Organ nudges

It's hard to tell what's a nudge.

Recall the basic thesis of Thaler and Sunstein's libertarian paternalism: the choice of defaults couldn't help but influence choices, so give some thought to the default chosen.

In New Zealand, and many other countries, you're not an organ donor unless you make an explicit choice to become one: you have to choose to sign your organ donor card. Because thinking about death is unpleasant, there will be some people who would wish to sign their card but haven't gotten around to it. The default has affected the number of people signed up. Flip the default around to presumed consent, where those who do not wish to be donors have to opt out, and you'll have higher donation rates. And indeed, that's what's found in most countries running presumed consent systems.

Can we call this a nudge though? A team of researchers running an international comparative study of nudge policies think so.

In early July the passage of the Human Transplantation (Wales) Bill through the Assembly made Wales the first UK nation to adopt a presumed consent system for organ donation.

The Bill, which comes into effect in 2015, should undoubtedly be celebrated: it will lead to far more people being on the Organ Donor Register in Wales, as presumed consent systems have in other countries where they have been introduced, and it will save lives.

The historic significance of the Bill, however, lies not only in the lifesaving difference it will make, but in fact that it is the most discussed aspect of a broader shift in systems of government in Wales and the UK.

This shift is characterised by the increasing use of psychological insights about the nature of human behaviour within the design of public policy.

Commonly referred to as “nudge” policies, these new ways of governing are based on the principles of soft paternalism, or the idea that governments should use policies to make it easier for people in act in ways that support their own, and the broader public’s, best interests.

Nudge policies are clearly in vogue.

It seems like a nudge. Flip in default position? Check. Easy opt-out? Check. But wait:

Bad idea “@ideas42: Wales has become the first country in the Uk to adopt an opt-out policy for organ donation: http://t.co/Cy3gg9uhUO”
— Richard H Thaler (@R_Thaler) September 25, 2013

Bad idea? Why?

To be clear I prefer prompted choice for organ donation. Wales "soft opt out" where families are asked is esp bad since no opt in list.
— Richard H Thaler (@R_Thaler) September 26, 2013

I agree with Thaler that there's nothing wrong with a prompted choice system.

I don't know enough about the system in Wales. New Zealand's opt-in system doesn't really have a list; families are asked whether or not the donor has ticked the box on the driver's licence. If they're moving in Wales from a system that never asks families while presuming you're out absent having signed an organ donor card to one where you're presumed in but your family can veto, then that does impose burden on the families. The change imposes a burden, and that burden counts:

@leemovic @ideas42 opt out puts burden on family members who have no clue of donor's wishes. I prefer prompted choice as in Illinois and CA
— Richard H Thaler (@R_Thaler) September 25, 2013

Policy has to be very specially crafted to count as a nudge, following Thaler's setup. Thaler entirely disavows any connection between the UK's internet porn filter and his nudge prescriptions because of the burden the opt-in regime imposes on families who might prefer not to have to have explicit conversations about such things. Just because something is opt-out doesn't make it a nudge, in Thaler's view. And yet Wales's 'opt-out plus bother the family' system is being sold as a nudge.

Now, a few folks, a few years ago, were just a bit worried that the policy application of Sunstein and Thaler's insights would be rather more hamfisted and that opening up this whole nudge project would yield a pile of things that Thaler would view as shoves. Thaler dismissed those worries as variety of bathmophobia: the fear of slopes of the slippery kind.

But it isn't just the politicos who get things wrong. Here's how the research team working on the international nudge comparison project sees things:

Beyond organ donation, we can now find nudge-type policies in a range of policy areas. The default setting has been changed on company pension schemes in the UK so now it is assumed that employees want to enrol. There are also new plans to change the default setting for domestic access to internet pornography, with households having to opt in to getting access to such sites.

It's always worth keeping half an eye out for how one's bright ideas might be mangled in policy application. Whitehead et al, the research team funded by the Economic and Social Research Council to run the international comparison of nudge policies, have a few insights. While definitely counting the porn filter as a nudge, they also have a worry:

What is most concerning is that I don’t hear any researchers offering alternative viewpoints on the political value of the Nudge theory. Rather, they seem busy trying to get onto the advisory boards of various Behaviour Change research networks, centres and institutes – perhaps in order to fulfil their duties to serve policy-makers in their research and to secure research ‘impact’ – now a pre-requisite of almost any research funding in an increasingly competitive funding environment.

They perhaps could read the Cato Unbound symposium on Nudge - the one where Thaler dismissed his critics' fears as paranoid - for a few alternative viewpoints on the political value of Nudge theory.