Association for Behavior Analysis International

Six decades of research on human decision making has revealed how sensitive our choices are to the ways in which options are framed. A key insight from this line of scholarship, which is typically referred to as behavioral economics, is that the influence of nudges – or intentional framings of options so as to make certain choices more likely – is greatest when people lack deep-seated or well-ordered preferences among the options. Most of us know, for example, whether we prefer vanilla or chocolate ice cream, or at least the situations in which we prefer one or the other, and so are unlikely to be nudged to choose differently. But unlike ice cream selections, seriously patients’ (and their family members’) choices about end-of-life care are made infrequently, and typically without receiving feedback about how choosing one way versus another makes us feel. For these reasons and perhaps others, research over the past decade has shown that these high-stakes, seemingly preference-sensitive decisions are in fact quite strongly influenced by the ways in which options are framed. This talk will begin by differentiating among behavior change strategies that differ in their likely effectiveness and threats to autonomous choice, and will then explore how behavioral economic concepts are being used by the speaker and others in efforts to improve the quality of serious illness care in the U.S. Examples from ongoing and recently completed randomized trials will be presented, and the ethics of consciously “nudging” certain end-of-life decisions will be considered.