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As COVID-19 cases rise again in the US, the possibility of a dire moral dilemma arises: Which patients should be prioritized when medical resources are scarce?
Researchers from the US and China asked more than 5,000 people from 11 countries how they would make a version of this ethical choice. Study participants looked at 15 possible scenarios and selected which of two COVID-19 patients should have access to a ventilator that could save their lives.
The two patients they had to choose between differed in 10 characteristics, including age, gender, probability of survival, and criminal history.
The results showed that people around the world attached the greatest weight to two criteria in their decision: age and survival probability.
These two characteristics explained about 50 percent of their decisions, the results showed. The other eight traits taken together accounted for the other 50 percent.
“People seemed to want to maximize the overall benefit to society by selecting those who would live the longest as a result of the treatment, either because of their younger age or because of the general probability of survival,” said Yunhui Huang, co-author of the study and assistant professor of marketing from Fisher College of Business at Ohio State University.
“It’s a very useful way of deciding.”
However, the study showed that there were some differences in people’s choices, depending on the culture of their country, the number of cases they lived in, and whether they felt personally threatened by the disease.
Huang conducted the study with Liyin Jin and Yongheng Liang from Fudan University in Shanghai and Qiang Zhang from the Chinese University of Hong Kong in Shenzhen. The study was recently published online in the Journal of the Association for Consumer Research.
The 5,175 participants came from 11 countries, which at the time of data collection (April 8-18, 2020) covered approximately 49 percent of the world’s population and 69 percent of confirmed COVID-19 cases. Among them were China, the United States, Brazil, the United Kingdom, Australia, and South Korea.
All people participated online. In the 15 scenarios, participants were presented with two COVID-19 patients who both needed a ventilator to survive when only one was available. You were asked which patient should receive the ventilator. They then completed a survey that collected demographic information and asked how COVID-19 is affecting their own lives.
Both patients in the scenarios were described on the basis of 10 characteristics: age, gender, probability of survival, socio-economic status, criminal record, number of infected people, also infected family members, expected number of days This patient must be on the ventilator, the costs are paid from public funds and the nationality paid.
“Aside from age and survival rate, the other eight in our sample were given significantly lower weights, and their weights were not significantly different,” Huang said.
However, the results showed that people generally preferred to give priority to people of their own nationality, people who had never committed a crime, and people who were likely to be lower cost, have fewer days on the ventilator, and have infected fewer people.
The researchers found differences in the responses of people from collectivist cultures who emphasize the needs and goals of the group compared to individualistic cultures.
In collectivist cultures like China, which emphasize respect for the elderly, there was a weaker preference for saving young versus old patients. They also prioritized people of the same nationality and people with no criminal record.
Individualistic cultures like the United States placed greater emphasis on patient survival when deciding who would get the ventilator.
There were also differences in the answers depending on the culture’s attitude towards power differences in society. Study participants from countries like Korea, where inequality between people is more accepted, place more emphasis on criminal records in their decisions.
“Research has shown that cultures that accept higher levels of inequality also prefer a more structured world, so it makes sense not to prioritize patients who disrupt this stability,” Huang said.
Cultures that perceive inequality among people as less acceptable placed an even greater emphasis on probability of survival, possibly because that attribute is unrelated to social class and status, she said.
The study found that elements of the COVID-19 pandemic themselves influenced people’s moral choices. People in areas with more COVID-19 cases preferred the teenagers even more often. This is in line with previous evidence, which found that the perceived loss of control that people are likely to experience frequently during a pandemic is linked to more benefit-based moral preferences.
People who said they felt more personally affected by COVID-19 used a different calculation in their decisions: They place less emphasis on the likelihood of survival when deciding who should get the ventilator.
“One possible explanation is that people who feel personally threatened by COVID-19 may place more emphasis on their own personal traits when considering who should get a ventilator at the expense of survival,” Huang said.
These insights into how the pandemic itself affected people’s choices has important implications.
“As the pandemic progresses, people’s moral choices could change as they feel more or less threatened by what is going on around them,” Huang said.
The research is not intended to guide the decision-making of doctors or policy makers, Huang said. However, it is important to know how the public feels about these ethical issues.
For example, the results showed that factors such as criminal records and nationality, which should probably not affect treatment decisions, sometimes influenced people’s decisions.
“Doctors and policy makers need to know what the public thinks about these issues when communicating their policies related to these difficult decisions,” Huang said.
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Liyin Jin et al., Ethical Preferences Regarding Medical Resource Allocation During the COVID-19 Pandemic, Journal of the Association for Consumer Research (2020). DOI: 10.1086 / 711734 Provided by Ohio State University
Quote: How People Would Choose Who Will Receive COVID-19 Rare Treatment (2020, October 29), accessed October 29, 2020 from https://medicalxpress.com/news/2020-10-people-scarce-covid- treatment.html
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