Nudge symposium proceedings

The current issue of the European Journal of Risk Regulation has the proceedings of a symposium on nudging, and it contains a set of insightful papers. The introduction by the editor says it best.

The EJRR starts the new year by hosting a pioneering symposium devoted to one of the latest policy innovations that is currently experimented in the United Kingdom and the United States: the ubiquitous, yet controversial, Nudge. This idea originates from the homonymous, 2008 best-selling book published by the economist Richard Thaler and the legal scholar Cass Sunstein. By building upon the findings of behavioural research, they refute the classic economic assumption that “each of us thinks and chooses unfailingly well”1 and they advocate the need for public authorities to nudge people to make decisions that serve their own long-term interests without however removing their right to choose.

At a time in which governments are taking considerable interest in the use of nudging, we have asked some of the leading authors who have already contributed to the literature surrounding the regulatory innovations, generally referred as New Governance, to share their ideas on this appealing regulatory approach.

In his opening essay, Nudging Healthy Lifestyles, Adam Burgess provides a critical assessment of the introduction of behavioural, nudging approaches to correct lifestyle behaviours in the UK. His thought-provoking analysis triggered a lively debate that has been framed along the subsequent essays signed by On Amir and Orly Lobel, Evan Selinger and Kyle Powys White, Alberto Alemanno and Luc Bovens.

The article by Alberto Alemanno, Managing Editor of the European Journal of Risk Regulation is a fulsome account of the propriety of nudging in the case of tobacco control (recently highlighted by Roland on these pages); that nudging in this instance overcomes many of the objections that are raised in the other contributions to the symposium.

I also liked Selinger & White’s analysis of nudging in the context of Brad Allenby and Dan Sarewitz’s insight on the three levels by which we should view technological fixes (as articulated in their excellent book The Techno-Human Condition, which I have written about before). In particular, they point out the naiveté of only considering shop-floor arguments, a topic we will return to again.

Hat tip to Marleen Eijkholt for alerting me to this symposium.

Image credit: Transcapitalist

Tobacco Denormalization and Stigma

Toronto’s Centre for Addiction and Mental Health (CAMH) – Canada’s largest addiction and mental health research and treatment facility – recently announced that come July 2010, three of its principle sites will be entirely smoke free. This announcement appears to be the next step from CAMH’s 2005 non-smoking policy,  in which smoking was prohibited in all buildings and in the designated smoking rooms on inpatient units. Clients, staff and visitors were still able to smoke in designated areas on the grounds.

Justification for the new policy is based on the following argument:

“This is first and foremost part of CAMH’s commitment to transform care for our clients…we should not accept a lower quality of life for people with mental vs physical illness. This decision is equally motivated by health and safety – CAMH has a legal and ethical obligation to provide a safe, hazard-free treatment setting and workplace for our clients, staff, volunteers and visitors. In 2009 the primary cause of death in mental health and addictions populations was tobacco-related medical illness…”

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Blogging Canadian Bioethics: Day 3

So many sessions, so little time. It really is a shame. The quality of sessions this year was truly remarkable, so it was difficult to decide on what to see. On Saturday morning I sat down with my breakfast of coffee, muffins and fruit and took a good long look at the program. After Bernard Keating‘s plenary lecture entitled, Squaring the circle: reconciling evidence and equity (which the majority of the audience was plugged into headphones with a direct line to an English translation, as the lecture was presented mainly en français), I made my way over to two fantastic sessions.

The first session by Cynthia Forlini of the Neuroethics Research Unit at the Institut de recherches cliniques de Montreal (IRCM), reported on a qualitative study on stakeholder perspectives on the use of cognitive enhancing drugs, particularly methylphenidate (I do not have the title of the presentation – it was unfortunately absent from the conference program and I lazily didn’t bother to write it down). The presentation was based upon a paper Forlini co-authored with supervisor Eric Racine in press for Neuroethics entitled, Autonomy and Coercion in AcPicture 8ademic “Cognitive Enhancement” Using Methylphenidate: Perspectives of Key Stakeholders. Forlini focused on the perspectives of University students using methylphenidate (MPH) to improve alertness and academic performance. She argued that the social context wherein these drugs are taken and obtained is of crucial importance, as many students reported feeling ‘coerced’ to take MPH in these settings to improve their academic performance. Moreover, the impact of social pressures to take cognitive enhancing drugs significantly impact the individual’s autonomy, such that it may cause a “funnel phenomenon” (see both the article and the figure in this post) leading to social acceptance of this type of enhancement despite beliefs in an individuals autonomous choice. During the discussion period, Forlini was hesitant to call for regulation of cognitive enhancers for use in ‘healthy’ populations, in spite of a recent high-profile commentary in Nature by Greely, Sahakian, Harris, et al. who advocate for responsible use and regulation. Forlini stated that she believes it may be too premature to call for regulation on the use of cognitive enhancing drugs in healthy individuals, as more integration of stakeholder perspectives is needed to inform future public health policy discussion.

Up next was Jennifer Bell from UBC. The title of her presentation, Rights, Risks and Smoking: how ‘denormalisation’ mediates patient-provider interactions in primary case settings, was in many ways a response to Bayer (2008) who justified the use of stigma campaigns to “effectively reduce the prevalence of behaivors linked to disease and death” (actually, volume 67 issue 3 of Social Science and Medicine is devoted to the notion of stigma, including a nifty little back-and-forth between Burris and Bayer). Bell and her co-authors argued that the success of smoking denormalisation campaigns can be witnessed in the stigma attached to smoking, and smokers. However, can stigmatising a group ever be justified as Bayer suggests? Bell and her co-authors disagree. In their analysis, they explore some of the ethical and policy implications of denormalisation strategies which construct health care as a privilege that smokers have forgone the ‘right’ to access. Moreover, Bell reminded us that the more severe health consequences of smoking tend to be greater associated with lower socio-economic status (SES) and that smoking denormalisation efforts further marginalise low SES individuals.

During the lunch hour, UBC’s own Michael McDonald was the recipient of the CBS Lifetime Achievement Award. Dr. McDonald has had a distinguished career in the area of research ethics and other areas of applied ethics. He is the founding director of the Centre for Applied Ethics at UBC and continues to significantly contribute to the ethics literature and actively participates in many ongoing projects. A well deserved honour.

Instead of attending more concurrent sessions in the afternoon, I attended a workshop entitled, Qualitative Ethics Research: Evidentiary Needs and Directions. This session was extremely useful, as we outlined various methods and methodological approaches to qualitative ethics research (not to be confused with qualitative research ethics), and discussed amongst the group some of the challenges that people have encountered in their own work. Although worthwhile, I was tempted by another session titled Conceiving the Post-Prozac Self which was occurring at the same time. Oh well. Can’t win ‘em all.