Ethical dimensions of healthcare nudges: a PRISMA-ScR–guided scoping review and framework for responsible behavioral governance

作者：Huifang Shang, Lu Xiong, Kefan Chen, Renbin Tian, Tu Jing, Xianhui Shang · 发表于：Frontiers in Public Health · 年份：2025 · DOI：10.3389/fpubh.2025.1716466 · 被引用次数：2 · 研究领域：Healthcare cost, quality, practices、Health Systems, Economic Evaluations, Quality of Life、Ethics in medical practice

Background: Nudging has gained momentum in healthcare as a behavioral strategy to support beneficial health choices. However, its ethical legitimacy remains contested, especially regarding autonomy, transparency, fairness, and risks of covert influence. Objective: This scoping review synthesizes ethical debates on healthcare nudges and proposes governance principles to guide ethically responsible implementation. Methods: We conducted a scoping review following the PRISMA-ScR framework across international and Chinese databases. Conceptual and empirical bioethics literature from 2013 to 2023 was analyzed through thematic synthesis. Results: Twenty-three studies met inclusion criteria. Ethical concerns centered on autonomy (22/23), informed consent and transparency (4/23), equity and distributive fairness (2/23), and risk of unintended harm (1/23). Reflective nudges that support deliberation were more widely endorsed than covert defaults. Recent scholarship emphasizes transparency, proportionality, stakeholder participation, and equity audits as conditions for ethical legitimacy. Contribution: To our knowledge, this is the first review to systematically synthesize ethical dimensions of healthcare nudges using the PRISMA-ScR framework and to propose an actionable governance model for responsible behavioral regulation. The review advances ethical theory by integrating principlism, consequentialism, and deontology with cross-cultural public health ethics, and policy insights by id...