BETWEEN PROD AND PERSUASION: INQUIRY INTO THE NATURE AND JUSTIFICATION OF HEALTH NUDGES

Purpose: Many support the use of insights from behavioral economics to improve health via the design of the environment in which individuals make health-affecting choices. There is, however, an on-going controversy as to whether these strategies are ethically permissible. I will argue that a pervasive confusion about the nature and justification of health nudges has hindered this debate.

Method: Thaler and Sunstein define nudges as “any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives” (2009, 6), and view them as part of a choice-preserving strategy designed to promote wellbeing when cognitive biases prevent optimal decision-making. Conceptual analysis reveals that the authors conflate (1) the class of tools used to obtain behavior change (tools that alter the target’s perception of the choice situation); (2) the function of nudges as a means to achieve one’s aims (as distinguished from coercion, for instance); (3) the justification of nudges in terms of the problems they may solve (these problems may (but need not) be framed in terms of the theoretical commitments of behavioral economics with regard to rationality).

Result: As a result, many examples that Thaler and Sunstein provide do not satisfy all the criteria they cite when defining nudges. For instance, even though “make-believe speed bumps” are designed to alter the driver’s perception of the choice situation thanks to 3-D painted triangles, they function as a coercive means to modify the driver’s behavior. Their message could be translated as, “Slow down or crash!”

Conclusion: I will therefore conclude that nudges should not be confused with the class of tools they typically use. Rather, the definition of nudges should pragmatically focus on the function they play as a means for achieving one’s aims distinct from coercion, incentives (or prods), and rational persuasion. In addition, questions relative to the aims of nudges concern their justification, such as whether nudges should be in-line with the recipients’ second-order preferences about what to eat or can (under some conditions) shape those preferences; whether they ought to directly promote each individual’s wellbeing or foster population-level health; and whether they should compensate for the effects of irrationality or be used to steer individuals toward a choice that is morally required or praiseworthy.