Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-25T16:31:01.988Z Has data issue: false hasContentIssue false
  • English
  • Français

Nudging in Neonatology: Practical Wisdom and Accountability for Reasonableness

Published online by Cambridge University Press:  12 February 2019

Michal Stanak Open the ORCID record for Michal Stanak [Opens in a new window]
Michal Stanak*
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment and Department of Philosophy, University of Vienna
*
Author for correspondence: Michal Stanak, E-mail: michal.stanak@hta.lbg.ac.at
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The way choice is presented has an impact on decision-making. This is the case also in the context of neonatal intensive care units (NICUs), particularly in the challenging cases that concern the limit of viability. The objective of this article is to examine the role of nudging in the shared decision-making in neonatology and elaborate on the respective moral challenges.

Results

Nudging is not morally neutral. There are two key sources of ethical issues at the heart of nudging. The first one concerns the lack of transparency, while the second concerns the background value judgments that are imminent whenever nudging is used for achieving a particular end. To solve the underlying conflict, a virtue ethics approach combined with the accountability for reasonableness framework is suggested to guide the use of the tool of nudging.

Conclusions

NICU professionals ought to use the tool of nudging transparently in line with their act of profession and their practically wise judgment.

Keywords

NudgingNeonatologyNICUAccountabilityPractical wisdom
Type
Article Commentary
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 1 , 2019 , pp. 5 - 9
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Mercurio, MR (2017) Periviable birth (Limit of viability) 2017 [09/11/2017]. Available from: https://www.uptodate.com/contents/periviable-birth-limit-of-viability?source=search_result&search=limit%20of%20viability&selectedTitle=1~23.Google Scholar
2.Guillén, Ú, Weiss, EM, Munson, D, et al. (2014) Guidelines for the management of extremely premature deliveries: A systematic review. Pediatrics 136, 343–350.Google Scholar
3.Leuthner, SR (2014) Borderline viability: Controversies in caring for the extremely premature infant. Clin Perinatol 41, 799–814.Google Scholar
4.Hawlik, K, Stanak, M (2017) Systematic analysis of outcomes and resource needs for neonatal intensive care units (NICU) to inform health care planning. Vienna: Ludwig Boltzmann Institute for Health Technology Assessment. Contract No.: 97b.Google Scholar
5.Stanak, M, Hawlik, K (2017) Perinatal care at the threshold of viability. Part II: Decision-making at the threshold of viability and ethical challenges at Neonatal Intensive Care Units (NICUs). Vienna: Ludwig Boltzmann Institute for Health Technology Assessment. http://www.hta.lbg.ac.at/page/ankuendigungen/de (accessed January 4, 2018).Google Scholar
6.Ploug, T, Holm, S (2015) Doctors, patients, and nudging in the clinical context—Four views on nudging and informed consent. Am J Bioeth 15, 28–38.Google Scholar
7.Halpern, D (2015) Inside the nudge unit. London: Penguin.Google Scholar
8.Kahneman, D (2011) Thinking, fast and slow. New York: Farrar, Straus and Giroux.Google Scholar
9.Sunstein, C (2014) Nudging: A very short guide. J Consum Policy 37, 583–588.Google Scholar
10.Stewart, SA (2005) Can behavioural economics save us from ourselves? Chicago: The University of Chicago Magazine 97(3).Google Scholar
11.Janvier, A, Barrington, K, Farlow, B (2014) Communication with parents concerning withholding or withdrawing of life-sustaining interventions in neonatology. Semin Perinatol 38, 38–46.Google Scholar
12.The Gerentological Society of America (2016) Medicine, health care and philosophy: Recognizing hidden traps in health care decision-making. Washington, DC: The Gerentological Society of America.Google Scholar
13.Nuffield Council on Bioethics (2007) Nuffield intervention ladder. London: Nuffield Council on Bioethics.Google Scholar
14.Stanak, M (2018) Professional ethics: The case of neonatology. Med Health Care Philos. doi: 10.1007/s11019-018-9863-9.Google Scholar
15.Gallagher, K, Marlow, N, Edgley, A, Porock, D (2011) The attitudes of neonatal nurses towards extremely preterm infants. J Adv Nurs 68, 1768–1779.Google Scholar
16.Daniels, N, Sabin, J (1997) Limits to health care: Fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff 4, 303–350.Google Scholar
17.MacIntyre, A (2014) After virtue. 4th ed. London: Bloomsbury Academic.Google Scholar
18.Pellegrino, ED (2009) Professing medicine, virtue based ethics, and the retrieval of professionalism. In: Walker, RL, Ivanhoe, PJ, editors. Working virtue. London: Oxford University Press.Google Scholar
19.Devettere, RJ (2000) Practical decision making in health care ethics: Cases and concepts. Washington DC: Georgetown University Press.Google Scholar
20.Weiss, ME, Barg, FK, Cook, N, Black, E, Joffe, S (2016) Parental decision-making preferences in neonatal intensive care. J Pediatr 179, 36–41.Google Scholar