Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Gary Kopf


Non-ethically relevant emotional content affects decision in difficult ethical dilemmas

Brian S. Marcus, Mark R. Mercurio, Denise Esserman, Gary Kopf

Section of Cardiothoracic Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT Objective: To evaluate the cognitive and affective factors which contribute to ethical evaluations by members of ethics committee (EC). Method: A total of 70 EC members at 4 large medical centers were given clinical vignettes and asked to make judgments. Each vignette had two versions and each EC member was randomly assigned one of the two versions to evaluate. The two versions differed only in affective content (likeability of agents) which had no bearing on the ethical issues. The EC members were then asked, using a 7-point Likert scale, to make an ethical judgment, and give an analysis as to what ethical principles they used in making their decision. Results: In two pairs of clinical ethical dilemmas, positive affect influenced the ethical evaluation in favor of the agent portrayed positively, and negative affect resulted in the opposite effect. In the clinical vignettes where there was no significant difference in any affective response to the agents of the evaluator, no difference in ethical decisions were seen between different versions of the vignette. Emotional content also had an effect on which ethical principles were used by EC members to explain their evaluations. Conclusion: Ethical evaluations by EC members are effected by non-ethically relevant emotive content of clinical scenarios. Emotional biases may play a significant role in the evaluation of ethical dilemmas, even though EC members may not be explicitly aware of them. Bioethical principles areused to rationalize these judgments after decisions have been made.


This is an Open Access Thesis.