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It is increasingly recognized that emotions can have an important impact on judgment and decision making. However, in many respects, it remains an undeveloped area of judgment and decision making, particularly in medicine. First, emotions are difficult to characterize or define. Second, the causal mechanisms by which emotions influence decisions—independent of purely cognitive interactions—are poorly understood. Third, the circumstances in which emotions are most important in changing decisions are only partially understood. Finally, most of the well-controlled empirical data on emotions and decision making are outside the field of medicine, rarely involving physicians and patients. Each of these limitations is important when describing the role emotions play in medical decision making, so the sections that follow address each of these points in turn.

Defining Emotions

Clear definitions are crucial for outlining the role of emotions in judgment and decision making. Definitions or characterizations of emotion range across multiple disciplines. The philosopher Paul Griffiths proposes dividing what we commonly call emotions into two categories of mental phenomenon: lower-level “affect programs” and higher-level “irruptive emotional states.” The first category of emotions consists of automated, stereotypical reactions that provide rapid responses to stimuli, seem rooted in evolutionarily justified patterns, are cross-cultural, and are correlated with survival needs in all higher animals. They are represented by the “lower” emotions of fear, anger, happiness, sadness, surprise, and disgust. The second category of emotions consists of those with complex mixtures of cognitive and emotional elements that occur more passively and interrupt other cognitive processes and tie together our mental lives in the long run. They are characterized by emotions such as love, guilt, envy, jealousy, and pride. They remain separate from other, more diffuse dispositional or visceral states referred to most accurately as “moods,” such as anxiety, depression, and elation.

The political scientist Jon Elster presents a cluster of “features” that are robustly associated with human emotions, but none of which are essential to them. These features include being unbidden in occurrence, possessing cognitive antecedents, having intentional objects, being arousing, leading to action tendencies, and having specific valence. He specifically distinguishes human emotions from emotions that have a sudden onset, brief duration, and characteristic expressions. These correspond to the affect programs Griffiths describes, which we largely share with other animals and across human societies and cultures.

The psychologists Reid Hastie and Robin Dawes define emotions as reactions to motivationally significant stimuli and situations that usually include three components: (1) a cognitive appraisal, (2) a signature physiological response, and (3) an accompanying phenomenal experience. This captures, at least operationally, the features of emotions that are most relevant for decision making.

Overall, there seems to be agreement that there are two groups of emotions. The first group consists of those that are more basic and stereotypical, are rooted most obviously in evolutionary survival, and suddenly interrupt ongoing cognition to cause different behavior. The second group consists of more complex cognitive states, with cognitive antecedents, less obviously tied to our evolutionary roots and less obviously interrupting other cognitive states. A third category, which is left aside here, consists of moods, which are more diffuse mental states that seem to be predispositions or precursors to other states and less obviously tied to specific actions.

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