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MBlume comments on Beware Trivial Inconveniences - Less Wrong
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I've felt for a long time that the same solution should be implemented for organ donation.
(Actually, there's a case to be made for "screw your sentimental attachment to your meat parts -- we can save lives". But soft paternalism is a start.)
I agree with you 200%. I think a couple of countries in Europe might have that. I heard Brazil used to have it, but had to change it when stupid people got angry.
Organ donation is a tricky thing, and people don't think rationally when confronted with the death of a loved one.
I'm from Singapore, where we're automatically registered as organ donors and the majority of us are cremated after death, so organ donation shouldn't really be that much of an issue.
Sadly(?), medical science has advanced to the point where we can be kept "alive" despite being brain dead, and it is from these corpses that the organs with the best chance of a successful transplant can be obtained. It's hard to expect a family to accept organ donation when they can see that the loved one still has a heartbeat, even if the heartbeat is produced with the aid of life-support machines.
If the hospital takes a "screw you, you're stupid and we're taking your organs" attitude, the inevitable backlash has no winners and the law will end up changed. It took a lot of cajoling from our governmental mouthpieces to soothe public sentiment when that happened.
There are two of you?
-- New York Times, The New, Soft Paternalism
Perhaps he feels twice as strongly (by some measure) about the issue than he estimates I do?
Huh. That actually makes sense. I withdraw my objection.
(Eric S. Raymond called me a "hyperintelligent pedantic bastard" at Penguicon 2009. I was flattered.)
How do you feel about allowing the sale of organs?
I fear the massive levels of abuse it could bring -- the possibility that someone would commit suicide because their organs can take care of their family and they can't, that someone's organs could be used as collateral in a loan à la Merchant of Venice, and of course, the temptation to gain the organs of others by force..
On the other hand, I would question what the market value of various organs would stabilize at if everyone were allowed to participate. Perhaps there'd be more potential donors than participants and the prices would stabilize to a reasonable level, discouraging abuse.
Has anyone attempted an analysis on this issue?
Actually, what if it were handled through insurance? What if opting to donate decreased your health insurance premiums by an amount settled at by actuarial tables and the likelihood of your dying with usable organs etc. etc. and then your insurance company got to sell your organs when you died?
Regarding my insurance company getting to sell my organs after my death...
No. Emphatically no.
This is a very, very bad mis-incentive for the insurance company toward my continued well-being. I'd rather have the current system, where because of continually rising premium rates, the insurance company has the incentive to keep me alive for as long as possible. (Note that I do think the current system is broken as-is, but that is a discussion for another day.)
Only the last is an abuse. The preceding points were merely uses that you're uncomfortable with.
I wish people would get this straight. Just because you're uncomfortable or disapproving of a particular utilization of a right or ability doesn't constitute an abuse of that right or ability.
Because "disapproving of" means that the right or ability doesn't comply with the speaker's moral values, while "abuse" means that the right or ability doesn't comply with objectively correct moral values?
I wouldn't classify that as abuse, but I can see how some would.
Yes, that seems like the biggest concern.
I'm not sure. There was a story a little while ago that Singapore was considering moves in this direction but it subsequently turned out to be inaccurate.
Your insurance idea is interesting, though it also sounds open to potential abuse.
Two possibilities:
a) someone rationally chooses such an action because they have no better options.
b) someone is mentally ill, depressed, etc. and drastically undervalues the future worth of their life.
I would consider the fact that a) can happen to be indicative of something fundamentally broken in the society in which it occurs -- there should be better options. Of course, simply disallowing the deal doesn't necessarily address that, merely sweeps it under the rug.
I would consider b) abuse. I consider paternalism to carry with it an intrinsic evil, but there are greater evils, and the loss of a human life because of a potentially temporary confusion is one of them
Even if another human life is saved in the process? That is after all the context here.
Sounds awesome to me. Some people get organs they need. Others get money. Even the "nightmare" scenarios only really occur when there was a pre-existing and serious problem. Usually the organ sale doesn't make things much worse.
Kieran Healy over at CrookedTImber presents evidence that, while opt-in vs. opt-out does make a difference to whether individuals agree to donate, this doesn't necessarily translate into differences in actual organ procurement rates, and argues that the real bottlenecks in many countries are organizational/logistical.
The apparent lesson: Don't assume that just by removing the obvious trivial obstacles, the problem will be solved. There may be less trivial obstacles lurking in the background.
P.S. Reading off the graphs, Austria, Belgium, France, Hungary, Italy, Norway, Poland, Portugal, Spain, Sweden, and Switzerland all appear to have presumed consent.
Mandatory donation would really screw you over if you were trying for cryonics.
Given mandatory donation, it seems reasonable to me that opting out of it would be standard part of the paperwork involved with signing up for cryonics.
If you can opt out of it, it's not mandatory! You could get the best of both worlds, though: vitrify your head and donate the rest of your body. The only loss is, I think, your corneas.
The process of vitrifying the head makes the rest of the body unsuitable for organ donations. If the organs are extracted first, then the large resulting leaks in the circulatory system make perfusing the brain difficult. If the organs are extracted after the brain is properly perfused, they've been perfused too, and with the wrong substances for the purposes of organ donation.
Oh, thank you! I didn't realize that. Perhaps a process could be developed? For example, maybe you could chill the body rapidly to organ-donation temperatures, garrote the neck, extract the organs while maintaining head blood pressure with the garrote, then remove the head and connect perfusion apparatus to it?
It's worse than I said, by the way. If the patient is donating kidneys and is brain dead, the cryonics people want the suspension to happen as soon as possible to minimize further brain damage. The organ donation people want the organ donation to happen when the surgical team and recipient are ready, so there will be conflict over the schedule.
In any case, the fraction of organ donors is small, and the fraction of cryonics cases is much smaller, and the two groups do not have a history of working with each other. Thus even if the procedure is technically possible, I don't know of an individual who would be interested in developing the hybrid procedure. There's lots of other stuff that is more important to everyone involved.
Right, but I assumed that Julian was still talking about Yvain's idea that Mblume referred to, where the government-mandated system is not strictly "mandatory" but rather the default option from which you can opt out.
I was just going to talk about a similar research. So imagine my delight when you mentioned this!
This was actually done! I heard this in a talk by Dan Arielly (of "Predicatably Irrational" fame), which he called "his favorite social science research ever."
Basically, in countries in which you opt out of organ donation (I think these were some Scandinavian countries), the percentage of organ donors was really high. In countries where you "opt in" to organ donation, the percentage of organ donors was really low.
Okay, here is what a simple Google search yielded:
http://scienceblogs.com/cognitivedaily/2008/10/dan_ariely_at_davidson.php
Not a good case. Not in any place with even a remote concern for liberty or natural rights. Unless, of course, that place also disallows inheritance; in that case, it could be argued that you don't own your body after you die.
I remember reading about this being tried somewhere. The response was that there was less donation because people didn't like the idea and took the "screw you!" attitude.
I don't remember where I read this, but I can try to find it if you'd like.
I would like to see it, considering that at least two other people are saying the exact opposite.
Hmm... I can't seem to find it =\
That's how it works in Poland. You can opt out of organ donation if you want. Almost nobody bothers.