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Do Moral Views Change during a Crisis? An Experiment on Health Care Priority Setting
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Prioriteringscentrum. Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden.ORCID iD: 0000-0001-9561-2859
Linköping University, Department of Culture and Society, Division of Philosophy and Applied Ethics. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences. Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden;Division of Philosophy and Applied Ethics, Department of Culture and Society, Linköping University, Sweden.ORCID iD: 0000-0001-5448-9209
Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden;Division of Economics, Department of Management and Engineering, Linköping University, Sweden. (jedilab)ORCID iD: 0000-0002-8159-1249
2026 (English)In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, article id 0272989X251391177Article in journal (Refereed) Published
Abstract [en]

 Background. During the COVID-19 pandemic, policymakers appeared to shift toward more efficiency-oriented medical decision making as resources became increasingly scarce. However, it remains unclear whether this shift was driven by the experience of scarcity itself or by the use of more concretely formulated ethical principles. This study investigates whether a national crisis influences public support for health care priority setting principles, and whether abstract versus concrete formulations of these principles affect that support. Design. We conducted a pre-registered online experiment (n = 1,404) to examine public attitudes toward three ethical principles formalized in the Swedish ethical platform—human dignity, needs-solidarity, and cost-effectiveness—in both crisis and non-crisis contexts. We also manipulated how the principles were presented, using either abstract or concrete formulations. Results. In the crisis condition, support for the human dignity and cost-effectiveness principles decreased, while support for the needs-solidarity principle increased. However, these effects were small, and the overall ranking of the principles remained stable. Notably, the level of abstractness had a stronger impact than the crisis context: support for needs-solidarity was higher when described abstractly, whereas support for cost-effectiveness increased when it was presented in a more concrete, action-oriented way. Support for the human dignity principle was unaffected by the abstractness manipulation. Conclusion. The findings suggest that people’s moral views are relatively stable in the face of crisis. Rather than the crisis context itself, the way ethical principles are formulated—abstractly or concretely—may be a more powerful driver of shifts in public support for different moral values in health care priority setting.

Place, publisher, year, edition, pages
2026. article id 0272989X251391177
Keywords [en]
Crisis exceptionalism; scarcity; moral consistency; abstractness: Health care; Priority setting;
National Category
Economics Health Care Service and Management, Health Policy and Services and Health Economy Medical Ethics Psychology (Excluding Applied Psychology)
Identifiers
URN: urn:nbn:se:liu:diva-219987DOI: 10.1177/0272989x251391177OAI: oai:DiVA.org:liu-219987DiVA, id: diva2:2021452
Funder
Swedish Civil Contingencies AgencyForte, Swedish Research Council for Health, Working Life and Welfare, 19-01101Available from: 2025-12-14 Created: 2025-12-14 Last updated: 2025-12-15

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Strand, LiamGustavsson, ErikTinghög, Gustav

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Medical decision making
EconomicsHealth Care Service and Management, Health Policy and Services and Health EconomyMedical EthicsPsychology (Excluding Applied Psychology)

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