Madeira Filipa, Do Bú Emerson Araújo, Freitas Gonçalo, Pereira Cicero Roberto
Institute of Social Sciences, University of Lisbon, Lisbon, Portugal.
Faculty of Psychology, University of Lisbon, Lisbon, Portugal.
Br J Health Psychol. 2023 May;28(2):552-566. doi: 10.1111/bjhp.12640. Epub 2022 Dec 11.
Drawing on theories of distributive justice and intergroup discrimination, we examined how much distributive justice criterion and racial group membership contribute to bias in healthcare allocation decisions, by testing a theoretical model that specifies perceived stereotypicality and individual responsibility as a serial mediation process in the relationship between disease's contraction controllability (controllable vs. non-controllable) and bias in medical decision-making.
White Portuguese medical students (N = 213) participated in an online experimental study conducted in two phases. In phase 1, we manipulated the cause of disease contagion and the salience of patient's racial categorization, and measured the stereotypicality of behaviour. In phase 2, we assessed perceived responsibility and likelihood of recommending medical treatment.
Controllable (vs. non-controllable) contraction behaviours in phase 1 were perceived as more stereotypic. As a spillover effect, more stereotypical behaviours in phase 1 predicted more patient's responsibility for their disease in phase 2. Importantly, controllable behaviours of disease contraction in phase 1 negatively affected recommendations for medical treatment in phase 2; and this negative effect was serially mediated by the stereotypicality of behaviour and patient responsibility. Furthermore, patients' skin colour moderated this process, meaning that perceptions of controllable behaviour as more stereotypic were stronger for Black than for White patients.
This research shows how stereotyping and social categorization bias allocation decisions through the patient's level of responsibility in decision-making processes. The findings are discussed in light of principles of distributive justice and the literature on intergroup relations with respect to racial disparities in health care.
借鉴分配正义和群体间歧视理论，我们通过测试一个理论模型来检验分配正义标准和种族群体成员身份在医疗资源分配决策中的偏见影响程度，该模型将感知到的刻板印象和个人责任确定为疾病感染可控性（可控与不可控）与医疗决策偏见之间关系的序列中介过程。
213名葡萄牙白人医学生参与了一项分两个阶段进行的在线实验研究。在第一阶段，我们操纵了疾病传播的原因和患者种族分类的显著性，并测量了行为的刻板印象。在第二阶段，我们评估了感知到的责任和推荐治疗的可能性。
第一阶段中可控（与不可控）的感染行为被认为更具刻板印象。作为一种溢出效应，第一阶段中更多的刻板行为预示着第二阶段中患者对其疾病应承担更多责任。重要的是，第一阶段中疾病感染的可控行为对第二阶段的治疗推荐产生了负面影响；并且这种负面影响通过行为的刻板印象和患者责任进行序列中介。此外，患者的肤色调节了这一过程，这意味着对于黑人患者而言，将可控行为视为更具刻板印象的认知比白人患者更强。
本研究表明刻板印象和社会分类如何通过患者在决策过程中的责任水平对分配决策产生偏见。我们根据分配正义原则以及关于医疗保健中种族差异的群体间关系文献对研究结果进行了讨论。
