Who should be prioritized? : the impact of meritocracy norm on medical decisions toward a low status group

This dissertation investigates whether (a) social status predicts prioritization in medical decisions and (b) whether the salience of meritocracy explains the effect of patient’ social status on those decisions. When deciding about prioritizing patients for a treatment or a medical procedure, providers rely on medical evidence and on the symptoms expressed by patients (Dovidio & Fiske, 2012). However, research shows a systematic disproportionate negative impact of medical decisions on members of low-status groups, such as racialized immigrant groups (Hicken et al., 2018; Smedley, et al., 2003). In previous research, implicit prejudice, stereotyping, and conservative ideologies were found to explain, at least under certain circumstances, status-based differentials in medical outcomes (Green et al., 2007). In the present thesis, we offer a novel and complementary perspective: the influence of social norms. In particular, we examine whether the Meritocracy norm explains differences in the prioritization, as a function of patient’ social status. We do so by investigating the impact of Meritocracy on socially critical decisions in the medical context and involving a low status group, the African immigrants. We propose medical decisions to be less favorable toward the low status group, particularly when the meritocracy norm is salient; thus, meritocracy norm is conceptualized as a moderator of the relationship between social status and medical decisions. We also propose that the adverse effect of meritocracy should operate when it is possible to infer a person's personal responsibility for the state of health and when the legitimizing meaning of meritocracy is salient. Particularly, we propose that in a situation involving medical decisions, such as transplants or expensive medical treatments, meritocracy operates through its legitimizing meaning, which may reduce the preference for members of socially disadvantaged groups. We present empirical evidence that provides general support for the hypotheses in seven studies and a systematic review analyzing, in medical settings, how the intergroup biases of the Portuguese towards the low status group portrayed are reinforced and legitimized in the presence of meritocracy, a social norm that regulates social relations