Comparison of Ethical Decision-Making in Emergency Service Workers and Laypeople
Dublin Core
Title
Comparison of Ethical Decision-Making in Emergency Service Workers and Laypeople
Creator
James Wright
Date
08/09/2021
Description
The Trolley Problem is a theoretical ethical dilemma in which it is asked whether it is morally acceptable to actively kill one person to save five (Thomson, 1976). Emergency service workers (ESW) are often presented with ethical dilemmas, such as whether to resuscitate someone who does not want to be resuscitated (Guru et al., 1999). The present study investigated the differences in decisions made when faced with variations of the Trolley Problem between laypeople (non-ESW) and ESW. The effect of time pressure on making these decisions was also investigated, measured through response time. 99 participants were tested, 47 laypeople and 52 ESW. Participants were presented with five different Trolley Problem dilemmas wherein they could passively allow five people to die, or to make an active decision to sacrifice one person to save the others. These dilemmas had distinct variations, such as the one person being a co-worker, or where participants had to physically push and kill a large man. Half the participants were placed into a time pressure condition, and were told that they had a time limit in which to respond, when no time limit existed. Results showed that neither occupation nor time pressure significantly affected response time or participant choice. Further analysis suggested some interaction effects between occupation, time pressure, and specific dilemma types. Implications such as suggested training practices for ESW will be discussed. Criticisms of the methodology and recommendations for future research will also be discussed.
Subject
Trolley Problem, ethical dilemmas, time pressure, emergency service workers, decision-making.
Source
Method
Sample
This project aimed to use a total of 112 participants, with 56 of these being ESW, and 56 being laypeople. This number was calculated using the G*Power software, using an alpha of .05, power of .8, and a medium expected effect size of .35, using five levels of measurement.
In total, 99 participants were gathered for the present study. 47 of the sample were laypeople, whilst the other 52 were ESW. Of these, 22 were police officers, and 30 were ambulance crewmembers. Overall, ESW had an average of 7.7 years of experience (SD = 8.29), with ambulance staff having an average of 10.14 years (SD = 9.89), and police having an average of 4.52 years (SD = 4.17). Unfortunately, no other emergency service branches such as coast guard or firefighters completed the study.
A gender split of 47 males to 48 females was gathered, along with an average age of 35.65 years old (SD = 12.98). Three participants declined to disclose their gender, and one participant identified as agender.
Ethical Approval and Pre-Registration
This study gained ethical approval on 13/04/2021, from members of the Psychology department at Lancaster University.
This study was also pre-registered on the Open Science Frameworks website on 17/05/2021. This can be found at the following link: https://osf.io/4ecjg/?view_only=95615bd16f2c4a9db88dd77543780ec2
Materials
Survey
The present study was delivered through a Qualtrics survey file, created fully by the researcher. The survey contains standard psychological research documents, such as an information page, consent form, demographic information page, and debriefing. The survey also contains two sets of five vignettes describing ethical dilemmas for each condition of the experiment.
Demographics
Participants are asked to provide some demographic information: age, gender, and occupation. Participants are given options for occupation, including police, fire, or ambulance, as well as an option for ‘other’ emergency services, where a free typing box is presented. This is to cover occupations outside of the main three emergency services, such as coastguard or mountain rescue. If participants are not ESW, they have the option to say they are not a member of the emergency services.
Ethical Dilemmas
The present study tests a set of five ethical dilemma vignettes. To read each dilemma, see Appendix A. Each vignette describes a version of the Trolley Problem, where there is an out-of-control trolley (the word “tram” is used to make it clearer to British participants) speeding down the tracks towards a group of five people. For each dilemma, there is an active choice, or a passive choice, which entails sacrificing one life to save five, or allowing five people to die to avoid killing one person. Each dilemma presents a different single person who could be placed in danger, these are: a non-descript person, an elderly person, a co-worker, a large man, and the “culprit”.
Non-Descript Person. This dilemma is a traditional retelling of the Trolley Problem. Participants are told that there is an out-of-control trolley speeding down the tracks, towards five people who are stranded. Participants are told that they have the choice to pull a lever and divert the trolley onto a different track, however there is one person stranded on those tracks. The decision participants are faced with here is whether to make an active choice or a passive choice. The active choice is to pull the lever, diverting the trolley and saving the five, whilst sacrificing the individual. The passive choice is to not pull the lever, allowing the trolley to hit the five people, whilst saving the individual.
