Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

Exploring the use of nudges and informed consent in medical ethics.

In his article “Nudging and Informed Consent,” Shlomo Cohen (2013) argues, among other things, that 1) “to the extent that the nudge-influenced decision making is rational—in whatever sense,” there...

I distinguish between 'hard nudges' and 'soft nudges', arguing that it is possible to show that the latter can be compatible with informed consent - as Cohen has recently suggested; but that the real challenge is the compatibility of the former. Hard nudges are the more effective nudges because they work on less than conscious mechanisms such as those underlying our habits: whether those influences - which are often beyond the subject's awareness - can be reconciled with informed consent in (...) health care is the more challenging question. I suggest two directions for possible answers: on the one hand, looking at the growing empirical literature on mindless judgement and behaviour; and on the other hand considering a more diversified conception of consent, which I sketch. (shrink)

Drawing from the literatures on the ethics of nudging and moral bioenhancement, I elaborate several pairs of cases in which one intervention is classified as an environmental behavioral intervention (EBI) and the other as a neurochemical behavioral intervention (NBI) in order to morally compare them. The intuition held by most is that NBIs are by far the more morally troubling kind of influence. However, if this intuition cannot be vindicated, we should at least entertain the _Similarity Thesis_, according to which (...) EBIs and NBIs share relevant moral features to the extent that moral conclusions about one are implied about the other in the described pairs of cases. I test this thesis by putting forward a number of possible moral grounds for setting EBIs and NBIs apart, including three of the most promising ones – physical invasiveness, disclosure and avoidance, and inevitability. I conclude that although these promising grounds might not bear the full burden of vindicating the intuition against _Similarity_ by themselves, clustering them together can establish discernible moral separation. (shrink)

Suppose that a patient is receiving treatment options from her doctor. In one case, the doctor says, “the surgery has a 90% survival rate.” Now, suppose the doctor instead said, “the procedure has a 10% mortality rate.” Predictably, the patient is more likely to consent on the first description and more likely to dissent on the second. This is an example of a framing effect. A framing effect occurs when “the description of [logically-equivalent] options in terms of gains (positive frame) (...) rather than losses (negative frame) elicits systematically different choices.” Framing effects are ubiquitous, but they are particularly troublesome in medicine. Many worry that there is tension between valuing informed consent and using framing effects in clinical settings. In this paper, I answer this question: if an individual is subject to a framing effect when she gives her consent, does this undermine the validity of her consent? I argue that framing effects do not undermine consent in general. (shrink)

This article is featured in a special issue dedicated to theme, "the human being in the digital era: awareness, critical thinking and political space in the age of the internet and artificial intelligence." In this article, I consider the way that social-media companies nudge us to spend more time on their platforms, and I argue that, in principle, these nudges are morally permissible: they are not manipulative and do not violate any obvious moral rules. The moral problem, I argue, is (...) not with nudging in principle but is instead with the fact that users are being nudged towards something bad for them. In practice, this often involves being nudged to spend an unhealthy amount of time using a social-media app or being nudged towards content that is bad for us, such as by promoting eating-disorder content to young girls. Since nudging is morally permissible, it is open to these companies to use the same technologies to nudge us towards the good. (shrink)

This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper (...) understanding of some of the most controversial issues in modern medicine. (shrink)

In this chapter, we provide an overview of the ethical considerations relevant to the use of nudges in organ donation policy. We do not defend a position on the permissibility of nudging in this context, but instead aim to clearly outline the strongest arguments on the different sides of this issue that have been presented in the English-language scholarly bioethics literature. We also highlight the questions that are in need of further investigation. In part 1, we briefly discuss nudging before (...) considering proposals to use nudges to increase the number of registered organ donors, including opt-out donor registration systems and the use of “nudge statements.” In part 2, we discuss the use of nudges to influence the decision-making of family members in circumstances where they have a veto over the donation of their loved one’s organs. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

