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Abstract

Nudging is the intentional manipulation of the way that a decision is presented to influence choices without taking away options. In medicine, nudging has been proposed as a way for physicians to promote patients’ well-being by steering them toward choices that are actually in their best interest. However, it has been argued that clinical nudging undermines informed consent by interfering with patients’ ability to weigh reasons bearing on their decisions. This paper defends (some) clinical nudges on the basis that they promote informed decision-making by making relevant considerations salient and thereby contributing to patients’ appreciation of them.

Keywords

clinical nudging informed consent rationality autonomy behavior change

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References

Pepijn

. 2025. “Is Framing of Treatment Options Misleading? Maybe, but Not Because of a Lower-Bound Reading.” Journal of Medical Ethics 51 (9): 651–52. https://doi.org/10.1136/jme-2024-110640

Bansback

Nick

Linda C.

Lynd

Larry

Bryan

Stirling

. 2014. “Exploiting Order Effects to Improve the Quality of Decisions.” Patient Education and Counseling 96 (2): 197–203. https://doi.org/10.1016/j.pec.2014.05.021

Blumenthal-Barby

J. S.

Naik

Aanand D.

. 2015. “In Defense of Nudge: Autonomy Compatibility.” The American Journal of Bioethics 15 (10): 45–47. https://doi.org/10.1080/15265161.2015.1074304

Broome

John

. 2007. “Does Rationality Consist in Responding Correctly to Reasons?” Journal of Moral Philosophy 4 (3): 349–74. https://doi.org/10.1177/1740468107083249

Chen

Stacy S.

Das

Sunit

. 2022. “‘What Are My Options?’ Physicians as Ontological Decision Architects in Surgical Informed Consent.” Bioethics 36 (9): 936–39. https://doi.org/10.1111/bioe.13076

Cohen

Shlomo

. 2013. “Nudging and Informed Consent.” The American Journal of Bioethics 13 (6): 3–11. https://doi.org/10.1080/15265161.2013.781704

Director

Samuel

. 2024. “Framing Effects Do Not Undermine Consent.” Ethical Theory & Moral Practice 27 (2): 221–35. https://doi.org/10.1007/s10677-023-10412-1

Dung

Leonard

. 2025. “The Effectiveness of Nudging and Its Ethical Implications.” Bioethics 39 (8): 748–54. https://doi.org/10.1111/bioe.70000

Dworkin

Gerald

. 2002 (2020). “Paternalism.” In The Stanford Encyclopedia of Philosophy, edited by Zalta

Edward N.

Nodelman

Uri

. https://plato.stanford.edu/entries/paternalism/

10.

Emanuel

Ezekiel J.

Emanuel

Linda L.

. 1992. “Four Models of the Physician-Patient Relationship.” JAMA 267 (16): 2221–26. https://doi.org/10.1001/jama.1992.03480160079038

11.

Engelen

Bart

. 2019. “Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis.” The American Journal of Bioethics 19 (5): 48–59. https://doi.org/10.1080/15265161.2019.1588411

12.

Fogal

Daniel

Worsnip

Alex

. 2021. “Which Reasons? Which Rationality?” Ergo 8 (11). https://doi.org/10.3998/ergo.1148

13.

Garson

Justin

. 2019. What Biological Functions Are and Why They Matter. Cambridge University Press.

14.

Gigerenzer

Gerd

Brighton

Henry

. 2009. “Homo Heuristicus: Why Biased Minds Make Better Inferences.” Topics in Cognitive Science 1 (1): 107–43. https://doi.org/10.1111/j.1756-8765.2008.01006.x

15.

Gorin

Moti

Joffe

Steven

Dickert

Neal

Halpern

Scott

. 2017. “Justifying Clinical Nudges.” Hastings Center Report 47 (2): 32–38. https://doi.org/10.1002/hast.688

16.

Grice

Paul

. 1989. Studies in the Way of Words. Harvard University Press.

17.

Grill

Kalle

. 2014. “Expanding the Nudge: Designing Choice Contexts and Choice Contents.” Rationality, Markets and Morals 5: 139–62. https://doi.org/10.22029/jlupub-426

18.

Hanna

Jason

. 2011. “Consent and the Problem of Framing Effects.” Ethical Theory & Moral Practice 14 (5): 517–31. https://doi.org/10.1007/s10677-011-9266-y

19.

Hausman

Daniel M.

Welch

Brynn

. 2010. “Debate: to Nudge or Not to Nudge.” The Journal of Political Philosophy 18 (1): 123–36. https://doi.org/10.1111/j.1467-9760.2009.00351.x

20.

Hieronymi

Pamela

. 2005. “The Wrong Kind of Reason.” The Journal of Philosophy 102 (9): 437–57. https://doi.org/10.5840/jphil2005102933

21.

Ivanković

Viktor

Engelen

Bart

. 2024. “Market Nudges and Autonomy.” Economics & Philosophy 40 (1): 138–65. https://doi.org/10.1017/S0266267122000347

22.

Kiesewetter

Benjamin

. 2020. “Rationality as Reasons-Responsiveness.” Australasian Philosophical Review 4 (4): 332–42. https://doi.org/10.1080/24740500.2021.1964239

23.

Levy

Neil

. 2019. “Nudge, Nudge, Wink, Wink: Nudging Is Giving Reasons.” Ergo 6 (10). https://doi.org/10.3998/ergo.12405314.0006.010

24.

Mandel

David R.

