Organ donation becomes opt-out in France
theguardian.com
theguardian.com
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, 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?
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?
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?
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.
And here some story reported in 2012, in Germany (English article, though): http://www.spiegel.de/international/germany/organ-transplant...
If the system has broken down to where doctors will kill patients for the nearby wealthy person, why not just kill you outright to steal your organs?
And, if someone thinks the system is so corrupt that those processes aren't followed, I'm not sure what laws etc. will make a difference.
You argument makes sense if a state made organ donation mandatory, but I don't think any country has such a law.
If you seriously fear for your life as a registered donor, it should be not too much work to check one box.
"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).
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?
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…
(by the way, I'm pretty sure that's what inspired the live heads in jars in Futurama.)
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.
I'm also good with door number two. If you are to be cryonically preserved then you should not even need to opt-out as you are not "dead".
> 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.
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.
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 real solution is artificial organs.
[0] https://imgur.com/a/qoeUR charts taken from https://www.organdonor.gov/dtcp/nationalsurveyorgandonation....
[1] http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916...
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.
> 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.
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]
[1] (fr) http://www.lemonde.fr/les-decodeurs/article/2016/12/22/don-d...
[2] (fr) http://fr.slideshare.net/amfe/guide-du-don-dorganes-2015-de-...
[3] (fr) https://www.agence-biomedecine.fr/Carte-Vitale-2-et-don-d-or...
Organ donation has been opt-out in France since the first law on the subject in 1976.
The only new thing in 2017 is that you can now easily opt-out online.
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.
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.
[1]http://www.nytimes.com/2009/09/27/business/economy/27view.ht...
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
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.
In any case, I'm not the one making the claim, so I'm not the one who has to back it up.
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 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.
Knowing doctors I find that fear extremely implausible, but it exists.
I am not sure this change makes any difference.
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.
It is the default, but the family is still considered.
And a link, in Dutch. I'm not sure how well you'd fare with google translate so sorry for that: http://reborntobealive.be/orgaandonatie/belgische-wetgeving-...
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.
"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.
http://www.donatelife.gov.au/national-protocol-donation-and-...
If I got a Euro for ever time someone made that mistake... ;)
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?
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.
In civilized countries secular law trumps religious law.
Aye, there's the rub.
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?
> 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.
> 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.
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.
Which they wouldn't have done if there was a ready supply of donated organs, instead of a critical shortage.
"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] http://www.independent.ie/entertainment/books/the-scandal-of...
> The Alder Hey organs scandal involved the unauthorised removal, retention, and disposal of human tissue
The key word is unauthorised.
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.
In any case your desire to not donate your organs to help others can and will be respected.
Why is it only Americans who have these strange 'screw everyone else' tendencies and opinions which seem to fall apart at the slightest scrutiny?
Besides, what are you going to do with your body? It'll be gone sooner or later.
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).
In most developed-world societies, definitely not. There are extensive restrictions on suicide, volunteering for cannibalism, disposal of bodies, etc.
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.
Can An Organ Transplant Change A Recipient's Personality? Cell Memory Theory Affirms 'Yes' - http://www.medicaldaily.com/can-organ-transplant-change-reci...
This study confirms behavioural changes but puts it down to 'fantasy' - https://www.ncbi.nlm.nih.gov/pubmed/1299456
Another paper - http://www.namahjournal.com/doc/Actual/Memory-transference-i...
Transplants don't save lives, they violate it in the worst possible way. And allowing the state to harvest your organs without your consent is bad.
The alternative is regrowing the needed organ from your own cells and using that, there's already been some progress growing them from stem cells.
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?"
Wait, what? I don't even know where to begin. That whole sentence does not make any sense.
> And allowing the state to harvest your organs without your consent is bad.
So opt-out and call it a day. Not that I oppose mandatory organ donation.
I'm not even going to touch that cell memory theory.