Nudge for Cancer Screening and Its Ethical Implications

Abstract

Human beings often make irrational choices of biases and their feature of thinking, even when they believe they made rational choices under sufficient information. Taking into account the behavioral-economic nature of humans, “nudge” is the design or architecture to promote people to make a preferable choice for themselves. In recent years, nudges have been increasingly used in the field of public health. In Japan, materials for promoting cancer screening with nudges have been published. These materials were verified that they increased the number of people who have cancer screening including breast cancer screening. Nudge is based on the theory of ethical and political philosophy called libertarian paternalism. In this theory, the value of a person is realized at a higher level by guiding with some amount of induction toward his/her purpose, compared with the case where a person's liberty is put highest priority. However, despite the validity at the level of the principle of the theory, nudge cannot avoid being questioned in its ethical soundness. There are some ethically-concerned cases such as non-educational nudges or nudging in an inappropriate direction for the target person. Considering these ethical concerns, it would be desirable to involve citizens in the process of system design to construct a cancer screening system that reflects sound information and the values of the general public.