It is often found that people sacrifice one person to save five in this dilemma (Thomson, 1976; Greene, 2016). Responses to this condition demonstrate how people weigh up lives on a strictly numerical basis, knowing nothing about the traits of the person. By having a condition in which participants know nothing about the person on the tracks, this can be compared to responses when it is an elderly person or a co-worker on the tracks.
Elderly Person. This dilemma is the same as the non-descript person dilemma, however participants are told that the person on the tracks is elderly.
This condition has been found to affect how people respond to the Trolley Problem, with people being more likely to sacrifice the elderly person over any other ages (Kawai et al., 2014). This is interesting in the study of moral psychology, as it shows how people weigh up the worth of lives based on certain attributes, such as age. This can also be compared to how people respond when they know nothing about the person on the tracks. This is also important to investigate in an ESW context, as elderly people are more likely to be admitted to hospital (Burns, 2001), leading ambulance crews to encounter them more often.
Co-Worker. This dilemma is the same as the non-descript person dilemma, however participants are told that the person on the tracks is one of their co-workers.
This dilemma was chosen based on past research suggesting that participants are less likely to sacrifice people they perceive to be part of their identity in-group (Swann Jr et al., 2010). This is a relevant factor to investigate as part of a study into ESW, a group who develop strong in-group feelings, including having better self-care and social support (Shakespeare-Finch et al., 2002). This is also interesting when investigating ESW populations such as firefighters or police, who may be placed into situations where a co-worker is in danger whilst trying to save members of the public. This dilemma demonstrates how ESW weigh up the lives of their co-workers compared to strangers.
Large Man. In this dilemma, participants are told that there are five people on the tracks, and stood next to them is a large man. Participants are told that if they push the large man into the tracks, that would stop the trolley and the five people would be saved. The decision participants are faced with here is whether to make an active choice and push the large man onto the tracks, stopping the trolley and saving the five, or to make a passive choice and allow the trolley to hit the five people.
This is a version of the “Footbridge Dilemma”, in which it is found participants are typically less willing to make the active decision and push the man (Nichols & Mallon, 2006). It is an interesting take on the Trolley Problem dilemma, as it forces participants to make a more physical decision through pushing and directly causing a person’s death, as opposed to pulling a switch which then indirectly leads to someone’s death. This is also relevant in the study of ESW, who tend to work directly and physically with people as opposed to making indirect decisions.
Culprit. This dilemma is the same as the Large Man dilemma, however rather than a large man, participants are told that stood next to them is the “culprit”. The “culprit” is explained to participants as the person who stranded the other five people on the tracks.
This dilemma was chosen as it tests how people respond to the same physical pushing decision as the Large Man condition, however when the person they can push is not an innocent bystander, and instead is someone who is trying to end the lives of others. This allows for the investigation of how people weigh the lives of criminals compared to innocent people. This is also interesting in the study of ESW, especially when regarding police, since their occupation involves apprehending criminals so they can then be sentenced, not choosing the punishment based on their own moral reasoning.
Time Pressure
Participants who are assigned to the Time Pressure condition are told both during instructions and above each dilemma that they only have a limited amount of time to make their decision. They are told that after that time has passed, they may not be able to provide a response. This is not true, there are no time limits on any question. This is to attempt to simulate time pressure, by making participants feel they have limited time to react.
Overall, 52 participants were assigned to the Time Pressure condition, and 47 were assigned to No Time Pressure. A more equal split was aimed for, however was not possible due to the number of incomplete responses interfering with the equal randomisation of conditions.
Response Time
The decision-making speed is automatically recorded by Qualtrics, determining how long it took participants to finalise their decision. This is taken as the time from when participants opened a vignette, until they submitted their response. It was decided that the response time would be taken at the point the choice is submitted, as opposed to the last button press participants made. This is as it cannot be certain at what point participants have finished considering their response. They may still be thinking about their answer after selecting the option, but before submitting. Therefore, it cannot be assumed that the final button press was the end of their decision-making.
Justification
After each decision, participants are asked to briefly explain why they made the decision they did, imagining they are speaking to a close friend. This ensures participants think deeper into the decision they make, as they know they will have to defend it. This is presented to participants as a free entry text box, shown after each dilemma they respond to.
Pilot Study
The present study was first piloted on an ESW member, in this case a senior paramedic, to test for validity of the ethical dilemmas as well as any other issues with the survey. The only negative feedback received was that some of the dilemmas looked visually similar on the page, and could be mistaken for being the same as the dilemma before. To resolve this, a section reminding participants to read carefully since every dilemma was different was added, as well as formatting changes such as boldening the critical sections of text to make them more obviously different.