Drunken sex is common. Despite how common drunken sex is, we think very uncritically about it. In this paper, I want to examine whether drunk individuals can consent to sex. Specifically, I answer this question: suppose that an individual, D, who is drunk but can still engage in reasoning and communication, agrees to have sex with a sober individual, S; is D’s consent to sex with S morally valid? I will argue that, within a certain range of intoxication, an individual (...) who is drunk can give valid consent to have sex with an individual who is sober. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk (...) of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design. (shrink)

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. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

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 nudge is any influence that is expected to predictably alter a person’s behaviour without 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. (shrink)

Andreas Schmidt and Neil Levy have recently defended nudging against the objection that nudges fail to treat nudgees as rational agents. Schmidt rejects two theses that have been taken to support the objection: that nudges harness irrational processes in the nudgee, and that they subvert the nudgee’s rationality. Levy rejects a third thesis that may support the objection: that nudges fail to give reasons. I argue that these defences can be extrapolated from nudges to some nonconsensual neurointerventions; if Schmidt’s and (...) Levy’s defences succeed, then some nonconsensual neurointerventions neither harness irrationality, nor subvert rationality, nor fail to give reasons. This, I claim, poses a challenge both to opponents of nonconsensual neurointerventions, and to defenders of nudging. (shrink)

In the article “Informed Consent: What Must be Disclosed and What Must be Understood?” Joseph Millum and Danielle Bromwich argue that informed consent requires satisfaction of certain disclosure an...

Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards. The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, (...) ethical debates are hampered by a toxic dichotomy in the public sphere between those who claim a move away from parental choice is necessarily a serious ethical violation; and others who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions. (shrink)

Libertarian paternalism describes the idea of nudging—that is, steering individual decision-making while preserving freedom of choice. In medicine, libertarian paternalism has gained widespread attention, specifically with respect to interventions designed to promote healthy behaviours. Some scholars argue that nudges appropriately balance autonomy and paternalistic beneficence, while others argue that nudges inherently exploit cognitive weaknesses. This paper further explores the ethics of libertarian paternalism in public health. The use of nudges may infringe on an individual’s voluntary choice, autonomy and informed consent, (...) but they are ethically justified when there is a clear public health benefit to the manipulation of choice. (shrink)

> The bullshitter may not deceive us, or even intend to do so, either about the facts or about what he takes the facts to be. What he does necessarily attempt to deceive us about is his enterprise. His only indispensably distinctive characteristic is that in a certain way he misrepresents what he is up to. 1 - Harry Frankfurt In both lying and truth-telling, the speaker intends the audience to believe what she says is true; that her enterprise is (...) to inform her audience. In contrast, the speaker who bullshits doesn’t care whether the audience believes what she says, rather she intends her audience to believe or do something else—to think highly of her, to buy what she is selling, or the like. 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. When a physician nudges, her intention is to irrationally influence her patient’s choice, not inform. Because of this, nudging cannot be understood as truth-telling ; rather it is essentially bullshit.1 In " Truth be told," Jennifer Blumenthal-Barby and Peter A Ubel argue that not all nudging is incompatible with truth-telling, contending that ‘nudges can be bullshit,’ but that ‘nudging does not require bullshitting.’3 They ask us to consider the following: Vaccination: Consider a physician who wants her patient to get a vaccine. She tells him why the vaccine is important, by providing factually correct information about the vaccine. In other words, she engages in informed disclosure aimed at enhancing the patient’s understanding. At the same time, she also tells the patient that the majority of people his age get the vaccine. In other words, she engages in nudging the patient by …. (shrink)

Richard Thaler and Cass Sunstein define a nudge as “any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates’ decision‐making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision‐making in the context of (...) pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well‐known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision‐making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision‐making authority; (2) nudging can help fulfill pediatric clinicians’ obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents’ decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. (shrink)

