In Britain, Brown's take on organ donation boosts new credo

Libertarian paternalism – 'framing' choices for people, but letting them opt out – is gaining traction among US and European leaders.

Kristy Wigglesworth/AP
Organ donation: British Prime Minister Gordon Brown wants to automatically enroll citizens to boost participation.

When British Prime Minister Gordon Brown announced last weekend that every Briton should be enrolled in an organ donor register to help address a shortfall, it delivered a boost not just for advocates of transplant operations but for proponents of a new political philosophy gaining traction in the US and Europe.

Libertarian paternalism sounds like an oxymoron – and an almost unpronounceable one at that. But in a world where individuals may be too busy or bewildered to work out where their best interests lie, a nudge from the state can help, say its proponents.

Not only could it boost the number of organs available for transplant, they argue, it could help smokers quit and obese people eat more healthily. It could protect gamblers from themselves, help limit carbon emissions, and boost national savings rates.

It is an economic credo that appeals to political leaders who see government as a force for good that wants to protect people from their own worst instincts, while safeguarding their liberty at the same time. The idea, objected to by proponents of strong individual rights, is that the state 'frames' citizens' choices so that the default option is the one generally considered most beneficial.

Take the organ donor situation. Hundreds die in Britain every year waiting for an operation because of a shortage of donors. Though polls show that 90 percent of the population supports the idea of organ donation, less than 25 percent have consented to participating.

Experts blame the discrepancy on the fact that people have to formally enroll in such a program.

"The problem," says Noel Davies of the UK Transplant authority, "is that people lead busy lives and just don't get round to joining the register."

Brown said he wants to change this. Everyone should automatically be enrolled, but with the right to opt out. A similar system operates in Spain. Donor rates there are 250 percent higher than in the United Kingdom.

Or consider retirement savings. Company pension schemes are generally a win-win. They come with tax breaks and contributions from employers. It is usually in the employee's interest to sign up. But enrollment is normally an option – one many people don't get around to taking.

Research has shown that enrollment rates soar if the "default" is to enroll people and give them the right to opt out. US presidential candidate Barack Obama has declared he will enact such a change to workplace pensions if elected president.

When it comes to things considered bad for citizens, such as smoking, overeating, and gambling, libertarian paternalists see all kinds of options – many of them controversial.

Julian LeGrand, a former British government adviser and London School of Economics professor, asks, for example, whether as many people would smoke if they had to "opt in" as smokers; if they had to apply for a license at the start of every year, fill in forms, and be issued a pass without which one couldn't buy cigarettes. This changes the default position, he says. Smokers still have a choice. But the default is not to smoke, and opting in requires time and effort.

On gambling, two US states have deployed a similar technique, by encouraging problem gamblers to sign up to voluntary schemes that forbid them from entering casinos. More than 10,000 have signed up in Missouri alone.

As for food, two of the earliest proponents of libertarian paternalism, the Chicago-based economists Cass Sunstein and Richard Thaler, argued that consumer decisions could be influenced by the position of food in a hypothetical cafeteria. Make the fruit more prominent than the ice cream, they said, and people will eat better.

Other experts in different fields see potential for changing behavior for the "better" by altering the default. Take carbon offsetting. Currently it's an option: you take a flight, and if you're feeling green or concerned about climate change, you might tick the box to pay a little extra to offset the greenhouse gases emitted by the plane. But if the default was buying the offset, and you had to tick the box to opt out, uptake would be far greater, argues Simon Retallack, a London-based environmental expert. "Research says the public are much more likely to go along with offsetting if it's assumed they will offset but can opt out if they don't want to," he says.

Yet those concerned about individual freedom see problems with this kind of paternalism.

Norman Lamb, a Liberal Democrat in British Parliament, says people should be left to make judgments themselves, and worries that if people are signed up for things unawares "then that undermines their freedom in a way that would be unacceptable."

AC Grayling, a philosophy professor at London's Birkbeck college, says that the general principle that the state must protect the liberty of the individual is at risk. "The thought that there is one imposable conception of a good life which the state knows and wants to impose is inimical to that great principle," he argues.

Prof. Robert Sugden, an economist from the University of East Anglia in England, worries that the idea "presupposes that the state has a better view than individuals" and says the era when people happily trusted government officials to know what is best for them is over.

"I think it's an idea whose time has passed," he says. "What are the restrictions that people will genuinely choose for themselves, where they really want government to intervene to protect them? My view is that there are many fewer of these than libertarian paternalists think."

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