2014. “Do Framing Effects Reveal Irrational Choice?” Journal of Experimental Psychology: General 143 (3): 1185–98. https://doi.org/10.1037/a0034207

25.

Manson

Neil C.

O’Neill

Onora

. 2007. Rethinking Informed Consent in Bioethics. Cambridge University Press.

26.

McKenzie

Craig R. M.

Liersch

Michael J.

Finkelstein

Stacey R.

. 2006. “Recommendations Implicit in Policy Defaults.” Psychological Science 17 (5): 414–20. https://doi.org/10.1111/j.1467-9280.2006.01721.x

27.

Mehta

Shivan J.

Jessie

Torgersen

Small

Dylan S.

, et al. 2022. “Effect of a Default Order vs an Alert in the Electronic Health Record on Hepatitis C Virus Screening Among Hospitalized Patients: A Stepped-Wedge Randomized Clinical Trial.” JAMA Network Open 5 (3): e222427. https://doi.org/10.1001/jamanetworkopen.2022.2427

28.

Millikan

Ruth Garrett

. 1989. “Biosemantics.” The Journal of Philosophy 86 (6): 281–97. https://doi.org/10.2307/2027123

29.

Mitchell

Thomas

Douglas

Thomas

. 2024. “Wrongful Rational Persuasion Online.” Philosophy & Technology 37: 35. https://doi.org/10.1007/s13347-024-00725-z

30.

Muyskens

Kathryn

Chloe

Ang

Eric Thomson

Kerr

. 2025. “Relational Epistemic Humility in the Clinical Encounter.” Journal of Medical Ethics, 1–7. ahead of print. https://doi.org/10.1136/jme-2024-110241

31.

Persad

Govind

. 2014. “Libertarian Patriarchalism: Nudges, Procedural Roadblocks, and Reproductive Choice.” Women's Rights Law Reporter 35 (3/4): 273–98.

32.

Ploug

Thomas

Holm

Søren

. 2015. “Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent.” The American Journal of Bioethics 15 (10): 28–38. https://doi.org/10.1080/15265161.2015.1074303

33.

Raskoff

Sarah Zoe

. 2022. “Nudges and Hard Choices.” Bioethics 36 (9): 948–56. https://doi.org/10.1111/bioe.13091

34.

Rizzo

Mario J.

Whitman

Glen

. 2019. Escaping Paternalism: Rationality, Behavioral Economics, and Public Policy. Cambridge University Press.

35.

Rubel

Alan

Castro

Clinton

Pham

Adam

. 2019. “Agency Laundering and Information Technologies.” Ethical Theory & Moral Practice 22 (4): 1017–41. https://doi.org/10.1007/s10677-019-10030-w

36.

Saghai

Yashar

. 2013. “Salvaging the Concept of Nudge.” Journal of Medical Ethics 39 (8): 487–93. https://doi.org/10.1136/medethics-2012-100727

37.

Schmidt

Andreas T.

2019. “Getting Real on Rationality—Behavioral Science, Nudging, and Public Policy.” Ethics 129 (4): 511–43. https://doi.org/10.1086/702970

38.

Sharadin

Nathaniel Paul

. 2018. “Patient Preference Predictors and the Problem of Naked Statistical Evidence.” Journal of Medical Ethics 44 (12): 857–62. https://doi.org/10.1136/medethics-2017-104509

39.

Sharadin

Nathaniel Paul

. 2025. “Predicting and Preferring.” Inquiry 68 (4): 1121–32. https://doi.org/10.1080/0020174X.2023.2261493

40.

Singh

Keshav

. 2019. “Acting and Believing Under the Guise of Normative Reasons.” Philosophy and Phenomenological Research 99 (2): 409–30. https://doi.org/10.1111/phpr.12497

41.

Singh

Keshav

. 2025. “Rationality, Responding to Reasons, and the First Person.” Res Philosophica 102 (3): 239–62. https://doi.org/10.5840/resphilosophica2773

42.

Thaler

Richard H.

Benartzi

Shlomo

. 2004. “Save More Tomorrow™: Using Behavioral Economics to Increase Employee Saving.” Journal of Political Economy 112 (S1): S164–87.

43.

Thaler

Richard H.

Sunstein

Cass R.

. 2008. Nudge: Improving Decisions About Health, Wealth, and Happiness. Yale University Press.

44.

Todd

Peter M.

Gigerenzer

Gerd

. 2012. Ecological Rationality: Intelligence in the World. Oxford University Press.

45.

Tsai

George

. 2014. “Rational Persuasion as Paternalism.” Philosophy & Public Affairs 42 (1): 78–112. https://doi.org/10.1111/papa.12026

46.

Ubel

Peter A.

Smith

Dylan M.

Zikmund-Fisher

Brian J.

, et al. 2010. “Testing Whether Decision Aids Introduce Cognitive Biases: Results of a Randomized Trial.” Patient Education and Counseling 80 (2): 158–63. https://doi.org/10.1016/j.pec.2009.10.021

47.

Wright

Larry

. 1976. Teleological Explanations: An Etiological Analysis of Goals and Functions. University of California Press.

48.

Yeo

Shang Long

. 2025. “Framing Effects from Misleading Implicatures: an Empirically Based Case Against Some Purported Nudges.” Journal of Medical Ethics 51 (7): 487–92. https://doi.org/10.1136/jme-2024-110015

Nudging as Informing

Abstract

Keywords

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