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

Abstract

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.

The ethics of nudging: An overview

“…First, while much of the discussion has rightly focused on tensions between the practice of nudging and important moral values, there is an increasing understanding that ethical concerns differ radically from practice to practice and from nudge to nudge. Instead of getting stuck in a stand‐off between proponents and opponents making overgeneralizing claims (“nudging violates autonomy” versus “nudging promotes autonomy”), ethical analysis should proceed case by case (Engelen, ; Sunstein, ). The use of defaults in organ donation differs drastically from the design of urinals.…”

Are defaults supportive of autonomy? An examination of nudges under the lens of Self-Determination Theory

“…They do not only target the welfare of the nudgee but are also beneficial for other people, thereby classifying them not only as a paternalist but also as a political tool that should be evaluated as such (Clavien, 2018;Guala & NUDGES AND AUTONOMY SUPPORT 4 Mittone, 2015). Their legitimacy is also questioned on the basis of criteria concerning both their means and their ends (Engelen, 2019). Perhaps the most important objection to nudges is that they undermine people's autonomy, even though their liberty remains generally unaffected (Bovens, 2009;Hausman & Welch, 2010;Nagatsu, 2015).…”

Nudge strategies for behavior-based prevention and control of neglected tropical diseases: a scoping review and ethical assessment

“…The evaluation of nudge strategy ethics was based on the criteria developed by Engelen [28], which were adapted to fit our purpose. We did not aim to develop a novel method for assessing ethical standards more broadly within nudging for global health and health promotion, but merely included this to advance the discussion and debate concerning the ethics of nudges.…”

“…Two criteria stand out, including most H-labeled nudges in their assessment: 'health benefits' and 'trust relationship'. Health benefits can be defined as measured by both the magnitude of the impact and the numbers of people positively affected by performing the behavior instigated by the nudge [28]. Since the scoping review focused on NTDs or related behaviors that prevent infectious disease transmission, hence affecting many people, it is only logical that this criterion would gain much support.…”