Desire to Avoid Difficult Decisions

Even in dispassionate moments, people can make irrational decisions—decisions that conflict with their own preferences. For example, imagine the following admittedly hypothetical situation: you were recently diagnosed with colon cancer, and there are two surgical treatments available. Surgery 1 cures 80% of patients without complications, but the remaining 20% die of colon cancer. Surgery 2 also cures patients without complications 80% of the time, but only 16% die of colon cancer. The remaining 4% are cured of their colon cancer, but experience one of four surgical complications: a permanent colostomy, chronic diarrhea, intermittent abdominal pain, or a wound infection that takes 1 year to heal. More than 90% of people say that the four side effects of surgery 2 are preferable to dying of colon cancer. And yet, 50% of people still choose surgery 1 over surgery 2.44 It appears that people are so overwhelmed by the sheer number and graphicness of the four complications of surgery 2 that they choose surgery 1. People minimize the survival difference between these two treatments ("the difference is only 4%") while fixating on the different rate of complications. This seemingly irrational choice does not go away when people are shown, in writing, the inconsistency of their views. Avoiding such decisions probably requires face-to-face conversations.

People do not need to be scared by graphic side effects to shy away from what seem like superior alternatives. For example, in one study, when physicians were presented with a hypothetical patient with severe osteoarthritis, many said they would prescribe a new nonsteroidal antiinflammatory drug (NSAID) for the patient if it were available at the same time that they referred the patient to an orthopedic specialist. But when physicians were told that two new NSAIDs were available, many decided not to prescribe either NSAID and simply referred the patient to a specialist without any new medication. Addition of the second NSAID put physi cians in a position where they had to make a slightly more difficult choice, and many physicians acted as if they were unwilling to make that choice.45 A similar phenomenon likely explains why people are more likely to purchase jams from a grocery store displaying 6 of the jams than one displaying 24; when there is too much to think about, people are averse to making tough choices.46

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