Resource allocation decisions under pandemic conditions: A cross-sectional survey of Ontario physicians.

The COVID-19 pandemic has forced physicians to confront difficult choices regarding the allocation of scarce resources, such as ventilators and critical care beds. Developing policies to guide the allocation of such resources has proven challenging. An understanding of physicians' attitudes and beliefs surrounding resource allocation could help inform policymaking. As a replication and extension of a survey of Ottawa physicians conducted in 2020, we surveyed physicians across Ontario, Canada in April 2021. This survey examined physicians' sense of preparedness to allocate critical care resources during the pandemic, attitudes concerning resource allocation policy, and approaches to resource allocation decision-making. Of the 253 responses included for analysis, the majority (67%) of respondents indicated feeling "somewhat" or "a little prepared" to make resource allocation decisions, while 20% indicated feeling "not at all prepared." Most respondents (86%) agreed that a policy to guide resource allocation in the event of scarcity should exist. Physicians overwhelmingly agreed that important factors to consider when making resource allocation decisions included the patient likelihood of survival, frailty index, comorbidities, and cognitive status. Responses from the province-wide survey conducted in 2021 resemble the results of an analogous survey of Ottawa physicians conducted in 2020. Physicians generally felt underprepared to make resource allocation decisions and agreed that official policies should guide such decisions. Identification of factors relevant to resource allocation was remarkably consistent across this sample and that taken in 2020.

Physician preparedness for resource allocation decisions under pandemic conditions: A cross-sectional survey of Canadian physicians, April 2020.

BACKGROUND: Under the pandemic conditions created by the novel coronavirus of 2019 (COVID-19), physicians have faced difficult choices allocating scarce resources, including but not limited to critical care beds and ventilators. Past experiences with severe acute respiratory syndrome (SARS) and current reports suggest that making these decisions carries a heavy emotional toll for physicians around the world. We sought to explore Canadian physicians' preparedness and attitudes regarding resource allocation decisions. METHODS: From April 3 to April 13, 2020, we conducted an 8-question online survey of physicians practicing in the region of Ottawa, Ontario, Canada, organized around 4 themes: physician preparedness for resource rationing, physician preparedness to offer palliative care, attitudes towards resource allocation policy, and approaches to resource allocation decision-making. RESULTS: We collected 219 responses, of which 165 were used for analysis. The majority (78%) of respondents felt "somewhat" or "a little prepared" to make resource allocation decisions, and 13% felt "not at all prepared." A majority of respondents (63%) expected the provision of palliative care to be "very" or "somewhat difficult." Most respondents (83%) either strongly or somewhat agreed that there should be policy to guide resource allocation. Physicians overwhelmingly agreed on certain factors that would be important in resource allocation, including whether patients were likely to survive, and whether they had dementia and other significant comorbidities. Respondents generally did not feel confident that they would have the social support they needed at the time of making resource allocation decisions. INTERPRETATION: This rapidly implemented survey suggests that a sample of Canadian physicians feel underprepared to make resource allocation decisions, and desire both more emotional support and clear, transparent, evidence-based policy.

Strategies for overcoming aversion to unnaturalness: The case of clean meat.

Clean meat (grown from animal cells rather than rearing animals) has the potential to address many concerns associated with meat production. However, research suggests that the perceived unnaturalness of clean meat could be a barrier to consumer acceptance. This study investigated the efficacy of different messages designed to address consumers' concerns about clean meat naturalness. In an experimental design, participants read one of four messages: clean meat is natural, conventional meat is unnatural, naturalness is not important, or highlighting benefits of clean meat without addressing naturalness. The results indicated that arguing that conventional meat is unnatural resulted in a significant increase in some measures of acceptance compared to other messages. Arguing that clean meat is natural and challenging the appeal to nature were less persuasive, and challenging the appeal to nature resulted in some measures of acceptance being lower than not addressing naturalness. We discuss these results in the context of existing naturalness research and give recommendations for further research.

Trust at zero acquaintance: more a matter of respect than expectation of reward.

Trust is essential for a secure and flourishing social life, but many economic and philosophical approaches argue that rational people should never extend it, in particular to strangers they will never encounter again. Emerging data on the trust game, a laboratory economic exchange, suggests that people trust strangers excessively (i.e., far more than their tolerance for risk and cynical views of their peers should allow). What produces this puzzling "excess" of trust? We argue that people trust due to a norm mandating that they show respect for the other person's character, presuming the other person has sufficient integrity and goodwill even if they do not believe it privately. Six studies provided converging evidence that decisions to trust follow the logic of norms. Trusting others is what people think they should do, and the emotions associated with fulfilling a social duty or responsibility (e.g., guilt, anxiety) account for at least a significant proportion of the excessive trust observed. Regarding the specific norm in play, trust rates collapse when respect for the other person's character is eliminated as an issue.

In search of the silver lining: the justice motive fosters perceptions of benefits in the later lives of tragedy victims.

Past research has demonstrated that people's need to perceive the world as fair and just leads them to blame and derogate victims of tragedy. The research reported here shows that a positive reaction--bestowing additional meaning on the lives of individuals who have suffered--can also serve people's need to believe that the world is just. In two studies, participants whose justice motive was temporarily heightened or who strongly endorsed the belief that reward and punishment are fairly distributed in the world perceived more meaning and enjoyment in the life of someone who had experienced a tragedy than in the life of someone who had not experienced tragedy, but this pattern was not found for participants whose justice motive was not heightened or who did not strongly endorse a justice belief. These results suggest that being motivated to see the world as just--a motivation traditionally associated with victim derogation--also leads people to perceive a "silver lining" to tragic events.