Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel

Background: Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender. Methods: Participants ( N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends’ approval of risky health care decisions, and their empathy. Results: We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions. Limitations: Hypothetical scenarios may not adequately represent emotional processes in health care decision making. Conclusions: Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making. Highlights People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients. Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments. Understanding the power of perceived social norms in shaping surrogates’ decisions may help physicians to engage surrogates in shared decision making. Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.

Inequality Biases Third-Party Evaluation of Decision-Making for Others

People often need to make risky decisions for others, especially in policymaking, where a single decision can affect the welfare of a number of people. Given that risky decisions can yield variable outcomes and that people often evaluate policies after knowing the outcomes, the same risky policy can be evaluated differently depending on its outcome. Nevertheless, very little is known about how people make third-party evaluations of risky policies. Because people are sensitive to inequality among others, we predicted that the same policy would be evaluated more negatively if it leads to inequality rather than other outcomes. To examine this, we conducted a scenario experiment on risky and sure policies and investigated whether people’s distributive preferences moderated policy evaluation. We show that participants rated the risky policy lower when it yielded unequal situations between the recipients. Interestingly, participants did not evaluate the risky policy higher than the sure policy even when the risky policy yielded more desirable outcomes. In addition, participants who preferred sure distributions as decision makers or recipients showed the inequality aversion, whereas participants who preferred risky distributions showed no such pattern. Our results suggest that policy evaluation may be susceptible to the risks and inequality of outcomes among recipients.

The role of anticipated regret in choosing for others

In everyday life, people sometimes find themselves making decisions on behalf of others, taking risks on another’s behalf, accepting the responsibility for these choices and possibly suffering regret for what they could have done differently. Previous research has extensively studied how people deal with risk when making decisions for others or when being observed by others. Here, we asked whether making decisions for present others is affected by regret avoidance. We studied value-based decision making under uncertainty, manipulating both whether decisions benefited the participant or a partner (beneficiary effect) and whether the partner watched the participant’s choices (audience effect) and their factual and counterfactual outcomes. Computational behavioural analysis revealed that participants were less mindful of regret (and more strongly driven by bigger risks) when choosing for others vs for themselves. Conversely, they chose more conservatively (regarding both regret and risk) when being watched vs alone. The effects of beneficiary and audience on anticipated regret counteracted each other, suggesting that participants’ financial and reputational interests impacted the feeling of regret independently.

Social deliberation systematically shifts resource allocation decisions by focusing on the fate of the least well-off

How much inequality should be tolerated? How should the poorest be treated? Though sometimes conflated, concerns about inequality and the fate of the poorest involve different allocation principles with different sociopolitical implications. We tested whether deliberation—the core of democracy—influences reasoning about distributive principles. 322 participants faced allocation decisions for others between egalitarian (low variance in allocation), utilitarian (high total amount), and maximin (maximizing the welfare of the poorest) options. After their initial decisions, participants either reflected upon similar decisions solely or discussed them in pairs before facing the same choices again individually. Social, but not solitary, deliberation led to more maximin and fewer egalitarian choices, and this change lasted at least 5 months after the experiment. Conversation analyses of approximately 7,500 utterances suggest that some participants initially made egalitarian choices heuristically, when in fact they mostly cared about the poorest, and dialogue promoted more internally coherent maximin preferences.

Economic Decisions for Others Are More Favorable for Close Than Distant Clients

This research investigates the role of social distance between decision makers and their clients. In 11 experiments (total N = 1,653), participants decided about unfair and hyper-fair offers in an advisor game for themselves or for a client who varied in social distance (e.g., for a close friend vs. a stranger). Participants were strongly influenced by client identity. They systematically accepted more hyper-fair offers for themselves and close clients than for distant clients, while client identity played no role in unfair offers. We show that the driving mechanism of this client privileging effect is joy (happy-for-ness) participants experience particularly for close clients, while envy did not explain this effect. Across all types of clients and experiments, hyper-fair offers were accepted at only 86% which can only be explained by participants being not exclusively motivated by absolute monetary payoffs but also, to some extent, factoring in nonmonetary concerns.