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助推何时会破坏自愿同意?

When do nudges undermine voluntary consent?

作者信息

Kiener Maximilian

机构信息

Faculty of Philosophy, The Queen's College, University of Oxford, High Street, Oxford, OX1 4AW UK.

出版信息

Philos Stud. 2021;178(12):4201-4226. doi: 10.1007/s11098-021-01644-x. Epub 2021 May 4.

Abstract

The permissibility of nudging in public policy is often assessed in terms of the conditions of transparency, rationality, and easy resistibility. This debate has produced important resources for any ethical inquiry into nudging, but it has also failed to focus sufficiently on a different yet very important question, namely: when do nudges undermine a patient's voluntary consent to a medical procedure? In this paper, I take on this further question and, more precisely, I ask to which extent the three conditions of transparency, rationality, and easy resistibility can be applied to the assessment of voluntary consent too. After presenting two examples, designed to put pressure on these three conditions, I show that, suitably modified, the three conditions can remain significant in the assessment of voluntary consent as well. However, the needed modifications are very substantial and result in a rather complicated view. To propose a tidier solution, I argue that nudging undermines voluntary consent if and only if it cannot be 'interpersonally justified' to the patient. I use the three modified conditions to motivate the idea of interpersonal justification and also to further specify the principles it involves. My resulting view is especially attractive because it builds on already existing insights from the debate on nudging, updates those insights with an eye to medical consent, and finally unites them in an elegant and simple framework.

摘要

公共政策中助推的可允许性通常根据透明度、合理性和易于抵制性等条件来评估。这场辩论为任何关于助推的伦理探究提供了重要资源,但它也未能充分聚焦于另一个虽不同却非常重要的问题,即:助推在何时会破坏患者对医疗程序的自愿同意?在本文中,我探讨这个进一步的问题,更确切地说,我要问透明度、合理性和易于抵制性这三个条件在多大程度上也可应用于对自愿同意的评估。在给出两个旨在对这三个条件施加压力的例子后,我表明,经过适当修改,这三个条件在对自愿同意的评估中仍可具有重要意义。然而,所需的修改非常大,结果形成了一个相当复杂的观点。为了提出一个更简洁的解决方案,我认为,当且仅当助推对患者而言无法“在人际层面得到证成”时,它才会破坏自愿同意。我利用这三个修改后的条件来激发人际证成的概念,并进一步明确它所涉及的原则。我所得出的观点特别有吸引力,因为它基于关于助推的辩论中已有的见解,着眼于医疗同意对这些见解进行更新,最后将它们统一在一个简洁优雅的框架中。

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Authenticity, Best Interest, and Clinical Nudging.真实性、最佳利益和临床推动
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Ethical persuasion: the rhetoric of communication in critical care.伦理劝导:重症监护中的沟通修辞
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Nudging by shaming, shaming by nudging.通过羞辱来推动,通过推动来羞辱。
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