Biases and Heuristics in Decision Making and Their Impact on Autonomy

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions.     

Undecidable Decisions: Rationality Limits and Decision-making Heuristics

In this article the theoretic evolution and the empirical-experimental efforts that have led to the affirmation of the bounded/procedural rationality paradigm are discussed. Moreover, the debate on supporters of the “optimization” approach and supporters of the “bounded/procedural rationality” approach is traced, highlighting the irreconcilability of these two approaches and, in retort, a solid defense against a merely “reductionist” attempt of the innovative context of the Simonian theory. Critically going over the debate on decision dynamics, it becomes clear how, due to the uncertain nature of rational processes, it is impossible to establish the decision-making best way. The imperfect character of individual choice is explained by how the decider identifies a solution that appears satisfying in that moment due to cognitive and temporal limits.     

When (and When Not) to Make Exceptions: Links among Age,Precedent Setting Decisions,and Argument Evaluation

Negative precedents are set when, in the absence of mitigating conditions, social rules are not enforced by relevant authorities. This study examined the effects of normative (i.e., to enforce rules) and nonnormative arguments (i.e., to “make exceptions”) on decisions that could establish negative precedents and whether those effects differed for children and adolescents. As expected, on baseline problems, age correlated positively with decision-making performance. After receiving normative arguments, normative decisions increased and adolescents—but not preadolescents—transferred their understanding to novel problems. Nonnormative arguments led to decrements in normative decisions across ages. However, only for preadolescents did performance decrements following nonnormative arguments transfer to novel problems. Discussion focuses on the abilities to engage in “metacognitive intercession,” variability in children’s and adolescents’ decisions, and developments in the understanding of the consequences of violating the social rules.     

医疗风险决策的自我他人差异及其影响因素

从心理学的层面梳理医疗风险决策自我他人差异的表现及影响因素,狭义的医疗风险是患者在医疗服务的过程中因为医疗过失导致的损害等不安全事件,而广义的医疗风险包含了患者受到的伤害和整个医疗卫生体系受到的损失。在实际的医疗决策中,医生、家属和患者三方通常会做出不同的决策并且伴随着其立场的合理性,决策时也会受到决策框架和医疗决策模式等多方面的影响,可以采用解释水平理论、社会价值理论和双系统理论对不同决策主体之间的决策差异进行解释。未来可以从真实的医疗情境、个人特质、文化差异等方面进行深入研究。

     

Risk,Uncertainty, and Gender Stereotypes in Healthcare Decisions

Disparities in healthcare access, treatment, and outcomes are widely prevalent for women and minorities. At the same time, healthcare choices have become increasingly intricate and correspondingly uncertain. We review contemporary issues in healthcare for women, with emphasis on access to care and on healthcare disparities. In the belief that forewarned is forearmed, we review the role of sexism and the psychology of decision making in producing health disparities. In the face of this complexity, therapists can help women seek sound healthcare and make informed choices. Implications for feminist therapy are suggested that emphasize client empowerment and agency.     

Toward a new conceptualization and operationalization of risk perception within the genetic counseling domain

The purpose of this paper is twofold. First, it provides an historical overview of studies of risk, risk perception, and decision making under risk within the genetic counseling domain. Second, it proposes an alternative conceptualization and operationalization for the study of risk perception. The conceptualization involves probability, adversity, incompleteness, and ambiguity. Prior studies of risk perception focus on the recurrence risk and operationalize risk perception by asking for interpretations of the magnitude of the probability of the outcome. Their focus is on the probability of a particular outcome. We formulate the problem in terms of a gamble and suggest that risk perception be operationalized in terms of the riskiness of the gamble. Our focus is on the riskiness of a decision option which entails two or more outcomes.     

自我框架、风险认知和风险选择

对行为决策中“框架效应”(Framing Effect)的研究进行了拓展：探讨了自我框架对风险决策的影响及其机制。面对运用图示方法表示的管理,健康,及投资方面的风险决策问题,参与者自主地选择对方案的描述（自我框架）。研究有四个主要发现：1）自我框架对风险选择的效应部分显著,而且对风险选择的影响方向因情境的不同而不同;2）机会威胁认知是自我框架效应的一个中介变量;3）自我框架在情绪语气上的差异对风险决策有显著影响：决策者对一个备选方案（确定性或风险性方案）相对于另一个备选方案的自我描述的情绪语气越积极正面,这个方案被选择的可能性越大;4）决策者的机会-威胁认知是这一自我框架效应的部分中介变量。也就是说,对备选方案的自我描述语气作为一种对决策信息的编码影响了风险（机会和威胁）认知,进而影响决策者的风险偏好和选择     

