Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Nudges. Show all posts
Showing posts with label Nudges. Show all posts

Saturday, May 27, 2023

Costly Distractions: Focusing on Individual Behavior Undermines Support for Systemic Reforms

Hagmann, D., Liao, Y., Chater, N., & 
Loewenstein, G. (2023, April 22). 

Abstract

Policy challenges can typically be addressed both through systemic changes (e.g., taxes and mandates) and by encouraging individual behavior change. In this paper, we propose that, while in principle complementary, systemic and individual perspectives can compete for the limited attention of people and policymakers. Thus, directing policies in one of these two ways can distract the public’s attention from the other—an “attentional opportunity cost.” In two pre-registered experiments (n = 1,800) covering three high-stakes domains (climate change, retirement savings, and public health), we show that when people learn about policies targeting individual behavior (such as awareness campaigns), they are more likely to themselves propose policies that target individual behavior, and to hold individuals rather than organizational actors responsible for solving the problem, than are people who learned about systemic policies (such as taxes and mandates, Study 1). This shift in attribution of responsibility has behavioral consequences: people exposed to individual interventions are more likely to donate to an organization that educates individuals rather than one seeking to effect systemic reforms (Study 2). Policies targeting individual behavior may, therefore, have the unintended consequence of redirecting attention and attributions of responsibility away from systemic change to individual behavior.

Discussion

Major policy problems likely require a realignment of systemic incentives and regulations, as well as measures aimed at individual behavior change. In practice, systemic reforms have been difficult to implement, in part due to political polarization and in part because concentrated interest groups have lobbied against changes that threaten their profits. This has shifted the focus to individual behavior. The past two decades, in particular, have seen increasing popularity of ‘nudges’: interventions that can influence individual behavior without substantially changing economic incentives (Thaler &Sunstein, 2008). For example, people may be defaulted into green energy plans (Sunstein &Reisch, 2013) or 401(k) contributions (Madrian & Shea, 2001), and restaurants may varywhether they place calorie labels on the left or the right side of the menu (Dallas, Liu, &Ubel, 2019). These interventions have enjoyed tremendous popularity, because they can often be implemented even when opposition to systemic reforms is too large to change economic incentives. Moreover, it has been argued that nudges incur low economic costs, making them extremely cost effective even when the gains are small on an absolute scaleTor & Klick (2022).

In this paper, we document an important and so far unacknowledged cost of such interventions targeting individual behavior, first postulated by Chater and Loewenstein(2022). We show that when people learn about interventions that target individual behavior, they shift their attention away from systemic reforms compared to those who learn about systemic reforms. Across two experiments, we find that this subsequently  affects their attitudes and behaviors. Specifically, they become less likely to propose systemic policy reforms, hold governments less responsible for solving the policy problem, and are less likely to support organizations that seek to promote systemic reform.The findings of this study may not be news to corporate PR specialists. Indeed, as would be expected according to standard political economy considerations (e.g., Stigler,1971), organizations act in a way that is consistent with a belief in this attentional opportunity cost account. Initiatives that have captured the public’s attention, including recycling campaigns and carbon footprint calculators, have been devised by the very organizations that stood to lose from further regulation that might have hurt their bottomline (e.g., bottle bills and carbon taxes, respectively), potentially distracting individual citizens, policymakers, and the wider public debate from systemic changes that are likely to be required to shift substantially away from the status quo.

Tuesday, April 5, 2022

The Emerging Science of Suicide Prevention

Kim Armstong
PsychologicalScience.org
Originally published 28 FEB 22

The decisions leading up to a person’s death by suicide are made under conditions unlike almost any other. Although we may spend weeks or even months considering whether to purchase a home, change jobs, or get married, the decision to attempt suicide is often made in the spur of the moment amid a crush of emotions, according to Brian W. Bauer and Daniel W. Capron (University of Southern Mississippi). A person may live with suicidal thoughts for years, yet anywhere from 25% to 40% of suicide attempts may take place less than 5 minutes after the individual decides to take their life, Bauer and Capron wrote in a 2020 Perspectives on Psychological Science article. 

These circumstances make people experiencing suicidal ideation uniquely vulnerable to common cognitive biases that can result in irrational decision-making, causing them to act against their own self-interest. We are particularly bad at predicting how our emotional state may change in the future and tend to value short-term relief over long-term outcomes, Bauer and Capron noted. Both of these tendencies can contribute to the decision to end severe psychological pain through suicide despite the strong possibility that those feelings will change given time. 