Procedure
Participants were recruited via social media, ESW were gathered via the Our Blue Light ESW charity’s social media pages, as well as being sent around stations via the researcher’s contacts. Laypeople were also gathered through social media, with some being recruited from the Our Blue Light pages, as well as through friends and family of the researcher.
Participants had access to the study through a link, which took them to the introduction page of the present study. After reading this and giving consent, the study began. Participants were randomly assigned by the Qualtrics software to either the Time Pressure or No Time Pressure condition. This affected which set of instructions they saw. Participants were all shown each of the five dilemmas, presented one by one on their screen. The dilemmas were presented in a randomised order for each participant, to avoid any order effects. Following each dilemma, participants were presented with the justification question and free entry text box. After repeating this for each dilemma, participants were presented with a debrief page, and the study concluded.
Data Analysis
To examine the choices ESW made compared to laypeople, a 2x2 chi square test will be conducted. A 2x2 chi square test will also be conducted to examine the choices made by those in the time pressure condition against those who were not. Descriptive statistics will also be presented, including the counts of each choice made separated into groups, along with means and standard deviations of response time.
In order to analyse the impact of Occupation, Time Pressure, and Type of Ethical Dilemma on the decisions participants make, a generalised linear mixed-effects model will be used (Baayen et al., 2008). The statistical family used for this model will be binomial. This test was chosen as the dependent variable here, participant choice, is a categorical variable with two options (push or no push). There are also three categorical independent variables, two of which are between-subjects factors (ESW v Layperson, Time Pressure v No Time Pressure), and one within-subjects factor (Type of Ethical Dilemma). The only random effect to be used in the model is individual subjects, as each independent variable is critical to the present study, and so will be treated as fixed effects.
To compare the response time between ESW and laypeople, as well as time pressured participants and participants with no time pressure, two one-way ANOVAs will be conducted. This was chosen as the intention here is to compare performance between two independent groups. A 2x2 ANOVA on sum scores was considered, however was not possible due to participants having simultaneous membership of two groups (e.g. ESW + Time Pressure, ESW + No time pressure).
To further analyse participant response times to the ethical dilemmas, a 2x2x5 Mixed ANOVA will be conducted. This was chosen as the method of analysis as one aim of the present study is to compare variance between ESW and laypeople, as well as participants being under time pressure or not. There is also the factor of ethical dilemma, which has five levels due to there being five different dilemmas.
Sample
This project aimed to use a total of 112 participants, with 56 of these being ESW, and 56 being laypeople. This number was calculated using the G*Power software, using an alpha of .05, power of .8, and a medium expected effect size of .35, using five levels of measurement.
In total, 99 participants were gathered for the present study. 47 of the sample were laypeople, whilst the other 52 were ESW. Of these, 22 were police officers, and 30 were ambulance crewmembers. Overall, ESW had an average of 7.7 years of experience (SD = 8.29), with ambulance staff having an average of 10.14 years (SD = 9.89), and police having an average of 4.52 years (SD = 4.17). Unfortunately, no other emergency service branches such as coast guard or firefighters completed the study.
A gender split of 47 males to 48 females was gathered, along with an average age of 35.65 years old (SD = 12.98). Three participants declined to disclose their gender, and one participant identified as agender.
Ethical Approval and Pre-Registration
This study gained ethical approval on 13/04/2021, from members of the Psychology department at Lancaster University.
This study was also pre-registered on the Open Science Frameworks website on 17/05/2021. This can be found at the following link: https://osf.io/4ecjg/?view_only=95615bd16f2c4a9db88dd77543780ec2
Materials
Survey
The present study was delivered through a Qualtrics survey file, created fully by the researcher. The survey contains standard psychological research documents, such as an information page, consent form, demographic information page, and debriefing. The survey also contains two sets of five vignettes describing ethical dilemmas for each condition of the experiment.
Demographics
Participants are asked to provide some demographic information: age, gender, and occupation. Participants are given options for occupation, including police, fire, or ambulance, as well as an option for ‘other’ emergency services, where a free typing box is presented. This is to cover occupations outside of the main three emergency services, such as coastguard or mountain rescue. If participants are not ESW, they have the option to say they are not a member of the emergency services.
