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)

Debates over how to conceptualize the nursing role were prominent in the nursing literature during the latter part of the twentieth century. There were, broadly, two schools of thought. Writers likeHenderson andOrem used the idea of a self‐care deficit to understand the nurse as doing for the patient what he or she could not do alone. Later writers found this paternalistic and emphasized the importance of the patient's free will. This essay uses the ideas of positive and negative freedom to (...) explore the differing conceptions of autonomy which are implicit in this debate. The notion of positive freedom has often been criticized as paternalistic, and the criticisms of self‐care in the nursing literature echo criticisms from political philosophy. Recent work on relational autonomy and on the relationship between autonomy and identity are used to address these objections. This essay argues for a more nuanced conception of the obligation to support autonomy that includes both positive (freedomto) and negative (freedomfrom) dimensions. This conception of autonomy provides a moral foundation for conceptualizing nursing in something like Henderson's terms: as involving the duty to expand the patient's capacities. The essay concludes by generalizing the lesson. Respect for autonomy on the part of any health care provider requires both respect for the patient's choices and a commitment to expand the patient's ability to actualize their choices. (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.

Partiality and Justice in Nursing Care examines the conflicting normative claims of partiality and impartiality in nursing care, looking in depth at how to reconcile reasonable concerns for one particular patient with equally important concerns for the maximisation of health-related welfare for all with relevant nursing-care needs, in a resource-limited setting. Drawing on moral philosophy, this book explores how discussions of partiality and impartiality in moral philosophy can have relevance to the professional context of clinical nursing care as well as (...) in nursing ethics in general. It develops a framework for normative nursing ethics that incorporates a notion of permissible partiality, and specifies which concerns an ethics of nursing care should entail when balancing partialist and impartialist concerns. At the same time, Nordhaug argues that this partiality must also be constrained by both principled and context-sensitive assessments of patients' needs, as well as of the role-relative deontological restriction of minimising harm, something that could be mitigated by institutional and organisational arrangements. This thought-provoking volume is an important contribution to nursing ethics and philosophy. (shrink)