When Good Intentions Backfire: Nudge Theory and Organ Donation Ethics

Addiction Economy Thought for Today - Fascinating article showing how the behavioural science of Nudge can make things worse. Here when an op-in default for organ donation was introduced donations decreased. For my purposes I am making it about about respect, assumptions about people and how instrumental good deeds, however honourable in theory, can back-fire.

"An important issue is that the deemed consent law challenges the longstanding norm in healthcare that emphasises explicit consent, and particularly the role of familial consent. This divergence from established ethical practices has placed healthcare professionals in a difficult position. They now face a dilemma – they want to respect the law and increase organ donations, but they also risk being perceived as overstepping ethical boundaries by “taking organs” without clear family consent.

"This fear of being seen as disregarding the emotions and rights of bereaved families has led to a high level of risk aversion among those responsible for implementing the law. Consequently, the processes involved in obtaining consent have become increasingly complex and cautious. This has undermined the law’s original purpose.

"A sympathetic understanding of this situation is crucial, however. The risk-averse stance adopted by official bodies is not a failure of intention but a reflection of the ethical and emotional complexities surrounding organ donation.

"The anticipated increase in organ donation has not materialised. Although the pandemic may have played a role in this, our research suggests that legislative changes alone are insufficient without addressing the underlying ethical tensions and the need for clear, compassionate communication with families during such difficult times."

Interested in what Dr Roger Miles, Christian Hunt, Ruth Steinholtz have to say about it. And whether changing back to opt in, and making that less bureaucratic and broadening criteria for assumed consent may be more respectful and ethical?