Policy Learning with Asymmetric Counterfactual Utilities

Data-driven decision making plays an important role even in high stakes settings like medicine and public policy. Learning optimal policies from observed data requires a careful formulation of the utility function whose expected value is maximized across a population. Although researchers typically use utilities that depend on observed outcomes alone, in many settings the decision maker’s utility function is more properly characterized by the joint set of potential outcomes under all actions. For example, the Hippocratic principle to “do no harm” implies that the cost of causing death to a patient who would otherwise survive without treatment is greater than the cost of forgoing life-saving treatment. We consider optimal policy learning with asymmetric counterfactual utility functions of this form that consider the joint set of potential outcomes. We show that asymmetric counterfactual utilities lead to an unidentifiable expected utility function, and so we first partially identify it. Drawing on statistical decision theory, we then derive minimax decision rules by minimizing the maximum expected utility loss relative to different alternative policies. We show that one can learn minimax loss decision rules from observed data by solving intermediate classification problems, and establish that the finite sample excess expected utility loss of this procedure is bounded by the regret of these intermediate classifiers. We apply this conceptual framework and methodology to the decision about whether or not to use right heart catheterization for patients with possible pulmonary hypertension. Supplementary materials for this article are available online.