'Empathy counterbalancing' to mitigate the 'identified victim effect'? Ethical reflections on cognitive debiasing strategies to increase support for healthcare priority setting

Jilles Smids*, Charlotte H. C. Bomhof, Eline Maria Bunnik

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the 'identified victim effect', that is, the greater willingness to spend resources helping identified victims than helping statistical victims. In this paper we explore a possible cognitive debiasing strategy that is being employed in discussions on healthcare priority setting, which we call 'empathy counterbalancing' (EC). EC is the strategy of directing attention to, and eliciting empathy for, those who might be harmed as a result of one-sided empathy for the very ill who needs expensive treatment. We argue that governments have good reasons to attempt EC because the identified victim effect distorts priority setting in ways that undermine procedural fairness. We briefly outline three areas of application for EC and suggest some possible mechanisms that might explain how EC might work, if at all. We then discuss four potential ethical concerns with EC. First, EC might have the counterproductive effect of reducing overall citizen support for public funding of expensive medical treatments, thereby undermining solidarity. Second, EC may give rise to a 'competition in suffering', which may have unintended side effects for patients who feature in attempts at EC. Third, there may be doubts about whether EC is effective. Fourth, it may be objected that EC comes down to emotional manipulation, which governments should avoid. We conclude that insofar these concerns are valid they may be adequately addressed, and that EC seems a promising strategy that merits further investigation.
Original languageEnglish
Number of pages5
JournalJournal of Medical Ethics
Early online date26 Feb 2024
DOIs
Publication statusE-pub ahead of print - 26 Feb 2024

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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