There is considerable evidence that how a question is framed can greatly affect how people answer it.  Framing effects can cause well-intentioned people to make unethical decisions, as you can see by watching our Concepts Unwrapped video Framing, or our Cases Unwrapped video Jack & Framing.

A commonly cited example of how framing can affect people’s decisions involves doctors and their patients.  As Cass Sunstein has reported, “people are far more likely to choose to have an operation if they are told that 90 percent of those who have had the operation are alive after five years than if they are told that after five years 10 percent are dead?”

This example came to my mind as I was reading an interesting paper by Professor Nadia N. Sawicki entitled Ethical Limitations on the State’s Use of Arational Persuasion.  Professor Sawicki’s addresses, among other issues, whether it is ethical for a government to encourage its citizens not to smoke by requiring tobacco companies to show graphic pictures of cancer-ridden lungs on cigarette packages or to discourage its pregnant citizens from choosing to have abortions by requiring them to view ultrasounds of their fetuses before being allowed to have an abortion.  In addition to these appeals to emotion, the use of deception, threats, and subliminal messaging would be three additional examples of “arational” persuasion.

Everyone seems to think it is fine for the government to use facts and figures to try to persuade citizens not to litter, to use seatbelts, to pay taxes, and the like.  But things get controversial when arational means are used.

I do a disservice to Professor Sawicki’s nuanced and multidisciplinary article when I focus on the two major ways she discussed to think about this issue of the doctor’s communication to the patient.  One is the Kantian approach that emphasizes human autonomy.  This means, in part, that moral law should be identified without reference to “alien influences” that cloud one’s reason, which Kant took to include “incitements from desires and impulses.”  Arational appeals seem intended to do exactly that which Kant believes infringes upon human autonomy.

And Sawicki quotes philosopher Thomas Hill as carving out for autonomy “a capacity and disposition to make choices in a rational manner; and this means choosing in the absence of particular attitudes and inner obstacles [that interfere with rational choice] such as blind acceptance of traditional and authority, neurotic compulsions, and the like.”  A Kantian approach weighs against the doctor using framing to persuade the patient to choose to have the operation.

The other obvious way to think about this issue is consequentialist.   Jeremy Bentham and John Stuart Mill might well argue that if the doctor is deeply convinced that the patient would benefit from the operation, then it would be ethical to frame the communication so as to make it more likely that the patient will consent.  Indeed, it is arguably malpractice for the doctor not to frame the information is the most persuasive possible way.

My natural instincts are generally deontological in accordance with Kant, though I generally try to override those instincts with a consequentialist analysis.  In this case, I would urge the doctor to tell the patient that 90% of the patients who have the operation survive after six months to increase the chances that the patient will agree to the surgery.  Am I urging the doctor to unethically infringe upon the patient’s autonomy?  What do you think?  Which approach would you choose?  Why?





Thomas Hill, Autonomy and Benevolent Lies, 18 The Journal of Value Inquiry 251 (1984)

Immanuel Kant, The Moral Law:  Groundwork for the Metaphysics of Morals.

Nadia N. Sawicki, Ethical Limitations on the State’s Use of Arational Persuasion,.   Loyola University School of Law Public Law & Legal Theory Research Paper No. 2013-004.

Cass R. Sunstein, Simpler: The Future of Government (2013)