Grave Decisions

Columbia psychologist Sheena Iyengar applies her expertise in human decision making to the most difficult question of all.

by David J. Craig Published Winter 2010-11
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Illustrations by James SteinbergIt is, increasingly, the way we die: Hooked up to ventilators, IV drip bags, feeding tubes, and catheters, we breathe on, stubbornly and uncomfortably, until someone tells a doctor, Let him go.

Today, nearly one in five Americans spends their final days in a hospital’s intensive-care unit. Many will have been connected to life-support systems for weeks or even months. And once a terminally ill person has gone unconscious, it’s usually a loved one who decides when the most aggressive forms of life support are removed.

When is the right time to pull the plug? When does medical technology become, rather than a life-saving miracle, a way of prolonging a person’s suffering?

“In U.S. hospitals, people don’t get much guidance on this,” says Columbia social psychologist Sheena Iyengar, who studies how people make end-of-life decisions. “A doctor will tell you if he thinks your mother or father is comfortable, but if you’re considering letting them go, you’ll need to broach the subject yourself. The doctor will then give a quick overview of the options and say, ‘Well, tell us whenever you’ve decided,’ and walk off.”

It’s not this way in all Western countries. In France, for instance, doctors consider it a part of their job to inform family members when they think it’s time to remove a person from life support. “The French take a more paternalistic approach,” says Iyengar. “They do this partly to protect the family from the stress of making the decision.”

For many Americans, the idea of letting a doctor decide when a parent or child should die might seem outrageous. After all, fear of so-called death panels — an allusion to government rationing of medical treatment — nearly derailed Barack Obama’s health-care-reform bill last year. Iyengar believes, however, that Americans have a lot to gain by deferring to doctors. She’s found that people who receive guidance from experts when making complicated decisions, including when to suspend life support, tend to be more at peace with the outcomes.

“Americans value personal autonomy almost as much as they value life itself,” says Iyengar. “But we need to ask ourselves: Are there some choices we’re better off not making?”

How many is too many?

Iyengar, who is the S. T. Lee Professor of Business at Columbia Business School, has made a career of decoding how we make decisions, from the yogurt we place in our shopping carts to the mutual funds we select for our IRAs. Her conclusion: Although we crave lots of choices, we get overwhelmed easily, even paralyzed with indecision, when weighing our options.

Iyengar, 41, is a celebrity in social science circles, but her ongoing work on end-of-life care isn’t yet well known. She’s built her reputation by teasing out the subtleties of how people make much less weighty decisions.

Iyengar’s big moment of inspiration came in a grocery store in the early 1990s, while she was a graduate student at Stanford. She recounts the episode in her recent book, The Art of Choosing, which provides a readable overview of her work. Back in Menlo Park, California, Iyengar often browsed the gourmet aisles of Draeger’s Market, only to leave empty-handed. She wondered, Might hundreds of varieties of produce be enough to cloud a shopper’s mind?

To test her hypothesis, Iyengar set up a tasting booth at Draeger’s. She offered some shoppers 6 varieties of jam, and others 24. She found that customers were more likely to approach the table with the larger selection, yet they were 10 times more likely to buy jam from the table with only six samples. Too many possibilities, it seemed, left a bad taste in shoppers’ mouths.

The jam study — which Iyengar soon repeated using Godiva chocolates and other foods, with the same result — provided a news-you-can-use nugget that made headlines across the country. It would also prove influential in the field of psychology. Since the 1960s, researchers interested in human decision making had focused mainly on how our irrationality hinders our ability to make good choices, such as through our tendency to be biased in favor of familiar options. Iyengar’s work opened up lots of new questions, such as: When can choosing be a pleasant experience? How many choices are too many? How does the range of our options affect our satisfaction with what we eventually choose?

Another one of Iyengar’s early studies found that Americans who observe a fundamentalist religious faith are happier than those who follow a more liberal practice. Her findings seemed counterintuitive to many psychologists: She found that people who observe customs that limit their personal freedom — for example, by prohibiting premarital sex, alcohol, or some kinds of music — nevertheless feel a greater sense of control over their lives.

“Iyengar’s work is brilliant and has had a profound impact,” Harvard psychologist Daniel Gilbert recently told the Chronicle of Higher Education. “It has shown us that there are cognitive and emotional costs to decision freedom.”

Although her work is rooted in psychology, Iyengar is an interdisciplinary scholar, drawing from a variety of fields — business, economics, philosophy, sociology, and biology. Over the course of her career, she’s found more and more practical applications for her work. In recent years, she’s examined enrollment in 401(k) retirement savings plans, determining that participation rates fall as the number of fund options increases. Ditto for Medicare’s prescription-drug plan.

And companies are responding.

Partly as a result of the jam study, consulting powerhouse McKinsey & Company instituted its 3-by-3 Rule: Never present clients with more than three options at a time. Similarly, Iyengar tells of an encounter with a Fidelity Investments executive who told her the study inspired a new mantra at the firm: Narrow it down.

Iyengar’s work has also demonstrated cultural variables associated with choice. She found, for instance, that college students in Japan are less bothered than American students about being told what to wear, what to eat, and what time to awake in the morning.

“The Japanese find meaning by fitting in and making other people happy,” Iyengar says, “and therefore they demand autonomy in far fewer aspects of their lives.”

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