By Shang Long Yeo

Suppose a doctor believes that some treatment best serves a patient’s interests, and knows that framing treatment outcomes in terms of survival rates (‘out of 100 who took the treatment, 90 survive’) rather than death rates (’10 die’) will make it more likely for the patient to consent. Is the doctor permitted to frame the treatment in this way? This issue is hotly debated, as part of broader discussions about the ethics of nudging – nudges are, roughly, policies which aim to influence people using their heuristics and biases.

Almost all parties to the debate take the two frames to convey the same numerical information. This seems obvious – if I say that 90 survive out of 100, that should imply that 10 die. Yet innovative psychological work by Mandel has queried this assumption, and found evidence against it. Mandel finds instead that a significant proportion of people read outcome numbers with a lower bound reading instead – that is, reading ’90 survive’ as ‘at least 90 survive’, and ’10 die’ is read as ‘at least 10 die’ – and that this may be responsible for observed framing effects in a similar choice problem. Importantly, if the lower-bound reading is used, the mortality and survival frames do not convey the same numerical information.

I thought that Mandel’s paper presented a powerful, rigorously-explored alternative explanation for framing effects, one that should be discussed in the ethics literature. Yet I found virtually no discussion of its ethical implications, so I decided to explore the issue myself. In a just-published paper in the Journal of Medical Ethics, you’ll find this exploration: I use Mandel’s findings to argue that treatment framing of this kind is presumptively wrong, because it violates a duty of proper disclosure. I also explore morally relevant features affecting the permissibility of framing in light of the lower bound reading – for example, the frames might be differentially misleading, making one frame permissible and the other one not – and tackle some objections to my arguments.

I’ve always been fascinated by this and other framing effects, having previously worked on framing effects in moral judgment. I think my paper is interesting because it highlights an important way that psychological findings may inform our ethical conclusions: by uncovering how people interpret communicative acts, which in turn tells us whether, when, and how certain ways of disclosing information can be misleading (and hence presumptively wrong). The paper is also interesting because it exemplifies an empirically-based, fine-grained approach to the ethics of nudging: it uses empirical evidence to level an argument against interventions which work through particular causal mechanisms (misleading numerical implicature) while leaving it open that other nudges remain permissible (e.g. those that don’t involve outcome numbers, or that don’t work through misleading implicature).

Paper title: Framing effects from misleading implicatures: an empirically based case against some purported nudges

Author: Shang Long Yeo

Affiliations: Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore

Competing interests: None

Social media accounts of post author: shanglongyeo.org (personal webpage)