How do people value life?: inconsistencies and mechanisms

This dissertation research examines the decision processes underlying how people value lives saved in situations of resource scarcity. Three policies a person could use are examined: (1) treating all lives equally, (2) prioritizing people who will gain the most benefit (e.g. additional life years) from an intervention, and (3) prioritizing young people regardless of the additional life years they have left. These metrics imply different strategies for health resource allocation, especially when such resources are scarce. Vaccination scenarios were used to probe which metrics lay people use in different situations and how the type of question influences the metric they used. In direct questions, people were asked about their general principles (e.g., all lives are equal, prioritize the young, etc.). In indirect questions, people were given an allocation problem (e.g., there are 1000 people at risk but only 500 vaccines; who should get the vaccines?) Two hypotheses were tested. Hypothesis 1: People show systematic inconsistencies in life-evaluating metrics they endorse when they are asked to express their views directly versus indirectly. Hypothesis 2: The above stated inconsistencies are caused by different goals. A moral goal is activated when people face the direct question, leading to preference for life-evaluating metrics consistent with established moral principles, such as equality; in contrast, an efficiency goal is activated when people face the indirect question, leading to preference consistent with maximizing efficiency, such as the “years-left” metric. The broader impacts of this research derive from the fact that the public's support for health policies may be malleable: While the pro-young tendencies may drive support for specific policies for how to prioritize scarce health resources (i.e. the 2009 H1N1 vaccine was prioritized for people under age 25), such tendencies may be concealed in more direct measures, where prioritizing life explicitly seems a more apparent contradiction to the oft-cited norm that "all lives are equal". Studying these inconsistencies provides important information on how to design public health policies and how to present them to the public.Ph. D.Includes bibliographical referencesby Meng L