Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (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)

Zealous nudging can deteriorate into paternalistic bullshitting. 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. These bolder claims involve a set of errors. The problem starts with Simkulet’s formal definition of ‘bullshit’, which says that conveying x while intending one’s audience to (...) believe y is sufficient for bullshit. This, however, is not true since the bullshitter’s not caring whether x is true is constitutive of bullshitting, and hence a necessary condition. Why, we then ask, must such lack of care be the case with the doctor who nudges? It is at least prima facie easy and intuitive to think of scenarios in which the ethical doctor is staunchly committed to telling the truth while simultaneously acting on additional motives regarding the expected effects of what is said. If the doctor cares about saying only truths, he is not a bullshitter. Having communicative motivations that transcend the trivial motive of transmitting the truth of the literal content of what is said is normal and indeed normative in conversations of regular people.2 …. (shrink)

To avoid potential abuse and respect patient autonomy, physicians have a moral obligation to obtain informed consent before performing any significant medical intervention. To give informed consent, a patient must be competent, understand her condition, options and their expected risks and benefits and must freely and expressly consent to one of those options. Shlomo Cohen challenges this conception of informed consent by constructing cases based on Edmund Gettier’s classic counterexamples to traditional theories of knowledge. In this paper, I argue Cohen-style (...) cases are not genuine threats to the concept of informed consent, however they provide an interesting challenge to theories of conscientious objection. (shrink)