Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent

Ploug, Thomas; Holm, Søren

doi:10.1080/15265161.2015.1074303

Cited by 58 publications

(49 citation statements)

References 21 publications

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“…If they did, people would either override the default initially or more frequently revise their nudged choices. This is a crucial point, for one major concern about the use of nudges is that they may undermine individual autonomy by substituting “the nudger's judgment of what should be done for the nudgee's own judgment.” The worry is that the use of clinical nudges would risk imposing treatment goals on patients that reflect clinicians’ or policy‐makers’ values rather than patients’ own . Such an imposition would run contrary to the guiding principle of the shared decision‐making model, patient autonomy.…”

Section: Nudges and Preferencesmentioning

confidence: 99%

Justifying Clinical Nudges

Gorin¹,

Joffe²,

Dickert³

et al. 2017

Hastings Center Report

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The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably affect people's choices. Choice-affecting features of the decision environment that do not restrict the range of choices or significantly alter the incentives have come to be known as "nudges." Although some have criticized conscious efforts to influence choice, we believe that clinical nudges may often be morally justified. The most straightforward justification for nudge interventions is that they help people bypass their cognitive limitations-for example, the tendency to choose the first option presented even when that option is not the best for them-thereby allowing people to make choices that best align with their rational preferences or deeply held values. However, we argue that this justification is problematic. We argue that, if physicians wish to use nudges to shape their patients' choices, the justification for doing so must appeal to an ethical and professional standard, not to patients' preferences. We demonstrate how a standard with which clinicians and bioethicists already are quite familiar-the best-interest standard-offers a robust justification for the use of nudges.

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Section: Nudges and Preferencesmentioning

confidence: 99%

Justifying Clinical Nudges

Gorin¹,

Joffe²,

Dickert³

et al. 2017

Hastings Center Report

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show abstract

“…Tapping into deeply rooted psychological mechanisms that have an impact behind people's backs and thus "systematically exploiting non-rational factors that influence human decision-making making" (Hausman and Welch 2010, 136), nudges threaten people's rationality, autonomy and liberty. Even if nudges leave all options on the table, they intentionally and successfully induce bad reasoning (Ploug and Holm 2015) and manipulate people and pervert their choices (Wilkinson 2013, 347). Bypassing or subverting people's rational capacities (Blumenthal-Barby 2012, 349-352;Ploug and Holm 2015), they do not respect people as rational and autonomous choosers.…”

Section: Objections About Meansmentioning

confidence: 99%

“…Even if nudges leave all options on the table, they intentionally and successfully induce bad reasoning (Ploug and Holm 2015) and manipulate people and pervert their choices (Wilkinson 2013, 347). Bypassing or subverting people's rational capacities (Blumenthal-Barby 2012, 349-352;Ploug and Holm 2015), they do not respect people as rational and autonomous choosers. Regardless of the desirability of the health benefits they generate, the way they are achieving those goals is disrespectful and inappropriate.…”

Section: Objections About Meansmentioning

confidence: 99%

Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis

Engelen

2019

The American Journal of Bioethics

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Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google's rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most-but not all-nudges in most-but not all-circumstances.

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“…According to Ploug and Holm,5 nudging is inappropriate in domains where informed consent is sought, precisely because informed consent ‘is a particular method for protecting personal autonomy’ (p. 37) 5. If the argument holds for the case of nudging, there is good reason to think that it should hold for bumping as well, with one important caveat.…”

Section: Bumping and Autonomymentioning

confidence: 99%

Blameworthy bumping? Investigating nudge’s neglected cousin

Miyata-Sturm

2019

J Med Ethics

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The realm of non-rational influence, which includes nudging, is home to many other morally interesting phenomena. In this paper, I introduce the term bumping, to discuss the category of unintentional non-rational influence. Bumping happens constantly, wherever people make choices in environments where they are affected by other people. For instance, doctors will often bump their patients as patients make choices about what treatments to pursue. In some cases, these bumps will systematically tend to make patients’ decisions worse. Put another way: doctors will sometimes harm their patients by bumping them in systematic (although still unintentional) ways. I use the case of medical overuse, the provision of medical services where the likely harm outweighs the likely benefit to the patient, as a touchstone for arguing that doctors who systematically bump their patients towards harm can be blameworthy for their unwitting influence.

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Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent

Cited by 58 publications

References 21 publications

Justifying Clinical Nudges

Justifying Clinical Nudges

Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis

Blameworthy bumping? Investigating nudge’s neglected cousin

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