Is It Ethical for Doctors to “Nudge” Patients in Decision-Making?

Derek Soled, 2018 Beecher Prize Winner, explores the issue in the Journal of Medical Ethics

Obtaining informed consent for medical treatments is both an ethical and legal requirement. As a physician, using a “nudge” or steering a patient toward a choice outside their self-interest is ethically questionable. However, are there situations in which nudges are ethically justifiable?

Derek Soled, a joint MD/MBA candidate at Harvard Medical School and Harvard Business School, explores the ethics of physician nudges in the October 30,  Journal of Medical Ethics article, “Public Health Nudges: Weighing individual liberty and population health benefits.” Soled considers the instances in which nudges are ethically justifiable, arguing that the good of the public health should be a factor in making that determination.

Soled initially explored the “nudge” in his winning 2018 Beecher Prize essay, “The Ethics of Public Health Nudges,” and has since focused his research on the concept of nudges in public health.

“I thought the use of nudges by physicians and health care policymakers towards achieving desired health goals was fascinating,” said Soled. “Do nudges usurp autonomy and informed consent? Do they restrict individual voluntary choice?”

Some moral philosophers argue that physicians who use nudges to sway their patients’ decisions are violating the principles of informed consent and patient autonomy. However, a “nudge,” Soled says, is a concept in behavioral economics that guides individual decision-making while preserving freedom of choice.

In his 2018 essay, Soled suggests, “Nudges represent a way to influence health decision-making behavior, but we must approach them with ethical scrutiny to ensure they are not misused.”

In a commentary published on November 2 in the JME, “Good health policy requires good moral philosophy,” Soled provides a rationale for the integration of bioethics and moral philosophy in the development of health policy.

Soled is currently working with several senators from both political parties in the U.S. Senate Committee on Health, Education, Labor, and Pensions on incorporating behavioral economics into an ethical framework for COVID health policy pertaining to the use masks and social distancing. He will also give a keynote address on the topic entitled “Navigating the Tension Between Individual Liberty and Population Health Benefits in Public Health Nudges” at UNESCO’s World Conference on Bioethics, Medical Ethics, and Health in March 2021.

Derek Soled, MD, MSc, will be graduating HMS and HBS in 2022. He received his undergraduate degree summa cum laude and Phi Beta Kappa from Yale University and his masters in medical anthropology degree from the University of Oxford as a Walter Byers Scholar, the highest honor bestowed by the NCAA. Derek also serves as the HMS Student Council President and is a co-founder and current board member of the international nonprofit Medicine in Motion. He aspires to be a practicing clinician immersed in public health service, delivery, and leadership.