Decisional Autonomy Undermines Advisees’ Judgments of Experts In Medicine And In Life

Kassirer, S., Levine, E., & Gaertig, C. (2020). Decisional autonomy undermines advisees’ judgments of experts in medicine and in life. Proceedings of the National Academy of Sciences May 2020, 201910572; DOI: 10.1073/pnas.1910572117

11 Pages Posted: 26 Sep 2019 Last revised: 8 May 2020

See all articles by Samantha Kassirer

Samantha Kassirer

Northwestern University

Emma Levine

University of Chicago - Booth School of Business

Celia Gaertig

University of Chicago - Booth School of Business

Date Written: May 08, 2019

Abstract

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 (N = 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.

Keywords: autonomy; paternalism; ethics; medical decision-making

Suggested Citation

Kassirer, Samantha and Levine, Emma and Gaertig, Celia, Decisional Autonomy Undermines Advisees’ Judgments of Experts In Medicine And In Life (May 08, 2019). Kassirer, S., Levine, E., & Gaertig, C. (2020). Decisional autonomy undermines advisees’ judgments of experts in medicine and in life. Proceedings of the National Academy of Sciences May 2020, 201910572; DOI: 10.1073/pnas.1910572117, Available at SSRN: https://ssrn.com/abstract=3455418 or http://dx.doi.org/10.2139/ssrn.3455418

Samantha Kassirer

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Emma Levine (Contact Author)

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

Celia Gaertig

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

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