In the article “Nudging and Informed Consent”, Cohen argues that the use of “nudging” by physicians in the clinical encounter may be ethically warranted because it results in an informed consent where obligations for beneficence and respect for autonomy are both met. However, the author's overenthusiastic support for nudging and his quick dismissal of shared decision-making leads him to assume that “soft” manipulation is un-problematic and that “wisdom” on the side of medical professionals will suffice to guard against abuse. Opposing (...) this view, we propose that: 1) patient preferences and values should not be boiled down to rational or irrational decisions based on cognitive reasoning alone, 2) potential threats to the physician-patient must be mitigated and could be minimized by employing alternative strategies that acknowledge the impact of cognitive heuristics in shaping decision-making but maintain transparency and trust, and 3) patient preferences and values can be legitimately influenced only under specific circumstances. The latter include: (1) exhaustion of other means; (2) evidence that nudging is effective in a specific context; (3) evidence of clear and active public misinformation (e.g., industry promoting smoking); (4) explicit pubic dialogue between various stakeholders including medical professional societies about nudging; (5) upholding shared decision-making as a preferred approach; and (6) a rich understanding of clinical reality beyond the simple dichotomy of beneficence-autonomy. (shrink)

This article proposes a novel integrative approach to moral judgment and a related model that could explain how unconscious heuristic processes are transformed into consciously accessible moral intuitions. Different hypothetical cases have been tested empirically to evoke moral intuitions that support principles from competing moral theories. We define and analyze the types of intuitions that moral theories and studies capture: those focusing on agents (A), deeds (D), and consequences (C). The integrative ADC approach uses the heuristic principle of “attribute substitution” (...) to explain how people make intuitive judgments. The target attributes of moral judgments are moral blameworthiness and praiseworthiness, which are substituted with more accessible and computable information about an agent's virtues and vices, right/wrong deeds, and good/bad consequences. The processes computing this information are unconscious and inaccessible, and therefore explaining how they provide input for moral intuitions is a key problem. We analyze social heuristics identified in the literature and offer an outline for a new model of moral judgment. Simple social heuristics triggered by morally salient cues rely on three distinct processes (role-model entity, action analysis, and consequence tallying—REACT) in order to compute the moral valence of specific intuitive responses (A, D, and C). These are then rapidly combined to form an intuitive judgment that could guide quick decision making. The ADC approach and REACT model can clarify a wide set of data from empirical moral psychology and could inform future studies on moral judgment, as well as case assessments and discussions about issues causing “deadlocked” moral intuitions. (shrink)

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. (...) In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership. (shrink)