One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer (...) screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making. (shrink)

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality (...) and autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

While nudging has garnered plenty of interdisciplinary attention, the ethics of applying it to climate policy has been little discussed. However, not all ethical considerations surrounding nudging are straightforward to apply to climate nudges. In this article, we overview the state of the debate on the ethics of nudging and highlight themes that are either specific to or particularly important for climate nudges. These include: the justification of nudges that are not self-regarding; how to account for climate (...) change denialists; transparency; knowing the right or best behaviours; justice concerns; and whether the efficacy of nudges is sufficient for nudges to be justified as a response to the climate crisis. We conclude that climate nudges raise distinct ethical questions that ought to be considered in developing climate nudges. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people’s ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have (...) been found between doctors’ ethical attitude to clinical nudging and that of patients. We show how these differences weaken the argument for nudging from public support. Moreover, our findings raise concerns regarding doctors’ ability to nudge ethically according to their own standards, as they may underestimate the degree of harm medical nudges can cause to informed consent, doctor–patient trust and other important ethically relevant features of health-related choices. (shrink)

So‐called nudge policies utilize insights from behavioral science to achieve policy outcomes. Nudge policies try to improve people's decisions by changing the ways options are presented to them, rather than changing the options themselves or incentivizing or coercing people. Nudging has been met with great enthusiasm but also fierce criticism. This paper provides an overview of the debate on the ethics of nudging to date. After outlining arguments in favor of nudging, we first discuss different objections that all revolve around (...) the worry that nudging vitiates personal autonomy. We split up this worry into different dimensions of autonomy, such as freedom of choice, volitional autonomy, rational agency, and freedom as nondomination. We next discuss worries that nudging is manipulative, violates human dignity, and prevents more important structural reform. Throughout, we will present responses that proponents of nudging can muster. On the whole, we conclude that the objections fail to establish that the nudge program as a whole should be rejected. At the same time, they give us important guidance when moving towards an ethical assessment of nudges on a case‐by‐case basis. Towards the end, we provide some possible ways forward in debates around the ethics of nudging. (shrink)

Robots are becoming an increasingly pervasive feature of our personal lives. As a result, there is growing importance placed on examining what constitutes appropriate behavior when they interact with human beings. In this paper, we discuss whether companion robots should be permitted to “nudge” their human users in the direction of being “more ethical”. More specifically, we use Rawlsian principles of justice to illustrate how robots might nurture “socially just” tendencies in their human counterparts. Designing technological artifacts in such a (...) way to influence human behavior is already well-established but merely because the practice is commonplace does not necessarily resolve the ethical issues associated with its implementation. (shrink)

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)

Many philosophical accounts of manipulation are blind to the extent to which actual people fall short of the rational ideal, while prominent accounts in political science are under-inclusive. We offer necessary and sufficient conditions – Suitable Reason and Testimonial Honesty – distinguishing manipulative from non-manipulative influence; develop a ‘hypothetical disclosure test’ to measure the degree of manipulation; and provide further criteria to assess and compare the morality of manipulation across cases. We discuss multiple examples drawn from politics and from public (...) policy with particular attention to recent debates about the ethics and politics of nudge. (shrink)

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides (...) of this debate sometimes seem committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

This chapter critically analyses the ethical and political dimensions of supposedly subtle and non-coercive interventions that aim to ‘prevent crime’ through environmental designs making certain public spaces less attractive for specific groups. Examples include benches designed to discourage sleeping (targeted at homeless people), high-pitched noises or classical music played to deter lingering (targeted at youngsters), and specific lighting to prevent aggression (targeted at nightlife). While these interventions may appear less problematic than more traditional exclusionary measures, they raise ethical and political (...) worries that come into view clearly when we analyse them as instances of nudging, on the one hand, and niche construction and affective scaffolding, on the other. Employing this approach reveals how these exclusionary environmental designs not only risk reinforcing problematic stereotypes and social inequalities and discipline rather than prevent crime, they also can alienate specific groups, constitute affective injustices, and inflexibly reduce the diverse purposes public spaces potentially have. The chapter argues that environments are never neutral as they inevitably support and encourage some bodies, behaviours, moods, and emotions while suppressing and discouraging others. (shrink)

