Trolleys, Triage and Covid-19: The Role of Psychological Realism in Sacrificial Dilemmas

Abstract

At the height of the Covid-19 pandemic, frontline professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique context for moral psychologists to understand how the general public reasons about real-world dilemmas involving trade-offs between human lives—in contrast to most prior research pursuing parallel questions via hypothetical thought experiments with limited relevance to the real world. In three studies (total N = 2387), we examined people’s moral attitudes toward triage of acute coronavirus patients. Our findings indicate that people generally support utilitarian approaches to critical care triage. These utilitarian tendencies do not stem from period change in people’s moral attitudes (relative to pre-pandemic levels); rather, people favor utilitarian resolutions of critical care dilemmas more than structurally analogous, non-medical dilemmas. Support for utilitarian triage decisions was rooted in prosocial dispositions, including empathy and impartial beneficence—which defies the received wisdom in moral psychology. Finally, despite abundant evidence of political polarization surrounding COVID-19, moral attitudes toward critical care triage differed modestly between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat. Our results also illustrate how the dominant research methods in moral psychology may be handicapped by their reliance on hypothetical stimuli (e.g., trolley cases) and could deliver insights that do not generalize to real-world, ethical priorities.

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“…Furthermore, the common paper-and-pencil surveys involving conceptual scenarios limit engagement of decision-makers. Recent studies using 3-D virtual reality [22] or computer simulations [23] surprisingly demonstrate that more realistic dilemmas enhance the utilitarian choice [24], despite invoking greater emotional responses in the decision-maker-an outcome shown in other studies to be associated with fewer utilitarian choices [25]. These findings point to the well-known problem that judging and acting are not the same [26,27] and make the role of emotions in Trolley Problem decision-making puzzling.…”

“…It was possible that attitudes on this scale could influence the decisions to redirect or not within our simulation. For instance, if a participant were to have more positive attitudes towards peace with significantly lower levels in their attitude towards war, they might display more passivist actions, deciding not to redirect in order to not have to take responsibility for the death of another as framed by the ME HURT YOU heuristic [24,34,49].…”