Nudging and obesity: How to get rid of paternalism?

Abstract

This paper reflects upon the conditions how 'nudging' can change individual health choices without being paternalistic and therefore can be defined as an instrument of social justice? So many problems we are facing in today's nursing are situated at the intersection of autonomy and heteronomy, i.e. why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is impossible; also autonomous individuals are 'contaminated' by heteronymous aspects, by influences from 'outside'. In an earlier article I made an analysis of my neologism 'oughtonomy' to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, more than they are merely opposites.Although nudging might be of help in many nursing settings, we should evaluate it with the same criticism as we judge upon paternalism. Despite the potential of nudging for nursing, there is a risk to put the nurse again in the position of the paternalistic outsider who knows how people should behave. But maybe the awareness of the oughtonomous decisions we all make in our lives, can help us to understand why people act mindless in some situations or why we choose what we choose. Knowing this is one thing, giving people the authority of an expert to know what is better off for others, another. Despite the potential of the last, the former concept does not legitimate paternalistic interferences in patient's lifestyle.

Informed consent in physiotherapy practice: it is not what is said but how it is said

“…Within most western healthcare contexts, the principle of autonomy is often given precedence over beneficence (to do good), this being a reflection perhaps of the neoliberal philosophies that currently shape contemporary western societies [15]. The ideals of rational choice and individualistic agency have been challenged by a number of authors and, partly as a response to the evolution of these concepts, so has the contemporary understanding of the concept of autonomy [10,15].…”