A core idea underlying nudging is that it helps individuals to achieve their own goals, yet many nudges actually aim at collective goals or specifically target the benefit of others. An example is nudging healthcare workers to be vaccinated against influenza. I distinguish between self‐regarding nudges, which primarily benefit the nudgee, and other‐regarding nudges, which mainly benefit others, and argue that the default justificatory reason to legitimize self‐regarding nudges, namely the ‘as judged by themselves’ standard, does (...) not apply and that we need to look for other justifications. I examine several possible moral justifications to support strong other‐regarding nudges, namely beneficence, the harm principle and solidarity. (shrink)

Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this (...) context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making. (shrink)

There is growing interest in using non-coercive interventions to promote and protect public health, in particular "health nudges." Behavioral economist Richard Thaler and law scholar Cass Sunstein coined the term nudge to designate influences that steer individuals in a predetermined direction by activating their automatic cognitive processes, while preserving their freedom of choice. Proponents of nudges argue that public and private institutions are entitled to use health-promoting nudges because nudges do not close off any options. Opponents (...) reply that the nudgee has no opportunity to deliberate over her choice. The nudger controls the nudgee, who has no real freedom of choice. -/- In my dissertation, I salvage the concept of nudge from the charge that it merely pays lip service to freedom of choice, offer an alternative account of the moral import of nudges for the evaluation of public health policies, and provide an ethical framework for their justified use. -/- My argument proceeds in four steps. First, I argue that nudging mechanisms often involve some form of incomplete deliberation, and do not always bypass deliberation. Second, I maintain that nudges preserve freedom of choice because they preserve the choice-set and are substantially noncontrolling. I show that the debate over nudges is plagued by confusion between real nudges, which are easily resistible and therefore substantially noncontrolling, and influences that are not easily resistible yet activate the same cognitive mechanisms as nudges. Third, I reject the view that nudges are systematically preferable to more controlling influences, even when they interfere with non-consequential liberties. I show that the principle of the least restrictive alternative often invoked in public health ethics is applied with too wide a scope. Fourth, I argue that paternalism is not central to the ethics of public health nudges. Rather, the substantive problem with nudges is that their overall cumulative effect might weaken our decisional capacities or undermine their proper exercise. This is a reason to limit recourse to certain nudges. I finally show, contra certain Kantians and Millians, that we have no perfect duty to engage or enhance decisional capacities. (shrink)

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)

Behavioral intervention techniques leveraging reactive responses have gained popularity as tools for promoting ethical behavior. Choice architects, for example, design and present default opt-out options to nudge individuals into accepting preselected choices deemed beneficial to both the decision-maker and society. Such interventions can also employ mild financial incentives or affective triggers including joy, fear, empathy, social pressure, and reputational rewards. We argue, however, that ethical competence is achieved via reflection, and that heavy reliance on reactive behavioral interventions can undermine the (...) development of ethical competence over the long term. Specifically, drawbacks may occur through motivational displacement, dependency, moral crowding out, loss of personal autonomy, and reactance. We introduce complementary cognitive boosting techniques designed to stimulate reflective cognition, as a more promising long-term strategy for instilling ethical behavior. One such approach is the Moral Self-Awareness (MSA) motivational construct, which incrementally leads agents to increasing levels of ethical reflection. We explain why ethical boosting approaches present more edifying and durable alternatives to reactive behavioral interventions and offer suggestions for social and organizational policy. (shrink)

Nudging refers to the subtle design of the context of choice in a way that mobilises the unconscious mind and alters human behaviour predictably. Nudging has been criticised for entailing numerous practical and ethical problems, including manipulation, elitism and cultural insensitivity. To respond to the problems, participatory and deliberative procedures have been proposed that would enable the questioning of the power relations embedded in behavioural governance. Yet participation and deliberation are themselves characterised by unconscious behavioural influences. I argue that awareness (...) of the prevalence of unconscious behavioural influences in environmental governance is a prerequisite for tackling the complex practical and ethical issues of nudging. I show that unconscious behavioural influences permeate environmental governance and outline analytical approaches for revealing them. (shrink)

