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)

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 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)