Regret

Regret is the negative emotion that we experience when realizing or imagining that our present situation would have been better had we decided or acted differently. Regret originates in a comparison between outcomes of a chosen course of action and the nonchosen alternatives in which the latter outperform the former. It is clearly a painful emotion that reflects on one's own causal role in the current, suboptimal situation. The emotion regret is accompanied by feelings that one should have known better and having a sinking feeling, by thoughts about the mistake one has made and the opportunities lost, by tendencies to kick oneself and to correct one's mistake, by desires to undo the event and get a second chance, and by actually doing this if given the opportunity. Put differently, regret is experienced as an aversive state that focuses attention on one's own causal role in the occurrence of a negative outcome. It is thus a cognitively based emotion that motivates one to think about how the negative event came about and how one could change it or how one could prevent its future occurrence.

As such, regret is unique in its relation to decision making and hence to feelings of responsibility for the negative outcome. This makes regret an emotion that is highly relevant for medical decision making. One only experiences regret over a bad outcome when, at some point in time, one could have prevented the outcome from happening. Of course, other emotions can also be the result of decisions; for example, one may be disappointed with a decision outcome or happy about the process by which one made a choice. But, all these other emotions can also be experienced in situations where no decisions are made, whereas regret is exclusively tied to decisions. For example, one can be disappointed in being the carrier of a genetic disease and happy with the fact that the medication works, but one cannot regret these instances. Thus, in regret, personal agency and responsibility are central, whereas in other aversive emotions, such as anger, fear, and disappointment, agency for the negative outcomes is either undetermined or in the environment or in another agent. Hence, regret is the prototypical decision-related emotion in the sense that it is felt in response to a decision and that it can influence decision making.

Tymstra may have been the first to introduce the concept of anticipated regret into the domain of medical decision making. He described the imperative character of medical technology and argued that the mere existence of medical-technical possibilities makes it hard for doctors and patients to reject them. The success of, among others, prenatal testing and IVF (in vitro fertilization) is argued to be testimony to the effects of anticipated regret. The reasoning is that as soon as these new technologies come into play, patients (and doctors) imagine not trying them and thereby forgo a potential improvement or remedy. The accompanying sense of regret urges both doctors and patients to use this new technology. The other side of the imperative character of regret is that even the ones who opted for using the new technologies but did not obtain the hoped-for outcomes generally do not regret this, because they felt that “at least they tried.” This is consistent with recent empirical findings in the science of regret by Sorum and colleagues.

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