Progress in medicine: autonomy, oughtonomy and nudging
Article first published online: 28 JUL 2011
© 2011 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Philosophy of Evidence Based Medicine
Volume 17, Issue 5, pages 857–861, October 2011
How to Cite
Devisch, I. (2011), Progress in medicine: autonomy, oughtonomy and nudging. Journal of Evaluation in Clinical Practice, 17: 857–861. doi: 10.1111/j.1365-2753.2011.01716.x
- Issue published online: 23 SEP 2011
- Article first published online: 28 JUL 2011
- Accepted for publication: 14 June 2011
Rationale In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites.
Methods In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today's medicine.
Results and conclusions Autonomy may and should be a shared target in today's medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy.