Companies increasingly offer their employees the opportunity to participate in voluntary Workplace Health Promotion programmes. Although such programmes have come into focus through national and regional regulation throughout much of the Western world, their ethical implications remain largely unexamined. This article maps the territory of the ethical issues that have arisen in relation to voluntary health promotion in the workplace against the background of asymmetric relationships between employers and employees. It addresses questions of autonomy and voluntariness, discrimination and distributive justice, (...) as well as privacy and responsibility. Following this analysis, we highlight the inadequacy of currently established ethical frameworks to sufficiently cover all aspects of workplace health promotion. Thus, we recommend the consideration of principles from all such frameworks in combination, in a joint reflection of an Ethics of Workplace Health Promotion. (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)

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)

I argue that it is impermissible to use nudges as a tool to influence patients in the context of informed consent. The motivation for such nudges is that their use can help reconcile potential conflicts between a physician’s duty of beneficence and duty to respect patient autonomy. I argue that their use places physicians in a position of domination over patients. That is, it violates the republican freedom of patients because it grants physicians the power to arbitrarily interfere. I also (...) argue that if one tries to adjust the duty of beneficence to avoid this conclusion, then the republican freedom of patients is still threatened under conditions of clinical equipoise. As ways to avoid the inevitability of nudging, I suggest the alternative of boosting or the pairing of patients with physicians who share their deep values. This latter option achieves the benefits nudging patients is supposed to provide without violating the republican freedom of those patients. (shrink)