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Progress in medicine: autonomy, oughtonomy and nudging

Ignaas Devisch UGent (2011) JOURNAL OF EVALUATION IN CLINICAL PRACTICE. 17(5). p.857-861
abstract
Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites. Methods: In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today’s medicine. Results and Conclusions: Autonomy may and should be a shared target in today’s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
autonomy, empowerment, nudging, oughtonomy, paternalism, progress, OWN HEALTH-CARE, PATIENT EMPOWERMENT, RESEARCH ISSUES, RESPONSIBILITIES, COMPLEMENTARY, PERSPECTIVE
journal title
JOURNAL OF EVALUATION IN CLINICAL PRACTICE
J. Eval. Clin. Pract.
volume
17
issue
5
pages
857 - 861
Web of Science type
Article
Web of Science id
000295177800004
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
1.229 (2011)
JCR rank
70/153 (2011)
JCR quartile
2 (2011)
ISSN
1356-1294
DOI
10.1111/j.1365-2753.2011.01716.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1908668
handle
http://hdl.handle.net/1854/LU-1908668
date created
2011-09-25 20:34:02
date last changed
2016-12-19 15:46:41
@article{1908668,
  abstract     = {Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today -- dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is impossible; autonomous individuals are {\textquoteleft}contaminated{\textquoteright} by heteronymous aspects, by influences from {\textquoteleft}outside{\textquoteright}. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism {\textquoteleft}oughtonomy{\textquoteright} to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites.
Methods: In this article, I reflect upon how social conditions might improve our {\textquoteleft}choice architecture{\textquoteright}, what Thaler \& Sunstein have called {\textquoteleft}nudging{\textquoteright}: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today{\textquoteright}s medicine. 
Results and Conclusions: Autonomy may and should be a shared target in today{\textquoteright}s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy.},
  author       = {Devisch, Ignaas},
  issn         = {1356-1294},
  journal      = {JOURNAL OF EVALUATION IN CLINICAL PRACTICE},
  keyword      = {autonomy,empowerment,nudging,oughtonomy,paternalism,progress,OWN HEALTH-CARE,PATIENT EMPOWERMENT,RESEARCH ISSUES,RESPONSIBILITIES,COMPLEMENTARY,PERSPECTIVE},
  language     = {eng},
  number       = {5},
  pages        = {857--861},
  title        = {Progress in medicine: autonomy, oughtonomy and nudging},
  url          = {http://dx.doi.org/10.1111/j.1365-2753.2011.01716.x},
  volume       = {17},
  year         = {2011},
}

Chicago
Devisch, Ignaas. 2011. “Progress in Medicine: Autonomy, Oughtonomy and Nudging.” Journal of Evaluation in Clinical Practice 17 (5): 857–861.
APA
Devisch, Ignaas. (2011). Progress in medicine: autonomy, oughtonomy and nudging. JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 17(5), 857–861.
Vancouver
1.
Devisch I. Progress in medicine: autonomy, oughtonomy and nudging. JOURNAL OF EVALUATION IN CLINICAL PRACTICE. 2011;17(5):857–61.
MLA
Devisch, Ignaas. “Progress in Medicine: Autonomy, Oughtonomy and Nudging.” JOURNAL OF EVALUATION IN CLINICAL PRACTICE 17.5 (2011): 857–861. Print.