SYSTEMATIC REVIEW article
Front. Public Health
Sec. Public Health Policy
This article is part of the Research TopicNudge Theory: Advancing Health Promotion and Disease PreventionView all 9 articles
Ethical Dimensions of Healthcare Nudges: A PRISMA-ScR–Guided Scoping Review and Framework for Responsible Behavioral Governance
Provisionally accepted
- 1The First People's Hospital of Zunyi, Zunyi, China
- 2The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
- 3Affiliated Hospital of Zunyi Medical University, Zunyi, China
- 4Guizhou Children's Hospital, Zunyi, China
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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 2013–2023 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 identifying operational safeguards for health systems. Conclusion: Healthcare nudges can be ethically justified when designed with transparency, meaningful opt-out options, proportionality of influence, and equity safeguards. Responsible behavioral governance requires culturally sensitive implementation, independent oversight, and continuous monitoring of autonomy and fairness outcomes. Future empirical work should examine real-world impacts on patient agency and equity across diverse clinical and cultural contexts.
Keywords: Nudge theory, healthcare ethics, PRISMA-ScR, autonomy, behavioral governance, Bioethics, health policy ethics, Behavioral Economics
Received: 30 Sep 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Shang, Xiong, Chen, Tian, Tu and Shang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lingfang Xiong, 181661075@qq.com
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