An under-examined aspect of human–robot interaction that warrants further exploration is whether robots should be permitted to influence a user’s behavior for that person’s own good. Yet an even more controversial practice could be on the horizon, which is allowing a robot to “nudge” a user’s behavior for the good of society. In this article, we examine the feasibility of creating companion robots that would seek to nurture a user’s empathy toward other human beings. As more and more computing devices (...) subtly and overtly influence human behavior, it is important to draw attention to whether it would be ethically appropriate for roboticists to pursue this type of design pathway. Our primary focus is on whether a companion robot could encourage humans to perform charitable acts; this design possibility illustrates the range of socially just actions that a robot could potentially elicit from a user and what the associated ethical concerns may be. (shrink)

A core idea underlying nudging is that it helps individuals to achieve their own goals, yet many nudges actually aim at collective goals or specifically target the benefit of others. An example is nudging healthcare workers to be vaccinated against influenza. I distinguish between self‐regarding nudges, which primarily benefit the nudgee, and other‐regarding nudges, which mainly benefit others, and argue that the default justificatory reason to legitimize self‐regarding nudges, namely the ‘as judged by themselves’ standard, does (...) not apply and that we need to look for other justifications. I examine several possible moral justifications to support strong other‐regarding nudges, namely beneficence, the harm principle and solidarity. (shrink)

This paper offers a theoretical framework that can be used to derive viable engineering strategies for the design and development of robots that can nudge people towards moral improvement. The framework relies on research in developmental psychology and insights from Stoic ethics. Stoicism recommends contemplative practices that over time help one develop dispositions to behave in ways that improve the functioning of mechanisms that are constitutive of moral cognition. Robots can nudge individuals towards these practices and can therefore help develop (...) the dispositions to, for example, extend concern to others, avoid parochialism, etc. (shrink)

This review article provides a new perspective on the ethics of green nudging. We advance a new model for assessing the ethical permissibility of green nudges (GNs). On this model, which provides normative guidance for policymakers, a GN is ethically permissible when the intervention is (1) efficacious, (2) cost-effective, and (3) the advantages of the GN (i.e. reducing the environmental harm) are not outweighed by countervailing costs/harms (i.e. for nudgees). While traditional ethical objections to nudges (paternalism, etc.) remain (...) potential normative costs associated with GNs, any such costs must be weighed against the injunction to reduce environmental harm to third parties. (shrink)

_Abstract_: Nudges have proven to be effective tools for steering citizens toward desirable behaviors and make valuable additions to any policy-maker’s toolbox. Disappointingly, however, there are no mechanistic explanations for how nudges work, leaving policy-makers unable to explain what happens when they are implemented. This paper identifies some neglected ethical implications of the resulting citizens lack of awareness of such mechanisms. We first examine mechanistic explanations in relation to citizens’ understanding on how they work. Then, we look at (...) mechanistic explanations in light of the suggestion advanced by some ethicists that nudges be considered ethically acceptable in modern liberal democracies provided the explicit transparency of the nudges employed. _Keywords_: Nudge; Ethics of Nudging; Mechanistic Evidence; In-principle Transparency; Explicit Transparency _Spiegazioni meccanicistiche e l’etica dei _nudges _Riassunto_: I _nudge_ si sono rivelati strumenti di _policy_ efficaci nello "spingere gentilmente" i cittadini verso comportamenti considerati desiderabili. Per questa ragione i nudge sono considerati validi strumenti della cassetta degli attrezzi di un _policymaker_. Tuttavia, è in qualche modo deludente la mancanza di spiegazioni meccanicistiche dei nudge, dalla quale risulta l'incapacità dei _policymaker_ di spiegare quello che succede quando i nudge vengono effettivamente implementati. Questo articolo identifica alcune implicazioni etiche finora trascurate connesse alla inconsapevolezza da parte dei cittadini circa i meccanismi che governano i _nudge_. Da una parte, le nostre considerazioni metteranno in relazione le spiegazioni meccanicistiche con la comprensione dei _nudge_ da parte dei cittadini. Dall'altra parte, metteremo in relazione le spiegazioni meccanicistiche con il concetto di trasparenza esplicita, ossia la richiesta avanzata da alcuni eticisti al fine di considerare i _nudge_ eticamente accettabili nelle moderne democrazie liberali. _Parole chiave_: Nudge; Etica dei nudge; Spiegazioni meccanicistiche; Trasparenza implicita; Trasparenza esplicita. (shrink)

