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Introduction
Behavioural economist Richard Thaler and law scholar Cass Sunstein (hereafter, T&S) popularised the term 'nudge' in a 2008 book of the same title. 1 Although the authors never provide a technical definition of nudge, we can reconstruct their view. For T&S, A nudges B when A makes it more likely that B will [straight phi], by triggering B's automatic cognitive processes, while preserving B's freedom of choice (p. 1-20). 1 The use of nudges has gained particular momentum in public health, health policy and health promotion-where actions and policies can affect individuals' health behaviour and use of the healthcare system-to obtain significant group-level effects. The concept of nudge matters for the moral evaluation of actions and policies because it is designed to pick up efficacious influences that preserve freedom of choice, yet bypass the deliberative capacities of those influenced. The moral import of the concept of nudge thus primarily arises from the conditions requisite for an influence truly to preserve freedom of choice.
Consider a sample of health-affecting influence attempts labelled 'nudge' in the book by T&S or its official online companion edited by John Balz, i The Nudge blog : Asparagus-Lovers. An investigator suggests to research participants that they liked or loved asparagus during childhood the first time they tried it, creating a false memory, and a false belief about the taste of asparagus. Subsequently, participants report increased general liking of asparagus, greater desire to eat it, and willingness to pay more for it. 2
Cafeteria. A cafeteria manager places healthy food at eye-level at the beginning of the food queue. Unhealthy food comes last and is least visible. The customer is then more likely to purchase healthy food (p. 1-3). 1
Deposit Contract. All primary care physicians of a healthcare system offer their patients the possibility to voluntarily deposit an agreed-upon sum of money with the physicians. The physicians will then return it to the patients in small installments if the latter meet certain agreed-upon objectives to improve their health (e.g., losing weight, exercising, quitting smoking) (p. 232). 1
Generic Medication. Medicare beneficiaries are given generic medication by default but are offered the option of getting the brand-name drug (p. 169). 1
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