Brainmatters | Choices in a system of options


Even people who were hiding under a rock last week cannot have missed it. A majority in the House of Representatives voted in favor of a change in the Dutch organ donation system. It was clearly noticeable that the majority was obtained by merely one vote: the discrepancy between supporters and adversaries was immense, ranging from great euphoria among patients on waiting lists for organs to anger among liberal adversaries who qualified D66 as rogue organ dealers.

In short, the change boils down to the following: at present the Netherlands has an ‘opt-in’ system, whereby somebody is not a donor unless they indicate otherwise. However, the House of Representatives has consented to a bill that states the opposite: the standard is that there is no objection to being a donor, unless you indicate that you do object (or not); a so-called ‘opt-out’ system.

The effectiveness of changing such a ‘choice architecture’ extends well beyond the fact that somebody now has to make an effort. Think of it as a family birthday where it is assumed that you will show up, unless you say you will not. Apart from the effort involved in opting out, other social and psychological factors come into play. Firstly the default choice of ‘going’ works like a social standard, so you soon assume that other family members will go to the birthday as well. Secondly, ‘going’ as a standard choice is a kind of recommendation, which makes it even more difficult to opt out.

These forces of the opt-out system also apply to organ donation. In countries with a similar system in Europe it is often more than 95% of the population who are potential donors, as against 25% of the population in the Netherlands now. Governments use such defaults also for other parts of the policy; for example, employees are automatically saving up for their pensions, instead of having to indicate this themselves.

Nevertheless the objections to the introduction of the organ donation system are understandable. Even if everybody is totally free to make a choice, an opt-out in this case is gnawing away at a basic right, namely the self-determination over one’s own body.

Most people are still born tired

That is why there are other, less radical options available which the government should certainly try out if the bill should fail in the Senate. Thus, in a number of American states the inhabitants are asked to make a donor choice upon the extension of their passports, and the English government tempts its inhabitants to make a choice after filing their electronic tax returns. Although these options evade the ‘controversial’ standard choice, they are a rather effective way of motivating passive citizens to make a choice. For most people are still born tired.

Alain Starke is a PhD at Human-Technology Interaction

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