Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical Ethics

Length: 264 pages
Edition: 1
Language: English
Publisher: The MIT Press
Publication Date: 2021-08-03
ISBN-10: 026254248X
ISBN-13: 9780262542487
Sales Rank: #495600 (See Top 100 Books)

An analysis of how findings in behavioral economics challenge fundamental assumptions of medical ethics, integrating the latest research in both fields.

Bioethicists have long argued for rational persuasion to help patients with medical decisions. But the findings of behavioral economics—popularized in Thaler and Sunstein’s Nudge and other books—show that arguments depending on rational thinking are unlikely to be successful and even that the idea of purely rational persuasion may be a fiction. In Good Ethics and Bad Choices, Jennifer Blumenthal-Barby examines how behavioral economics challenges some of the most fundamental tenets of medical ethics. She not only integrates the latest research from both fields but also provides examples of how physicians apply concepts of behavioral economics in practice.

Blumenthal-Barby analyzes ethical issues raised by “nudging” patient decision making and argues that the practice can improve patient decisions, prevent harm, and perhaps enhance autonomy. She then offers a more detailed ethical analysis of further questions that arise, including whether nudging amounts to manipulation, to what extent and at what point these techniques should be used, when and how their use would be wrong, and whether transparency about their use is required. She provides a snapshot of nudging “in the weeds,” reporting on practices she observed in clinical settings including psychiatry, pediatric critical care, and oncology. Warning that there is no “single, simple account of the ethics of nudging,” Blumenthal-Barby offers a qualified defense, arguing that a nudge can be justified in part by the extent to which it makes patients better off.

Contents
Acknowledgments
Introduction
	The Core Ideas and Arguments
	Intended Audience and Reading Tips
1. Decision Psychology and Medical Decision-Making: How Patients Decide
	Heuristics and Biases in Decision-Making
	Theoretical and Normative Issues in Heuristics and Biases Research
	Conclusion
2. Bad Decisions? What Behavioral Economics Means for Patient Autonomy, Decision Quality, and Well-Being
	Are Patients Generally Autonomous? Lessons from Behavioral Economics
	Are Patients at Risk for Poor-Quality Decisions? Lessons from Behavioral Economics
	How Behavioral Economics Raises Concerns about Patient Harm and Well-Being
	Clarifying and Concluding Remarks
3. The Ethics of Using Nudging and Choice Architecture to Improve Decision-Making: Four Arguments for Nudging
	Basic Terminology
	Preface to the Arguments: Nudging Is Unavoidable, Neutrality Is Impossible
	Argument 1: The Argument from Decisional Improvement and the Rule of Easy Rescue
	Argument 2: The Argument from the Principle of Beneficence
	Argument 3: The Argument from Justified Soft Paternalism and Respect for Autonomy
	Argument 4: Patients Don’t Mind and the Principle of Endorsement
	Why Not (and When) to Use Rational Persuasion
	Why Not (and When) to Use Coercion
	When Not to Nudge (or When to Minimize Nudging)
	Nudging Alternatives? The Promise of Debiasing Strategies, Bumps, and Boosts
	Conclusion
4. Are All Nudges Ethically Equal?
	Additional Questions Related to Types of Nudges
	Additional Questions Related to When Nudging Is Justified
	Conclusion
5. Nudging in the Weeds: Case Studies of Nudging in the Clinic
	Nudging in Psychiatry
	Nudging in Pediatric Critical Care
	Nudging in Maternal Fetal Surgery
	Nudging in Prostate Cancer Decision-Making
	Conclusion
Conclusion
Notes
	Chapter
	Chapter
	Chapter
	Chapter
	Chapter
	Conclusion
Bibliography
Index