EXPRESS: Beyond Opt-Out: How Presumed-Consent Language Shapes Persuasion
Research article
Romain Cadario, Jenny Zimmermann, Bram Van den Bergh
Journal of Marketing, 16 February 2025
Abstract
When using opt-out (vs. opt-in) policies, choice architects presume that people consent, rather than explicitly asking them to state their consent. While opt-out policies often increase compliance, they are also associated with managerial issues such as ethical considerations, legal regulations, limited public support, and increased no-show rates. This research demonstrates that choice architects can also establish presumed-consent through the language they use, holding the opt-in policy constant. Seven studies in various health domains indicate that presumed-consent language (e.g., “a vaccine was arranged for you”) rather than explicit-consent language (e.g., “you can choose to get a vaccine”) increases persuasion (i.e., behavioral intentions, actual behaviors). This effect occurs through perceived endorsement: Decision makers infer through the presumed-consent language that the desired health behavior (e.g., vaccination) is the recommended course of action. Furthermore, this research examines the proposed endorsement process under various conditions. When product tangibility is low (e.g., a flu shot), the effectiveness of presumed-consent language stems primarily from perceived endorsement rather than psychological ownership or perceived ease. In contrast, when product tangibility is high (e.g., a sunscreen lotion), the effect stems primarily from psychological ownership rather than perceived endorsement or perceived ease.

Informed Consent, Autonomy, False Beliefs, and Ignorance
James Stacey Taylor
Social Philosophy and Policy, 6 February 2025
Abstract
It is widely believed that health policy should take care to ensure that persons are informed about the expected risks as well as the anticipated advantages of medical procedures. This is often justified by a concern for the moral value of personal autonomy, as it is widely believed that to the extent that a person makes decisions on the basis of false beliefs or ignorance her autonomy with respect to them is compromised. This essay argues against this widespread claim. A person’s autonomy with respect to her decisions will not be compromised by either ignorance or false beliefs. However, it does not follow that there is no reason to provide persons with the opportunity to have access to the available information relevant to their decisions concerning their medical treatment. The epistemic requirements for a person to give her consent to her treatment are more stringent than those that must be met for her to be autonomous with respect to her consent. Consent, not autonomy, can be undermined by ignorance or false belief. It is a concern for consent, not a concern for autonomy, that justifies providing people with information about their prospective medical procedures.

Pragmatic Clinical Research, Informed Consent, and Clinical Equipoise
Lynn A. Jansen
Social Philosophy and Policy, 6 February 2025
Abstract
There is a growing movement within contemporary medical ethics to blur the boundaries between clinical medicine and clinical research. Some writers now argue that the research-practice distinction is outdated and the importance of distinguishing between research and medicine is no longer as pressing as it once was or seemed to be. Instead, we are now urged to view the health-care system as a dynamic “learning health-care system” in which research components are embedded within standard clinical care. This essay defends the ethical significance of the research-practice distinction while acknowledging the reality and usefulness of integrated health care. A key claim that this essay advances is that the principle of clinical equipoise, which has largely been rejected by research ethicists, can be reinterpreted and repurposed to help distinguish medical practices that call for more demanding forms of informed consent from those that do not.