Miyata Ainar
Centre for the Study of Professions (SPS), Oslo Metropolitan University, Oslo, Norway
J Med Ethics. 2025 Jan 2. doi: 10.1136/jme-2024-110268.
When should doctors nudge their patients towards the treatments they think are best? If the nudge is compatible with the patient giving informed consent, then the nudge could be permissible. To be compatible with informed consent, the nudge must, at minimum: (1) not make the patient's understanding worse and (2) not make it hard for the patient to resist consenting. Arguably, many nudges will meet these criteria. However, since unjustified nudging, in this context, would also be unjustified paternalism, the permissibility of nudging hinges on whether it is justified. Perhaps surprisingly, this is often not the case. In situations where the best medical judgement does not conclusively favour a single course of action but there are multiple viable options, patient preference ought to be the deciding factor. In such contexts of , there is no good reason for doctors to nudge the patient towards a specific course of action, and hence, nudging is unjustified. Outside such contexts, nudging may be both justified and permissible.
医生应该在何时促使患者接受他们认为最佳的治疗呢?如果这种促使与患者给出知情同意相符,那么这种促使可能是被允许的。要与知情同意相符,这种促使至少必须:(1)不会使患者的理解变差,并且(2)不会让患者难以拒绝同意。可以说,许多促使行为会满足这些标准。然而,由于在这种情况下不合理的促使也会是不合理的家长式作风,促使行为是否被允许取决于它是否合理。也许令人惊讶的是,情况往往并非如此。在最佳医学判断并未明确支持单一行动方案而是存在多种可行选择的情况下,患者的偏好应该是决定性因素。在这样的情形下,医生没有充分理由促使患者采取特定的行动方案,因此,促使是不合理的。在这种情形之外,促使可能既是合理的也是被允许的。