Should we nudge informed consent ?

Critics argue that nudge theory manipulates rather than respects the informed consent of patients. Cohen (2013) convincingly argues that this criticism falls short of the mark. But we might go one step further: nudges are not only defensible, there are also inescapable. Cohen’s defence should be more robust and recognize the importance of context and unavoidable framing effects. The question is not whether nudges are acceptable, but rather how they might be better employed to improve informed consent and public policy. This Open Peer Commentary will explain the inevitability of nudging. A respect for informed consent is to respect choices within context. We can improve our efforts to support and improve informed consent, but we cannot act independently of contextual factors. So long as we must choose within context, we are subjected to nudges. We should not ask whether or not to nudge, but how best to nudge instead