Andreas Schmidt and Neil Levy have recently defended nudging against the objection that nudges fail to treat nudgees as rational agents. Schmidt rejects two theses that have been taken to support the objection: that nudges harness irrational processes in the nudgee, and that they subvert the nudgee’s rationality. Levy rejects a third thesis that may support the objection: that nudges fail to give reasons. I argue that these defences can be extrapolated from nudges to some nonconsensual (...) neurointerventions; if Schmidt’s and Levy’s defences succeed, then some nonconsensual neurointerventions neither harness irrationality, nor subvert rationality, nor fail to give reasons. This, I claim, poses a challenge both to opponents of nonconsensual neurointerventions, and to defenders of nudging. (shrink)

[Feel free to email me for a preprint] The combination of philosophy, politics, and economics (PPE) delivers a powerful approach for analysing social and political phenomena, and is an exemplar of productive interdisciplinary integration. Integrating the constituent disciplines is key to the power of an approach like PPE, yet such integration is neither simple nor natural. In this paper, I reflect on the process of designing and convening a PPE course, as a case study for understanding the benefits, challenges, and (...) nature of interdisciplinary integration. This PPE course is an upper-level seminar on the ethics of nudges – which, roughly, are policies that use peoples' heuristics and biases to influence them to act in certain ways, without removing options or significantly changing financial incentives. I first argue that the ethics of nudging is a fruitful site for interdisciplinary integration. I then walk through my course design, showing how specific topics and readings facilitate such integration while overcoming common challenges to it. I also present concrete examples of integrative class activities and assessment. Using this case study, I draw out general lessons and models for how to teach an interdisciplinary course. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

This book addresses the growing use of computerized systems to influence people’s decisions without their awareness, a significant but underappreciated sea-change in the way the world works. To assess these systems, this volume’s contributors explore the philosophical and ethical dimensions of algorithms that guide people’s behavior by nudging them toward choices preferred by systems architects. Particularly in an era of heightened awareness of bias and discrimination, these systems raise profound concerns about the morality of such activities. This volume brings together (...) a diverse array of thinkers to critically examine these nudging systems. Not only are high-level perspectives presented, but so too are of those who use them on a day-to-day basis. While algorithmic nudging can produce benefits for users there are also many less-obvious costs to using such systems, costs that require examination and deliberation. This book is a major step towards delineating these concerns and suggesting ways to provide a sounder basis for future policies for algorithms. It should be of interest to system designers, public policymakers, scholars, and those who wonder more deeply about the nudges they receive from various websites and on their phones. (shrink)

Traditional medical practices and relationships are changing given the widespread adoption of AI-driven technologies across the various domains of health and healthcare. In many cases, these new technologies are not specific to the field of healthcare. Still, they are existent, ubiquitous, and commercially available systems upskilled to integrate these novel care practices. Given the widespread adoption, coupled with the dramatic changes in practices, new ethical and social issues emerge due to how these systems nudge users into making decisions and changing (...) behaviours. This article discusses how these AI-driven systems pose particular ethical challenges with regards to nudging. To confront these issues, the value sensitive design approach is adopted as a principled methodology that designers can adopt to design these systems to avoid harming and contribute to the social good. The AI for Social Good factors are adopted as the norms constraining maleficence. In contrast, higher-order values specific to AI, such as those from the EU High-Level Expert Group on AI and the United Nations Sustainable Development Goals, are adopted as the values to be promoted as much as possible in design. The use case of Amazon Alexa's Healthcare Skills is used to illustrate this design approach. It provides an exemplar of how designers and engineers can begin to orientate their design programs of these technologies towards the social good. (shrink)

