Department of Economics, Monash University, Clayton, Victoria, 3800, Australia.
Department of Economics, Monash University, Clayton, Victoria, 3800, Australia.
Soc Sci Med. 2021 Aug;282:114171. doi: 10.1016/j.socscimed.2021.114171. Epub 2021 Jun 21.
Recommendations by health experts to deal with public health emergencies are primarily guided by the principle of "saving more lives". It is unclear whether people perceive this principle as ethically more legitimate than some other principle such as "saving more life-years". Understanding the answer to this question is particularly relevant to the allocation of scarce medical resources during public health emergencies. Different principles typically lead to different allocations, and consequently have dramatically different implications as to who survives and who dies. We fielded an online randomized controlled survey experiment in the context of scarce ventilator allocation with a demographically representative sample of US adults (n = 700) from October 22 to October 30, 2020. Participants faced hypothetical situations where they had to allocate few available ventilators among several needy patients. The experiment was designed such that the allocation decision made by a participant can be used to infer the principle in line with their personal ethical values. We interpret this inferred principle as the one that the participant perceives to be most legitimate. The treatment group, but not the control group, was provided balanced information that described the ethical dilemmas faced by experts in developing ventilator allocation guidelines. Nearly half of the participants in the control group perceive saving more lives the most legitimate principle. Despite the balanced nature of the information, the perceived legitimacy of saving more lives was 7·6 percentage points higher in the treatment group. The magnitude of this impact was particularly strong among republican-leaning participants, a subgroup that has less trust in experts according to previous research. Our findings suggest that enhancing public awareness of ethical dilemmas faced by health experts can increase the perceived legitimacy of their proposed guidelines even among those with lower trust in experts.
卫生专家应对公共卫生突发事件的建议主要以“拯救更多生命”为指导原则。人们是否认为这一原则在伦理上比“拯救更多生命年”等其他原则更合理尚不清楚。了解这个问题的答案对于公共卫生突发事件期间稀缺医疗资源的分配尤其重要。不同的原则通常会导致不同的分配,因此对于谁生存和谁死亡会有截然不同的影响。我们在 2020 年 10 月 22 日至 10 月 30 日期间,以具有代表性的美国成年人(n=700)为对象,开展了一项在线随机对照调查实验,内容是在稀缺呼吸机分配的情况下进行。参与者面临着在几个有需要的患者中分配少量可用呼吸机的假设情况。该实验的设计使得参与者的分配决策可用于推断符合其个人伦理价值观的原则。我们将推断出的原则解释为参与者认为最合理的原则。治疗组(而非对照组)提供了平衡的信息,描述了制定呼吸机分配指南的专家所面临的伦理困境。对照组近一半的参与者认为拯救更多生命是最合理的原则。尽管信息是平衡的,但治疗组中认为拯救更多生命更合理的比例却高出 7.6 个百分点。这一影响在共和党倾向参与者中尤为强烈,根据先前的研究,这一群体对专家的信任度较低。我们的研究结果表明,提高公众对卫生专家所面临伦理困境的认识,即使是在对专家信任度较低的人群中,也能增加他们对所提出指南的认可程度。
Dev World Bioeth. 2022-3
Rev Assoc Med Bras (1992). 2020-9-21
JAMA Netw Open. 2024-3-4