Department of Philosophy, School of Communication and Society, Aarhus University, Jens Chr. Skous Vej 7, Aarhus C 8000, Denmark.
Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark.
Health Promot Int. 2021 Aug 30;36(4):1140-1150. doi: 10.1093/heapro/daaa146.
Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people's choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people's reflective capabilities. Information materials are, on the face of it, meant to engage citizens' reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.
推动已在公共卫生领域进行了讨论，并且强调了在公共卫生背景下推动所引发的伦理问题。在本文中，我们首先确定了在筛选计划中使用的推动方法和技术的类型，以及与推动相关的伦理问题：家长主义、有限的自主权和操纵。然后，我们确定了用于丹麦国家大肠癌筛查计划的小册子中使用的推动技术。这些包括框架、默认推动、利用麻烦偏见、权威推动和启动。小册子和筛查计划本身就可以被视为推动。推动策略是否存在伦理问题取决于它们是否被归类为教育性或非教育性推动。教育性推动旨在通过吸引人们的反思能力来影响人们的决策。非教育性推动通过绕过人们的反思能力起作用。信息材料从表面上看，旨在吸引公民的反思能力。收件人很可能会带着这种期望收到信息材料，因此不会期望以其他方式受到影响。因此，在关于筛查的信息背景下，非教育性推动可能特别成问题，因为参与筛查并不总是对个人有益。
