Hot-Cold Empathy Gaps and Medical Decision Making

Authors: George Loewenstein, Carnegie Mellon University

Publication: Health Psychology

Year: 2005

Focus Area: Emotion, Decision Making

Relevance: Scam artists can elicit emotional responses in their victims. These “hot” affective states can lead people to make rash judgments about subjects that they would normally weigh carefully before deciding.

Summary: Anger, fear, hunger and cravings are examples of the range of “hot” affects that can influence decision making. People who are in a “hot” state have trouble imagining how they would behave if they were in a “cool” affective state, and vice versa. Furthermore, people in a given affective state cannot easily imagine the behavior of another person, who is in the opposite affective state.

  • People in “hot” states give more weight to their current desires, without acknowledging that their preferences may change when they “cool off” – and that a “cooler” affect would allow them to make better decisions for the long run.
  • On the other hand, people in “cold” states underestimate the potential of affect to sway their decision making in future situations, and do not take adequate action to avoid “hot” states.
  • These empathy gaps can be classified temporally. Prospective gaps occur when looking ahead to future decision making situations, while retrospective gaps occur when people inaccurately recall a decision that they made in the past. Interpersonal gaps occur when two people are in different affective states and cannot correctly predict or understand each other’s motivations.
  • Loewenstein applies these findings to the ethics of medical decision making, in which empathy gaps are common. Doctors and patients must span hot-cold empathy gaps to make appropriate decisions, but are often in different emotional states when making these decisions.

Author Abstract: Prior research has shown that people mispredict their own behavior and preferences across affective states. When people are in an affectively “cold” state, they fail to fully appreciate how “hot” states will affect their own preferences and behavior. When in hot states, they underestimate the influence of those states and, as a result, overestimate the stability of their current preferences. The same biases apply interpersonally; for example, people who are not affectively aroused underappreciate the impact of hot states on other people’s behavior. After reviewing research documenting such intrapersonal and interpersonal hot-cold empathy gaps, this article examines their consequences for medical, and specifically cancer-related, decision making, showing, for example, that hot-cold empathy gaps can lead healthy persons to expose themselves excessively to health risks and can cause health care providers to undertreat patients for pain.

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