Which conceptualisations of autonomy are addressed in the ethical discussion on nudging?

Abstract

Background: One of the strongest ethical concerns about nudges is that they threaten personal autonomy. Autonomy can be understood in various ways. The aim of this study was to identify different conceptualisations of autonomy as used in the literature on the ethics of nudging. Methods: Scopus, PubMed and Google Scholar databases were searched for articles on the ethics of nudging. From the 101 search results, 33 articles were included in a literature review in Atlas.ti. The analysis consisted of three steps: First, autonomy arguments were identified in the text and labelled with autonomy-codes. Next, a more limited set of super-codes was developed and applied in a deliberation round. Finally three conceptualisations of autonomy were identified that connect to the super-codes and to the philosophical literature on freedom and autonomy. Findings: Three conceptualisations of autonomy were identified: 1) autonomy as freedom of choice involves the availability of options that are accessible and between which persons can choose; 2) autonomy as agency involves being able to lead one’s life and act on the basis of reasons and intention; 3) autonomy as self-constitution emphasizes a person’s individuality and authenticity. Discussion: Three conceptualisations of autonomy were identified in the literature on the ethics of nudging. Autonomy as self-constitution was less frequently used than the other conceptualisations. These conceptualisations of autonomy will eventually be operationalized and used in a series of empirical studies in various health related contexts. The aim of these experiments will be to investigate the impact of nudges on personal autonomy.