Trolleys, triage and Covid-19: the role of psychological realism in sacrificial dilemmas

Abstract

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people's moral attitudes toward triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did not stem from period change in moral attitudes relative to pre-pandemic levels--but rather, from the heightened realism of triage dilemmas. Participants favored utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas-and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarization surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people's robust support for utilitarian measures in the face of a global public health threat, and illustrate how hypothetical scenarios in moral psychology (e.g. trolley cases) should strive for more experiential and psychological realism, otherwise their results might not generalize to real-world moral dilemmas.

Moral Decision-Making During COVID-19: Moral Judgements, Moralisation, and Everyday Behaviour

“…Despite variability within individuals, utilitarian preferences remained stable over time, and we did not find evidence that these principles change in a global pandemic (see Supplementary Material for similar repeated-measures results). This supports recent findings showing that while people displayed a preference for utilitarian triage decisions during the pandemic, this was not related to pre-pandemic decisions but rather dispositional traits (Kneer and Hannikainen, 2021).…”

Rational framing effects: A multidisciplinary case

“…(Thomson, 1976), the cabin boy (i.e., would you kill and eat the cabin boy to save yourself and other starving shipwrecked sailors?) (Harris, 2020), triage in a pandemic (Kneer & Hannikainen, 2022), and many others (Edmonds, 2014;Koenigs et al, 2007). These situations are logically indistinguishable from the bystander case (i.e., switching the lever).…”

Contextualizing sacrificial dilemmas within Covid-19 for the study of moral judgment

“…For some authors, sacrificial dilemmas related to the Covid-19 pandemic were perceived as an alternative to traditional sacrificial dilemmas and as a unique opportunity to overcome criticisms about the lack of realism of hypothetical moral scenarios. According to Kneer and Hannikainen [ 35 ]: « Sacrificial dilemmas related to the Covid-19 pandemic—henceforth triage/critical care dilemmas—have both experimental and mundane realism; they are real-life situations with which most participants are at least indirectly acquainted. Consequently, we suspected that their level of psychological realism would also be high” (p.7).…”

“…Consequently, we suspected that their level of psychological realism would also be high” (p.7). In one of their studies ([ 35 ], study 3), they investigated the effect of realism with dilemmas patterned after the trolley problem scenarios contextualized, or not, within the medical triage context. They observed a greater utilitarian tendency in response to triage dilemmas compared to dilemmas unrelated to Covid-19: Participants were more likely to disconnect an oxygen tank used to treat a single coronavirus patient in order to save five others than to order firefighters to stop rescuing a single person trapped in a burning house in order to save five others in another burning house.…”

“…They started from the assumption that the situations and actions described were perceived as realistic by the participants. Kneer and Hannikainen [ 35 ], for example, argued that sacrificial dilemmas related to the Covid-19 pandemic are high in experimental, mundane and psychological realism compared to dilemmas unrelated to Covid-19, and hypothesized that the former are perceived as more realistic than the latter. But they did not measure the perceived realism of the two types of dilemmas.…”