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)

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)

> 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)

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing (...) debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals. (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)