Nudges could offer some hope to people in crisis. Based in behavioral economics, these microinterventions are designed to push people toward making choices that align with their own self-interest, such as conserving energy or getting vaccinated, by providing easily digestible information about the benefits of those choices (e.g., stickers on washing machines reading “Fuller laundry loads save water”) or even removing barriers to making those choices (e.g., offering walk-in vaccinations instead of requiring appointments). 

Nudges have been used in mental health contexts to help people cut back on their drinking and enroll in treatment programs. In the case of suicide prevention, pre-crisis interventions can occur at several levels, Bauer said in an interview with the Observer.  

Public safety campaigns, for example, might advise gun owners to store their firearms and ammunition separately, creating a barrier to impulsive self-harm, and encourage them to save the number for a local crisis hotline in their phone. In clinical care settings, reframing education on coping skills as a way to assist peers, rather than oneself, may increase patients’ willingness to complete safety plans and participate in suicide prevention workshops. And for individual patients, smartphones may offer an avenue for effective “just-in-time” interventions. 

Unfortunately, no nudge is a one-size-fits-all solution, Bauer said. 

Monday, November 29, 2021

People use mental shortcuts to make difficult decisions – even highly trained doctors delivering babies

Manasvini Singh
The Conversation
Originally published 14 OCT 21

Here is an excerpt:

Useful time-saver or dangerous bias?

A bias arising from a heuristic implies a deviation from an “optimal” decision. However, identifying the optimal decision in real life is difficult because you usually don’t know what could have been: the counterfactual. This is especially relevant in medicine.

Take the win-stay/lose-shift strategy, for example. There are other studies that show that after “bad” events, physicians switch strategies. Missing an important diagnosis makes physicians test more on subsequent patients. Experiencing complications with a drug makes the physician less likely to prescribe it again.

But from a learning perspective, it’s difficult to say that ordering a test after missing a diagnosis is a flawed heuristic. Ordering a test always increases the chance that the physician catches an important diagnosis. So it’s a useful heuristic in some instances – say, for example, the physician had been underordering tests before, or the patient or insurer prefers shelling out the extra money for the chance to detect a cancer early.

In my study, though, switching delivery modes after complications offers no documented guarantees of avoiding future complications. And there is the added consideration of the short- and long-term health consequences of delivery-mode choice for mother and baby. Further, people are generally less tolerant of having inappropriate medical procedures performed on them than they are of being the recipients of unnecessary tests.

Tweaking the heuristic

Can physicians’ reliance on heuristics be lessened? Possibly.

Decision support systems that assist physicians with important clinical decisions are gathering momentum in medicine, and could help doctors course-correct after emotional events such as delivery complications.

For example, such algorithms can be built into electronic health records and perform a variety of tasks: flag physician decisions that appear nonstandard, identify patients who could benefit from a particular decision, summarize clinical information in ways that make it easier for physicians to digest and so on. As long as physicians retain at least some autonomy, decision support systems can do just that – support doctors in making clinical decisions.

Nudges that unobtrusively encourage physicians to make certain decisions can be accomplished by tinkering with the way options are presented – what’s called “choice architecture.” They already work for other clinical decisions.

Saturday, October 9, 2021

Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence

de Ridder, D., Kroese, F., & van Gestel, L. (2021). 
Perspectives on psychological science 
Advance online publication. 
https://doi.org/10.1177/1745691621995183

Abstract

Nudges are behavioral interventions to subtly steer citizens' choices toward "desirable" options. An important topic of debate concerns the legitimacy of nudging as a policy instrument, and there is a focus on issues relating to nudge transparency, the role of preexisting preferences people may have, and the premise that nudges primarily affect people when they are in "irrational" modes of thinking. Empirical insights into how these factors affect the extent to which people are susceptible to nudge influence (i.e., "nudgeable") are lacking in the debate. This article introduces the new concept of nudgeability and makes a first attempt to synthesize the evidence on when people are responsive to nudges. We find that nudge effects do not hinge on transparency or modes of thinking but that personal preferences moderate effects such that people cannot be nudged into something they do not want. We conclude that, in view of these findings, concerns about nudging legitimacy should be softened and that future research should attend to these and other conditions of nudgeability.

From the General Discussion

Finally, returning to the debates on nudging legitimacy that we addressed at the beginning of this article, it seems that concerns should be softened insofar as nudges do impose choice without respecting basic ethical requirements for good public policy. More than a decade ago, philosopher Luc Bovens (2009) formulated the following four principles for nudging to be legitimate: A nudge should allow people to act in line with their overall preferences; a nudge should not induce a change in preferences that would not hold under nonnudge conditions; a nudge should not lead to “infantilization,” such that people are no longer capable of making autonomous decisions; and a nudge should be transparent so that people have control over being in a nudge situation. With the findings from our review in mind, it seems that these legitimacy requirements are fulfilled. Nudges do allow people to act in line with their overall preferences, nudges allow for making autonomous decisions insofar as nudge effects do not depend on being in a System 1 mode of thinking, and making the nudge transparent does not compromise nudge effects.