Ethical Dilemmas
The present study tests a set of five ethical dilemma vignettes. To read each dilemma, see Appendix A. Each vignette describes a version of the Trolley Problem, where there is an out-of-control trolley (the word “tram” is used to make it clearer to British participants) speeding down the tracks towards a group of five people. For each dilemma, there is an active choice, or a passive choice, which entails sacrificing one life to save five, or allowing five people to die to avoid killing one person. Each dilemma presents a different single person who could be placed in danger, these are: a non-descript person, an elderly person, a co-worker, a large man, and the “culprit”.
Non-Descript Person. This dilemma is a traditional retelling of the Trolley Problem. Participants are told that there is an out-of-control trolley speeding down the tracks, towards five people who are stranded. Participants are told that they have the choice to pull a lever and divert the trolley onto a different track, however there is one person stranded on those tracks. The decision participants are faced with here is whether to make an active choice or a passive choice. The active choice is to pull the lever, diverting the trolley and saving the five, whilst sacrificing the individual. The passive choice is to not pull the lever, allowing the trolley to hit the five people, whilst saving the individual.
It is often found that people sacrifice one person to save five in this dilemma (Thomson, 1976; Greene, 2016). Responses to this condition demonstrate how people weigh up lives on a strictly numerical basis, knowing nothing about the traits of the person. By having a condition in which participants know nothing about the person on the tracks, this can be compared to responses when it is an elderly person or a co-worker on the tracks.
Elderly Person. This dilemma is the same as the non-descript person dilemma, however participants are told that the person on the tracks is elderly.
This condition has been found to affect how people respond to the Trolley Problem, with people being more likely to sacrifice the elderly person over any other ages (Kawai et al., 2014). This is interesting in the study of moral psychology, as it shows how people weigh up the worth of lives based on certain attributes, such as age. This can also be compared to how people respond when they know nothing about the person on the tracks. This is also important to investigate in an ESW context, as elderly people are more likely to be admitted to hospital (Burns, 2001), leading ambulance crews to encounter them more often.
Co-Worker. This dilemma is the same as the non-descript person dilemma, however participants are told that the person on the tracks is one of their co-workers.
This dilemma was chosen based on past research suggesting that participants are less likely to sacrifice people they perceive to be part of their identity in-group (Swann Jr et al., 2010). This is a relevant factor to investigate as part of a study into ESW, a group who develop strong in-group feelings, including having better self-care and social support (Shakespeare-Finch et al., 2002). This is also interesting when investigating ESW populations such as firefighters or police, who may be placed into situations where a co-worker is in danger whilst trying to save members of the public. This dilemma demonstrates how ESW weigh up the lives of their co-workers compared to strangers.
Large Man. In this dilemma, participants are told that there are five people on the tracks, and stood next to them is a large man. Participants are told that if they push the large man into the tracks, that would stop the trolley and the five people would be saved. The decision participants are faced with here is whether to make an active choice and push the large man onto the tracks, stopping the trolley and saving the five, or to make a passive choice and allow the trolley to hit the five people.
This is a version of the “Footbridge Dilemma”, in which it is found participants are typically less willing to make the active decision and push the man (Nichols & Mallon, 2006). It is an interesting take on the Trolley Problem dilemma, as it forces participants to make a more physical decision through pushing and directly causing a person’s death, as opposed to pulling a switch which then indirectly leads to someone’s death. This is also relevant in the study of ESW, who tend to work directly and physically with people as opposed to making indirect decisions.
Culprit. This dilemma is the same as the Large Man dilemma, however rather than a large man, participants are told that stood next to them is the “culprit”. The “culprit” is explained to participants as the person who stranded the other five people on the tracks.
This dilemma was chosen as it tests how people respond to the same physical pushing decision as the Large Man condition, however when the person they can push is not an innocent bystander, and instead is someone who is trying to end the lives of others. This allows for the investigation of how people weigh the lives of criminals compared to innocent people. This is also interesting in the study of ESW, especially when regarding police, since their occupation involves apprehending criminals so they can then be sentenced, not choosing the punishment based on their own moral reasoning.
Time Pressure
Participants who are assigned to the Time Pressure condition are told both during instructions and above each dilemma that they only have a limited amount of time to make their decision. They are told that after that time has passed, they may not be able to provide a response. This is not true, there are no time limits on any question. This is to attempt to simulate time pressure, by making participants feel they have limited time to react.
Overall, 52 participants were assigned to the Time Pressure condition, and 47 were assigned to No Time Pressure. A more equal split was aimed for, however was not possible due to the number of incomplete responses interfering with the equal randomisation of conditions.
