As I’m currently in the process of writing something a little more substantial about the ethics of donations, in particular donations connected with incentives, I found the assignment set this week by Dan Ariely in his Coursera class on Irrationality particularly interesting. Dan asked us to come up with a theoretical solution to a real world problem using some of the observations and experimental results regarding people’s irrational behaviour. I found the reading regarding organ donation particularly fascinating, especially the fact that, despite people being sure that they would only reach such an important decision after careful consideration, most of us in fact do make snap decisions about certain big decisions and are heavily influenced by our environment. This opens up interesting policy questions about to what extent we can or should use our understanding of people’s behaviour to influence their decisions. I, for one, have found myself more than once debating whether an “opt-out” or “mandated choice” system should be implemented at national level (incidentally, I think the standard “opt-in” model to be far too ineffective to defend, and in fact, due to its connection to sadly low levels of organ donation, unethical to leave in place). You can read my short suggestion below, keeping in mind I wrote this quickly at the end of the work-day, as I was about to leave the office. Nonetheless I think it might be a point worth exploring.
A serious issue facing many societies today is the lack of organ donations for transplantation. Being registered as a donor is of utmost importance because of the difficulties and delays of having to ask the families of the victim of a tragedy to make this decision during a time of grief. For example, in the UK fewer than 5,000 people each year die in circumstances where they can become a donor.[i] Though, in theory, many people would be prepared to donate some of all of their organs after death, it seems that many simply do not think about this decision before it is too late. A market research study undertaken by Optimisa Research in the UK in May and June 2013 found that; “54% of those questioned have not seen any recent publicity about organ donation. One third say it has never come up in conversation.” They further found that “51% of those questioned are definitely willing to donate some or all of their organs. 31% would consider donating some or all of their organs“ and importantly that “Key barriers to donating personally include a mistrust of medical professionals, a discomfort in thinking about death and a lack of education about the donation process.”[ii]
This problem is exacerbated by some of the issues we discussed in class such as status quo bias, where, despite the fact that we generally feel that we have well thought-out positions on important decisions, we in fact seem to be substantially swayed by whatever position is the status quo. One of the examples here was precisely the theme of organ donation. The landmark study by Johnson and Goldstein in this area found that in countries where people must make the active decision to “opt-in” to organ donation, the ultimate donation levels were much lower than those in which donation was the default and people may “opt-out”,[iii] as “defaults impose physical, cognitive, and in the case of donation, emotional costs on those who must change their status.”
This can be a tricky problem to address, as many people could backlash against an opt-out system (despite the findings saying it is beneficial) and some academics are critical opt-out systems for moral reasons; many, such as Dr. Gill Haddow of the University of Edinburgh, suggest alternatives such as the “mandated choice” model, in which much of the inertia about reaching a decision is removed by forcing the decision be made.[iv] Davidai, Gilovich and Ross point out that “imposing a penalty on behavior one would like to discourage, such charging a fee for parents arriving late to pick up their children from day care[v], might seem like a sensible policy because it makes the behavior more costly. However, if people think of it as a price instead of a penalty, it paradoxically can produce more of the very behavior one wants to discourage.”[vi] It is possible though, that even forcing a decision under mandated choice models could cause a backlash.
To best go about addressing this problem, it might be helpful to take a few lessons from other areas of the course, in which we discuss ideas such as “the cost of zero”, and “the cost of social norms” (respectively chapters 3 and 4 of Dan Ariely’s book Predictably Irrational). One of the findings about “zero” is that people are disproportionately drawn to anything offered for “free”. Thus, people might be enticed to undergo a few medical tests (which could test suitability for organ donation) if it was offered for “free”. These tests might well benefit the potential donor, nonetheless they might not have undertaken them otherwise, or if they had to pay a consultant’s or GP’s fee. Though this would incur some cost for healthcare authorities, it would bring a number of potential donors to their attention, and have the added benefit of in-advance determining the suitability of any donations. Once these “free” blood tests and/or exams were done, the participants could be required to fill out a form indicating their preferences for organ donation. This would have the double benefit of “mandating” the choice in a friendly environment, also doing so under circumstances where no money had changed hands and, as such, the interaction was regulated by “social norms”. Having received the “favour” of a free test, the participants would be more likely to do the “favour” of signing up to be a donor.
[iii] Johnson, E., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339.
[iv] Wellcome Trust, In or Out?, video interview with Dr. Gill Haddow http://www.wellcomecollection.org/whats-on/events/in-or-out/gill-haddow.aspx, PDF transcript available at http://www.wellcomecollection.org/whats-on/events/in-or-out/idoc.ashx?docid=a6f05217-ddff-4b06-98af-0f5106097cd3&version=-1
[v] Gneezy U, Rustichini A (2000) A fine is a price. J Legal Stud 29:1–17.
[vi] Davidai, S., Gilovich, T., & Ross, L.D. (2012). The meaning of default options for potential organ donors. PNAS, 109(38), 15201-15205.
Photo Credit: <a href=”http://www.flickr.com/photos/dade_f/7537830246/”>Dade Freeman</a> via <a href=”http://photopin.com”>photopin</a> <a href=”http://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a>