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

There are instances where the provider of an intervention, such as surgery, has failed to obtain necessary informed consent from the recipient of the intervention. Perhaps the surgeon has failed to warn the patient that she may go into a coma, or even be killed, from the surgery. Sometimes, as a result of this intervention, the recipient cannot give informed consent to researchers for the release of their personal data precisely because of the intervention. If they are in a coma, (...) they cannot be reached. Sometimes, this personal data itself can prove that the provider of the intervention failed to obtain informed consent for the intervention. For example, a personal file may include a consent form that does not include warnings about the risk of falling into a coma from the surgery. Paradoxically, those who cannot give informed consent for the disclosure of their personal data on an intervention may have been especially ill-informed about the repercussions of the intervention. In such instances, should researchers ever use the data and disclose the data in their research? In an attempt to demonstrate when this dilemma may be relevant, and how it may be solved, I will present a real-world case of this dilemma in my own empirical research on refugees who agreed to repatriate to their countries of origin from Israel. I will consider what theories on consent, if any, can help us resolve this dilemma. (shrink)

One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer (...) screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making. (shrink)

Victoria’s Voluntary Assisted Dying Act 2017 (Vic) became the first state law to permit VAD in Australia under limited circumstances from June 2019. Before this, many palliative care physicians relied on the doctrine of double effect (DDE) to justify the use of pain relievers for terminally ill patients that were known to hasten death. The DDE claims that there is a morally significant difference between intending evil and merely foreseeing some bad side-effect will occur as a result of one’s actions. (...) This article argues that the legacy of the DDE is promoting inequitable access to VAD in Victoria due to the assumption that death represents an “evil” for the patient and that the intentions of physicians providing VAD cannot be trusted. The latter claim relies on two common objections to the DDE: the risk of “purifying the intentions” and the issue of “closeness” when evaluating moral acts under this theory. (shrink)

In “Two Minds, One Patient: Clearing Up Confusion About ‘Ambivalence,’” Moore and colleagues provide a sophisticated and subtle taxonomy of ambivalence. As they explain, clinical ethicists a...

Behavioral economics is the latest trendy form of economics. Increasingly theorists are advocating using behavioral economics to do normative ethics or claiming that the behavioralists’ findings render normative claims otiose. I argue in this paper that we should be extremely wary when it comes to accepting any such normative pronouncements. I argue that behavioral economics: (a) minimizes and/or misunderstands the role that character and architectonic life goals play in accounting for the why of ethical behavior, (b) fundamentally misconceives human practical (...) rationality, (c) often unduly narrows the range of human action and choice, (d) misleadingly assumes that options are merely given to us rather than generated by us in accordance with our character, (e) is parasitic upon normative ethics, (f) results in an unhelpful ad hoc approach to ethical thinking, which is unlikely to prove all that useful and may even dangerously mislead ordinary agents or those who operate corporate compliance programs and who seek to improve corporate cultures, and (g) ignores the key role played in ethical behavior by meso‐ and macro‐factors. (shrink)

Volume 20, Issue 3, March 2020, Page 85-87.

“Moral hazard” is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general (...) concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties. (shrink)

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

In “Nudging and Informed Consent,” ShlomoCohen (2013) attempts to address the common objection against nudges that they are autonomy-thwarting because they foster irrationality. He explicitly focuses on informed consent, which he contrasts with the policy context in which health nudges are usually discussed. I think Cohen’s rich article is a significant contribution to the nudge literature. However, I have some concerns with the way he frames and motivates his inquiry...

