Influence of selective phrasing on consent to DNAR.

Area of Science:

• Medical Ethics
• Behavioral Economics
• Health Communication

Background:

• Libertarian paternalism and nudging aim to guide decisions while preserving autonomy.
• Nudges exploit cognitive biases like framing effects but have limited medical application.
• Physician selective phrasing is explored as a direct intervention influencing surrogate decisions on do not attempt resuscitation (DNAR) orders.

Purpose of the Study:

• To investigate if physicians' selective phrasing impacts surrogate consent for DNAR orders.
• To compare selective phrasing to conventional nudging in a medical context.

Main Methods:

• Conducted vignette-based online experiments with hypothetical end-of-life scenarios.
• Participants evaluated scenarios with subtle linguistic variations in physician explanations.
• Tested effects of mentioning cardiopulmonary resuscitation (CPR) harms and framing DNAR as "natural" on consent rates.

Main Results:

• Selective phrasing significantly influenced participants' willingness to consent to DNAR.
• Highlighting CPR harms and framing DNAR as "natural end-of-life care" increased DNAR acceptance rates.
• Physician language shapes end-of-life decisions without explicit constraints.

Conclusions:

• Physician language is critical in shaping end-of-life decisions, acting as a form of nudging.
• Raises ethical considerations regarding permissible linguistic selectivity in medical communication.
• Selective phrasing influences surrogate decision-making for DNAR orders.