BackgroundThe use of policies in medical treatment reimbursement decisions, in which only future patients are affected, prompts a moral dilemma: is there an ethical difference between withdrawing and withholding treatment?DesignThrough a preregistered behavioral experiment involving 1,067 participants, we tested variations in public attitudes concerning withdrawing and withholding treatments at both the bedside and policy levels.ResultsIn line with our first hypothesis, participants were more supportive of rationing decisions presented as withholding treatments compared with withdrawing treatments. Contrary to our second prestated hypothesis, participants were more supportive of decisions to withdraw treatment made at the bedside level compared with similar decisions made at the policy level.ImplicationsOur findings provide behavioral insights that help explain the common use of policies affecting only future patients in medical reimbursement decisions, despite normative concerns of such policies. In addition, our results may have implications for communication strategies when making decisions regarding treatment reimbursement.HighlightsWe explore public’ attitudes toward withdrawing and withholding treatments and how the decision level (bedside or policy level) matters. People were more supportive of withholding medical treatment than of withdrawing equivalent treatment. People were more supportive of treatment withdrawal made at the bedside than at the policy level. Our findings help clarify why common-use policies, which impact only future patients in medical reimbursement decision, are implemented despite the normative concerns associted with thesepolicies.

中文翻译：

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医疗报销决定中撤回与拒绝治疗：公众态度研究


背景在医疗报销决策中使用政策（其中只有未来的患者受到影响）会引发道德困境：退出治疗和停止治疗之间是否存在道德差异？设计通过一项涉及 1,067 名参与者的预先注册行为实验，我们测试了公众对以下问题的态度变化：在床边和政策层面撤回和暂停治疗。结果与我们的第一个假设一致，与撤回治疗相比，参与者更支持以暂停治疗的配给决定。与我们第二个预设的假设相反，与政策层面做出的类似决定相比，参与者更支持在床边做出的撤回治疗的决定。 意义我们的研究结果提供了行为见解，有助于解释仅影响未来患者的政策在医疗领域的常见使用尽管对此类政策存在规范性担忧，但仍作出报销决定。此外，我们的结果可能会对做出有关治疗报销的决策时的沟通策略产生影响。亮点我们探讨了公众对退出和停止治疗的态度以及决策层面（床边或政策层面）的重要性。人们更支持停止治疗而不是撤回同等治疗。与政策层面相比，人们更支持在床边停止治疗。我们的研究结果有助于阐明为什么尽管存在与这些政策相关的规范问题，但仍实施仅影响未来患者医疗报销决策的通用政策。