Today, my column on FindLaw (here by noon) discusses some of the controversy that kept the Senate from voting on Professor Cass Sunstein's April nomination as head of OIRA until the middle of September (he came to a vote last Thursday and was confirmed).
Sunstein co-authored a book in which he suggested that we might help alleviate the organ shortage in the U.S. by assuming, in the absence of an affirmative statement otherwise, that a deceased person had been willing to donate organs to patients in need of a transplant. My column discusses the general question of "default" settings -- what we (legally and customarily) assume until told otherwise -- and how such settings manifest themselves in the contexts not only of organ donation but of medical treatment, pregnancy, and abortion as well. Selecting a default setting can reflect anticipated preferences in the real world, or it may instead reflect a policy preference. In this post, I want to call attention to the related phenomenon of presumptions in evidence law to shed light on the operation of default settings in the organ donation context.
In the law of evidence, a presumption instructs jurors that if they find some basic fact to be true (e.g., the plaintiff mailed a stamped, properly addressed letter), they must conclude that the presumed fact is true as well (e.g., the letter arrived at its destination), unless and until the party that opposes the presumption offers evidence that the presumed fact is not true (e.g., sworn testimony from the defendant that he never received the letter). As in the case of default settings in the world at large, presumptions generally either reflect things as they are (e.g., odds are that a mailed letter arrived at its destination) or "nudge" the jury toward the party that has proved the basic fact, even if the presumed fact is not especially likely to follow from the basic fact (e.g., protect life insurance beneficiaries unless there is a strong case against doing so).
Once this nudge happens, it becomes the job of the opponent to come forward and make its case rather than sitting back and automatically winning without doing anything.
With respect to the pro-donation default, a person who does not want to be an organ donor at death would have to indicate explicitly (perhaps on a driver's license, perhaps by putting it into a will), "When I die, I want my organs buried or cremated and not shared with another person whose life might depend on receiving a transplant like the one that I am denying him." Having such a default accomplishes two things. First, it makes more organs available, because many people simply go with the default, whatever it happens to be. Second, and relatedly, it forces people who wish to act selfishly -- by insisting that life-saving medical resources be buried or burned rather than given to a patient in need -- to confront that selfishness and its consequences directly.
Some of those who ultimately do not "opt out" may actually have preferred not to donate but feel a sense of shame about their inclination. Requiring an opt-out thus makes it emotionally (and perhaps socially) more costly than it would otherwise be to refuse to donate organs.
What Cass Sunstein's default switch proposal does is therefore to make explicit some of the implicit and harmful decisions that might otherwise -- and improperly -- meet no resistance. If we are to be members of a society in which we purport to care about one another's health and wellbeing, it is more than appropriate that we take steps to ensure that it is costly -- if only socially and emotionally -- to choose to be a Bad Samaritan. And it is as appropriate to place such a burden on non-donors as it is to do so to parties in the context of a trial in which some facts, once proven, shift the burden of having to come forward and offer support for a competing vision.
Posted by Sherry Colb
Subscribe to:
Post Comments (Atom)
20 comments:
Hi Sherry,
I'm trying to reconcile the default donation position with support for inherent privacy rights.
In say, the reproductive rights arena, the default position handicaps the government -- there is no assumption that the state owns the decision in the absence of a woman's written personal rule.
Further, in the electronic communications context, privacy advocates typically prefer an "opt-in" framework to manage the use of personal information by marketers.
I can think of a few ways to clean this up, but I'm curious to read your thoughts.
thanks!
They are dead and no longer have any needs or desires for their organs. Opt-out should not even be an option.
The United States is a whole lot closer to an "opt out" organ donation system than most people know. Most people think you're assumed not to be an organ donor unless you sign up to be one. That used to be true, but it's not true any more.
Under the 2006 Uniform Anatomical Gift Act, an organ procurement organization (OPO) can assume you are an organ donor while they search for evidence of your true intentions. They can hook you up to artificial life support machines to keep your organs fresh, even if your advance healthcare directive says you don't want artificial life support. They can ask your family for permission to harvest your organs. They can ask a government bureaucrat for permission if they can't find your family. They can do all this even if the "organ donor" box on your driver’s license is blank.
The 2006 UAGA has been enacted in 39 states and the District of Columbia, including eight of the ten largest states by population (California, Texas, New York, Florida, Ohio, Michigan, Georgia, and North Carolina). Over 80% of the U.S. population lives in states that have enacted this law.
