Hamilton Paul
The University of Missouri, 1133 Ashland Rd., Apt. 302, Columbia, MO, 65201, USA.
HEC Forum. 2018 Sep;30(3):267-282. doi: 10.1007/s10730-017-9343-2.
I argue that it is impermissible to use nudges as a tool to influence patients in the context of informed consent. The motivation for such nudges is that their use can help reconcile potential conflicts between a physician's duty of beneficence and duty to respect patient autonomy. I argue that their use places physicians in a position of domination over patients. That is, it violates the republican freedom of patients because it grants physicians the power to arbitrarily interfere. I also argue that if one tries to adjust the duty of beneficence to avoid this conclusion, then the republican freedom of patients is still threatened under conditions of clinical equipoise. As ways to avoid the inevitability of nudging, I suggest the alternative of boosting or the pairing of patients with physicians who share their deep values. This latter option achieves the benefits nudging patients is supposed to provide without violating the republican freedom of those patients.
我认为，在知情同意的背景下，将助推手段用作影响患者的工具是不允许的。使用此类助推手段的动机在于，其有助于调和医生的行善义务与尊重患者自主权的义务之间潜在的冲突。我认为，使用这些手段会使医生处于对患者的支配地位。也就是说，这侵犯了患者的共和式自由，因为它赋予了医生任意干涉的权力。我还认为，如果有人试图调整行善义务以避免这一结论，那么在临床 equipoise 的情况下，患者的共和式自由仍然会受到威胁。作为避免助推不可避免性的方法，我建议采用激励的替代方法，或者将患者与具有相同深层价值观的医生配对。后一种选择在不侵犯患者共和式自由的情况下，实现了助推患者本应带来的益处。
