Commitment devices: beyond the medical ethics of nudges

Area of Science:

• Behavioral Science
• Medical Ethics
• Public Health

Background:

• Commitment devices (CDs) are tools individuals use to overcome self-control issues and adhere to plans.
• CDs involve willingly making future options less desirable to influence behavior, often through financial forfeits.
• Applications include promoting healthy lifestyles, addiction cessation, and medication adherence, proving acceptable and effective even with small sums.

Purpose of the Study:

• To critically evaluate the ethical implications of using commitment devices in healthcare.
• To address and refute common objections to nudging within the medical context.
• To identify and propose solutions for ethical challenges specific to commitment devices.

Main Methods:

• Analysis of existing objections to nudges in healthcare, specifically in relation to commitment devices.
• Ethical appraisal of commitment devices, focusing on potential exclusions and unintended consequences.
• Development of strategies to mitigate ethical risks and key considerations for implementation.

Main Results:

• Common objections to nudging lack force when applied to commitment devices.
• Commitment devices can exclude vulnerable populations ('naifs') and potentially exacerbate health inequalities.
• Risks include promoting undesirable behaviors, the possibility of legitimate mind changes, and perverse incentives for intermediaries.

Conclusions:

• Commitment devices present unique ethical challenges beyond general nudging objections.
• Addressing issues like exclusion, behavior appropriateness, and intermediary incentives is crucial.
• A case-by-case ethical assessment is essential for the responsible implementation of commitment devices in medicine.