Caution needed with opt-out schemes

The raging controversy around the automatic creation of e-health records for Australians is a lesson for governments on the need for caution in using opt-out schemes.

Rightly or wrongly, the public has serious concerns about privacy, digital security and the risk of their personal health information being misused.

But this raises broader questions about the ethics of opt-out schemes. Are they ever justified?

Such schemes can undermine the autonomy of individuals and their ability to make truly free choices. They also create a penalty for those who do not want to sign up, by forcing them to take active steps to opt out.

But opt-out schemes are tempting for governments to use, because they can be more efficient and result in higher take-up. Governments also justify opt-out schemes as a type of positive nudge — that is, they can encourage people to make the ‘right’ decision.

Conversely, if a scheme is opt-in, governments must actively convince people to sign up — usually through costly marketing and public awareness campaigns. And there is no guarantee of success.

In the case of our e-health record system; it was introduced in 2012 as an opt-in scheme but failed to generate significant uptake. Hence, a government review recommended a change to an opt-out system.

And given the cost of creating the system has reportedly exceeded $1 billion, it is understandable why the government needs a high uptake.

But uptake should not be the only consideration. Individual autonomy, privacy and perceptions of risk are important ethical issues.

The debate around organ donation is a good example of the ethical debate about opt-out schemes.

In Australia, there has been a long-running debate on making organ donation an opt-out decision, where drivers would be automatically registered as organ donors.

But ultimately, this proposal has never gone very far, due to ethical concerns about the nature of personal consent.

Generally, there are good reasons why governments avoid the use of opt-out schemes — especially where they infringe on very personal decisions or carry significant downside risk.

But if Canberra believes an opt-out is justified, it must make a compelling case to the public.

Otherwise, the government will lose public trust — as the current e-health debacle has so effectively proven.