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A Politics Against Thinking

M2X00246_9.jpgAmong the more heartbreaking realities in modern medicine is that we don't have enough solid organs for transplantation. Thousands and thousands of people -- many of them children -- die because their liver, or their kidney, fails, and there is no replacement. One effort to save these people takes place at the DMV: When you receive your license, you can choose to become an organ donor in the event of a fatal accident. In losing your life, you are given the opportunity to save other lives. But most people don't like to think about losing their life. They skip the question. They save it for later. This, in fact, is exactly what I did the first time I saw it. I left it blank. Not out of a desire to jealously hoard my liver after my death, but out of a desire to deny the possibility of my death.

In his book "Nudge," Cass Sunstein proposed a way to save more lives: Make the default for organ donation "yes." Anyone who didn't want to donate their organs could check the box "no." But if nothing was done, if the question was examined and left untouched, that person would be an organ donor. It's a smart solution to a hard problem. Predictably, some conservative outlets have fastened on this for their next line of attack: "Obama Regulation Czar Advocated Removing People's Organs Without Explicit Consent," blared CNS News. You'd think Sunstein was going to leave America in a bathtub full of ice with a scar running down its back.

The attack on Sunstein echoes the attack on Zeke Emanuel: another smart thinker who took on thorny problems, including the problem of organ scarcity. He was attacked in much the same terms as Sunstein. What you're seeing here is not a strange obsession with organs, however, so much as the emergence of a pattern. The Obama administration is hiring smart people. Before coming to the Obama administration, these smart people had jobs where they thought about hard problems. That's part of how they proved they were smart. And they're being attacked for the very willingness to reason through these problems, and suggest options.

The message here isn't simply that we can't make the hard and necessary decisions in public life, as doing so will invite attacks from opportunists and ensure the loss of reelection. It's that if you ever want to work in public life, you shouldn't engage such questions in private life, either. It's a politics that is flatly opposed to considering hard choices on difficult dilemmas. That is flatly opposed, in other words, to thinking. That, however, is also a choice: It is a brief for the consequences of inertia, and against the possibility of progress. That will sound good to its advocates, I guess, as long as Obama is in office, and up till the day when one of their children needs an organ transplant.

Photo credit: Bloomberg.

By Ezra Klein  |  September 8, 2009; 10:04 AM ET
 
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Comments

nothing like tackling easy subjects just when most are back from a long holiday weekend. While I agree that we should and will eventually get to this system I would rather try a little harder to educate the public. The lovely folks at the DMV enjoy being there so much that many times they never even bother to mention to me every 4 years if its filled out or not. One time I forgot to check it and it went unfilled for that time frame so my intent was to donate but they wouldn't likely have been had I died in that time frame. 75% of organs needed in the US are for kidneys where we all have a "spare" one so people shouldn't be going without if there was more education on the subject. I've marked my organ donor card since I was able to drive (God help the soul who gets my organs) and I fear the backlash if this even were brought up nowadays as Ezra mentions.

Not only do they want to kill Grandma, they want her organs first!

Posted by: visionbrkr | September 8, 2009 10:40 AM | Report abuse

i personally think the solution to this kind of crap is relatively simple: cass sunstein should call the right-wing crazies "liars."

repeatedly.

as in "i won't dignify the lying comments with a response, since such lies don't deserve respect."

even he said/she said "journalists" would be forced to note that "he said" lying.

Posted by: howard16 | September 8, 2009 10:40 AM | Report abuse

The entire book is full of smart ideas like that. It's hard to see what the actual ethical/policy objection would be to shifting the form to "opt out." This is what happens when the opposition party has no interest in effective government and instead cares solely about opposing whatever the Democrats want to do.

Posted by: etdean1 | September 8, 2009 10:45 AM | Report abuse

Actually, just this morning I was thinking about this "opt-out" approach and what a great idea it is. I guess it shouldn't at this point, but it still blows my mind that someone could get pilloried for an idea as good as this.

Posted by: MosBen | September 8, 2009 11:09 AM | Report abuse

"It's a politics that is flatly opposed to considering hard choices on difficult dilemmas."

Unless they involve a ticking time bomb.

Posted by: you-dont | September 8, 2009 11:11 AM | Report abuse

Being "smart" doesn't just mean having intelligence, or accomplishing great things, writing brilliant books, or even being correct on the issue.

It means understanding how to craft a political strategy that swiftly and effectively deals with the opposition. Understanding that the argument "well, these are smart people who really know what we ought to do and that's why we should implement their ideas," - no matter true, and of course it's true - is NOT the "smart" way to win over or shut down the other side.

Posted by: Melancholy_Korean | September 8, 2009 11:13 AM | Report abuse

I hear the larger point, but I'd suggest you speak with a couple of bioethicists on this issue.

Sunstein hardly thought of the idea, its been debated in medical circles for a long time. Generally, bioethicists look for pragmatic approaches-- ones where consent could be explicitly granted more frequently, thereby preventing the ethically murky situation of opt-outs for organ donation clauses.