Sunday, October 6, 2019

Thinking Fast and Furious: Emotional Intensity and Opinion Polarization in Online Media

David Asker & Elias Dinas
Public Opinion Quarterly
Published: 09 September 2019
https://doi.org/10.1093/poq/nfz042

Abstract

How do online media increase opinion polarization? The “echo chamber” thesis points to the role of selective exposure to homogeneous views and information. Critics of this view emphasize the potential of online media to expand the ideological spectrum that news consumers encounter. Embedded in this discussion is the assumption that online media affects public opinion via the range of information that it offers to users. We show that online media can induce opinion polarization even among users exposed to ideologically heterogeneous views, by heightening the emotional intensity of the content. Higher affective intensity provokes motivated reasoning, which in turn leads to opinion polarization. The results of an online experiment focusing on the comments section, a user-driven tool of communication whose effects on opinion formation remain poorly understood, show that participants randomly assigned to read an online news article with a user comments section subsequently express more extreme views on the topic of the article than a control group reading the same article without any comments. Consistent with expectations, this effect is driven by the emotional intensity of the comments, lending support to the idea that motivated reasoning is the mechanism behind this effect.

From the Discussion:

These results should not be taken as a challenge to the echo chamber argument, but rather as a complement to it. Selective exposure to desirable information and motivated rejection of undesirable information constitute separate mechanisms whereby online news audiences may develop more extreme views. Whereas there is already ample empirical evidence about the first mechanism, previous research on the second has been scant. Our contribution should thus be seen as an attempt to fill this gap.

Friday, September 27, 2019

Nudging Humans

Brett M. Frischmann
Villanova University - School of Law
Originally published August 1, 2019

Abstract

Behavioral data can and should inform the design of private and public choice architectures. Choice architects should steer people toward outcomes that make them better off (according to their own interests, not the choice architects’) but leave it to the people being nudged to choose for themselves. Libertarian paternalism can and should provide ethical constraints on choice architects. These are the foundational principles of nudging, the ascendant social engineering agenda pioneered by Nobel Prize winning economist Richard Thaler and Harvard law professor Cass Sunstein.

The foundation bears tremendous weight. Nudging permeates private and public institutions worldwide. It creeps into the design of an incredible number of human-computer interfaces and affects billions of choices daily. Yet the foundation has deep cracks.

This critique of nudging exposes those hidden fissures. It aims at the underlying theory and agenda, rather than one nudge or another, because that is where micro meets macro, where dynamic longitudinal impacts on individuals and society need to be considered. Nudging theorists and practitioners need to better account for the longitudinal effects of nudging on the humans being nudged, including malleable beliefs and preferences as well as various capabilities essential to human flourishing. The article develops two novel and powerful criticisms of nudging, one focused on nudge creep and another based on normative myopia. It explores these fundamental flaws in the nudge agenda theoretically and through various examples and case studies, including electronic contracting, activity tracking in schools, and geolocation tracking controls on an iPhone.

The paper is here.

Monday, September 16, 2019

Increasing altruistic and cooperative behaviour with simple moral nudges

Valerio Capraro, Glorianna Jagfeld,
Rana Klein, Mathijs Mul & Iris van de Pol
Natrure.com
Published Online August 15, 2019

The conflict between pro-self and pro-social behaviour is at the core of many key problems of our time, as, for example, the reduction of air pollution and the redistribution of scarce resources. For the well-being of our societies, it is thus crucial to find mechanisms to promote pro-social choices over egoistic ones. Particularly important, because cheap and easy to implement, are those mechanisms that can change people’s behaviour without forbidding any options or significantly changing their economic incentives, the so-called “nudges”. Previous research has found that moral nudges (e.g., making norms salient) can promote pro-social behaviour. However, little is known about whether their effect persists over time and spills across context. This question is key in light of research showing that pro-social actions are often followed by selfish actions, thus suggesting that some moral manipulations may backfire. Here we present a class of simple moral nudges that have a great positive impact on pro-sociality. In Studies 1–4 (total N =  1,400), we use economic games to demonstrate that asking subjects to self-report “what they think is the morally right thing to do” does not only increase pro-sociality in the choice immediately after, but also in subsequent choices, and even when the social context changes. In Study 5, we explore whether moral nudges promote charity donations to humanitarian organisations in a large (N =  1,800) crowdfunding campaign. We find that, in this context, moral nudges increase donations by about 44 percent.

The research is here.

