Choice Architecture and Informed Consent in Public Health: Ethical Conditions for Community-Based Interventions
DOI:
https://doi.org/10.15517/5tzky323Keywords:
community participation, decision-making, policy making, social determinants of health, social justiceAbstract
The use of choice architecture in public health policy has renewed debate over the ethical legitimacy of interventions that shape shared decision environments without coercion but, because of their population-wide scope, preclude obtaining individual informed consent. Proposition: This article argues that the legitimacy of such interventions does not rest on formally preserving individual choice but on establishing institutional safeguards that protect autonomy through transparency, fairness, and democratic participation. Arguments for discussion: The analysis shows that the impossibility of obtaining individual informed consent does not diminish the obligation to protect autonomy. Instead, it requires replacing the protective function of consent with collective accountability mechanisms. Accordingly, a legitimacy framework is proposed based on transparency in intervention design, equitable distribution of benefits and burdens, prevention of structural stigma, and meaningful incorporation of the knowledge and perspectives of affected communities. The article also advances a deliberative governance model that integrates citizens' assemblies, independent bioethics review, proportionality, revisability, reversibility, collective objection mechanisms, and auditable design records. Conclusions: Choice architecture in public health can be considered ethically justifiable only when grounded in transparent, participatory, and accountable institutional procedures. Relational autonomy therefore provides a more appropriate normative framework than individual informed consent for evaluating interventions targeting populations and shared decision environments.
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