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Are health nudges coercive?

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A Commentary to to this article was published on 01 June 2015

Abstract

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this article I focus on claims of coercion, examining nudges within two of the main approaches to coercion—the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature.

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Notes

  1. I take the reference to ‘stumbles’ from Amir and Lobel (2008).

  2. Otherwise termed system 1 and system 2 processes.

  3. See http://www.behaviouralinsights.co.uk/about-us. Retrieved September 3, 2014.

  4. See also http://www.whitehouse.gov/administration/eop/ostp/initiatives. Retrieved September 3, 2014.

  5. See http://bi.dpc.nsw.gov.au/. Retrieved September 3, 2014.

  6. The UK team, in particular, has produced a number of reports across a range of areas, including an early one on the application of behavioural insights to health. This contained a range of potential policy applications of behavioural research, including in the areas of smoking, alcohol consumption, organ donation, and diet, weight loss, and exercise (Behavioural Insights Team 2010, 2013).

  7. Emphasis removed.

  8. Whether or not opt-out systems actually have a significant impact on the numbers of organs available for transplantation is a complex question. Many factors impact on this, even if more potential donors are available. See Willis and Quigley 2014.

  9. See http://wales.gov.uk/topics/health/nhswales/majorhealth/organ/?lang=en. Retrieved September 3, 2014.

  10. For a small selection of these see Nozick (1969), Feinberg (1986), Lammond (2000), Anderson (2010), Pallikkathayil (2011), Hughes (2013), Conly (2013a, b).

  11. See, for example, both Scoccia and Hausman and Welch who seem to do this (Scoccia 2014, p. 2; Hausman and Welch 2010, p. 124, fn 4).

  12. In the case of the law, for example, Hughes notes the long-standing divergence of views between legal and political philosophers. The former tend to deny that law is coercive, while the latter group often readily accepts that it is (Hughes 2013, p. 231).

  13. Joel Feinberg, for example, draws such a line, arguing that compulsion-proper operates via direct force and leaves the person with no choice whatsoever, while coercion occurs when they are forced to choose the least-worst option (or to choose the ‘lesser of two evils’). See Feinberg (1986), p. 151 & 190–192. Whether such a distinction holds need not trouble us here since the non-rational influences under consideration unequivocally do not involve the use of direct physical force.

  14. I follow Scott Anderson in his use of this term for these general approaches to coercion. See Anderson (2010). See also Lammond (2000), p. 44.

  15. Emphasis added. As Scott Anderson puts it “for the coercee to choose otherwise would be contrary to practical reason.” Anderson (2014, p. 30).

  16. Feinberg, for example, distinguishes between an agent making “an intervention on the stage rather than [being] part of the stage setting” (Feinberg 1986, p. 149).

  17. Nozick’s account contained six elements which I reproduce in their summary from as set out by Anderson: “(1) P aims to keep Q from choosing to perform action A; (2) P communicates a claim to Q; (3) P's claim indicates that if Q performs A, then P will bring about some consequence that would make Q's A-ing less desirable to Q than Q's not A-ing; (4) P's claim is credible to Q; (5) Q does not do A; (6) Part of Q's reason for not doing A is to lessen the likelihood that P will bring about the consequence announced in (3)” (Anderson 2014, p. 15). This was intended to be a non-moralised account and stands in contrast to later accounts such as Alan Wertheimer’s who argued that coercion needs to be measured against a moral baseline. See generally Wertheimer (1987, pp. 206–221).

  18. For a discussion on some aspects of the moral relevance of random versus designed choice architecture see Quigley 2013, pp. 610–617.

  19. Plausibly, regardless of the layout of the cafeteria, it may be even be harder to resist the allure of the burger and chips than the salad bar. For a discussion of resistibility in the context of his definition of nudges see Saghai (2013). As alluded to earlier, for him, nudges-proper must be easily resistible.

  20. Thank you to Michael Selgelid for this point and for prompting me to clarify my thoughts here.

  21. Some might be, but, Thaler and Sunstein’s specific appeal to libertarian paternalism aside, this need not be a feature of all nudges.

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Authors and Affiliations

  1. Centre for Ethics in Medicine, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS, United Kingdom

    Muireann Quigley

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  1. Muireann Quigley
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Correspondence to Muireann Quigley.

Additional information

I am grateful to Wouter Kalf, Wendy Rogers, and the editors for their comments on earlier drafts of this manuscript. Thank you also Stephen Wilkinson and other attendees at the Analytic Bioethics in Europe Workshop in Ghent May 2014. Albeit on a slightly different topic I had conversations with them which helped with my thoughts here.

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Quigley, M. Are health nudges coercive?. Monash Bioeth. Rev. 32, 141–158 (2014). https://doi.org/10.1007/s40592-014-0008-5

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