Evaluating Risk and Benefit Sensitivity for Cognitive Treatments

Ethical judgments require clinicians, researchers, research participants, and patients to weigh risks and benefits. Novel treatments for cognitive deficits are rapidly emerging, but little is known about how individual differences in risk and benefit sensitivity influence ethical judgments to administer treatments. The public plays important roles as citizens, taxpayers, and consumers of cognitive treatments, yet little is known about how they evaluate risks and benefits in ethical judgments. We examined the influence of risk and benefit sensitivity on the public's choices about treating cognitive dysfunction. We administered surveys, cognitive measures, and an ethical judgment paradigm to 425 participants recruited via Amazon Mechanical Turk. Participants were asked to choose whether to recommend a hypothetical cognitive treatment with varying degrees of risks and benefits across seven different cognitive domains. We expected participants to be more risk-sensitive than benefit-sensitive, especially when evaluating treatments that influence cognitive functions central to personal identity such as mood, self-control, and long-term memory. Unexpectedly, participants were slightly more sensitive to benefits and showed inter-domain stability across cognitive dysfunctions. Our results suggest that risks and benefits influence whether the public might recommend cognitive treatments. The relatively higher weight placed on benefits could be explained by prominent theories of decision-making under risk. Overall, this study suggests that judgment tasks can be adapted to study psychological ethical choices about treatments for cognitive deficits. Further study of individual variation in risk and benefit sensitivity and their influence on real-world ethical choices about cognitive repair could inform frameworks to enhance optimal neuroethical decision-making.