#BELHP2014 Panel 1, The Ethics of Nudges in Health Care

[Ed. Note: On Friday, May 2 and Saturday, May 3, 2014, the Petrie-Flom Center hosted its 2014 annual conference: “Behavioral Economics, Law, and Health Policy.”  This is the first installment in our series of live blog posts from the event; video will be available later in the summer on our website.]

The panel on the Ethics of Nudges in Health Care was comprised of:

  • Yashar Saghai, Post-Doctoral Fellow and Director of Global Food Ethics, John Hopkins University
  • Jennifer Blumenthal-Barby, Assistant Professor, Baylor College of Medicine, presenting with Zainab Shipchandler and Julika Kaplan, Rice University
  • Nir Eyal, Associate Professor at Harvard Medical School
  • Jonathan Gingerich, Ph.D. student, Department of Philosophy, UCLA

Yashar Saghai’s presentation, titled Public Health Nudges and the Principle of the Least Restrictive Alternative, argued against the notion that policies or interventions that impose fewer restrictions on individual choice should always be preferred over more restrictive options. More on this topic in Saghai’s 2012 BMJ article “Salvaging the Concept of Nudge.”

Jennifer Blumenthal-Barby and student collaborators Zainab Shipchandler and Julika Kaplan asked whether incentives in global health studies should be viewed as nudges and what are the potential ethical implications. In their presentation, titled Incentives as Nudges for Childhood Vaccination in Rural India, they showed evidence that suggests food incentives to participate in vaccine programs could function as nudges that influence individual’s behavior in a wider range of healthcare related ways, beyond simply increasing participation in the vaccine program.

Nir Eyal explored potential arguments for When nudging is just fine, and why? Eyal started with the observation that nudges can cause large modifications in individual behavior despite being very easily resistible, and canvassed several related ideas about the appeal of nudges, finding problematic counterarguments to most of these prima facie claims. He concluded by suggesting that nudges could be viewed as morally acceptable ways of manipulating people into behaving in ways that are better for them without transgressing on any fundamental liberties.

Jonathan Gingerich argued that the ethical acceptability of nudges should be put into question when they prevent democratic deliberation on important issues. In his presentation, The Political Morality of Nudges, Gingerich presented several examples of how interventions that claim to improve social welfare through nudges could in fact prevent broader substantive deliberation over important political issues for which we generally require democratic decision making.

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