This essay has three general themes. The first involves the claim that nudging threatens human agency. My basic response is that human agency is fully retained (because nudges do not compromise freedom of choice) and that agency is always exercised in the context of some kind of choice architecture. The second theme involves the importance of having a sufficiently capacious sense of the category of nudges, and a full appreciation of the differences among them. Some nudges either (...) enlist or combat behavioral biases but others do not, and even among those that do enlist or combat such biases, there are significant differences. The third general theme is the need to bring various concerns (including ethical ones) in close contact with particular examples. A legitimate point about default rules may not apply to warnings or reminders. An ethical objection to the use of social norms may not apply to information disclosure. Here as elsewhere, abstraction can be a trap. We continue to learn about the relevant ethical issues, about likely public reactions to nudging, and about differences across cultures and nations. Future progress will depend on a high level of concreteness, perhaps especially in dealing with the vexing problem of time-inconsistency. (shrink)

In his excellent essay, ‘Nudges in a post-truth world’, Neil Levy argues that ‘nudges to reason’, or nudges which aim to make us more receptive to evidence, are morally permissible. A strong argument against the moral permissibility of nudging is that nudges fail to respect the autonomy of the individuals affected by them. Levy argues that nudges to reason do respect individual autonomy, such that the standard autonomy objection fails against nudges to reason. In (...) this paper, I argue that Levy fails to show that nudges to reason respect individual autonomy. (shrink)

Michael Bloomberg's three terms in New York City's mayoral office are coming to a close. His model of governance for public health influenced cities and governments around the world. What should we make of that model? This essay introduces a symposium in which ethicists Sarah Conly, Roger Brownsword and Alex Rajczi discuss that legacy.

In “Nudging and Informed Consent,” ShlomoCohen (2013) attempts to address the common objection against nudges that they are autonomy-thwarting because they foster irrationality. He explicitly focuses on informed consent, which he contrasts with the policy context in which health nudges are usually discussed. I think Cohen’s rich article is a significant contribution to the nudge literature. However, I have some concerns with the way he frames and motivates his inquiry...

The widespread practices of data collection by third-party actors pose challenges to children’s and adolescents’ privacy when they navigate digital environments. Given that the informed-consent par...

Although vaccines are considered an efficient public health tool by medical experts, in different countries, people’s confidence in them has been decreasing. COVID-19 has elevated medical scientists’ and practitioners’ social reputation, and it may have reduced global vaccination hesitancy. Still, this alone will not altogether remove the existent frictions that prevent people from complying with vaccination schedules. This paper will review the common causes behind vaccination hesitancy. It will also explore different types of public policy interventions that health experts in (...) governments and institutions employ to fight vaccine hesitancy and non-compliance. The main objective of this article is to argue that, considering the nature of the issue (vaccine hesitancy and its causes), among the various possibilities, policies based on behavioral insights can provide an effective instrument to remove those frictions. Among them, special attention will be devoted to nudges which promise efficiency while avoiding some of the ethical and political costs of other interventions, thanks to their libertarian paternalistic frame. The article concludes by suggesting that public health policymakers should consider the libertarian paternalistic approach of nudges when deploying interventions that aim at changing people’s attitudes and behavior. (shrink)

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be (...) vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (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)

Zealous nudging can deteriorate into paternalistic bullshitting. To the extent that William Simkulet’s paper is a reminder against that danger, it does us good service.1 Simkulet, however, makes the far bolder claims that nudging just is bullshitting and that—since bullshitting deviates from truthfulness, and truthful disclosure is essential for valid consent—nudging invalidates informed consent. These bolder claims involve a set of errors. The problem starts with Simkulet’s formal definition of ‘bullshit’, which says that conveying x while intending one’s audience to (...) believe y is sufficient for bullshit. This, however, is not true since the bullshitter’s not caring whether x is true is constitutive of bullshitting, and hence a necessary condition. Why, we then ask, must such lack of care be the case with the doctor who nudges? It is at least prima facie easy and intuitive to think of scenarios in which the ethical doctor is staunchly committed to telling the truth while simultaneously acting on additional motives regarding the expected effects of what is said. If the doctor cares about saying only truths, he is not a bullshitter. Having communicative motivations that transcend the trivial motive of transmitting the truth of the literal content of what is said is normal and indeed normative in conversations of regular people.2 …. (shrink)

