Do Moral Views Change during a Crisis? An Experiment on Health Care Priority Setting

Background Resource scarcity during large-scale crises, such as pandemics, can increase the emphasis on efficiency in medical decision making. However, it remains unclear whether such shifts are primarily driven by the direct experience of scarcity or by the way in which ethical principles for health care priority setting are expressed in the context of a crisis. This study investigates whether a national crisis affects public support for health care priority-setting principles and whether abstract versus concrete formulations of these principles shape that support. Design We conducted a preregistered online experiment ( N = 1,404) to examine public attitudes toward three ethical principles formalized in the Swedish ethical platform—human dignity, needs-solidarity, and cost-effectiveness—in both crisis and noncrisis contexts. We also manipulated how the principles were presented, using either abstract or concrete formulations. Results In the crisis condition, support for the human dignity and cost-effectiveness principles decreased, while support for the needs-solidarity principle increased. However, these effects were small, and the overall ranking of the principles remained stable. Notably, the level of abstractness had a stronger impact than the crisis context did: support for needs solidarity was higher when described abstractly, whereas support for cost-effectiveness increased when it was presented in a more concrete, action-oriented way. Support for the human dignity principle was unaffected by the abstractness manipulation. Conclusion The findings suggest that people’s moral views are relatively stable in the face of crisis. Rather than the crisis context itself, the way ethical principles are formulated—abstractly or concretely—may be a more powerful driver of shifts in public support for different moral values in health care priority setting. Highlights Public support for ethical principles remained largely stable during a simulated national crisis. The level of abstraction in how principles were presented strongly influenced support. Support for needs-solidarity increased in a crisis, while cost-effectiveness support declined. The way ethical principles were formulated had a greater impact than the presence of a crisis.