A new fMRI study shows that when people are exposed to the idea of unequal healthcare funding, a region of the brain associated with social and moral disgust is strongly activated.
The study, which is the first to use fMRI scans to observe what happens in the brain when people are asked to make difficult choices on 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 human disgust — such as the experience of 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 research was conducted 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.
For the study, the researchers asked a series of hypothetical questions to 30 participants on whether different scenarios for dividing funds between a variety of social groups were ‘fair’ or ‘unfair’. This included questions about spending on healthcare, superfast broadband, and housing benefit. The social groups were defined by criteria including age, marital status, and income.
The brain scan findings showed that brain processes involved in making decisions of fairness were significantly different for medical compared to non-medical scenarios. Subjects were far more likely to perceive uneven distributions of healthcare funding as unfair.
Furthermore, when subjects did approve of unequal distributions of resources in any setting, they appeared to suppress their ‘disgust’ response in order to make rational, utilitarian choices.
For example, the scans revealed activation of the inferior frontal cortex — an area of the brain associated with response inhibition — when subjects were pre-briefed on the principle that resources might need to be distributed unequally to maximize the benefit. This suppression was much less prevalent in the medical scenarios.
“Important healthcare decisions like funding allocations are often measured by a system called Quality Adjusted Life Years (QALY), which prioritizes choices that deliver the maximum benefit to the greatest number of people,” said co-author Professor Timothy Hodgson, head of the University of Lincoln’s School of Psychology.
“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 results are consistent with previous research showing that decision-making involves complex interactions between two distinct systems of the brain: one rational and one emotional.
The new findings represent a preliminary first step for cognitive neuroscience into the field of health economics — an area of major socioeconomic importance.
The findings are reported in the Journal of Neuroscience Psychology and Economics.
Source: University of Lincoln