has managed to buy the censorship of a national newspaper, the journalist Jamal Khashoggi was murdered for criticising the Saudi regime and in the US, members of the Democrats were sent bombs in the post.
On top of all of this, last Friday, a private members’ bill snuck through an almost empty House of Commons for its third reading. The Organ Donation Bill, tabled by Labour’s Geoffrey Robinson, will change the way in which cadaveric organ donors (harvested from dead people) are registered.
This another nail in the coffin for individual autonomy. Or so some would have you believe.
Under the current system, nobody is assumed to be a willing donor and people have to opt into the donor programme. But if this bill passes through the Lords without delay, in early 2020 everyone will be presumed to be a willing cadaveric organ donor, and people will have to opt out.
This “nudge” will attempt to capitalise on people’s status-quo bias – an individual’s tendency to stick with the default – in order to increase the pool of organs available for transplants.
From my observations in the Twittersphere, it appears that many feel uncomfortable with the proposed changes. “You’re telling me that the government will be allowed to tear the liver from my dead body because it presumes I’d just be OK with that!” sums up their position.
This, they argue, is a serious violation of individual autonomy as it effectively places one’s body under state ownership without prior consent. However, shifting to an opt-out system for donating organs is not the enemy of freedom which many like to paint it as.
For brevity, let’s park the effectiveness aspect of the debate (if anyone doubts the capacity of an opt-out system to increase cadaveric donor registration numbers, take a look at the 1986 Belgian transition which saw registration rates increase by 55 per cent). Instead, I’d argue to my fellow liberals that this new system will actually improve individual choice.
The first point to make is that, although explicit agreement is not needed for your name to be added to the donor list, consent is still taken nevertheless. It just so happens that consent is signalled by not deferring from the default – but this is still an agreement in itself.
Implicit consent is not any less legitimate than explicit consent, as long as everyone understands its implications. For example, when the chair asks if there are any objections to a proposal at a board meeting, silence will be taken as consent, even though there may not be explicit agreement.
It is, therefore, up to the government to make the new opt-out system widely known and crystal clear, as well as relatively hassle-free – both of which should be straightforward.
An NHS survey from 2017 shows that about 80 per cent of the population support their organs being harvested for donation. But, despite this, only 36 per cent of us are actually signed up to the donor register.
If autonomy is the ability to make decisions affecting your own life, then surely the current system is falling short? If a majority of people are willing for their organs to be used for medical practices, but this only happens in a minority of cases, then an opt-out system would actually nudge outcomes closer to people’s desires.
Whereas a nanny-state policy tries to tell people how they should live their lives, this new bill simply helps people to get the outcome they want.
Ask yourself: “would I mind my organs being used by doctors to save others when I die?” If your answer is that you probably wouldn’t mind, have you ever even thought about signing up and, if you have, would you honestly ever get round to it?
Those who would on balance be willing to become a donor often can’t be bothered to go through the process of signing up despite it a simple task. And that’s if the thought ever even crossed your mind in the first place.
This could not be more different from people who do not wish their organs to be donated. Through either religious or ideological reasons, those who oppose being donors will be strongly compelled to make their wishes known. Is it not, therefore, sensible to place the onus on reluctant donors, who will almost certainly defer from the status quo, rather than on willing donors?
The truth is that in either an opt-in system or an opt-out system there are likely going to be people who fail to switch from the default even if they don’t approve of it. Under opt-in, there will be people who support becoming donors but forget to sign up. Under opt-out, there will be people who do not want their organs to be donated but forget to make this known.
Yet, if 80 per cent of us support being donors there would fewer mistakes under an opt-out regime because the status-quo bias will work in favour of the majority who support being organ donors, rather than the minority who object.
With this new law, we will move closer to ensuring that the desired outcome for an individual’s wishes is met, which is surely the liberal way.