It's not me, its you

In this presentation, the legitimacy of nudging is being discussed. Nudging is in recent debates an upcoming intervention that is both seen as high potential as well as a possible threat to (public) health issues. It is considered as highly potential being able to steer peoples behavior in such ways that they would consider as good – as judged by themselves - without imposing anything on them or enforcing it. It is, as Thaler and Sustein argue, a version of liberal paternalism, a gesture to change behavior smoothly, without losing the option to opt out or choose for oneself. [1] Many policy makers and health advisors think that the temptations of the unhealthy consumption and behavior of citizens will more easily be resisted (I can learn not to choose the Big Mac [2]) and it a preferable alternative on the intervention ladder of public health interventions. [3] At the same time, nudging interventions are also being disputed for stimulating one’s unconscious behavior, as this is jeopardizing free and voluntary choice, is manipulative and therefore unjustified [4] In this presentation I want to focus on the questions whether the legitimacy of nudging is influenced by considerations that are not focusing on the individual. Instead, other-regarding or context-dependent considerations might be a good reason (not) to nudge. I will use two, completely different, examples to explore the relevance of what I call ‘it’s not me, it’s you’ considerations in debates on legitimacy of nudging.

First, nudging seems to assume that individuals can choose a certain life-style or behavioral pattern, even though at the same time it builds on the fact that people are ‘bad choosers’ [1]. In a way, this seems a bit unfair if we know that risk factors for obesity are poverty, low-self esteem and low education. If it is true that people are ‘determined’ by the social context that they live in, why focus on the individual behavior, even if it is a gentle push, instead of changing social conditions in which individuals live their life. It is really me, or is it you (as society) that puts people in a certain context and that makes them responsible for it too? But if we put it the other way around: would non-obese people be willing to accept health stimulating nudges, if we know that it will condition the less off towards a healthier life style, hence will decrease health inequalities?
Or take another example: it is conceived as a professional responsibility to be immunized against influenza, and several institutions already require mandatory immunization.[5] Such immunization are motivated primarily on other-regarding considerations (to protect vulnerable patients from becoming ill). In other words, a moral responsibility is put on health care workers as professionals. Yet, the uptake in voluntary immunization programs is not always high.[6] Could nudging be a legitimate intervention to gently steer professionals towards immunization if we accept their moral responsibility to it?
The result of the discussion are first building blocks in determining the legitimacy of nudging.

Reference list:
1. Thaler, R, Sunstein, C. (2008). Nudge. Improving decisions about health, wealth and happiness, London: Penguin books.
2. Bovens, L. (2013). Why couldn’t I be nudged to dislike a Big Mac? Journal of Medical Ethics 39 (8): 495-6.
3. Nuffield Council report on Public Health
4. White, M.D. (2013). The Manipulation of Choice. Ethics and Libertarian Paternalism. New York: Palgrave Macmillan.
5. http://www.cdc.gov/flu/healthcareworkers.htm (accessed June 1 2015)
6. Hollmeyer HG, Hayden, F, Poland G, Buchholz U, Influenza vaccination of health care workers in hospitals – A review of studies on attitudes and predictors, Vaccine 2009; 27 (30): 3935-3944.