The Costs of Autonomy: Decisional Autonomy Undermines Advisees' Judgements of Experts

Abstract

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Doctors routinely encourage patients to come to their own decisions about their medical care, rather than providing patients with clearer, yet more paternalistic, advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients, and decision-makers in general, react to full decisional autonomy when making decisions under uncertainty. Across 6 experiments (N = 3,261) we find that advisers who give advisees decisional autonomy, rather than providing more paternalistic advice, are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers, and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results in a variety of domains (including medical, financial, and managerial advice, as well as advice about risky gambles) using both hypothetical scenarios and incentive- compatible paradigms. We find that the preference for paternalistic advice holds when both paternalistic and autonomy- oriented advice are accompanied by detailed information and expert guidance, and that the preference for paternalism holds regardless of the positivity or negativity of the outcome associated with the advice. Finally, we show that experiencing decision difficulty is a necessary condition for our effects. These results deepen our understanding of preferences for autonomy and paternalism, and challenge the benefits of recently adopted practices in medical decision-making that prioritize full decisional autonomy.