- Title
- End-Of-Life Decision Making: A Behavioural Economics Perspective
- Creator
- Proulx, Damon James
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Since the introduction of the ‘Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002 in the Netherlands, assisted dying, broadly termed ‘Euthanasia’, has become a controversial health policy that crosses mainstream social, moral and ethical boundaries. Nevertheless, it presents a holistic solution to medical resource scarcity in palliative care facing global healthcare systems. However, contrary to the Netherlands’ , elsewhere, policymakers struggle to evaluate the economic benefit of euthanasia. The conflict is due to the complex transdisciplinary nature of evidence underpinning policy feasibility. These factors carry significant personal and religious biases that undermine the direction of euthanasia policy to align with true social preferences from scientifically driven policy decisions in line with the Netherlands. Consequently, in examples such as North America, Europe and Australia, consistent failures to regulate euthanasia occur. As such, this poses the following policy question, what is the relationship between state and public preference on euthanasia policy? In the existing literature, three issues hinder an answer to this policy problem. The first issue is in health science, which fails to apply psycho-social insights underlying socio-demographic determinants to euthanasia and distinguish these from suicide. The second issue is in political psychology, as it is yet to consider how euthanasia relates to voter psychology and how it may present forecastable insights into political feasibility. The third issue relates to understanding the relationship between voter preferencing in public and state contexts, associated vote motivations and formal institutional circumstances dictating these behaviours and policy outcomes. The culmination of these issues presents an inherently interdisciplinary problem to research and policy, which is overlooked by health and social science initiatives, and is without an empirical contribution from the behavioural economics literature which may present a viable solution. Specifically, each issue contains transferrable theoretical and applied overlaps to behavioural economic theory in social, welfare, institutional, public choice and political economics. However, all behavioural economic initiatives for euthanasia are theoretical, and none encompass application to these three issues. Therefore, the aim of this thesis is to amend these significant oversights in the behavioural economics literature. Three empirical economic studies are used to measure the social, political and institutional feasibility of emerging euthanasia frameworks. Each study adopts randomly sampled cross-sectional survey data from the Netherlands. The first published study adopts the European Values Study and targets health sciences to distinguish between suicide and euthanasia socio-demographic determinant frameworks. It draws from psycho-social theory in behavioural theory and applies this through quasi-experimental methodology. It finds euthanasia acceptance increases over time compared to suicide underpinned by intergenerational, religious institutional and framing effects bias across policy changes. The second study adopts the Dutch Parliamentary Election Studies and examines individual voter psychology to euthanasia at federal elections to identify underlying institutional factors that may undermine euthanasia in the political process. The study draws from political and economic psychology, as well as institutional economics and assesses this via a Bayesian model averaging technique. It finds that euthanasia is strongly associated with political cynicism and government satisfaction, suggesting in-group psychology to euthanasia policy. The third study adopts the Dutch Parliamentary Election Studies and Dutch Parliamentary Behaviour dataset. It examines revealed vote decisions from the public and policymakers against socio-demographic and institutional predictors in a quasi-experimental design underpinned by a narrative analytical technique. This third study draws from experimental findings and theory in political economics and public choice. It finds that public and state preferences for euthanasia do not align despite public voters holding a high preference for euthanasia when voting for conservative parties. Only after the policy change did political parties adjust in line with social preferences, which elicits characteristics of retrospective voting, path dependency behaviour, political learning and Bayesian belief updating from economic theory. These findings provide a significant and original contribution to behavioural economics by introducing empirical economic applications to euthanasia research. Additionally, the research outcomes provide a transferrable framework for policymakers to measure these social, political and institutional phenomena in other contexts to determine the feasibility of emerging euthanasia policy proposals.
- Subject
- attitudes; behavioural; political process; psychology; public choice; psycho-social; social Ecology; socio-demographics; suicide; voter; voting; welfare; economics; elections; euthanasia; institutions; microeconometric; microeconomics; moral; norms
- Identifier
- http://hdl.handle.net/1959.13/1476714
- Identifier
- uon:49850
- Rights
- Copyright 2023 Damon James Proulx
- Language
- eng
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