Protecting who I am: The role of gender identity in medical decision making

Using a dual process theoretical approach, this study tests the central concept that identity is a protected value and examines how people process conflicts between identity and risk when making medical decisions. Gender congruent males (N=187), gender congruent females (N=471), and transgender men (N=229) participated in an online study of how people process conflicts between identity and risk. Across four medical scenarios, participants were asked to choose between an identity preserving option that was paired with a higher risk outcome and an identity threatening option that was paired with a lower risk option. Then participants completed a questionnaire assessing gender identity, personal values, and basic demographics. Results indicated that identity is a protected value. Respondents were not willing to trade the integrity of their gender identity for a lower risk alternative, even when the option to preserve identity carried a higher risk of death. Both participant gender and vignette protagonist gender predicted choices across the decision problems. More specifically, when the participant's gender identity matched the gender identity of the protagonist in the medical scenario (e.g., a female-identified respondent making a choice about which breast cancer treatment to pick for the female in the medical dilemma), participants chose the identity-preserving option more than respondents whose gender identities were not matched to the protagonist (e.g., male or transgender men's responses to the breast cancer dilemma). The current findings demonstrate that identity is a protected value in decision making in medical contexts, even when the identity preserving context involves greater risk than an alternative choice. Thus, in line with dual process theory, these data suggest that surgical decision making is a function of the risk perceptions that are shaped by identity and values.