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Nudging is a concept in behavioural science, political theory and economics that refers to the usage of indirect psychological strategies to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In the article «Nudging in Nursing? (Nursing Ethics 26(6), 2018), we consider the legitimacy of using nudges in nursing. We examine current knowledge about how different nursing decisions (rational and pre-rational decisions, major and minor decisions) are made and how these decisions affect patients. We consider their legitimacy in light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing only in light of free will and patient autonomy. Sometimes nurses must take charge and exhibit leadership in the nurse-patient relationship. From the perspective of nursing as leadership, nudging might in certain circumstances be a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. Our contention is that the use of nudging in nursing to influence patients' decisions and actions is legitimate if it is in alignment with the nursing project and in accordance with the patient's own values and goals. More specifically, we argue that nudging may be an ethically legitimate tool of influence in nursing to the extent that it may safeguard especially vulnerable patients' dignity. In the article "Could information about herd immunity help us achieve herd immunity? Evidence from a population representative survey experiment?" (Scandinavian Journal of Public Health, Vol 46 (8), 2018) we use a vaccination case to discuss whether nudging people to make health related decisions that entails a small risk, but also great benefit not only to themselves but also to others, can be ethically justified. Immunisation causes dramatic reductions in morbidity and mortality from infectious diseases; however, resistance to vaccination is nonetheless widespread. An understudied issue is whether appeals to collective as opposed to individual benefits of vaccination may nudge people to vaccinate. Knowledge of this is important not least with respect to the design of public health campaigns, which often lack information about the collective benefits of vaccination. Using a between-subjects experimental survey design we tested whether information about the effects of herd immunity can influences people?s decision to vaccinate. In the article "Addiction as a Disorder of Self-Control?" (in The Routledge Handbook of Philosophy and Science of Addiction, 2019) we argue that the underlying neuro-cognitive mechanisms of addiction influence addicts' decision-making in a way similar to the way in which nudges shape people's choice-architectures. We argue that in the case of addiction, this influence impairs addicts' capacity for self-control. Since self-control plausibly is a condition of autonomous decision-making more generally, this supports the claim that it cannot simply be presumed that nudges do not undermine people's autonomy. Nudging in the healthcare context can therefore only be legitimately carried out on the basis of a case-to-case approach where the special circumstances of the case are taken carefully into consideration. In the article "Empowerment in Healthcare: A Thematic Synthesis and Critical Discussion of Concept Analyses of Empowerment" (Patient Education and Counseling 103(7), 2020), the objective was to shed light on common characteristics revealed in concept analyses of empowerment to contribute to further understanding of this concept. A further objective was to discuss how the perspective of healthcare service users appeared in the concept analyses. A systematic literature review was performed by systematically searching Medline, CINAHL, EMBASE, PsycINFO and ERIC. The search yielded 255 abstracts, which were reduced by relevance and critical appraisal to the 12 concept analyses included. The analysis process involved thematic synthesis as described by Thomas and Harden. The result of the analysis was 13 descriptive themes structured according to antecedents, attributes and consequences of empowerment. The synthesis revealed how sparsely the question of equality and power in the relation between health professionals and healthcare service users is addressed. In the discussion we argued that empowerment to a great extent is viewed as a helping process of making patients act differently, rather than redistribution of power. The article "Addiction and autonomy: Why emotional dysregulation in addiction impairs autonomy" (Frontiers in Psychology, 2023) explains why emotional dysregulation in addiction impairs addicts' autonomy and explores implications for addicts' decision-making capacity.

Prosjektet har frembragt ny generell teoretisk kunnskap om på hvilken måte eksternt styrte påvirkninger på individers beslutningsprosesser kan påvirke deres autonomi og evne til å fatte selvstendige beslutninger. Prosjektet har videre frembragt ny kunnskap om når og under hvilke betingelser slike påvirkninger kan undergrave autonomi og potensielt ugyldiggjøre informert samtykke. Til sammen kan denne nye kunnskapen forventes å gi beslutningstagere i helsesektoren et bedre grunnlag når det gjelder å vurdere nytte/kostnad ved anvendelse av styrte påvirkninger for å fremme pasienters helse og velferd.

Informed consent, which is a shorthand for informed, voluntary, and decisionally-capacitated consent, is required across a wide swath of human activities, including employment, medical care, medical research, professional relationships, and so forth. Underlying this requirement is the value placed in liberal societies on allowing for the pursuit of rival conceptions of the good life, thereby respecting the autonomy of individuals to make decisions in matters that concern their own welfare. This project aims to develop a theory of what constitutes undue influence on such decisions - in particular influence exerted through various forms of manipulation - that makes explicit its connections with non-autonomous decision-making. Second, it will attempt to determine what role, if any, "nudges" and other interventions can legitimately play in enhancing decision-making in the health care context. In particular, it focuses on two cases which have been little explored in the literature. First, the use of empowerment strategies in nurse-patient relationships to enhance patients' capacity to make informed decisions. Second, the use of "nudges" to guide or manipulate the health-related life-style choices of socially disadvantaged individuals. It is argued that both cases raise important ethical challenges. Through conceptual analysis of key terms, such as "empowerment" and "autonomy", as well as thorough investigation into the impact of social and cultural constraints on the autonomy of individuals' health-related life-style choices, the project will suggest how best to deal with these challenges. To make the analysis practically relevant, the general findings will be condensed into clarified policy recommendations.