Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)

In recent years, ‘nudge’ theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees’ deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. (...) In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences. (shrink)

In this article I will argue first that if ignorance poses a problem for valid consent in medical contexts then framing effects do too, and second that the problem posed by framing effects can be solved by eliminating those effects. My position is thus a mean between two mistaken extremes. At one mistaken extreme, framing effects are so trivial that they never impinge on the moral force of consent. This is as mistaken as thinking that ignorance is so trivial that (...) it never impinges on the moral force of consent. At the other mistaken extreme, framing effects are so serious that their existence shows that consent has no independent moral force. This is as mistaken as the idea that ignorance is so serious that its existence shows that consent has no independent moral force. I will argue that, instead of endorsing either of these mistaken extreme views, we should instead endorse a moderate view according to which framing effects sometimes pose a serious challenge for the validity of consent, just as ignorance does, but one which we can solve by eliminating the effect, just as we can solve the problem of ignorance by eliminating it. (shrink)

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.