In Defense of Nudge–Autonomy Compatibility

In their article “Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent,” Thomas Ploug and Søren Holm argue that nudging is inconsistent with autonomy protection and informed consent in part because (1) nudges trigger flawed reasoning, which (a) is itself incompatible with autonomy on “process” accounts, (b) thwarts patients’ understanding about an intervention, and (c) results in an inability to form and pursue their own goals, and (2) nudging involves clinicians imposing their will on patients at the expense of patient preferences (Ploug and Holm 2015). We focus our commentary on these two claims. In response to claim (1) we make three arguments. First, process accounts of autonomy do not themselves preclude decisional processes that do not “go through reasons” successfully. Second, it is not the case that nudges necessarily (or even often) result in a patient not understanding the proposed intervention. Nudging may even enhance informed consent by producing levels of understanding more aligned with dual process models of reasoning (Slovic et al. 2004). Third, it is not the case that nudges necessarily (or even often) interfere with patients pursuing their own goals, and nudges may actually aid patients through their values clarification. In response to the second claim, we argue that this is not necessarily the case. In many clinical scenarios, patients are faced with consequences that pit one set of personal goals and values against another. When done as part of a trusted clinical relationship, clinicians can use their understanding of patient’s values and informed preferences to guide their nudges in ways that help patients to more efficiently work through competing goals.