When the Rule is Ruled Out: Exemplars and Rules in Decisions from Memory

What are the cognitive processes underlying people's decisions from memory? Previous research suggests that these processes can be best described by strategies that are based on abstract knowledge about the decision task (e.g., cue–criterion relations). However, recent results show that different cue presentation formats trigger the use of different decision strategies and that exemplar‐based strategies can account for memory‐based decisions as well. In three experiments, this effect was replicated, and mediation analyses identified the quality of the underlying knowledge representation as the critical variable that determines decision behavior. This supports the view that exemplar‐based reasoning is used as a backup system if cue abstraction is hindered. Copyright © 2012 John Wiley & Sons, Ltd.     

投资决策风险的周边组织因素和多阶段评估

本研究在现场研究基础上,设计了动态投资决策实验模拟任务,选取53名工商管理硕士研究生被试,研究投资决策不同决策阶段上所具有的动态风险特征。结果发现：不同的投资决策项目具有不同的风险特征;投资决策项目在不同决策阶段上的风险特征具有动态性;决策情景中责任意识、环境与组织管理周边情景等关键因素对决策风险具有重要作用。     

情绪和任务框架对自我和预期他人决策时风险偏好的影响

两个实验考察了情绪和任务框架对自我和预期他人决策时风险偏好的影响。结果表明:(1)获益框架下,悲伤情绪比愉悦情绪诱发更强的风险偏好,自我决策比预期他人决策表现出更强的风险偏好;(2)损失框架下,愉悦情绪比悲伤情绪诱发更强的风险偏好,预期他人决策比自我决策表现出更强的风险偏好;(3)在自我决策时,愉悦情绪在损失框架下比在获益框架下诱发了更强的风险偏好,悲伤情绪在获益框架下比在损失框架下诱发了更强的风险偏好;在预期他人决策时,无论是愉悦情绪还是悲伤情绪,损失框架均比获益框架诱发了更强的风险偏好。     

Emotion,Decision, and Risk: Betting on Gambles versus Betting on People

We examined the effects of two emotions, fear and anger, on risk‐taking behavior in two types of tasks: Those in which uncertainty is generated by a randomizing device (“lottery risk”) and those in which it is generated by the uncertain behavior of another person (“person‐based risk”). Participants first completed a writing task to induce fear or anger. They then made choices either between lotteries (Experiment 1) or between actions in risky two‐person decisions (Experiments 2 and 3). The experiments involved substantial real‐money payoffs. Replicating earlier studies (which used hypothetical rewards), Experiment 1 showed that fearful participants were more risk‐averse than angry participants in lottery‐risk tasks. However—the key result of this study—fearful participants were substantially less risk‐averse than angry participants in a two‐person task involving person‐based risk (Experiment 2). Experiment 3 offered options and payoffs identical to those of Experiment 2 but with lottery‐type risk. Risk‐taking returned to the pattern of Experiment 1. The impact of incidental emotions on risk‐taking appears to be contingent on the class of uncertainty involved. For lottery risk, fear increased the frequency of risk‐averse choices and anger reduced it. The reverse pattern was found when uncertainty in the decision was person‐based. Further, the effect was specifically on differences in willingness to take risks rather than on differences in judgments of how much risk was present. The impact of different emotions on risk‐taking or risk‐avoiding behavior is thus contingent on the type, as well as the degree, of uncertainty the decision maker faces. Copyright © 2010 John Wiley & Sons, Ltd.     

What a Feeling: The Role of Immediate and Anticipated Emotions in Risky Decisions

The risk‐as‐feelings hypothesis argues that many risky decisions are not only predicted by anticipated emotions, as most consequentialistic decision making theories would presume, but also by immediate emotions. Immediate emotions refer to the “hot” visceral feelings people feel as they contemplate a specific decision option at the cusp of making a decision, whereas anticipated emotions are those emotions that people forecast that they will feel once they experience possible consequences of that decision. Four studies focused on the role of both types of emotions in decisions under risk and uncertainty. Decisions were substantively predicted by immediate emotional states beyond anticipated emotions or the subjective probability attached to outcomes. Thus, risky choices may be prompted, in part, by how people feel about the “riskless” portion of the decision—specifically, the various decision options they are contemplating—rather than the potential outcomes those options may produce. Copyright © 2011 John Wiley & Sons, Ltd.     