I've personally been in favor of compensation for organs from those deceased from uncomplicated deaths (read: no questions of funny business), such as a tax credit. That also has its issues as well, but generally I don't think this is the best example of the point you're trying to make. Many bioethicists would think Sunstein came to the wrong recommendation, whereas some of the issues Emmanuel dealt with were more nuanced with no good answers in the mix.

Posted by: wisewon | September 8, 2009 11:20 AM | Report abuse

wisewon, I took Ezra's larger point to be that things like your response are what we should be looking for. Instead, people who suggest policies like "opt-out" instead of "opt-in" are pilloried for even talking about the issue. They're smart people making a policy recommendation based on their expert opinion but they're treated like they're trying to steal America's fillings by people uninterested in having a reasoned policy debate, and that's unfortunate.

Posted by: MosBen | September 8, 2009 11:33 AM | Report abuse

The opposition to the (sensible) plan of Sunstein et al. is much more insidious, and tracks the standard far-right campaign. It is not just a fear-based campaign (they'll take your organs!) but it addresses a particular existential fear, that of annihilation, that is at the root of the whole right-wing mind set. It grows out of the pathology of right-wing leaders and plays on the fears of their followers.

This same fear of annihiliation is at the root of opposition to abortion and is used (death panels! pulling the plug on Grandma!) in most of the opposition to health care. And the support for the war, surveillance, torture etc.

Sidney Blumenthal has a new book that details this pathology at the core of the far right and how it is used both to create more followers and to maintain them as followers. It is explored in more detail here.

It is really worth thinking about. Reason can't be used on these people, nor can simply repeating that this is all lies. The best tack is for Obama and the Dems to speak reasonably to the persuadable people in the middle and really get busy trying to solve problems in a way that takes some of the anxiety out of modern life. Of course this will make the far right get even crazier, because they realize the importance of maintaining anxiety to their return to power. But it has to be done that way.

And I think it would be good for the media in general and the lefty media in particular to give them much less oxygen.

Posted by: Mimikatz | September 8, 2009 11:53 AM | Report abuse

So html links failed. Blumenthal's book is called "Republican Gomorrah: Inside the Movement that Shattered the Party" and it is reviewed here: http://www.powells.com/biblio/9781568583983 and here: http://www.openleft.com/diary/14947/republican-gommorrah-max-blumenthal-the-gops-heart-of-darkness.

Posted by: Mimikatz | September 8, 2009 11:57 AM | Report abuse

Here, I think, is a better way: give anyone who agrees to donate a higher priority if they ever need an organ themselves. Apparently the lists are already prioritized first by compatibility and second by a point score that is a function of need, urgency, and how long the recipient has been waiting. So perhaps we can just give a few extra points to those who agree to donate their organs should they die. That gives real personal incentive to donate, isn't prone to exploitation like "cash for organs" is, and doesn't surprise people who weren't aware they were defaulted into being a donor. For those who object to being given preference for agreeing to donate, they can be allowed to opt out of receiving the preference and instead donate altruistically. For those who say that it is unfair for donors to be given preference over non-donors, I say that 1) if you're willing to receive an organ from someone else, you ought to be willing to give an organ to someone else, and 2) having a program like this will increase the number of organs available anyway, so even if you are lower down on the list you might be just as likely to get an organ in time as you would be without this system, but if you agree to donate you would have an even greater likelihood. In other words, this would very likely be a Pareto improvement: those who choose not to donate will not be worse off, while those who choose to donate will be better off.

Posted by: bluegrass1 | September 8, 2009 12:25 PM | Report abuse

http://www.lifesharers.org/articles/nadel.pdf

Using Reciprocity To Motivate Organ Donations, Mark S. Nadel, J.D. and Carolina A. Nadel, M.D., Yale Journal of Health Policy, Law, and Ethics.

Posted by: bluegrass1 | September 8, 2009 12:35 PM | Report abuse

Excellent post, but the 2nd point, the major point about "hard choices on difficult dilemmas" is...*incomplete*.

One area this incompleteness stands out is if you try to think on "hard choices", such as how to gauge how far to go in health care in old age, without a sufficient intellectual analysis.

Here is a more thoughtful, from the ground-up consideration of such "hard choices" (note that the instance of 'rationing' is only one instance in a general consideration:

http://findingourdream.blogspot.com/2009/07/rationing-failure-of-knowledge-and.html

Posted by: jozzer | September 8, 2009 1:43 PM | Report abuse

I think the third paragraph of this post explains the scope of the political back and forth (even beyond health care) we are seeing more clearly than anyone else has been able to.

As simple as many would like it to be, there is nothing simple about government. I applaud the Obama Administration for finding those who aren't afraid to publicly discuss options to difficult situations, however "unfavorable" they may come across as.

Posted by: RTaughrin | September 8, 2009 7:43 PM | Report abuse

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