In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

Is it possible to interfere with individual decision-making while preserving freedom of choice? The purpose of this article is to assess whether ‘libertarian paternalism’, a set of political and ethical principles derived from the observations of behavioural sciences, can form the basis of a viable framework for the ethical analysis of public health interventions. First, the article situates libertarian libertarianism within the broader context of the law and economics movement. The main tenets of the approach are then presented and particular (...) attention is given to its operationalization through the notion of a ‘nudge’. Essentially, a ‘nudge’ consists in an intervention, which aims to suggest one choice over another by gently steering individual choices in welfare-enhancing directions yet without imposing any significant limit on available choices. Finally, the article concludes that, while it fails as an overreaching framework of ethical analysis, libertarian paternalism nonetheless constitutes a valuable addition to the conceptual toolbox of public health ethics. (shrink)

Philosophers’ intuitions about what constitutes autonomy are largely driven by the exemplars or paradigms that we recognize. There are indefinitely many exemplars, inasmuch as there are relatively private personae that serve as autonomy exemplars such as our parents, third grade teacher, or, for the megalomaniac, oneself. But among Western philosophers there are doubtless some exemplars that are widely shared and broadly influential. Philosophical exemplars include Socrates, Aristotle’s magnanimous man, Kant’s noumenal self that is perfectly attuned to the moral law, Mill’s (...) anti-authoritarian non-conformist, Marx’s manin-society, Nietzsche’s Zarathustra, and Sartre’s authentic youth who must decide whether to join the French resistance or stay at home for the sake of his mother. Exemplars from outside of philosophy include Antigone, Christ, Faust, Ibsen’s Enemy of the People, Winston Churchill, and even figures from popular culture such as the baseball player Ted Williams, the free spirited flower children of the 1960s, and practically any character that John Wayne ever played. (shrink)