The Costs of Autonomy: Decisional Autonomy Undermines Advisees’ Judgments of Experts

39 Pages Posted: 26 Sep 2019 Last revised: 3 Oct 2019

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: September 17, 2019

Abstract

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Doctors 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 decisions under uncertainty. Across 6 experiments (N = 3,261) 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 (e.g., within financial and managerial advice, as well as advice about risky gambles), suggesting the preference for paternalism is not unique to medicine, but rather, is a feature of situations in which (a) there are advisor-advisee asymmetries in expertise and (b) advisees see their choice as difficult. We find that the preference for paternalism holds when both paternalism and autonomy are accompanied by detailed information and expert guidance, and regardless of the positivity or negativity of the advisee’s outcome. These results deepen our understanding of preferences for autonomy and paternalism, and 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, The Costs of Autonomy: Decisional Autonomy Undermines Advisees’ Judgments of Experts (September 17, 2019). 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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