Influence of selective phrasing on consent to DNAR
- 1Hiroshima University, Higashi-Hiroshima, Japan
- 2Nagoya University of Commerce & Business, Nisshin, Japan
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.
Methods: 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.
Results: 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.
Conclusions: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12910-026-01548-7.
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BibTeX
@article{inarimori2026influence,
title = {{Influence of selective phrasing on consent to DNAR}},
author = {Kiichi Inarimori and Yugo Maeda},
journal = {BMC Medical Ethics},
year = {2026},
month = jul,
doi = {10.1186/s12910-026-01548-7},
url = {https://doi.org/10.1186/s12910-026-01548-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Influence of selective phrasing on consent to DNAR
AU - Kiichi Inarimori
AU - Yugo Maeda
PY - 2026
DA - 2026/07/14
JO - BMC Medical Ethics
DO - 10.1186/s12910-026-01548-7
UR - https://doi.org/10.1186/s12910-026-01548-7
AB - 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. Methods: 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. Results: 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. Conclusions: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12910-026-01548-7.
SN - 1472-6939
ER -