Good Ethics and Bad Choices

From Basic Bioethics

Good Ethics and Bad Choices

The Relevance of Behavioral Economics for Medical Ethics

By Jennifer S. Blumenthal-Barby

An analysis of how findings in behavioral economics challenge fundamental assumptions of medical ethics, integrating the latest research in both fields.





An analysis of how findings in behavioral economics challenge fundamental assumptions of medical ethics, integrating the latest research in both fields.

Bioethicists have long argued for rational persuasion to help patients with medical decisions. But the findings of behavioral economics—popularized in Thaler and Sunstein's Nudge and other books—show that arguments depending on rational thinking are unlikely to be successful and even that the idea of purely rational persuasion may be a fiction. In Good Ethics and Bad Choices, Jennifer Blumenthal-Barby examines how behavioral economics challenges some of the most fundamental tenets of medical ethics. She not only integrates the latest research from both fields but also provides examples of how physicians apply concepts of behavioral economics in practice.

Blumenthal-Barby analyzes ethical issues raised by “nudging” patient decision making and argues that the practice can improve patient decisions, prevent harm, and perhaps enhance autonomy. She then offers a more detailed ethical analysis of further questions that arise, including whether nudging amounts to manipulation, to what extent and at what point these techniques should be used, when and how their use would be wrong, and whether transparency about their use is required. She provides a snapshot of nudging “in the weeds,” reporting on practices she observed in clinical settings including psychiatry, pediatric critical care, and oncology. Warning that there is no “single, simple account of the ethics of nudging,” Blumenthal-Barby offers a qualified defense, arguing that a nudge can be justified in part by the extent to which it makes patients better off.


$45.00 X ISBN: 9780262542487 264 pp. | 6 in x 9 in


  • “Blumenthal-Barby (Baylor College of Medicine) offers a fascinating exploration [.... ] The ensuing discussions will be juicy.


  • "[T]his is a great book and the discussion is nuanced and often very convincing....Any readers interested in behavioral economics and its relevance for medical ethics—whether they have previous experience with medical ethics literature or not—will be able to understand and make use of this book."

    American Journal of Bioethics

  • "An admirable treatment....clearly written and engaging....should be of general interest to philosophers, especially ethicists, political philosophers, and those working on agency, and even those thinking and writing on relatively esoteric topics within these areas. This is because the insights offered up by the decision sciences, along with those of philosophers like Blumenthal-Barby who have taken up their results, confront us with difficult, perennial philosophical questions about the kinds of beings we are, where our good lies, and how best to live with one another."



  • "Good Ethics and Bad Choices takes place at the intersection of the psychology of human decision-making and the ethics of relationships in health care. It begins from the premise that influence is unavoidable and that human decision-making is often a complicated and messy mix of implicit shortcuts and explicit reasoning, and then it explores the ethical boundaries of the way this knowledge might be used to influence patient decision making. The result is a comprehensive, accessible, and insightful work that is a must-read for anyone interested in health care ethics."

    Alex John London

    Clara L. West Professor of Ethics and Philosophy, Carnegie Mellon University

  • "An excellent book. The arguments are thoughtful, nuanced, and compelling: nudging and choice architecture are ubiquitous. In some clinical decisions they are strongly justified, while in other contexts nudges should be minimized. The detailed case examples are very helpful."

    Bernard Lo, M.D,

    University of California, San Francisco School of Medicine