The 2006 UAGA stacks the deck against people who don't want to be organ donors. Unless your decision not to donate is documented in exactly the right way, OPOs can ignore your decision and ask your family or a government official to overturn it.
State organ donor registries, which OPOs must search under the 2006 UAGA, are also biased against non-donors. None of them, not a single one, will record your decision not to donate. They literally won't take “no” for an answer.
DoNotTransplant.com operates the only online donor registry that allows you to say “no” to organ donation in a way that will stand up under the 2006 UAGA. OPOs are required under the law to check this registry. If they find your name in the registry, they’re legally forbidden from harvesting your organs.
"The 2006 UAGA stacks the deck against people who don't want to be organ donors."
Great news!
The SPAM analogy egarber raises was actually what popped into my head while I read Sherry's post. Of course, the CAN-SPAM Act of 2003 is actually an opt-out law, not an opt-in law, despite the privacy rights advocacy egarber noted.
Is it inconsistent to have an opt-out policy for SPAM but an opt-in policy for organ donation?
In utilitarian terms, we can think of a choice of a particular default as reflecting a determination that the aggregate benefit of the default outcome ("B") outweighs the aggregate harm ("H") in getting it wrong (with both sides weighted by the probability of each event obtaining). So BP > H(1-P), where P is the probability that a randomly selected person's desires will align with the default setting.
In the SPAM context, an "opt-out" law like the 2003 Act means that the default setting is to receive SPAM. I think it fairly uncontroversial to say that P, in this case, will be virtually 0.
The harm, H, is significant. In addition to an invasion of privacy, as indicated by egarber, there is also the harm simply of having to wade through hundreds of emails in your inbox every day, some of which have viruses or links to viruses that can create catastrophic damage to your computer. SPAM costs businesses significant amounts of productivity.
The only way structuring the SPAM Act as an opt-out law makes sense, then, is if B, the aggregate societal benefits of having people receive SPAM by default, is so high that BP > H(1-P) is still true, even though P is extremely low and H is significantly high.
In the organ donation context, B, saved lives, is extremely high - it's hard to imagine higher stakes. H, the harm in taking the organs of a dead person who, when alive, did not want his organs to be taken upon his death, I submit is 0, or very low (I see the harm here as at best non-existent because dead persons cannot be harmed, just as they cannot be murdered, and at worst, as a frustration of desire, ala Thomas Nagel's argument for why death is an evil). So here, one would have to imagine a near-zero P, that is, that just about NO ONE wants to donate their organs in order to make BP > H(1-P) untrue under the opt-out regime envisioned by Cass Sunstein.
And if H turns out, metaphysically speaking, to be 0, notwithstanding people's stated preferences while they are alive, then BP > H(1-P) is by definition true when the default is opt-out (because we know P is not only greater than 0, but significant, because there are a significant number of people choose to donate their organs).
Nicely put, Tam! On egarber's question, the default rule (re organs and reproductive rights) is not whether the government or the individual owns the decision; it is whether we assume, absent evidence to the contrary, that the individual wants to sacrifice his or her bodily integrity. The right of privacy means that a person who does not want to sacrifice his or her bodily integrity and says "no" must have his or her wishes obeyed. For example, the default rule that "no means no" in sexual encounters translates into a "silence means yes" rule, and this is actually the more progressive of laws on the books, where force or threat need not be proved, yet we wouldn't say that people lack a privacy right in deciding with whom to have sex.
To play devil's advocate on the question of whether people should even be able to refuse to donate organs, I'd suggest that when people die, we do tend to honor their wishes regarding their property (so that, for example, they can leave millions of dollars to an already-wealthy child (who will, say, place the money under a mattress) rather than give the millions to a fund to provide cancer treatments for poor patients), and we might consider their organs to be an especially important form of property. I'm not sure I find this argument persuasive, but if we honor other dying wishes regarding a person's possessions, I'm not sure we are being consistent if we fail to honor their wishes regarding their body parts. (One response might be that unlike other kinds of property, body parts may not be sold on the market, and lacking the alienability of ordinary property, can serve no concrete purpose for the beneficiaries).
Thank you, Sherry. I actually forgot to answer the question I posed re: consistency. I suppose it's not technically inconsistent to have an opt-out regime for SPAM and opt-in for organ donation, but it does seem backwards.
