Evidence-Based Persuasion: An Ethical Imperative

The primacy in modern medical ethics of the principle of respect for autonomy has led to the widespread assumption that it is unethical to change someone's beliefs, because doing so would constitute coercion or paternalism. In this Viewpoint we suggest that persuasion is not necessarily paternalistic and is an essential component of modern medical practice. There are at least 3 different types of persuasion. The first is the removal of biases; the second is recommending a particular course of action and providing evidence and reasons in favor of it; and the third is the potential creation of new biases, which could cross the line into unethical manipulation. The first of these is always mandatory, the second is usually permissible but sometimes inappropriate, and the third is normally impermissible but sometimes acceptable in rare cases.