Mid Michigan College, Harrison, Michigan, USA.
Bioethics. 2019 Jan;33(1):169-184. doi: 10.1111/bioe.12449. Epub 2018 Jun 19.
In order to avoid patient abuse, under normal situations before performing a medical intervention on a patient, a physician must obtain informed consent from that patient, where to give genuine informed consent a patient must be competent, understand her condition, her options and their expected risks and benefits, and must expressly consent to one of those options. However, many patients refrain from the option that their physician believes to be best, and many physicians worry that their patients make irrational healthcare decisions, hindering their ability to provide efficient healthcare for their patients. Some philosophers have proposed a solution to this problem: they advocate that physicians nudge their patients to steer them towards their physician's preferred option. A nudge is any influence designed to predictably alter a person's behavior without limiting their options or giving them reasons to act. Proponents of nudging contend that nudges are consistent with obtaining informed consent. Here I argue that nudging is incompatible with genuine informed consent, as it violates a physician's obligation to tell their patients the truth, the whole truth, and nothing but the truth during adequate disclosure.
为了避免患者受到虐待，在对患者进行医疗干预之前，医生通常必须获得患者的知情同意。在这种情况下，要想获得真正的知情同意，患者必须具备行为能力，理解其自身状况、可选择的治疗方案以及这些方案的预期风险和获益，并且必须明确表示同意其中一种方案。然而，许多患者会放弃医生认为最佳的治疗方案，许多医生担心他们的患者做出不合理的医疗决策，从而妨碍他们为患者提供高效的医疗服务。一些哲学家提出了解决这一问题的方案：他们主张医生可以利用助推来引导患者选择医生所偏好的治疗方案。助推是指任何旨在可预测地改变一个人的行为而不限制其选择或不给其提供行动理由的影响。助推的支持者认为，助推符合获得知情同意的要求。在这里，我认为助推与真正的知情同意是相悖的，因为它违反了医生在充分披露过程中告知患者真实情况、全部情况和只告知真实情况的义务。
