• 2021
• Working Paper

A growing body of work suggests that people are sensitive to moral framing in economic games involving prosociality, suggesting that people hold moral preferences for doing the “right thing”. What gives rise to these preferences? Here, we evaluate the explanatory power of a reputation-based account, which proposes that people respond to moral frames because they are motivated to look good in the eyes of others. Across four pre-registered experiments (total N = 9,601), we investigated whether reputational incentives amplify sensitivity to framing effects. Studies 1-3 manipulated (i) whether moral or neutral framing was used to describe a Trade-Off Game (in which participants chose between prioritizing equality or efficiency) and (ii) whether Trade-Off Game choices were observable to a social partner in a subsequent Trust Game. These studies found that observability does not significantly amplify sensitivity to moral framing. Study 4 ruled out the alternative explanation that the observability manipulation from Studies 1-3 is too weak to influence behavior. In Study 4, the same observability manipulation did significantly amplify sensitivity to normative information (about what others see as moral in the Trade-Off Game). Together, these results suggest that moral frames may tap into moral preferences that are relatively deeply internalized, such that the power of moral frames is not strongly enhanced by making the morally-framed behavior observable to others.

• May 2021
• Case

The link to this multimedia case should be provided to students in advance as preparation for classroom case discussion.

• May 2021
• Article

Background: Clinicians’ use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence. Objective: To assess physicians’ abilities to predict how common choice frames influence people’s choices. Methods: We conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured interviews. Participants were senior resident physicians from a large health system. Of 160 eligible participants, 93 (58.1%) completed the scenario-based questionnaire and 15 completed the semistructured interview. The primary outcome was choice architecture competency, defined as the number of correct answers on the eight-item scenario-based choice architecture competency questionnaire. We generated the scenarios based on existing decision science literature and validated them using an online sample of lay participants. We then assessed senior resident physicians’ choice architecture competency using the questionnaire. We interviewed a subset of participating physicians to explore how they approached the scenario-based questions and their views on choice architecture in clinical medicine and medical education. Results: Physicians’ mean correct score was 4.85 (95% CI 4.59 to 5.11) out of 8 scenario-based questions. Regression models identified no associations between choice architecture competency and measured physician characteristics. Physicians found choice architecture highly relevant to clinical practice. They viewed the intentional use of choice architecture as acceptable and ethical, but felt they lacked sufficient training in the principles to do so. Conclusion: Clinicians assume the role of choice architect whether they realise it or not. Our results suggest that the majority of physicians have inadequate choice architecture competency. The uninformed use of choice architecture by clinicians may influence patients and family members in ways clinicians may not anticipate nor intend.