Exploiting the Wisdom of Others to Make Better Decisions: Suspending Judgment Reduces Egocentrism and Increases Accuracy

Although decision makers often consult other people's opinions to improve their decisions, they fail to do so optimally. One main obstacle to incorporating others' opinions efficiently is one's own opinion. We theorize that decision makers could improve their performance by suspending their own judgment. In three studies, participants used others' opinions to estimate uncertain quantities (the caloric value of foods). In the full‐view condition, participants could form independent estimates prior to receiving others' opinions, whereas participants in the blindfold condition could not form prior opinions. We obtained an intriguing blindfold effect. In all studies, the blindfolded participants provided more accurate estimates than did the full‐view participants. Several policy‐capturing measures indicated that the advantage of the blindfolded participants was due to their unbiased weighting of others' opinions. The full‐view participants, in contrast, adhered to their prior opinion and thus failed to exploit the information contained in others' opinions. Moreover, in all three studies, the blindfolded participants were not cognizant of their advantage and expressed less confidence in their estimates than did the full‐view participants. The results are discussed in relation to theories of opinion revision and group decision making. Copyright © 2011 John Wiley & Sons, Ltd.     

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.     

Encouraging Prosocial Decisions: The Role of Fairness Salience and Uncertainty

Although the decision to engage in prosocial behavior has received research attention, the literature offers a limited understanding of fairness and uncertainty as antecedents. We propose that one can encourage prosocial decision making simply by invoking the notion of fairness because of its effects on the perceived trustworthiness of the invoking party. We also elucidate the complex role of uncertainty in prosocial decisions in that it has a negative effect while also serving to strengthen the positive effect of fairness salience. Our ideas are tested in two prosocial decision contexts, including participative pricing (i.e., “pay what you want”) and charitable giving. Data from an archival study of a naturally occurring event and two controlled experiments offer support for our arguments. Copyright © 2016 John Wiley & Sons, Ltd.     

The public's probabilistic numeracy: How tasks,education and exposure to games of chance shape it

As we navigate a world full of uncertainties and risks, dominated by statistics, we need to be able to think statistically. Very few studies investigating people's ability to understand simple concepts and rules from probability theory have drawn representative samples from the public. For this reason we investigated a representative sample of 1000 Swiss citizens, using six probabilistic problems. Most reasoned appropriately in problems representing pure applications of probability theory, but failed to do so in approximations of real‐world scenarios – a disparity we replicated in a sample of first‐year psychology students. Additionally, education is associated with probabilistic numeracy in the former but not the latter type of problems. We discuss possible reasons for these task disparities and suggest that gaining a comprehensive picture of citizens' probabilistic competence and its determinants requires using both types of tasks. Copyright © 2008 John Wiley & Sons, Ltd.     

通过医患沟通引导病人就医行为:美国的做法

病人对病情的理解和对医疗信息的记忆能力是医生影响病人就医的基础。耐心的积极教育是病人自愿同意推荐诊疗计划的必须。在协商时尊重病人和知晓病人的期盼对医生如何影响病人的就医行为是很有帮助的。     

Probability Biases in Genetic Problem Solving: A Comparison of Undergraduates, Genetic Counseling Graduate Students, and Genetic Counselors

Heuristics are mental shortcuts that aid people in everyday problem-solving and decision-making. Although numerous studies have demonstrated their use in contexts ranging from consumers’ shopping decisions to experts’ estimations of experimental validity, virtually no published research has addressed heuristics use in problems involving genetic conditions and associated risk probabilities. The present research consists of two studies. In the first study, 220 undergraduates attempted to solve four genetic problems—two common heuristic problems modified to focus on genetic likelihood, and two created to study heuristics and probability rule application. Results revealed that the vast majority of undergraduates used heuristics and also demonstrated a complete misuse of probability rules. In the second study, 156 practicing genetic counselors and 89 genetic counseling students solved slightly modified versions of the genetic problems used in Study 1. Results indicated that a large percentage of both genetic counselors and students used heuristics, but the counselors demonstrated superior problem-solving performance compared to both the genetic counseling students and the undergraduates from Study 1. Research, training, and practice recommendations are presented.