Response Time
The decision-making speed is automatically recorded by Qualtrics, determining how long it took participants to finalise their decision. This is taken as the time from when participants opened a vignette, until they submitted their response. It was decided that the response time would be taken at the point the choice is submitted, as opposed to the last button press participants made. This is as it cannot be certain at what point participants have finished considering their response. They may still be thinking about their answer after selecting the option, but before submitting. Therefore, it cannot be assumed that the final button press was the end of their decision-making.
Justification
After each decision, participants are asked to briefly explain why they made the decision they did, imagining they are speaking to a close friend. This ensures participants think deeper into the decision they make, as they know they will have to defend it. This is presented to participants as a free entry text box, shown after each dilemma they respond to.
Pilot Study
The present study was first piloted on an ESW member, in this case a senior paramedic, to test for validity of the ethical dilemmas as well as any other issues with the survey. The only negative feedback received was that some of the dilemmas looked visually similar on the page, and could be mistaken for being the same as the dilemma before. To resolve this, a section reminding participants to read carefully since every dilemma was different was added, as well as formatting changes such as boldening the critical sections of text to make them more obviously different.
Procedure
Participants were recruited via social media, ESW were gathered via the Our Blue Light ESW charity’s social media pages, as well as being sent around stations via the researcher’s contacts. Laypeople were also gathered through social media, with some being recruited from the Our Blue Light pages, as well as through friends and family of the researcher.
Participants had access to the study through a link, which took them to the introduction page of the present study. After reading this and giving consent, the study began. Participants were randomly assigned by the Qualtrics software to either the Time Pressure or No Time Pressure condition. This affected which set of instructions they saw. Participants were all shown each of the five dilemmas, presented one by one on their screen. The dilemmas were presented in a randomised order for each participant, to avoid any order effects. Following each dilemma, participants were presented with the justification question and free entry text box. After repeating this for each dilemma, participants were presented with a debrief page, and the study concluded.
Data Analysis
To examine the choices ESW made compared to laypeople, a 2x2 chi square test will be conducted. A 2x2 chi square test will also be conducted to examine the choices made by those in the time pressure condition against those who were not. Descriptive statistics will also be presented, including the counts of each choice made separated into groups, along with means and standard deviations of response time.
In order to analyse the impact of Occupation, Time Pressure, and Type of Ethical Dilemma on the decisions participants make, a generalised linear mixed-effects model will be used (Baayen et al., 2008). The statistical family used for this model will be binomial. This test was chosen as the dependent variable here, participant choice, is a categorical variable with two options (push or no push). There are also three categorical independent variables, two of which are between-subjects factors (ESW v Layperson, Time Pressure v No Time Pressure), and one within-subjects factor (Type of Ethical Dilemma). The only random effect to be used in the model is individual subjects, as each independent variable is critical to the present study, and so will be treated as fixed effects.
To compare the response time between ESW and laypeople, as well as time pressured participants and participants with no time pressure, two one-way ANOVAs will be conducted. This was chosen as the intention here is to compare performance between two independent groups. A 2x2 ANOVA on sum scores was considered, however was not possible due to participants having simultaneous membership of two groups (e.g. ESW + Time Pressure, ESW + No time pressure).
To further analyse participant response times to the ethical dilemmas, a 2x2x5 Mixed ANOVA will be conducted. This was chosen as the method of analysis as one aim of the present study is to compare variance between ESW and laypeople, as well as participants being under time pressure or not. There is also the factor of ethical dilemma, which has five levels due to there being five different dilemmas.
Publisher
Lancaster University
Format
Main Data_35645845/Excel.csv , 35645845 Occupation Response Time Sum Scores/Excel.csv , 35645845 Time Pressure Response Time Sum Scores/Excel.csv, 35645845_RStudio Code/RStudio.R
Identifier
Wright2021
Contributor
Paige Givin & Chloe Crawshaw
Rights
Open
Relation
None
Language
English
Type
Data
Coverage
LA1 4YW
LUSTRE
Supervisor
Prof. Nicola Power
Project Level
MSC
Topic
Social
Sample Size
99
Statistical Analysis Type
ANOVA, Chi-Squared, Linear Mixed Effects Modelling
Files
Collection
Citation
James Wright, “Comparison of Ethical Decision-Making in Emergency Service Workers and Laypeople ,” LUSTRE, accessed April 28, 2024, https://www.johnntowse.com/LUSTRE/items/show/107.