Center for Medical Ethics and Health Policy

Choice Architecture


Project Description

Media Component
Dr. Jennifer Blumenthal-Barby, Ph.D.

Choice architecture refers to how the presentation of choices may influence decision-making and is a technique that has been implemented in public and private policy domains. The way in which options are categorized and then presented to a decision-maker is an example of presenting options in a way that influences choice. Related to health care, for example, nations that require citizens to opt-out of organ transplant donation have a significantly higher organ-donor rate than nations where the citizens must affirmatively choose to take part (opt-in). Another technique suggested is laying out various outcomes of a decision in a way that is easy for the choice-maker to understand. The literature on choice architecture builds a framework to distinguish between two types of tools that choice architects can use: those that structure a choice in a certain way, and tools that make use of how options are presented to decision-makers. To illustrate, the use of a default, where the default option will lead to a more socially desirable outcome, is an example of structuring choices.

This project aims to develop empirically-informed comprehensive normative guidelines for the use of choice architecture in (1) prostate cancer treatment decision-making, and (2) decision-making about tracheostomy placement in critically ill children.

Supported by: The Greenwall Foundation, Making a Difference in Real-World Bioethics Dilemmas Grant Initiative


Project Personnel


Principal Investigator

Jennifer Blumenthal-Barby, Ph.D., Principal Investigator




Blumenthal-Barby J, Loftis L, Cummings CL, Meadow W, Lemmon M, Ubel PA, McCullough L, Rao E, Lantos JD. Should Neonatologists Give Opinions Withdrawing Life-sustaining Treatment? Pediatrics 138(6), 2016:1-7.

Blumenthal-Barby J. Biases and Heuristics in Decision Making and Their Impact on Autonomy. Am J Bioeth. 16(5), 2016: 5-15.

Blumenthal-Barby JS, Denise L, Volk R. Towards Ethically Responsible Choice Architecture in Prostate Cancer Treatment Decision Making. CA: Cancer J For Clin. 65(4), 2016: 257-60.

Volk R, Kinsman G, Le Y, Swank P, Blumenthal-Barby JS, McFall S, Byrd T, Mullen P, Cantor S. Designing Normative Messages About Active Surveillance for Men With Localized Prostate Cancer. J Health Commun. 20(9), 2016: 1014-20.

Blumenthal-Barby JS, Naik A. In Defense of Nudge-Autonomy Compatibility. American Journal of Bioethics 15(10), 2015: 45-47




Blumenthal-Barby JS. Doing With, Doing For, and Doing To: Nudges and Participatory Influence. The American Society for Bioethics and Humanities Annual Meeting, San Diego, CA. October 2014.

Blumenthal-Barby JS. ‘Autonomous’ Decisions and the Ethics of Nudging. Cedars-Sinai Noon Ethics Conference, Los Angeles, CA. September 2014. Meriter Hospital Fall Ethics Conference, Madison, WI. November 2014.

Blumenthal-Barby JS. Ethical Considerations in Shared Decision Making. Retired Physicians Organization, Houston, TX. November 2014. PriMed Current Clinical Issues in Primary Care Conference, Houston, TX. March 2014.

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