Decisional Autonomy Undermines Advisees' Judgments of Experts in Medicine and in Life

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (N = 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser–advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.

在过去的数十年间，美国医疗体系日益强调患者的自主权。医生们通常鼓励患者就其医疗护理做出个人决定，而非提供清晰但带有家长式倾向的建议。尽管政治理论家、生物伦理学家和哲学家普遍认为这是一种积极的趋势，但本研究探讨了在不确定性环境下，患者和受咨询者在拥有完全决策自主权时如何作出反应这一重要问题。在六项实验（N = 3,867）中，我们发现那些给予受咨询者决策自主权而非提供家长式建议的顾问，被认为能力较低且帮助较少。因此，受咨询者不太可能再次寻求并推荐这些顾问，且对他们支付的薪酬也较低。值得注意的是，我们同样证明顾问并未预见到这些影响。我们记录了这些结果，不仅在医疗领域内，也在医疗领域外，这表明对家长式管理的偏好并非仅限于医学领域，而是存在于专家顾问与受咨询者之间存在专业知识不对等的情况。我们发现，当征询或未征询建议时，当家长式管理和自主权均伴随专家指导时，以及当家长式建议的结果实现之前和之后，这种对家长式管理的偏好均持续存在。最后，我们发现，只有当决策者认为他们的决策具有难度时，才会出现对家长式管理的偏好。这些结果挑战了近年来在医疗决策中优先考虑完全决策自主权的新采纳实践的益处。