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)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in her Natural (...) Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

In this article, we apply the literature on the ethics of choice-architecture (nudges) to the realm of virtual reality (VR) to point out ethical problems with using VR for empathy-based nudging. Specifically, we argue that VR simulations aiming to enhance empathic understanding of others via perspective-taking will almost always be unethical to develop or deploy. We argue that VR-based empathy enhancement not only faces traditional ethical concerns about nudge (autonomy, welfare, transparency), but also a variant of the semantic variance problem (...) that arises for intersectional perspective-taking. VR empathy simulations deceive and manipulate their users about their experiences. Despite their often laudable goals, such simulations confront significant ethical challenges. In light of these goals and challenges, we conclude by proposing that VR designers shift from designing simulations aimed at producing empathic perspective-taking to designing simulations aimed at generating sympathy. These simulations, we claim, can avoid the most serious ethical issues associated with VR nudges, semantic variance, and intersectionality. (shrink)

Richard Thaler and Cass Sunstein (2008) contend that mandated choice is the most practical nudge for increasing organ donation. We argue that they are wrong, and their mistake results from failing to appreciate how perceptions of meaning can influence people's responses to nudges. We favor a policy of default to donation that is subject to immediate family veto power, includes options for people to opt out (and be educated on how to do so), and emphasizes the role of organ procurement (...) organizations and in-house transplant donation coordinators creating better environments for increasing the supply of organs and tissues obtained from cadavers. This policy will provide better opportunities for offering nudges in contexts where in-house coordinators work with families. We conclude by arguing that nudges can be introduced ethically and effectively into these contexts only if nudge designers collaborate with in-house coordinators and stakeholders. (shrink)

Choice architecture describes the environment in which choices are presented to decision-makers. In recent years, public and private actors have looked at choice architecture with great interest as they seek to influence human behaviour. These actors are typically called choice architects. Increasingly, however, this role of architecting choice is not performed by a human choice architect, but an algorithm or artificial intelligence, powered by a stream of Big Data and infused with an objective it has been programmed to maximise. We (...) call this entity the autonomous choice architect. In this paper, we present an account of why artificial intelligence can fulfil the role of a choice architect and why this creates problems of transparency, responsibility and accountability for nudges. We argue that choice architects, be them autonomous computational systems or human-beings, at a most basic level select, from a range of designs, the design which is most likely to maximise a pre-determined objective. We then proceed to argue that, given the growing demand for targeted, personalised choice architecture and for faster, dynamic reconfigurations of choice architecture, as well as the ever-expanding pool of data from which feedback can be drawn, the role of the human choice architect is increasingly obscured behind algorithmic, artificially intelligent systems. We provide a discussion of the implications of autonomous choice architects, focusing on the importance of the humans who programme these systems, ultimately arguing that despite technological advances, the responsibility of choice architecture and influence remains firmly one human beings must bear. (shrink)

There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology have gained prominence on the political agenda. The relationship between the social determinants of health and behavioural science in health policy has not hitherto been explored. Given the (...) on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures. (shrink)