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The Ethics of Vaccination Nudges in Pediatric Practice

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Abstract

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges.

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Acknowledgments

The author is grateful for the helpful feedback he received from Eric Chwang, Ami Harbin, Joyce Havstad, Phyllis Rooney, Jason Wasserman, audiences at the 2015 meetings of both IVR and the WMU Medical Humanities Conference, and two anonymous reviewers at HEC Forum.

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This project was completed with no specific support.

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  1. Department of Philosophy, Oakland University, 746 Mathematics and Science Center, Rochester, MI, 48309-4401, USA

    Mark C. Navin

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  1. Mark C. Navin
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Correspondence to Mark C. Navin.

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Navin, M.C. The Ethics of Vaccination Nudges in Pediatric Practice. HEC Forum 29, 43–57 (2017). https://doi.org/10.1007/s10730-016-9311-2

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