Your implicit comparison of a mandatory donation law to the estate tax made me wonder about the possibility of avoidance behavior. I can't imagine that anyone would purposely damage their body while alive for the purpose of avoiding mandatory post-mortem donation. It might encourage intervivos donation (a friend choosing to donate a kidney to his ailing friend) to avoid having it donated to a stranger upon death, but that would generally be a good thing and in furtherance of the law's purpose anyway. (I'm thinking of the Curb Your Enthusiasm Episode where Richard Lewis needs a kidney and Larry David and Jeff Green both try to avoid being the friend who has to donate it.) I can also imagine people moving to another state at the end of their lives to avoid mandatory organ donation. Putting aside the practical fact that those who can ascertain the time of their death with that level of precision are either too ill or too old to be donation candidates anyway, it seems to me such a move might raise an interesting long-arm jurisdictional question.
我們提供融資服務需要的人及工商融資週轉不靈的朋友們融資手續簡便資料保密工商融資撥款快速值得您的信賴催眠心靈探索課程,催眠前世今生以催眠探索問題根源,圓滿你的人生現在法拍屋正熱現在進場買法拍屋正是時候台大翻譯社是國內最久等台北寵物認養俱樂部提供迷你瑪爾濟斯狗狗認養及迷你紅貴賓狗狗認養全部只要補貼飼料費就可以您需要寵物買賣歡迎來電洽詢
他們老闆還開一家翻譯社他們利用催眠的方式讓瑪爾濟斯睡著後來因為怕吵到他請看護馬麗亞抱他到房間睡此時外勞阿力來找她說人力仲介公司老闆今天要請客問他要不要去老闆公司最近需要工商融資因為資金週轉不靈整個公司的運作都受影想所以需要融資服務公司的廣告業務也不太好於是也的工作真是屋漏偏逢連夜雨老闆生病他之前買遠雄人壽公司所出的無上線終身醫療險因為忘了繳費被停止保單服務了。
法拍網提供線上全國法拍屋法拍屋流程,法拍代標,法拍屋知識,代標等服務今日銀樓 黃金價格, 國際 黃金價格 查詢, 買 賣黃金 走勢, 銀樓 黃金回收舊金回收, 食用消化酵素高之水果,幫助消化,吃完粽子可立即食用消化酵素含量高的木瓜提供 白蟻及消毒蟑螂, 老鼠..等各類害蟲驅除的專業 除蟲公司來幫你吧。
兼差
台北酒店經紀
酒店經紀
酒店打工
酒店兼差
酒店兼職
酒店工作
酒店上班
寒假打工
暑假打工
酒店
禮服酒店
合法酒店經紀
喝酒
酒店消費
制服酒店
酒店喝酒
婦幼徵信社-外遇
徵信社首選南愛徵信社
抓姦│偵探│私家偵探-成功徵信社
離婚|徵信婦幼有限公司
徵信-中華民國徵信專業經理人協會
徵信社首選大愛徵信社
中華民國工商經濟市場調查徵信協會
奇美徵信社
抓姦|離婚專業服務
外遇.大老婆徵信社
兩岸徵信社
海峽偵探│偵探社
偵探│私家偵探 推薦婦幼徵信
抓姦-專業大陸抓姦達網
婚姻挽回協助所
外遇|抓姦追蹤器
MONEY徵信社專業調查
外遇|MONEY帳款催收部
徵信器材網
鴻海徵信社
徵信社品質保障關懷協會推薦-遠傳徵信社
外遇-債務催收徵信社
外遇調查哨|外遇
鴻海徵信社
大統徵信
警民徵信
婦幼徵信社-外遇
徵信社首選南愛徵信社
抓姦│偵探│私家偵探-成功徵信社
離婚|徵信婦幼有限公司
徵信-中華民國徵信專業經理人協會
徵信社首選大愛徵信社
中華民國工商經濟市場調查徵信協會
奇美徵信社
抓姦|離婚專業服務
外遇.大老婆徵信社
兩岸徵信社
海峽偵探│偵探社
偵探│私家偵探 推薦婦幼徵信
抓姦-專業大陸抓姦達網
婚姻挽回協助所
外遇|抓姦追蹤器
MONEY徵信社專業調查
外遇|MONEY帳款催收部
徵信器材網
鴻海徵信社
徵信社品質保障關懷協會推薦-遠傳徵信社
外遇-債務催收徵信社
外遇調查哨|外遇
鴻海徵信社
大統徵信
警民徵信
婦幼徵信社-外遇
徵信社首選南愛徵信社
抓姦│偵探│私家偵探-成功徵信社
離婚|徵信婦幼有限公司
徵信-中華民國徵信專業經理人協會
徵信社首選大愛徵信社
中華民國工商經濟市場調查徵信協會
奇美徵信社
抓姦|離婚專業服務
外遇.大老婆徵信社
兩岸徵信社
海峽偵探│偵探社
偵探│私家偵探 推薦婦幼徵信
抓姦-專業大陸抓姦達網
婚姻挽回協助所
外遇|抓姦追蹤器
MONEY徵信社專業調查
外遇|MONEY帳款催收部
徵信器材網
鴻海徵信社
徵信社品質保障關懷協會推薦-遠傳徵信社
外遇-債務催收徵信社
外遇調查哨|外遇
鴻海徵信社
大統徵信
警民徵信
