Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical Ethics (Basic Bioethics)

An analysis of how findings in behavioral economics challenge fundamental assumptions of medical ethics, integrating the latest research in both fields.Bioethicists have long argued for rational persuasion to help patients with medical decisions. But the findings of behavioral economics—popularized in Thaler and Sunstein’s Nudge and other books—show that arguments depending on rational thinking are unlikely to be successful and even that the idea of purely rational persuasion may be a fiction. In Good Ethics and Bad Choices, Jennifer Blumenthal-Barby examines how behavioral economics challenges some of the most fundamental tenets of medical ethics. She not only integrates the latest research from both fields but also provides examples of how physicians apply concepts of behavioral economics in practice. Blumenthal-Barby analyzes ethical issues raised by “nudging” patient decision making and argues that the practice can improve patient decisions, prevent harm, and perhaps enhance autonomy. She then offers a more detailed ethical analysis of further questions that arise, including whether nudging amounts to manipulation, to what extent and at what point these techniques should be used, when and how their use would be wrong, and whether transparency about their use is required. She provides a snapshot of nudging “in the weeds,” reporting on practices she observed in clinical settings including psychiatry, pediatric critical care, and oncology. Warning that there is no “single, simple account of the ethics of nudging,” Blumenthal-Barby offers a qualified defense, arguing that a nudge can be justified in part by the extent to which it makes patients better off. Contents 6 Acknowledgments 8 Introduction 10 The Core Ideas and Arguments 11 Intended Audience and Reading Tips 13 1. Decision Psychology and Medical Decision-Making: How Patients Decide 16 Heuristics and Biases in Decision-Making 17 Theoretical and Normative Issues in Heuristics and Biases Research 28 Conclusion 32 2. Bad Decisions? What Behavioral Economics Means for Patient Autonomy, Decision Quality, and Well-Being 36 Are Patients Generally Autonomous? Lessons from Behavioral Economics 36 Are Patients at Risk for Poor-Quality Decisions? Lessons from Behavioral Economics 46 How Behavioral Economics Raises Concerns about Patient Harm and Well-Being 53 Clarifying and Concluding Remarks 68 3. The Ethics of Using Nudging and Choice Architecture to Improve Decision-Making: Four Arguments for Nudging 72 Basic Terminology 72 Preface to the Arguments: Nudging Is Unavoidable, Neutrality Is Impossible 75 Argument 1: The Argument from Decisional Improvement and the Rule of Easy Rescue 78 Argument 2: The Argument from the Principle of Beneficence 94 Argument 3: The Argument from Justified Soft Paternalism and Respect for Autonomy 96 Argument 4: Patients Don’t Mind and the Principle of Endorsement 106 Why Not (and When) to Use Rational Persuasion 109 Why Not (and When) to Use Coercion 113 When Not to Nudge (or When to Minimize Nudging) 115 Nudging Alternatives? The Promise of Debiasing Strategies, Bumps, and Boosts 116 Conclusion 118 4. Are All Nudges Ethically Equal? 126 Additional Questions Related to Types of Nudges 127 Additional Questions Related to When Nudging Is Justified 136 Conclusion 149 5. Nudging in the Weeds: Case Studies of Nudging in the Clinic 150 Nudging in Psychiatry 150 Nudging in Pediatric Critical Care 155 Nudging in Maternal Fetal Surgery 162 Nudging in Prostate Cancer Decision-Making 169 Conclusion 172 Conclusion 174 Notes 176 Chapter 1 176 Chapter 2 181 Chapter 3 192 Chapter 4 209 Chapter 5 214 Conclusion 216 Bibliography 218 Index 242 **An analysis of how findings in behavioral economics challenge fundamental assumptions of medical ethics, integrating the latest research in both fields.** Bioethicists have long argued for rational persuasion to help patients with medical decisions. But the findings of behavioral economics—popularized in Thaler and Sunstein’s Nudge and other books—show that arguments depending on rational thinking are unlikely to be successful and even that the idea of purely rational persuasion may be a fiction. In __Good Ethics and Bad Choices__, Jennifer Blumenthal-Barby examines how behavioral economics challenges some of the most fundamental tenets of medical ethics. She not only integrates the latest research from both fields but also provides examples of how physicians apply concepts of behavioral economics in practice. Blumenthal-Barby analyzes ethical issues raised by “nudging” patient decision making and argues that the practice can improve patient decisions, prevent harm, and perhaps enhance autonomy. She then offers a more detailed ethical analysis of further questions that arise, including whether nudging amounts to manipulation, to what extent and at what point these techniques should be used, when and how their use would be wrong, and whether transparency about their use is required. She provides a snapshot of nudging “in the weeds,” reporting on practices she observed in clinical settings including psychiatry, pediatric critical care, and oncology. Warning that there is no “single, simple account of the ethics of nudging,” Blumenthal-Barby offers a qualified defense, arguing that a nudge can be justified in part by the extent to which it makes patients better off. "An original examination of the relevance of behavioral economics for the practice of medical ethics"-- Provided by publisher.