Nudging in the clinic: the ethical implications of differences in doctors’ and patients’ point of view

Avitzour, David; Barnea, Rani; Avitzour, Eliana; Cohen, Haim A.; Nissan-Rozen, Ittay

doi:10.1136/medethics-2018-104978

Cited by 13 publications

(11 citation statements)

References 17 publications

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“…Whilst SSAs may have good reasons to nudge citizens towards certain contraceptive methods (influencing outcomes using default rules, practices or priorities), this 9 should not be confused with the legitimacy of nudges or incentives used by HCPs in the clinical encounter. 27 In the former, we have an impersonal, anonymous relationship; in the latter we have an identifiable relationship that is supposed to be founded on trust. 27 There are several distinctive features that require careful consideration in the context of the promotion and provision of LARC.…”

Section: Preliminary Considerationsmentioning

confidence: 99%

“…27 In the former, we have an impersonal, anonymous relationship; in the latter we have an identifiable relationship that is supposed to be founded on trust. 27 There are several distinctive features that require careful consideration in the context of the promotion and provision of LARC. Firstly, LARC methods are not an unqualified good or a risk-free option for users.…”

Section: Preliminary Considerationsmentioning

confidence: 99%

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The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

Wale

Rowlands

2020

BMJ Sex Reprod Health

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ObjectivesTo review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals.MethodsNarrative review and ethical analysis.FindingsThere is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care.ConclusionsThis review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.

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Section: Preliminary Considerationsmentioning

confidence: 99%

Section: Preliminary Considerationsmentioning

confidence: 99%

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

Wale

Rowlands

2020

BMJ Sex Reprod Health

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“…For example, in applications that have a triage function, who is responsible for monitoring the monitors? Also, PCPs should be aware of potential responsibility gaps [29]. Who is responsible or accountable if an alert generated by a remote monitoring technology, such as the home monitoring of cardiac rhythm, is missed: the patient, the PCP, the manufacturer, the digital infrastructure, or the data scientist?…”

Section: Roles and Responsibilities Of Pcpsmentioning

confidence: 99%

SERIES: eHealth in primary care. Part 2: Exploring the ethical implications of its application in primary care practice

Boers

Jongsma

Lucivero

et al. 2019

European Journal of General Practice

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The impact of eHealth on primary care is paired with ethical implications including questions of autonomy and professional responsibilities Practice-specific ethical guidance for the use of eHealth in primary care should be developed Primary care professionals should be aware of the ethical implications when using eHealth approaches ABSTRACT Background: eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients' and primary care professionals' (PCPs) experiences, values, norms, and relationships. Objectives:We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated. Discussion: (1) EHealth influences dealing with predictive and diagnostic uncertainty. Machinelearning based clinical decision support systems offer (seemingly) objective, quantified, and personalised outcomes. However, they also introduce new loci of uncertainty and subjectivity. The decision-making process becomes opaque, and algorithms can be invalid, biased, or even discriminatory. This has implications for professional responsibilities and judgments, justice, autonomy, and trust. (2) EHealth affects the roles and responsibilities of patients because it can stimulate self-management and autonomy. However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient-eHealth-PCP requires a reconsideration of the role of human interaction and 'humanness' in primary care as well as of shaping Shared Decision Making. Conclusion: Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations.

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“…nudges that health practitioners use to influence the decisions of specific patients). See for example the discussion inAvitzour et al (2019).…”

mentioning

confidence: 99%

Libertarian Paternalism And Susan Hurley's political philosophy

Nissan-Rozen

2021

Inquiry

Self Cite

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As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in her Natural Reasons (1989) can be viewed as offering powerful responses to them.

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Nudging in the clinic: the ethical implications of differences in doctors’ and patients’ point of view

Cited by 13 publications

References 17 publications

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

SERIES: eHealth in primary care. Part 2: Exploring the ethical implications of its application in primary care practice

Libertarian Paternalism And Susan Hurley's political philosophy

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