Abstract
In bioethics, the predominant categorization of various types of
influence has been a tripartite classification of rational persuasion (meaning
influence by reason and argument), coercion (meaning influence by irresistible
threats—or on a few accounts, offers), and manipulation (meaning everything
in between). The standard ethical analysis in bioethics has been that rational
persuasion is always permissible, and coercion is almost always impermissible
save a few cases such as imminent threat to self or others. However, many forms
of influence fall into the broad middle terrain—and this terrain is in desperate
need of conceptual refining and ethical analysis in light of recent interest in using
principles from behavioral science to influence health decisions and behaviors.
This paper aims to address the neglected space between rational persuasion and
coercion in bioethics. First, I argue for conceptual revisions that include removing
the “manipulation” label and relabeling this space “nonargumentative]influence,”
with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue
that bioethicists have made the mistake of relying heavily on the conceptual
categories themselves for normative work and instead should assess the ethical
permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence
on autonomy and (2) the relationship between the influencer and the influenced.
Finally, I apply my analysis to two examples of nonargumentative influence in
health care and health policy: (1) governmental agencies such as the Food and
Drug Administration (FDA) trying to influence the public to be healthier using
nonargumentative measures such as vivid images on cigarette packages to make
more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery.