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KMID : 1172020220230020001
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Journal of Korean Bioethics Association
2022 Volume.23 No. 2 p.1 ~ p.16
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Nudge strategies and Relational Autonomy in the Biomedical context: Focusing on the Patient-Physician Relationship
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Mok Kwang-Su
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Abstract
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Nudge strategies, which result from insights from behavioral economics on human cognitive abilities and psychology, have been used in various fields, including public policy field. This is because a nudge is a strategy of libertarian paternalism that steers individual decision-making of benefits, while preserving freedom of choice and autonomy. Recently, it has been argued that nudge strategies, which have been restrictively used in the public health, also should be introduced into the patient-physician relationship of clinical context. This is because nudge strategies are expected to solve the dilemma between paternalistic beneficence and respect for autonomy which physicians have often faced in the clinical context. The purpose of this paper is to examine whether nudge strategies can be ethically justified or permissible in the patient-physician relationship and to explore how they can do. According to the analysis of this paper, nudge strategies as libertarian paternalism can be ethically used for a limited purpose to correct the bias that distorts patients’ relational autonomy. However, when these are used to induce a judgment beyond this purpose, they amount to manipulation in dispute. This paper argues that such manipulation is ethically permissible in the clinical context of ordinary treatments premised on verbal consent. This is because a kind of paternalistic influence is inevitable among most interactions including nudge strategies in the patient-physician relationship and, in nudge strategies of ordinary treatments, the patient's expected damage is relatively small compared to the patient's expected benefits. However, this paper also argues that such manipulation is not ethically permissible in the clinical context of high values and high stakes, requiring written consent including informed consent. This is because, despite the paternalistic specificity of clinical context, the patient's expected damage is relatively severe compared to the patient's expected benefits. Thus, this paper argues that nudge strategies should be carefully used in the clinical context, considering the guarantee of relational autonomy,
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KEYWORD
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nudge, libertarian paternalism, relational autonomy, the patient-physician relationship, manipulation
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