Of course, most patients who are not well-versed in the issues involved still rely on their doctor's assistance in making that ultimate decision. New research in psychology and behavioral economic shows that perhaps patients do in some cases need this "nudge" in the right direction. However, as the article notes, if one cannot trust the public to act in their own interests after even a "nudge," why not do more?
Many of the suggestions in “Nudge” seem like good ideas, and even, as with “Save More Tomorrow,” practical ones. The whole project, though, as Thaler and Sunstein acknowledge, raises some pretty awkward questions. If the “nudgee” can’t be depended on to recognize his own best interests, why stop at a nudge? Why not offer a “push,” or perhaps even a “shove”? And if people can’t be trusted to make the right choices for themselves how can they possibly be trusted to make the right decisions for the rest of us?But, therein lies the problem: if doctors push, we risk the pendulum swinging too far back towards paternalism. It seems that there is a real dilemma brewing between the necessity of paternalism and the ideal of autonomy. Modern medicine so far does not seem to have a palatable answer.