{
  "abstract": "Background: Within the framework of libertarian paternalism, nudges have been proposed as a way to guide decision-making while preserving individual autonomy, often by exploiting cognitive biases such as framing effects. Although nudges are commonly discussed as a promising means of promoting patients’ best interests, their practical application in real medical contexts remains limited. This study examines whether physicians’ selective phrasing, as a more direct form of intervention than conventional nudging, influences surrogates’ decisions regarding “do not attempt resuscitation” (DNAR) orders.\n\nMethods: We conducted a series of vignette-based online experiments in which participants evaluated hypothetical end-of-life scenarios. We tested whether subtle linguistic variations in physicians’ explanations—such as mentioning potential harms of cardiopulmonary resuscitation (CPR) or associating DNAR with “naturalness”—affected participants’ consent to DNAR.\n\nResults: Across studies, participants’ willingness to consent to DNAR was significantly influenced by selective phrasing. Specifically, briefly highlighting the potential harms of CPR and framing DNAR as a form of “natural end-of-life care” were associated with higher rates of DNAR acceptance.\n\nConclusions: The findings demonstrate that physicians’ language plays a crucial role in shaping end-of-life decisions without imposing explicit constraints on choice. This suggests that selective phrasing may function as a form of nudging in the broader sense, raising important ethical questions about the boundaries of permissible linguistic selectivity in medical communication.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12910-026-01548-7.",
  "abstract_shown": true,
  "affiliations": [
    "Hiroshima University, Higashi-Hiroshima, Japan",
    "Nagoya University of Commerce & Business, Nisshin, Japan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kiichi Inarimori"
    },
    {
      "affs": [
        1
      ],
      "name": "Yugo Maeda"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/18k00a45z3a79.bib",
  "cited_by": 1,
  "doi": "10.1186/s12910-026-01548-7",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13741579/",
  "id": "18k00a45z3a79",
  "issns": [
    "1472-6939"
  ],
  "landing_url": "https://doi.org/10.1186/s12910-026-01548-7",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2739|Palliative Care and End-of-Life Issues"
    ]
  ],
  "openalex": "W7168235261",
  "pdf_url": null,
  "pmcid": "PMC13741579",
  "pmid": "42449340",
  "published": "2026-07-14",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/18k00a45z3a79.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T12:22:37Z",
      "native_id": "PMC13741579",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12910-026-01548-7"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Palliative Care and End-of-Life Issues",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Influence of selective phrasing on consent to DNAR",
  "title_text": "Influence of selective phrasing on consent to DNAR",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T12:22:37Z",
  "url": "https://research.draconitic.com/paper/18k00a45z3a79",
  "venue": "BMC Medical Ethics",
  "versions": []
}