Title : Does Pandemic Triage Undermine Trust in the Medical System How Lay People and Medical Practitioners View COVID19 Sacrificial Decisions
19 dilemmas. Crucially, this pattern emerged for both COVID-19 and classic dilemmas.
Next, we surveyed practicing healthcare providers (N = 614) and comparison samples of students (N = 604) and online workers (N = 1402). Participants considered each COVID-19 dilemma, indicated whether sacrificial harm is appropriate or not appropriate, and how warm, competent, and moral they feel. Contrary to expectations, online The COVID-19 pandemic overwhelmed hospitals around the world, leading medical practitioners to face difficult trade-offs analogous to classic sacrificial dilemmas: harming a few patents would save a greater number of people. Such conditions may foster a 'strict utilitarian' approach—saving the most lives by prioritizing care for patients with the best chance of survival (Mounk, 2020). However, medical decision-makers may worry that such decisions come across as convening ‘death panels’ (Truog, et al., 2020). Their concern is justified: laypeople tend to trust moral decision-makers who express emotional concern for individuals and reject sacrificial judgments (i.e., adopt a ‘strict deontological’ approach, Rom et al., 2017). Yet, healthcare professionals tend to demonstrate less emotional distress and less regret than laypeople when accepting sacrificial harm (Francis et al., 2018). Therefore, healthcare professionals facing COVID-19 sacrificial dilemmas risk appearing callous about sacrificial harm, potentially eroding public trust in the medical system and increasing reactance to medical advice (Kohn, et al., 2000). In the current work, we examined how medical practitioners versus laypeople view COVID-19 sacrificial decisions.
In Study 1 (N = 208), we compared a new set of COVID-19 sacrificial dilemmas to a classic dilemma battery (Rom et al., 2017): Participants considered the pneumonia dilemma where refusing care to a pneumonia patient will save several healthier patients, the coma patient dilemma where removing life-support from a coma patient will free resources to treat multiple COVID-19 patients, and the treatment dilemma where administering an experimental treatment will kill a few patients but save many others. They also considered the crying baby dilemma where smothering a baby will save townspeople, the motorcycle dilemma where killing one motorcycle racer will prevent a fatal pileup, and the drug lord dilemma where killing a drug lord will reduce lethal crime. Participants imagined that a decision-maker either accepted or rejected sacrificial harm, and reported perceptions of decision-maker warmth, competence, and morality (Fiske, Cuddy, & Glick, 2006). Results replicated past work: participants rated decision-makers rejecting sacrificial harm as warmer and more moral but less competent than those accepting sacrificial harm, for both classic and COVIDworkers were more likely to accept sacrificial harm than either healthcare providers or students. Moreover, people who rejected sacrificial harm rated themselves higher in than competence, whereas people who accepted sacrificial harm rated themselves similarly in warmth and competence. However, healthcare providers rated themselves especially high in warmth and competence when accepting sacrificial harm. Finally, in Study 3 (N = 1209) online workers rated healthcare workers who rejected harm as warmer but equally competent to those accepting harm, and rated them differently in terms of focus on individuals and the group. Participants preferred healthcare workers who rejected harm for both their own doctor and to run the hospital, but overall trust was not affected. These findings have implications for trust in the medical system and suggest pragmatic communication strategies for healthcare workers facing difficult choices such as triage decisions during and beyond the pandemic.