Areas of the brain associated with social and moral disgust are triggered when healthcare funding is split unequally, researchers from the UK and Australia have found.
The study, which is the first to use fMRI scans to examine what happens in the brain when people are tasked with making difficult decisions about healthcare spending, found that the anterior insula was activated when people felt an unfair choice had been proposed.
The anterior insula is involved in processing humans’ sense of physical disgust – like when we are exposed to foul smells or unpleasant images – but is also triggered when we feel a strong sense of moral outrage – for example, at the perceived breach of social or ethical norms.
The study was carried out by neuroscientists, psychologists and economists from the University of Lincoln, the Open University, University of Oxford, and the Exeter Magnetic Resonance Research Centre in the UK, and Flinders University in Australia.
The researchers posed a series of hypothetical questions to 30 study participants, asking whether different scenarios for allocating millions of pounds in funding between different social groups were ‘fair’ or ‘unfair’. It included questions about spending on healthcare, superfast broadband and housing benefit. The social groups were defined by criteria including age, marital status and income.
Results from the experiment, reported in the Journal of Neuroscience Psychology and Economics, showed that brain processes involved in making decisions of fairness were significantly different for medical compared to non-medical scenarios. Participants were much more likely to perceive uneven distributions of healthcare funding as unfair.
The study also showed that when participants did approve of unequal distributions of resources in any setting, they appeared to suppress their ‘disgust’ response to make rational, utilitarian choices. Brains scans showed activation of the inferior frontal cortex – an area of the brain associated with response inhibition – when participants were pre-briefed on the principle that resources might need to be distributed unequally to maximise the benefit. This suppression was much less prevalent in the medical scenarios.
Co-author Professor Timothy Hodgson, Head of the University of Lincoln’s School of Psychology, said: “Important healthcare decisions like funding allocations are often measured by a system called Quality Adjusted Life Years (QALY), which prioritises choices that deliver the maximum benefit to the greatest number of people.
“The problem is those decisions are often viewed negatively by members of the general public, who instead believe that everybody has a right to receive medical care and anything that violates this principle is unfair and immoral.
“Given enough information people may be more inclined to support healthcare decisions based on QALYs, but this requires cognitive effort to override a more emotion-based bias towards absolute equality and universal rights.”
The findings are consistent with the existing body of research in behavioural psychology which suggests decision-making involves complex interactions between two distinct systems of the brain: one rational and one emotional. They represent a preliminary first step for cognitive neuroscience into the field of health economics – an area of major socioeconomic importance.
About this neuroimaging and psychology research
Source: Cerri Evans – University of Lincoln Image Source: The image is adapted from the University of Lincoln article Original Research: Full open access research for “An fMRI investigation of moral cognition in healthcare decision making” by Lisa J. Smith, Paul Anand, Abdelmalek Benattayallah, Timothy L. Hodgson in Journal of Neuroscience Psychology and Economics. Published online April 28 2015 doi:10.1037/npe0000038
An fMRI investigation of moral cognition in healthcare decision making
This study used fMRI to investigate the neural substrates of moral cognition in health resource allocation decision problems. In particular, it investigated the cognitive and emotional processes that underpin utilitarian approaches to health care rationing such as Quality Adjusted Life Years (QALYs). Participants viewed hypothetical medical and nonmedical resource allocation scenarios which described equal or unequal allocation of resources to different groups. In addition, participants were assigned to 1 of 2 treatments in which they either did or did not receive advanced instructions about the principles of utilitarianism. In all cases, participants were asked to judge the proposed allocations as “fair” or “unfair.” More brain activity was observed within the superior parietal lobe, angular gyrus, middle temporal gyrus, and bilateral caudate nucleus when participants viewed scenarios depicting equal divisions of resources. Conversely, unequal resource divisions were associated with more activity in the inferior frontal gyrus and insula cortex. Furthermore, instructions about the principles of utilitarianism led to significant activation differences within the inferior frontal gyrus and the middle frontal gyrus. Significant differences in activity were also found within the inferior frontal cortex and anterior insula between medical and nonmedical scenarios. The implications for cognitive control mechanisms and the cognitive and neural bases of utilitarian ethical judgment are discussed.
“An fMRI investigation of moral cognition in healthcare decision making” by Lisa J. Smith, Paul Anand, Abdelmalek Benattayallah, Timothy L. Hodgson in Journal of Neuroscience Psychology and Economics. Published online April 28 2015 doi:10.1037/npe0000038