Affective Forecasting - in Health

In Health

Affective forecasting has implications in health decision-making and medical ethics and policy. Research in health-related affective forecasting suggests that nonpatients consistently underestimate the quality of life associated with chronic health conditions and disability. The so-called "disability paradox" states the discrepancy between self-reported levels of happiness amongst chronically ill people versus the predictions of their happiness levels by healthy people. The implications of this forecasting error in medical decision-making can be severe, because judgments about future quality of life often inform health decisions. Inaccurate forecasts can lead to patients refusing life-saving treatment in cases when the treatment would involve a drastic change in lifestyle, for example, the amputation of a leg. A patient who falls victim to focalism would fail to take into account all the aspects of their life that would remain the same after losing a limb. Although Halpern and Arnold suggest interventions to foster awareness of forecasting errors and improve medical decision-making amongst patients, the lack of direct research in the impact of biases in medical decisions provides a significant challenge.

Research also indicates that affective forecasts about future quality of life are influenced by the forecaster's current state of health. Whereas healthy individuals associate future low health with low quality of life, less healthy individuals do not forecast necessarily low quality of life when imagining having poorer health. Thus, patient forecasts and preferences about their own quality of life may conflict with public notions. Because a primary goal of healthcare is maximizing quality of life, knowledge about patients' forecasts can potentially inform policy on how resources are allocated.

Some doctors suggest that research findings in affective forecasting errors merit medical paternalism. Others argue that although biases exist and should support changes in doctor-patient communication, they do not unilaterally diminish decision-making capacity and should not be used to endorse paternalistic policies. This debate captures the tension between medicine's emphasis on protecting the autonomy of the patient and an approach that favors intervention in order to correct biases.