Introduction
Focusing on improving the effectiveness of treatment, some healthcare providers may forget about another significant aspect – ethical considerations. One of the situations when these two aspects are in conflict, is nudging. Busch et al. (2020) studied the ethical dilemma that arises when doctors or policymakers use nudging to persuade patients or the public to agree to a recommended intervention or a new healthcare policy. On the one hand, the professionals have the knowledge, expertise, and experience necessary to suggest the best treatment or policy. Thus, nudging may be beneficial for the public’s health promotion. On the other hand, ignoring patients’ opinions seems to violate human rights. Therefore, nudging can be a useful tool for effective intervention promotion or an instrument for manipulation and dominance over patients.
Nudging as an Ethical Dilemma
To solve the presented ethical issue, one should identify what cases of nudging are truly beneficial and harmless for patients and which ones are ethically challenged. Thaler and Sunstein, the authors of the nudging theory, noted that context always influences people’s choices (as cited in Busch et al., 2020, p. 1141). Thus, nudging may be used as a positive alternative to restrictions (as cited in Busch et al., 2020, p. 1141). However, they emphasize that it “should be easy to avoid” and be used in the best interests of the person affected (as cited in Busch et al., 2020, p. 1141). Busch et al. (2020) studied various nudging techniques and suggested dividing them into educative and non-educative, according to Sunstein’s classification (as cited in Busch et al., 2020, p. 1141). If nudges are presented in a “form of information provision,” they are educative; if they “exploit cognitive biases,” Sunstein considers them non-educative (as cited in Busch et al., 2020, p. 1141). Non-educative nudges may demonstrate a one-sided view of the suggested intervention, appeal to fear, or even threaten. In brief, the nudging can be provided as information-sharing or manipulation.
I believe healthcare professionals should be aware of this distinction and always analyze the interaction patterns they use in communication with patients. If they want a patient to consider a certain intervention, they should focus on clearly providing full information rather than pressuring the patient. The latter would only cause discomfort and distrust in the patient impeding their recovery. Thus, only educative nudges should be considered an appropriate health promotion tool.
It aligns with ethical principles, guidelines, and values that all healthcare providers should follow and respect. They are enshrined in rules of conduct and codes of ethics adopted by medical organizations. According to the American Public Health Association’s Code of Ethics, transparency is an important ethical principle in healthcare. It means that no vital information should be withheld from the patient, and healthcare providers must explain the reasoning behind their treatment-related decisions clearly and explicitly (American Public Health Association). This document also highlights patient rights, including “personal autonomy, self-determination, privacy, and the absence of domination” from people or institutions as respected values (American Public Health Association, Section 2, para. 6). The same stance is reflected in the American Medical Association’s Code of Medical Ethics. It states that a patient has the right to receive all relevant information about their health status and the proposed interventions, ask questions about them, make decisions and have them respected (American Medical Association). Thus, patients’ rights of informed consent, autonomy, and decision-making concerning the recommended interventions are officially acknowledged, and non-educative nudging techniques that violate these rights should be eliminated from medical practice.
Conclusion
In conclusion, nudging can positively and negatively impact patients depending on its form: educative or informative and non-educative or manipulative. The former aligns with basic ethical principles and patient rights and can help a patient choose the most suitable option. Non-educative nudging goes against patient rights of autonomy and informed consent, and healthcare professionals should abstain from them to not lose the patient’s trust.
References
American Medical Association. (n.d.). Code of medical ethics: Patient rights. Web.
American Public Health Association. (n.d.). Public health code of ethics. Web.
Busch, J., Madsen, E. K., Fage-Butler, A. M., Kjær, M., & Ledderer, L. (2020). Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet.Health Promotion International, 36(4), 1140–1150. Web.