Influence of uncertainty on framed decision-making with moral dilemma

Beyond Choice: Affective Representations of Economic and Moral Decisions

Decision-making in economic and moral contexts involves complex affective processes that shape judgments of fairness, responsibility, and conflict resolution. While previous studies have primarily examined behavioral choices in economic games and moral dilemmas, less is known about the underlying affective structure of these decisions. This study investigated how individuals emotionally represent economic (ultimatum game) and moral (trolley dilemma) decision-making scenarios using multidimensional scaling (MDS) and classification. Participants rated their emotional responses, including positive (pleased, calm, happy, peaceful) and negative (irritated, angry, gloomy, sad, fearful, anxious) affective states, to 16 scenarios varying by game type, the presence or absence of conflict, and intensity. MDS revealed two primary affective dimensions of distinguishing conflict from no-conflict and economic from moral scenarios. No-conflict-economic scenarios were strongly associated with positive affective responses, while the no-conflict-moral scenarios elicited heightened fear and anxiety rather than positive emotions. Increasing unfairness in the ultimatum game affected affective representation, while variations in the number of lives at stake in the trolley dilemma did not. Cross-participant classification analyses demonstrated that game type and conflict conditions could be reliably predicted from affective ratings, indicating systematic and shared emotional representations across participants. These findings suggest that economic and moral decisions evoke distinct affective structures, with fairness modulating conflict perception in economic contexts, while moral decisions remain affectively stable despite changes in intensity.

Ethical choice reversals

Understanding the systematic ways that human decision making departs from normative principles has been important in the development of cognitive theory across multiple decision domains. We focus here on whether such seemingly "irrational" decisions occur in ethical decisions that impose difficult tradeoffs between the welfare and interests of different individuals or groups. Across three sets of experiments and in multiple decision scenarios, we provide clear evidence that contextual choice reversals arise in multiples types of ethical choice settings, in just the way that they do in other domains ranging from economic gambles to perceptual judgments (Trueblood et al., 2013; Wedell, 1991). Specifically, we find within-participant evidence for attraction effects in which choices between two options systematically vary as a function of features of a third dominated and unchosen option-a prima facie violation of rational choice axioms that demand consistency. Unlike economic gambles and most domains in which such effects have been studied, many of our ethical scenarios involve features that are not presented numerically, and features for which there is no clear majority-endorsed ranking. We provide empirical evidence and a novel modeling analysis based on individual differences of feature rankings within attributes to show that such individual variations partly explains observed variation in the attraction effects. We conclude by discussing how recent computational analyses of attraction effects may provide a basis for understanding how the observed patterns of choices reflect boundedly rational decision processes.

Association of Self-reported Primary Care Physician Tolerance for Uncertainty With Variations in Resource Use and Patient Experience

Importance

Inappropriate variations in clinical practice are a known cause of poor quality and safety, with variations often associated with nonclinical factors, such as individual differences in cognitive processing. The differential response of physicians to uncertainty may explain some of the variations in resource use and patient experience.

Objective

To examine the association of physician tolerance for uncertainty with variations in resource use and patient experience.

Design, Setting, and Participants

This survey study linked physician survey data (May to June 2019), patient experience survey data (January 2016 to December 2019), and billing data (January 2019 to December 2019) among primary care physicians (PCPs) at Massachusetts General Hospital with at least 10 visits in 2019. The statistical analysis was performed in 2021.

Main Outcomes and Measures

The analysis examined associations of PCP tolerance for uncertainty with the tendency to order diagnostic tests, the frequency of outpatient visits, hospital admissions, emergency department visits, and patient experience data (focused on physician communication and overall rating). A 2-stage hierarchical framework was used to account for clustering of patients under PCPs. Binary outcomes were modeled using a hierarchical logistic model, and count outcomes were modeled using hierarchical Poisson or negative binomial models. The analysis was adjusted for patient demographic variables (age, sex, and race and ethnicity), socioeconomic factors (payer and neighborhood income), and clinical comorbidities.

Results

Of 217 included physicians, 137 (63.1%) were women, and 174 (80.2%) were adult PCPs. A total of 62 physicians (28.6%) reported low tolerance, 59 (27.2%) reported medium tolerance, and 96 (44.2%) reported high tolerance for uncertainty. Physicians with a low tolerance for uncertainty were less likely to order complete blood cell counts (odds ratio [OR], 0.66; 95% CI, 0.50-0.88), thyroid tests (OR, 0.67; 95% CI, 0.52-0.88), a basic metabolic profile (OR, 0.78; 95% CI, 0.60-1.00), and liver function tests (OR, 0.72; 95% CI, 0.53-0.99) than physicians with a high tolerance for uncertainty. Physicians who reported higher tolerance for uncertainty were more likely to receive higher patient experience scores for listening to patients carefully (OR, 0.65; 95% CI, 0.50-0.83) and higher overall ratings (OR, 0.80; 95% CI, 0.66-0.98) than physicians with medium tolerance. Conversely, no association was found between physician tolerance for uncertainty and patient outpatient visits, hospital admissions, or emergency department visits.

Conclusions and Relevance

In clinical practice, identifying and effectively managing inappropriate variations and improving patient experience have proven to be difficult, despite increased attention to these issues. This study supports the hypothesis that physicians' tolerance for uncertainty is associated with differences in resource use and patient experience. Whether enhancing physicians' tolerance for uncertainty could help reduce unwarranted practice variations, improve quality and patient safety, and improve patient's experience remains to be established.

Impact of uncertainty and ambiguous outcome phrasing on moral decision-making

The literature has shown that different types of moral dilemmas elicit discrepant decision patterns. The present research investigated the role of uncertainty in contributing to these decision patterns. Two studies were conducted to examine participants' choices in commonly used dilemmas. Study 1 showed that participants' perceived outcome probabilities were significantly associated with their moral choices, and that these associations were independent from the dilemma type. Study 2 revealed that participants had significantly less preference for killing the individual when the outcome probabilities were stated using the modal verb 'will' than when they were stated using the numerical phrasing of '100%'. Our findings illustrate a discord between experimenter and participant in the interpretation of task instructions.