Assessment of Nudges Delivered to Critically Ill Children: What Makes a Nudge Ethically Defensible.
Thursday, October 12, 2023
8:15 AM – 9:30 AM ET
Location: Atlantic (Third Floor)
Behavioral nudges utilize changes in choice architecture to positively influence behaviors. When applied to the practice of medicine nudges can be relatively benign; increasing patient follow-up, or consequential; encouraging patients to undergo or avoid certain interventions. Recently nudging has found a home in the adult ICU, where this technique is deployed to improve patient outcomes and clarify goals of care. While the ethical permissibility of deploying nudges in critically ill adults is a source of constant debate, less attention has been paid to the ethical issues that surround the use of this tool in critically ill neonates and children. The challenge of ethically deploying nudges in PICUs and NICUs is twofold 1) Nudging parents or guardians to make decisions that are in the best interest of their child is complicated by one’s definition of best interest, which spans the quality-quantity of life spectrum. 2) Past research illustrates that the use of nudges in PICUs is incredibly polarizing, some pediatric and neonatal intensivists liberally use this tool to achieve outcomes deemed ideal, while others are opposed to the use of nudges, viewing this tool as a paternalistic, disingenuous and limiting. Through the examination of three scenarios; delayed withdrawal of care, transfer from curative to palliative goals of care, and the development of default care options this project identities salient features among various nudge options and explores why some nudges deployed in PICUs and NICUs settings are considered ethically tenuous and others are better received by providers, patients, and families.