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Avoiding bias in medical ethical decision-making. Lessons to be learnt from psychology research

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Abstract

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making.

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Notes

  1. Binge eating disorder is characterized by compulsive overeating in which people consume huge amounts of food while feeling out of control and powerless to stop.

  2. Balancing of interest’ is a method developed in the discipline of ethics. It describes the process of practical reasoning needed for a qualified solution to a choice or decision conflict. Such conflicts arise because a specific decision may be beneficial for one person or group, but detrimental for another person or group. In such cases, the expected benefits and burdens must be weighed as carefully as possible, while taking into account individual and collective needs in addition to their urgency; the rights of the individual; precedence of public welfare, and questions of justice.

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Acknowledgments

This paper is part of the project “Between Over-Treatment and Under-Treatment: Ethical Problems of Micro-Allocation”, no. 3200B0-113724/1, funded by the Swiss National Science Foundation. We are grateful for the helpful comments of Prof. Volker Dittmann, Legal and Forensic Medicine, University of Basel. We also thank Marcel Mertz, MA, for his helpful comments. Piera Jones, MA, and Nicola Stingelin Giles, MBA, MAS, MAE gave invaluable help in translating and editing the manuscript into native English. The paper has benefited much from the discussions in the PhD Colloquium, Dept. Medical and Health Ethics, Medical Faculty, University Hospital Basel.

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  1. Department for Medical and Health Ethics, Medical Faculty, University Hospital Basel, Basel, Switzerland

    Heidi Albisser Schleger, Nicole R. Oehninger & Stella Reiter-Theil

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  1. Heidi Albisser Schleger
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Correspondence to Heidi Albisser Schleger.

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Albisser Schleger, H., Oehninger, N.R. & Reiter-Theil, S. Avoiding bias in medical ethical decision-making. Lessons to be learnt from psychology research. Med Health Care and Philos 14, 155–162 (2011). https://doi.org/10.1007/s11019-010-9263-2

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