Nudging, informed consent and bullshit

Abstract

Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a is any influence that is expected to predictably alter a person's behaviour without (substantively) restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent. I assume informed consent requires that a physician tells her patient the truth about her options and argue that nudging is incompatible with truth-telling. Instead, nudging satisfies Harry Frankfurt's account of bullshit.

At odds with the truth

“…I argue that nudging is incompatible with securing genuine informed consent 2. I assume, but do not argue, that informed consent requires truth-telling during adequate disclosure.…”

“…Proponents of nudging contend that both frames convey the same medical information, and thus the fact that patients react differently suggests that their choices are not rational. I argue that this is a mistake 2. Although a physician might believe the frames convey identical medical information, the mere fact that one emphasises life and the other death is relevant when analysing what is being conveyed.…”

Physicians’ framing and recommendations. Are they nudging? And do they violate the requirements of informed consent?

“…In his recent article ‘Nudging, Informed Consent and Bullshit’, William Simkulet1 convincingly argues that certain types of nudging satisfy Frankfurt’s criteria of bullshit. As a prelude to this argument, Simkulet considers whether recommendations and framing are types of nudging and whether they satisfy the requirement of adequate disclosure essential for a valid informed consent.…”

Truthful nudging

“…To the extent that William Simkulet’s paper is a reminder against that danger, it does us good service 1. Simkulet, however, makes the far bolder claims that nudging just is bullshitting and that—since bullshitting deviates from truthfulness, and truthful disclosure is essential for valid consent—nudging invalidates informed consent.…”

“…This implausibly strong sense is necessary for presenting nudging as untruthful. This move is problematic in three ways 1. (1) Understanding the information is intuitively different from appraising it.…”