Structured Autonomy: Increasing Self-Governance in Modern Medicine

AbstractAs one of the core tenets of bioethics, autonomy describes the ability of patients to make informed decisions about their medical care. Over the past decade, however, research in behavioral economics has called into question just how much liberty or agency individuals have when making decisions. Patients sometimes harbor irrational decision-making biases and are impacted by their surrounding environments. In particular, purposely or inadvertently, physicians can operate as choice architects: they may use "nudges" to exert their influence and guide their patients' decisions. Although such nudges occur without limiting the patients' rights to either refuse or request alternative options, the use of nudges stands in stark contrast to conventional definitions of autonomy, which assume that all actors can function independently.