Trolleys, triage and Covid-19: the role of psychological realism in sacrificial dilemmas

ABSTRACT

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did not stem from period change in moral attitudes relative to pre-pandemic levels–but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas–and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas.

KEYWORDS:

• Moral judgment
• values
• Covid-19
• utilitarianism
• politics

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research was supported by a Swiss National Science Foundation grant (PZ00P1_179912, PI Markus Kneer). Data and materials are available on the Open Science Framework at https://osf.io/dpsq9/.