Some bioethicists argue that a doctor may frame treatment options in terms of effects on survival rather than on mortality in order to influence patients to choose the better option. The debate over such framing typically assumes that the survival and mortality frames convey the same numerical information. However, certain empirical findings contest this numerical equivalence assumption, demonstrating that framing effects may in fact be due to the two frames implying different information about the numerical bounds of survival and mortality (...) rates. In this paper, I use these findings to argue that framing is presumptively wrong because it violates the duty of proper disclosure. Along the way, I highlight morally relevant features affecting the permissibility of framing, tackle three objections and draw some general lessons for the ethics of nudging. (shrink)

The permissibility of nudging in public policy is often assessed in terms of the conditions of transparency, rationality, and easy resistibility. This debate has produced important resources for any ethical inquiry into nudging, but it has also failed to focus sufficiently on a different yet very important question, namely: when do nudges undermine a patient’s voluntary consent to a medical procedure? In this paper, I take on this further question and, more precisely, I ask to which extent the three conditions (...) of transparency, rationality, and easy resistibility can be applied to the assessment of voluntary consent too. After presenting two examples, designed to put pressure on these three conditions, I show that, suitably modified, the three conditions can remain significant in the assessment of voluntary consent as well. However, the needed modifications are very substantial and result in a rather complicated view. To propose a tidier solution, I argue that nudging undermines voluntary consent if and only if it cannot be ‘interpersonally justified’ to the patient. I use the three modified conditions to motivate the idea of interpersonal justification and also to further specify the principles it involves. My resulting view is especially attractive because it builds on already existing insights from the debate on nudging, updates those insights with an eye to medical consent, and finally unites them in an elegant and simple framework. (shrink)

There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people’s ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have been (...) found between doctors’ ethical attitude to clinical nudging and that of patients. We show how these differences weaken the argument for nudging from public support. Moreover, our findings raise concerns regarding doctors’ ability to nudge ethically according to their own standards, as they may underestimate the degree of harm medical nudges can cause to informed consent, doctor–patient trust and other important ethically relevant features of health-related choices. (shrink)

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice (...) behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed. (shrink)

BackgroundHealth behavior change is among the top recommendations for improving health of patients with lifestyle-related chronic diseases. An array of behavior change techniques have been developed to support behavior change initiation and maintenance. These BCTs often show limited success when they are not informed by theory, leading to a mismatch between the intention of the BCT and patients’ needs or expectations. Previous studies have identified a number of resources which patients may require to initiate and maintain health behavior change. Indeed, (...) not yet well established is how BCTs address these resources, i.e., the functional mechanisms of BCTs.PurposeProvide a theoretical framework of the functional mechanisms of BCTs for developing and implementing successful interventions for health behavior change.MethodsConceptual review, including literature analysis and synthesis as well as conceptualization of a new model based on the synthesis.ResultsThrough the integration of dual-process models as well as reward and motivation proceeding, i.e., affective, emotional, or intuitive neurobiological cues, into the rational framework of rather linear cognitive or task-related decision progress, we categorize previously identified resources into three distinct sets: external, internal reflective, and internal affective resources. Based on this triad, we classify BCTs according to their functional mechanisms into facilitating, boosting, and nudging. Consequently, we present a simplified Behavior Change Resource Model that is centered on patients’ resources.ConclusionThe model can be applied to develop health behavior change interventions, which promote engagement and empowerment. Future studies should aim at testing the applicability and practicality of the BCRM. (shrink)

In “Nudging, Bullshitting, and the Meta-Nudge”, the author responds to William Simkulet’s claim that nudging is bullshitting (according to Harry Frankfurt’s analysis of bullshit and bullshitting), and therefore nudging during the process of informed consent renders consent invalid. The author argues that nudging is not necessarily bullshitting and then explains that although this issue is philosophically interesting, practically speaking, even if nudging is bullshitting, it does not follow that nudging necessarily renders informed consent invalid. This is obviously true in those (...) situations in which nudging during the process of informed consent is unavoidable. The author concludes with a discussion of the meta-nudge and suggests that physicians can use the meta-nudge to eliminate or decrease the power of inappropriate, problematic, or undesirable nudges. (shrink)

Volume 20, Issue 3, March 2020, Page 83-85.

BackgroundPrevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization lately has been adopted and translated into policy in most Sub – Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.MethodsPapers published in English and French Languages between 1990 (...) and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.DiscussionMost authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society. The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.ConclusionsThe Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice. (shrink)