Book Description

This study tests the central concept that identity is a protected value. More specifically, the purpose of the proposed research is to assess how people process conflicts between identity and risk when making medical decisions, especially in regard to how people trade (or refuse to trade) protected values such as gender identity (i.e., an enduring sense of self as a man or a woman or some combination thereof) against important risks, such as those encountered in identity-relevant surgeries (e.g., sex reassignment surgery, prostatectomy, and mastectomy). 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. Participants were randomized into a control condition, a standard dual process condition, or a fuzzy-trace theory condition. 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. Gender identity was measured using personal report and validated using the Hoffman Gender Scale. Personal values were scored on a 10-point Likert rating scale from completely unimportant to extremely important. Results indicated that identity is a protected value and when triggered in threatening medical scenarios, people were not willing to trade the integrity of their gender identity for a less risky alternative, even when the option to preserve identity carried a higher risk of death. Both participant gender and the gender of the protagonist in the hypothetical medical dilemmas 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). Thus, 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. These data also provide an empirical test of standard dual process against fuzzy-trace theory mental representations in decision making that involves a trade off.