Influence of Selective Phrasing on Consent to DNAR

This paper investigates how physicians’ selective phrasing influences individuals’ attitudes toward “do not attempt resuscitation” (DNAR) orders. Within the framework of libertarian paternalism, nudges have been proposed as a way to guide choices while preserving autonomy, often by leveraging cognitive biases such as framing effects. Nudges are often discussed as a promising means of promoting patients’ best interests without undermining autonomy; however, their practical use in real medical contexts remains limited. Instead, this study focuses on a more direct form of intervention: physicians’ selective phrasing. Specifically, it examines how the use of selective phrasing in DNAR explanations influences patients’ decisions. Using a series of online experiments, we found that people’s consent to DNAR in hypothetical medical scenarios is influenced by slight linguistic differences in the physician’s explanation. The results show that briefly noting the potential harms of CPR, or associating the decision not to perform resuscitation with “naturalness,” contributes to higher acceptance of DNAR. These findings underscore the power of physicians’ language in shaping patients’ decisions without imposing particular options or restricting freedom of choice, or the potentiality of nudging in a broader sense.