Originally published on Spiked.
Organ donation is a contentious issue. As it stands in the UK, losing a close relative can suddenly mean a difficult decision on whether or not to donate their organs, especially if they did not indicate any prior consent. There are moves towards ‘presumed consent’ – where it is assumed, unless otherwise indicated, that the deceased’s organs can be used. This is a controversial idea, put forward in the context that Britain lags behind the rest of Europe with the lowest number of available organ donors. Around 1,000 people die each year waiting for a transplant. The marketing of donor cards persuading people voluntarily to give their consent to donation has failed to increase the supply of much-needed organs.
However, the results of an investigation by the National Health Service’s Organ Donation Taskforce released in November found that while people do support donation, there is little evidence to suggest that a presumed consent system would result in more available organs (1). Instead, the taskforce concluded that what matters most is a well-established support network of donor specialists and consultants who are on hand to assist relatives and ensure recipient patients receive the right organs.
The debate about organ donation reveals a lot about attitudes towards giving the public the freedom to choose. So even though the UK government is set to provide £4.5million for a much-needed drive to recruit more donors, prime minister Gordon Brown has threatened that legalisation will follow if the campaign fails. The issue of whether to run an opt-in or an opt-out scheme is a genuine dilemma, given the competing demands of patient choice and the need for organs. However, as the book Nudge: Improving Decisions About Health, Wealth, and Happiness happily tells us, left to our own devices, we tend to make bad, uninformed choices – ignoring the harsh reality, for example, of a depleted supply of badly needed organ donors. Nudge‘s authors, Richard H Thaler and Cass R Sunstein — experts in what is known as ‘behavioural economics’ — suggest the solution lies in establishing a ‘default option’: presumed consent.
In what they term ‘libertarian paternalism’, ordinary people need help making the right choices in their best interests, especially when they are unaware of the facts to make an informed choice. This is libertarian, they argue, because there is no need for government coercion (we are still free to choose to ‘opt out’); and it is paternal because government is able to offer a gentle guiding hand to ‘nudge’ us in the right direction, towards the choices we must make. In this sense, everyone is a winner – apparently.
Unsurprisingly Nudge has many fans across the political spectrum, including the US president-elect, Barack Obama, the director of the Royal Society of Arts, Matthew Taylor, and the UK Conservative Party’s shadow chancellor of the exchequer, George Osborne. In fact, Nudge excited Osborne so much that he used it to take the intellectual high ground against Gordon Brown’s lame-duck government earlier this summer, proclaiming in the Guardian that ‘our work with the world’s leading behavioural economists and social psychologists is yet more proof that the Conservative Party is now the party of ideas in British politics’ (2).
“Nudge is a retreat from political debate, replaced by a psychological agenda that appeals to our base urges”
The poignancy of Nudge’s argument is in the cover it offers the establishment, helping politicians to appear benevolent at a time when they have little to offer us in terms of a progressive agenda. Instead Nudge offers them a glimpse of how to establish renewed leadership over many difficult social problems, including obesity, smoking and safety. It could even, so we are told, encourage wider adoption of environmentally friendly lifestyles. But all of this comes at a cost; not to the establishment, but to us.
George Osborne clearly believes that Nudge presents a rigorous intellectual argument that is capable of spreading the public-centred ideas and debate necessary to engage, convince and persuade a willing populace. In fact, it does the exact opposite. The very idea of libertarian paternalism, and of behaviour economics in general, is based on harnessing an individual’s hidden, unconscious and psychological response to the external world. If you can show how some people choose not to smoke then, as the authors demonstrate, others will likely follow. This is because, they claim, we invariably exhibit an animalistic innate herd-like tendency to follow the crowd.
For Thaler and Sunstein, the job of creating a libertarian paternalistic agenda is to create the right conditions (or ‘social norms’ as the authors call them) to encourage more people to change their behaviour. This is a telling retreat from political debate, which is replaced by a psychological agenda that appeals to base, biological urges rather than any view of ourselves as people who are rational in the decisions we make.
Chapter after chapter is peppered with examples (mostly using students in sterile laboratory conditions) to show just how susceptible people are to being influenced when they are left on their own. Nudge tells us that girls who have pregnant friends are themselves more likely to become pregnant; people with fat friends are more likely to put on weight; and binge drinking encourages more drinking amongst friends, and so it goes on.
The books shows how easy it is to ‘prime’ people and sway our appreciation of things, recounting experiments showing how people tend to select food placed at the start in a display counter over stuff at the end of the queue; or how candidates at the top of a ballot paper tend to do better than those further down the list. Here, the authors reduce our comprehension and responses to a matter of unconsciously responding to stimuli – much like a chicken pecking on a red button as a way of asking for more food. Any notion of a conscious rationale for the decisions we make is left far behind.
Nudge assumes that the sterile conditions of a laboratory equate to the experience of the real world. But in the real world, we are unsurprisingly affected by the actions of others around us -and influenced by them – because we are social beings. So whilst the placement of food in a display cabinet or the order candidates on a ballot paper may have a marginal effect on our choices, such things are negligible when compared with how we engage and reason with people through the conscious world of ideas, content and meaning.
“Libertarian paternalism makes relations between individuals and the establishment malign and corrosive.”
Indeed, the authors only operate along one trajectory throughout the whole book in order to make their point: the systematic demolition of any notion of humans as being capable of rational decision-making. They consciously choose to point out human fallibility and frailty as being a defining human characteristic. This reveals their lack of admiration of the human spirit. For them, the failing individual is like an animal who must be reintroduced to society. They focus on how we are often prone to mistakes, make bad choices and regularly ignore common sense. They think our ‘behaviour can be improved by understanding how people systematically go wrong’.
All of this is pure misanthropy. Thaler and Sunstein generously concede that ‘humans are not exactly lemmings’, but add that we are ‘easily influenced by the statements and deeds of others’. In this Frankenstein-like process, they argue, we normally act due to our ‘automative response’ to many situations in an unconscious manner, before we apparently realise we’re doing it. So the ‘trick’ is to recognise how people are able unconsciously to recognise and respond to the many hidden clues, stimuli and social norms present in the world around us, and ultimately can have a positive effect on our behaviour. The clue for any government, or anyone else wishing to influence human behaviour, is therefore is to create the necessary conditions so as to ‘nudge’ us in the right direction in the choices we make.
All of this, of course, is no answer to the continuing exhaustion many of us feel with what passes for politics today. Libertarian paternalism will make matters worse. It will make relations between individuals and the establishment malign and corrosive. This dismissal of any attempt at a public-centred engagement through ideas, debate and discussion will only help reveal the deep-seated mistrust the establishment has of the public, and of its own failing agenda. Likewise, the complexity surrounding organ donation must be answered through engaged public debate that raises awareness, but which ultimately leaves people to make up their own minds.
What libertarian paternalism cannot solve is the problem of provision. It cannot make a poor healthcare system into a good one and it cannot generate competing visions of a better tomorrow where none exists. ‘Nudging’ us is not harmless – it is an underhand way of imposing solutions upon us, the very antithesis of choice.
(1) Presumed consent ‘not ruled out’, BBC News, 17 November 2008
(2) Nudge, nudge, win, win, Guardian, 14 July 2008