Decisional autonomy undermines advisees’ judgments of experts in medicine and in life

Abstract

<jats:p>Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (<jats:italic>N</jats:italic>= 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser–advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.</jats:p>

Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery

“…Research specifically evaluating the role of the hearing health professional's attitude in both patient expectations and likelihood to proceed with CI is limited due to the difficulty in measuring subjective processes, although it is widely accepted that patient decision-making is dependent on the manner in which data are presented to them. 70 Consequently, a surgeon or audiologist who presents more pessimistic outcomes data may inadvertently deter patients from proceeding with CI.…”

Are people more or less likely to follow advice that is accompanied by a confidence interval?

“…The notion that overconfident advice may be more persuasive is also in line with the widespread belief that people dislike uncertainty (e.g., Kahneman, 2011;Tetlock & Gardner, 2015), a belief that persists even in the context of science communication (National Academies of Sciences, Engineering, and Medicine, 2017). In general, research suggests that overconfident statements of belief are driven at least in part by strategic, self-presentational concerns, and that those concerns may have some basis in reality (Anderson et al, 2012;Van Zant, 2022).…”

“They don’t Know Better than I do”: People Prefer Seeing for Themselves Over Using the Wisdom of Crowds in Perceptual Decision Making

“…Boosting accuracy by accepting advice comes with the price of compromising decision autonomy. People generally value their autonomy and tend to adhere to their own opinion ( Baer & Brown, 2012 , but see Kassirer et al, 2020 ). Accordingly, they have a sense of psychological ownership towards decisions or ideas that they develop on their own, and revising of opinions in response to environmental feedback will take place more often when the feedback adds to this sense of ownership.…”