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February 15, 2006

An Opt-In Revolution?

Actually, why isn't this a good idea? If it was understood that the default treatment assumption was Do Not Resuscitate/Intubate and you had to consciously opt-in to a different standard by providing a living will or offering written instructions at an earlier date, wouldn't that be better for everyone? There's no cost to claiming a different code status, but there's a huge cost, currently, when we assume the maximum. This would seem a more logical system all around.

For that matter, I also think folks should be considered organ donors unless they opt-out or their descendants raise post-death objections. We should err on the side of positive social outcomes, not huge spending and wasted organs (which translate into more wasted lives).

February 15, 2006 | Permalink

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You warm my utilitarian heart. Sadly, people's feelings of ownership over their organs (even after death, when it's hard to say you have any rights) will probably generate some opposition.

Posted by: Neil the Ethical Werewolf | Feb 15, 2006 4:02:57 PM

Great idea. We spend waaaay too much money on end-of-life care as it is, and it makes sense on an economic and moral level to have the default procedure to let nature take its course.

Too bad the right wing will accuse all of us that are for this process as genocidal maniacs. The Culture of Life and all that...

Posted by: verplanck colvin | Feb 15, 2006 4:04:41 PM

I'm for DNR and organ donation as the default, but I'd like to see some public opinion on this before I'd advocate it as Dem. public policy.

My guess is that some qualification on the DNR would gain a majority, such as "if in the opinion of the attending physician and the chief of hospital staff the injury or illness is some more likely than not to result in permanent incapacity to live or function without mechanical breathing assistance, then DNR orders will be issued, unless a living will or other legally binding written instructions from the patient or spouse/partner are available to the treating physicians". (my wording could certainly be clearer)

Organ donation by default is a harder call on public opinion. I won't even guess. Some education on this could probably change the numbers dramatically: this is a very poorly understood situation and the lifesaving benefits are important but probably not clear to most people - especially to the young who don't think they ever will have a fatal accident.

Posted by: JimPortandOR | Feb 15, 2006 4:11:09 PM

For that matter, I also think folks should be considered organ donors unless they opt-out or their descendants raise post-death objections. We should err on the side of positive social outcomes, not huge spending and wasted organs (which translate into more wasted lives).

Why not just allow payments to organ donors and/or their families? That would surely increase the supply of transplantable organs without breaching a person's right to bodily autonomy (yeah, even after death...the government doesn't gain control of my body just because I happen to die). I see a major problem with a policy (banning organ markets) that lets thousands of people die every year under the guise of protecting "the sanctity of life" (or the sanctity of organs, whatever.)

Lloyd Cohen has an interesting proposal along these lines.

Posted by: Adrienne | Feb 15, 2006 4:31:33 PM

For that matter, I also think folks should be considered organ donors unless they opt-out or their descendants raise post-death objections. We should err on the side of positive social outcomes, not huge spending and wasted organs (which translate into more wasted lives).
As lovely as that would be, it would also be unconstitutional. Some religions have strong views about being buried with all your bodyparts. First Amerndment and all that…

I like the idea of paying people for their organs, on the other hand. Consider that it could be a serious alternative to life insurance for the poor.

Posted by: Mastiff | Feb 15, 2006 4:42:29 PM

NO! how is this practical? under your rules, if you're in the ER with a heart attack and your doctor isn't one of the two or three people you've told about your end-of-life wishes, and only "heroic measures" can save you, you die. if your living will turns up later while your children dig through your leftover belongings and it says "i like living, so please save me," oh, whoopsies.

that's not okay at all. in emergency situations, the default absolutely must be saving the life. if a person is stable in a bad coma, then all the relevant people and papers can be consulted. but for emergencies, your idea is really awful, simply because there's no way your doctor knows you want to die.

i'm not a republican, but the notion that doctors should stop trying to save people's lives unless they have "please resuscitate. pretty please?" tattooed on their chests is a little sickening. what kind of values are those?

Posted by: jami | Feb 15, 2006 4:49:37 PM

I don't think opt-in works here. How many people are resuscitated or intubated under circumstances where their wishes can't be determined? What if there are disagreements among the next of kin? Don't try to decide this based only on the idea that the caregivers will certainly know if the patient wants to be revived.

Posted by: jackd | Feb 15, 2006 4:51:35 PM

This might work for terminal patients (though who exactly would get classified would be a very sticky issue), but for Joe Average who had a heart attack or fell in a pool, I think they'd want someone to revive them whether or not they had the foresight to create such a document and the fortune to have it on them when the accident occurred.

And I shudder to think at the impact on those too poor or too poorly educated to get themselves a living will.

Posted by: Royko | Feb 15, 2006 5:01:26 PM

people's feelings of ownership over their organs (even after death, when it's hard to say you have any rights) will probably generate some opposition.

If it were a matter of organ donation AFTER death, then I'd agree with you - but most organ donations are taken BEFORE you are actually dead. So I'd be absolutely against such an opt-out system; it would be a violation of fundamental rights, since organ donation involves killing you.

Posted by: Dadahead | Feb 15, 2006 5:05:39 PM

Problem with the organ donation is the same raised jami. Let's say I have strong religious objections to donating my organs, but the doctor doesn't know. I've been in a horrible boating accident (and didn't have ID on me). Religiously, not so good for me. So then the hospital donates my organs and gets sued by my family who found out about the accident a day later when i didn't show up for work. Not good for the hospital. Granted, someone else has hopefully lived, but now the hospital has another issue that isn't care for the sick to deal with.

Posted by: tweedledopey | Feb 15, 2006 5:35:33 PM

It's probably really not a good thing to leave life-or-death decisions as opt-in, given the number of people likely to prefer to be kept alive in various scenarios who might just not get around to it before some accident forces the situation on them.

Posted by: Iron Lungfish | Feb 15, 2006 6:17:12 PM

It's probably really not a good thing to leave life-or-death decisions as opt-in, given the number of people likely to prefer to be kept alive in various scenarios who might just not get around to it before some accident forces the situation on them.

That's the point, Lungfish. Ezra has found a dishonest way to get some of these people off the roles and save some money. The only problem is it smells of trickery, doesn't it?

Posted by: Fred Jones | Feb 15, 2006 7:34:23 PM

I think I would prefer to be implanted with an RFID that medical personnel can scan to know what my wishes are.

...

Posted by: Emma Zahn | Feb 15, 2006 8:42:14 PM

Jami's right, hence me calling it flawed and unethical.

Posted by: Graham | Feb 15, 2006 10:37:31 PM

I don't know what's up today but your sense of irony is charged on full : people are acting as if you're in your right mind when you're trolling for all you're worth on your own blog.

Posted by: opit | Feb 16, 2006 12:58:09 AM

Yeah, I gotta say this seems rather conflicting with the 'right to life' portion of the constitution.

Opt in might work for 401Ks or drug beneifts, but not at that one moment of life or death.

Posted by: Adrock | Feb 16, 2006 11:06:28 AM

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Posted by: judy | Oct 1, 2007 4:53:11 AM

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