Monday, September 10, 2018

Cognitive Biases Tricking Your Brain

Ben Yagoda
The Atlantic
September 2018 Issue

Here is an excerpt:

Because biases appear to be so hardwired and inalterable, most of the attention paid to countering them hasn’t dealt with the problematic thoughts, judgments, or predictions themselves. Instead, it has been devoted to changing behavior, in the form of incentives or “nudges.” For example, while present bias has so far proved intractable, employers have been able to nudge employees into contributing to retirement plans by making saving the default option; you have to actively take steps in order to not participate. That is, laziness or inertia can be more powerful than bias. Procedures can also be organized in a way that dissuades or prevents people from acting on biased thoughts. A well-known example: the checklists for doctors and nurses put forward by Atul Gawande in his book The Checklist Manifesto.

Is it really impossible, however, to shed or significantly mitigate one’s biases? Some studies have tentatively answered that question in the affirmative. These experiments are based on the reactions and responses of randomly chosen subjects, many of them college undergraduates: people, that is, who care about the $20 they are being paid to participate, not about modifying or even learning about their behavior and thinking. But what if the person undergoing the de-biasing strategies was highly motivated and self-selected? In other words, what if it was me?

The info is here.

Monday, April 30, 2018

Can Nudges Be Transparent and Yet Effective?

Bruns, Hendrik and Kantorowicz-Reznichenko, Elena and Klement, Katharina and Luistro Jonsson, Marijane and Rahali, Bilel.
Journal of Economic Psychology, Forthcoming. (February 28, 2018).

Abstract

Nudges receive growing attention as an effective concept to alter people's decisions without significantly changing economic incentives or limiting options. However, being often very subtle and covert, nudges are also criticized as unethical.  By not being transparent about the intention to influence individual choice they might be perceived as limiting freedom of autonomous actions and decisions. So far, empirical research on this issue is scarce. In this study, we investigate whether nudges can be made transparent without limiting their effectiveness. For this purpose we conduct a laboratory experiment where we nudge contributions to carbon emission reduction by introducing a default value. We test how different types of transparency (i.e. knowledge of the potential influence of the default, its purpose, or both) influence the effect of the default. Our findings demonstrate that the default increases contributions, and information on the potential influence, its purpose, or both combined do not significantly influence the default effect. Furthermore, we do not find evidence that psychological reactance interacts with the influence of transparency. Findings support the policy-relevant claim that nudges (in the form of defaults) can be transparent and yet effective.

The paper can be downloaded here.

Friday, August 4, 2017

Re: Nudges in a Post-truth World

Guest Post: Nathan Hodson
Journal of Medical Ethics Blog
Originally posted July 19, 2017

Here is an excerpt:

As Levy notes, some people are concerned that nudges present a threat to autonomy. Attempts at reconciling nudges with ethics, then, are important because nudging in healthcare is here to stay but we need to ensure it is used in ways that respect autonomy (and other moral principles).

The term “nudge” is perhaps a misnomer. To fill out the concept a bit, it commonly denotes the use of behavioural economics and behavioural psychology to the construction of choice architecture through carefully designed trials. But every choice we face, in any context, already comes with a choice architecture: there are endless contextual factors that impact the decisions we make.

When we ask whether nudging is acceptable we are asking whether an arbitrary or random choice architecture is more acceptable than a deliberate choice architecture, or whether an uninformed choice architecture is better than one informed by research.

In fact the permissibility of a nudge derives from whether it is being used in an ethically acceptable way, something that can only be explored on an individual basis. Thaler and Sunstein locate ethical acceptability in promoting the health of the person being nudged (and call this Libertarian Paternalism — i.e. sensible choices are promoted but no option is foreclosed). An alternative approach was proposed by Mitchell: nudges are justified if they maximise future liberty. Either way the nudging itself is not inherently problematic.

The article is here.

Thursday, June 1, 2017

Nudges in a post-truth world

Neil Levy
Journal of Medical Ethics 
Published Online First: 19 May 2017

Abstract

Nudges—policy proposals informed by work in behavioural economics and psychology that are designed to lead to better decision-making or better behaviour—are controversial. Critics allege that they bypass our deliberative capacities, thereby undermining autonomy and responsible agency. In this paper, I identify a kind of nudge I call a nudge to reason, which make us more responsive to genuine evidence. I argue that at least some nudges to reason do not bypass our deliberative capacities. Instead, use of these nudges should be seen as appeals to mechanisms partially constitutive of these capacities, and therefore as benign (so far as autonomy and responsible agency are concerned). I sketch some concrete proposals for nudges to reason which are especially important given the apparent widespread resistance to evidence seen in recent political events.

The article is here.