The law and psychology of altruism in allocating scarce medical resources

This experimental study (N = 2706) investigated the relationship between costly altruism in medical decision-making and various predictors, such as health status and demographic characteristics. It also examined bias in social expectations about costly altruism, and assesses the impact of inducing individuals to be more other-regarding. We found that participants tended to expect others to use risk-based criteria, prioritizing individuals at higher medical risk. They did not expect others to rely on remaining life expectancy, quality-adjusted life years (QALYs), or identity-based biased approach such as gender or race. These expectations largely aligned with actual allocation patterns, though there were some differences in degree. For instance, participants did not adopt identity-based stereotypes of altruism, expecting people with greater altruistic reputations to be more altruistic. In practice, these groups did not give significantly more resources than others, and older adults even gave less. Additionally, participants correctly anticipated no racial bias against Black recipients, but underestimated the extent to which Black individuals would actually be favored: participants gave more resources to Black recipients than to White recipients. As to factors designed to increase other-regardingness, the evidence failed to show that the identifiability of a target generally enhances altruism, and it may even reduce it among certain groups. The study adds to the existing literature on expectations about altruism and altruistic behavior, expanding it to consider circumstances that involve a higher level of self-sacrifice than donating, volunteering, or allocating a fixed amount of money in dictator games. The ambition of this study is to provide empirical evidence to help lawmakers think about the fair allocation of scarce medical resources not just during a pandemic, but even during normal times.

Name thesis:degree_name

J.S.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Law

Grantor

University of Illinois Urbana-Champaign

Year dc:date

2025

Author dc:creator

• Zhi, Qiaoyuan

Contributors dc:contributor

• Bilz, Kenworthey
• Kaplan, Richard
• Robbennolt, Jennifer
• Ulen, Thomas

• Altruism
• Medical Resources
• Medical Decision-making
• Bias

Statement dc:rights

• Copyright 2025 Qiaoyuan Zhi

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/130053

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F130053