In “Nudging, Bullshitting, and the Meta-Nudge”, the author responds to William Simkulet’s claim that nudging is bullshitting (according to Harry Frankfurt’s analysis of bullshit and bullshitting), and therefore nudging during the process of informed consent renders consent invalid. The author argues that nudging is not necessarily bullshitting and then explains that although this issue is philosophically interesting, practically speaking, even if nudging is bullshitting, it does not follow that nudging necessarily renders informed consent invalid. This is obviously true in those (...) situations in which nudging during the process of informed consent is unavoidable. The author concludes with a discussion of the meta-nudge and suggests that physicians can use the meta-nudge to eliminate or decrease the power of inappropriate, problematic, or undesirable nudges. (shrink)

Cornell realism (CR), a prominent meta-ethical position that has emerged since the last decades of the twentieth century, proposes a non-reductionist naturalistic account of moral properties and facts. This paper argues that the best version of CR’s chosen methodology for arriving at justified moral beliefs must be seen as a variant of reflective equilibrium. In comparison to the traditional versions, our proposal offers a ‘social’ reinterpretation of reflective equilibrium in delineating CR’s epistemology. We argue that it satisfactorily accounts for objectivity (...) and calls for the inclusion of the social nature of both moral and scientific inquiries. Emphasising the social dimension of their epistemological account also nudges debates in metaethics into incorporating the much-needed social dimension while dealing with questions of moral beliefs and facts that have been of CR’s concern. (shrink)

One of the most pervasive criticisms of nudges has been the claim that they violate, undermine or decrease people’s autonomy. This claim, however, is seldom backed up by an explicit and detailed conception of autonomy. In this paper, we aim to do three things. First, we want to clear up some conceptual confusion by distinguishing the different conceptions used by Cass Sunstein and his critics in order to get clear on how they conceive of autonomy. Second, we want to (...) add to the existing discussion by distinguishing between ‘autonomy’ as the ability to set your own ends and ‘autocracy’ as the ability to actually realize those ends. This will allow for a more careful ethical evaluation of specific nudge interventions. Third, we will introduce the idea of ‘perimeters of autonomy’ in an attempt to provide a realistic account of personal autonomy and we will argue that it can alleviate most of the worries about nudging being autonomy-undermining. (shrink)

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions (rational and pre-rational decisions, major and minor decisions) are made and how this decision-making process pertains to patients. We view this knowledge in (...) light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals. (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)

Nudging is considered a promising approach for behavioural change. At the same time, nudging has raised ethical concerns, specifically in relation to the impact of nudges on autonomous choice. A complexity is that in this debate authors may appeal to different understandings or dimensions of autonomy. Clarifying the different conceptualisations of autonomy in ethical debates around nudging would help to advance our understanding of the ethics of nudging. A literature review of these considerations was conducted in order to identify (...) and differentiate between the conceptualisations of autonomy. In 33 articles on the ethics of nudging, we identified 280 autonomy considerations, which we labelled with 790 unique autonomy codes and grouped under 61 unique super-codes. Finally, we formulated three general conceptualisations of autonomy. Freedom of choice refers to the availability of options and the environment in which individuals have to make choices. Agency involves an individual's capacity to deliberate and determine what to choose. Self-constitution relates to someone's identity and self-chosen goals. In the debate about the ethics of nudging, authors refer to different senses of autonomy. Clarifying these conceptualisations contributes to a better understanding of how nudges can undermine or, on the other hand, strengthen autonomy. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 22-24, February 2012.

The American Journal of Bioethics, Volume 12, Issue 2, Page 24-25, February 2012.

Volume 19, Issue 10, October 2019, Page W9-W13.

Exploring the use of nudges and informed consent in medical ethics.