thanks so much for that great blog and thanks also for accepting my links thanks
طريقة عمل الدونات طريقة عمل البان كيك طريقة عمل الكنافة طريقة عمل البسبوسة طريقة عمل الكيك طريقة عمل عجينة البيتزا فوائد القرفه
thanks so much i like very so much your post
فوائد الحلبة فوائد الزنجبيل فوائد الرمان فوائد زيت السمسم علاج البواسير فوائد البصل فوائد اليانسون فوائد الكركم فوائد الزعتر قصص جحا تعريف الحب علامات الحمل
台中徵信社價格,合法徵信社,感情挽回,外遇,財務公司
徵信協會 ,合法徵信社,免費法律諮詢,外遇徵兆,
台中徵信社,免費諮詢律師,徵信社工作,徵信,外遇問題,抓姦,合格徵信社,徵信社工作
心理醫生,捉姦,新竹徵信社,徵信社收費,徵信公司
基隆徵信社,女人徵信社,尋人徵信社,女人徵信社,合法徵信社,外遇徵兆,法律諮詢免費
外遇搜證,徵信社推薦,尋人啟事,徵信社工作,台中徵信社,女人徵信社
蒐證,徵信,桃園徵信社,婚外情,法律諮詢
徵信社工作,財產徵信,第三者,尋人查址
彰化徵信社,台中徵信,免費法律諮詢,政府立案徵信社,出軌
合法徵信社,法律諮詢,小三,律師,婚姻挽回,徵信社價格
台中徵信公司,通姦,離婚,婚姻,感情挽回
外遇解析,女人徵信社,外遇抓姦,法律諮詢服務,
免費法律諮詢,外遇蒐證
外遇抓姦
penyakit kencing bernanah gonore Obat menghilangkan kencing nanah dari mbah dukun cara menghilangkan nanah dari kemaluan cara menyembuhkan kemaluan keluar nanah
cara herbal mengobati penyakit kanker herbal kanker apakah obat tekanan darah penyebab apakah pengobatan kanker yang ada benar obat kanker resiko kanker dari alkohol herbal kanker pengobatan kanker mesothelioma obat herbal penyakit kanker
cara herbal mengobati penyakit kanker herbal kanker apakah obat tekanan darah penyebab apakah pengobatan kanker yang ada benar obat kanker resiko kanker dari alkohol herbal kanker pengobatan kanker mesothelioma obat herbal penyakit kanker
cara mengobati bintik kutil pada kelamin dan cara mengobati menghilangkan kutil dan cara mengobati kutil kelamin dan kelamin keluar nanah dan obat kutil kelamin dan obat kutil kelamin tradisional dan peyakit herpes genital dan infeksi herpes simpleks dan apa penyebab dan bagaimana herspes bisa dan apa penyebab dan bagaimana herspes bisa dan cara pencegahan penularan herpes dan bagaimana penyakit herpes bisa menular yang tentunya sangat berbahaya
cara mengobati bintik kutil pada kelamin dan cara mengobati menghilangkan kutil dan cara mengobati kutil kelamin dan kelamin keluar nanah dan obat kutil kelamin dan obat kutil kelamin tradisional dan peyakit herpes genital dan infeksi herpes simpleks dan apa penyebab dan bagaimana herspes bisa dan apa penyebab dan bagaimana herspes bisa dan cara pencegahan penularan herpes dan bagaimana penyakit herpes bisa menular yang tentunya sangat berbahaya
Obat kencing Nanah De Nature Obat Herbal obat Kutil Kelaminobat kanker payudara stadium 3 kanker serviks obat kanker serviks obat herbal kanker
Post a Comment