I argue that it is impermissible to use nudges as a tool to influence patients in the context of informed consent. The motivation for such nudges is that their use can help reconcile potential conflicts between a physician’s duty of beneficence and duty to respect patient autonomy. I argue that their use places physicians in a position of domination over patients. That is, it violates the republican freedom of patients because it grants physicians the power to arbitrarily interfere. I also (...) argue that if one tries to adjust the duty of beneficence to avoid this conclusion, then the republican freedom of patients is still threatened under conditions of clinical equipoise. As ways to avoid the inevitability of nudging, I suggest the alternative of boosting or the pairing of patients with physicians who share their deep values. This latter option achieves the benefits nudging patients is supposed to provide without violating the republican freedom of those patients. (shrink)

Summary This essay speculates about the degree to which a counter-image of Europe imagined by Romantic period writers showed them to be transforming an inherited idea of the republic of letters for political purposes. While Anglophone romanticists recognise that the French Revolution is an indisputable agent in shaping the contemporary English literary imagination, they then usually ignore the role played by the Restoration which followed. Romantic criticism can perhaps learn an appropriate sensitivity here from the work of critics of English (...) Restoration writing of the seventeenth century. That epochal uncertainty, when the regicides beheaded the King and then wondered what to do politically, was succeeded in the Restoration by a kind of Dissenting determination to continue under or memorialise that uncertainty, not as a dilemma but as the experience of political opportunity. A similar pattern of pursuing revolution by other means is visible in the political revisionism and literary experimentation of post-Revolutionary Romantic radicals. In my picture, then, the Romantic transformation of the republic of letters recovers an older literary republicanism. In what is here dubbed Realpoetik the battle for what is to be political reality is fought on a rhetorical field whose free speech is exemplary of what politics should be like. (shrink)