Good health policy requires good moral philosophy

By Derek Soled.

Now, more than ever, countries around the world need good health policy. While more big data and efficiency are important, better integration of the humanities embodied in moral philosophy will help achieve this goal. In policymaking decisions, ethicists deserve a place at the table as their insights into human behaviour are essential in reforming the structures that govern our society and everyday lives.

First, ethics helps us ask poignant questions. Whereas policymakers identify where and how to intervene, ethicists identify the origin and rationale of policies, and can help determine why particular courses of action are superior to others. Furthermore, they can anticipate dissent and strategically plan to address pressing concerns.

Second, ethicists help define the scope of health policies and their applications to individuals, business entities, and social institutions. The dictates of moral philosophy can help determine the legitimate boundaries of proposals and define when there lurks the possibility of illegitimacy.

Finally, ethicists can help make health care policy decisions that are internally consistent and sustainable. While governments and political climates frequently change, human nature generally does not. Incorporating long-standing ethical underpinnings into today’s policymaking decisions will result in policies that are apt to be impregnable as the years unfold.

In my recent article, “Public health nudges: Weighing individual liberty and population health benefits,” I discuss the ethics of health policies that utilize the nudge, defined by behavioural economists as something that guides individual decision-making while preserving freedom of choice. Examples of nudges include the way choices are framed, the layout of products, or which options are selected as defaults. For example, Google has instituted several subtle nudges to prompt their employees to eat healthier.

Some contemporary moral philosophers believe that physicians who actively use nudges to influence their patients’ decisions violate the fundamental tenets of informed consent and patient autonomy. In assessing the ethics and legitimacy of nudges, however, it is unclear to what extent public health benefits should be weighed against individual liberties. For instance, nudging people to wear masks or social distance to prevent the spread of Covid-19 hampers complete voluntary decision-making but improves the health of the population on a whole. Ultimately, I conclude that while nudges may infringe on individual rights, they are ethically justified when there is a clear public health benefit to be gained.

To create stronger and more sustainable health policy, moral philosophy should guide nudge usage. Ethicists can determine criteria for when public health nudges are appropriate and how they should best be integrated and preventing their abuse. Specifically, programs designed to change behaviour through nudges should satisfy the following five conditions: (1) respect people’s choices; (2) hold individuals accountable and responsible for the consequences of their choices; (3) encourage fair decision-making; (4) carefully and neutrally promote informed decision-making; and (5) offer transparency in goals by way of public service announcements so that the populace is aware of how their decision-making may be influenced. Striving to meet these criteria will also lead to greater trust in public institutions, as well as promote dialogue and informed decision-making.

It would be a major disservice to neglect the humanities in public policy, as many insights about human behaviour and questions regarding which practices are right and wrong, cannot be answered with empiricism alone. As we continue to navigate the biggest public health crisis of our generation in an ever-increasing polarized political climate, moral philosophy will continue to serve a vital role in yielding robust policy and advancing societal wellbeing.

Paper title: Public health nudges: Weighing individual liberty and population health benefits

Author: Derek Soled

Affiliations: Harvard Medical School and Harvard Business School

Competing interests: None

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