Nudging Without Ethical Fudging: Clarifying Physician Obligations to Avoid Ethical Compromise

摘要

In the article "Nudging and Informed Consent," Cohen (2013) argues that the use of "nudging" by physicians in the clinical encountermay be ethically warranted because it results in an informed consent where obligations for beneficence and respect for autonomy can both be met. However, the author's support for nudging and his rather quick dismissal of shared decision making lead to assumptions that "soft" manipulation is justified and that professional judgment will guard against abuse. In order to avoid compromising physicians and their ethical responsibilities, we propose thatweighing the potential use of nudging must include considerations about 1) the importance of integrating and respecting individual patient preferences; 2) the potential threats to the patient-physician relationship, which must be mitigated while upholding transparency and trust within shared decision-making approaches; and 3) the specific conditions in which patient preferences and values can be legitimately influenced by health care providers. These considerations stem from general tenets of medical ethics and fundamental deontological obligations to honesty and respect for patients' well-being that define the ethos of the medical profession, and that are challenged by nudging practices (AmericanMedical Association 2008-2009).