Wednesday, October 1, 2008

Moral Luck

In philosophy, the term moral luck is used to describe the morality of an action judged in the light of its uncontrollable and unforeseeable consequences instead of in isolation. Such judgments are not normative. The morality of an action should not be different because of a lucky good outcome or an unfortunate bad end. Questions of moral luck are not new to philosophy but they seemed like fertile ground for experimental behavioral research. In fact I have been working on a rough experimental design to demonstrate the moral luck effect in collaboration with Columbia’s Leonard Lee.

Here is the draft set up:

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A doctor is visited by a patient complaining of a stomach ache and other vague symptoms. The doctor has a “gut feeling” that the patient may be suffering from Disease X. Disease X is a serious condition and, left untreated, it can reduce the expected lifespan of a sufferer by up to 5 years. The majority of medical experts estimate there is only a 1 in 10,000 chance that a randomly selected person in the population will have Disease X. None of the symptoms of which the patient is complaining are associated with Disease X and two other doctors have already examined the patient and ruled out the disease. These other two doctors believe the patient has a mild form of a flu virus that should resolve itself in a few days.

There is a test for Disease X that is 100% accurate in its diagnosis. Diagnosed early the disease can be cheaply treated with outstanding success; however, the test costs $5,000 to administer and in 2% of cases the test itself results in a serious infection, which also has negative effects on expected lifespan.

The doctor decided to run the test based on his own judgment. [GOOD OUTCOME: The lab results from the test show that the patient does have Disease X which can now be cheaply and effectively treated. The patient may or may not have an infection resulting from the test (2% chance of infection). BAD OUTCOME: The lab results from the test show that the patient does not have Disease X. The patient may or may not have an infection resulting from the test (2% chance of infection).] On a scale of 1 to 5, how moral was the doctor’s decision to run the test?

Very Immoral (1 to 7 scale) Highly Moral


Should an experienced doctor be allowed to make such a decision even if the statistical odds are not in favor of his or her decision?

Yes / No


If you believe the patient’s family is justified in suing the doctor for medical malpractice, what is a reasonable dollar amount that the doctor’s insurance should be expected to pay in compensation? The average malpractice payment at the doctor’s hospital is $50,000.

$__________________


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There are a number of improvements that should be made to this set up before running it with real subjects but that may not be necessary. In researching the project I ran across two new papers on the subject that already provide quite solid evidence of a moral luck like effect.

Francesca Gino, Don A. Moore, and Max H. Bazerman, “No harm, no foul: The outcome bias in ethical judgments,” HBS Working Paper Number: 08-080, February 2008

Gino, Francesca, Lisa Lixin Shu, and Max H. Bazerman. "Nameless + Harmless = Blameless: When Seemingly Irrelevant Factors Influence Judgment of (Un)ethical Behavior." Harvard Business School Working Paper, No. 09-020, August 2008.

So it looks like we do not get to be the experimental moral luck vanguard. On the plus side I was at least lucky enough to have a wonderful coffee conversation with one of the authors yesterday, Lisa Shu. I look forward to reading more of her work.

1 comment:

Corey said...

Justin,

Your setup has some big flaws. You're asking participants to judge statistical likelihoods when research shows that people have trouble thinking statistically. Additionally, people don't usually deal with the full cost of healthcare...insurance pays for it.

You also might want to try setting up a manipulation orthogonal to the one you have already (or something). I really don't see any alternate hypotheses tested.