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01-12-2012 | Symposium

Heuristics and Life-Sustaining Treatments

Authors: Adam Feltz, Stephanie Samayoa

Published in: Journal of Bioethical Inquiry | Issue 4/2012

Abstract

Surrogates’ decisions to withhold or withdraw life-sustaining treatments (LSTs) are pervasive. However, the factors influencing surrogates’ decisions to initiate LSTs are relatively unknown. We present evidence from two experiments indicating that some surrogates’ decisions about when to initiate LSTs can be predictably manipulated. Factors that influence surrogate decisions about LSTs include the patient’s cognitive state, the patient’s age, the percentage of doctors not recommending the initiation of LSTs, the percentage of patients in similar situations not wanting LSTs, and default treatment settings. These results suggest that some people may use heuristics when making these important life-and-death decisions. These findings may have important moral implications for improving surrogate decisions about LSTs and reconsidering paternalism.

Many theorists (e.g., experimental philosophers) have been using empirical methods to help shed light on philosophically important issues. These issues have included ethics (e.g., Nadelhoffer and Feltz 2008), epistemology (e.g., Feltz and Zarpentine 2010; Weinberg, Nichols, and Stich 2001), philosophy of mind (e.g., Cokely and Feltz 2009; Feltz, Cokely, and Nadelhoffer 2009), and applied ethics (Feltz and Cokely in press; Cokely and Feltz in press; Allhoff 2003, 2005).

All of our studies followed this same procedure and the participants had the same basic demographics. Since these demographics were not involved in predictions in our studies, we do not report them in subsequent studies.

Following a significant result from a MANOVA with ANOVAs is a tested practice. See Hummel and Sligo (1971) and Rencher and Scott (1990).

One worry with Experiment 1b and 1c is that the prompts indicate doctors’ recommendations against and other patients’ preference against treatment. This may make the prompts particularly difficult to understand. While failures on the comprehension question were consistent with the other studies in Experiment 1, it still could be that many people did not truly understand the nature of the question. If that is the case, then we actually underestimate the effects, since the confusion would reduce the true effect.

For example, because people have a tendency to stick with defaults, that bias may lead to better decisions for things such as organ donation (Johnson and Goldstein 2003). However, these biases can also lead to worse decisions, such as sticking with some default retirement plans that have lower overall expected value (Choi et al. 2002).

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Title: Heuristics and Life-Sustaining Treatments
Authors: Adam Feltz
Stephanie Samayoa
Publication date: 01-12-2012
Publisher: Springer Netherlands
Published in: Journal of Bioethical Inquiry / Issue 4/2012
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI: https://doi.org/10.1007/s11673-012-9396-5

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