The American psychologist Barry Schwartz, who can be read frequently in The New York Times or listened to in TED (Technology, Entertainment, Design) conferences, invites us to reflect on the paradox of choice. His talk begins with what he calls the "official dogma" of all Western industrial societies, which states: "If we are interested in maximizing the welfare of our citizens, the way to do so is to maximize individual freedom." The reason for this is that freedom itself is good, valuable, praiseworthy and essential for human beings: "If people have freedom, each of us can act on their own to do things that will maximize our well-being and no one will have to make decisions for us. The way to maximize freedom is to maximize choice: the more possibilities people have, the more freedom and greater well-being they will have."
This concept also applies to health services with the transfer of responsibility to the patient when choosing therapeutic alternatives, both in free market environments such as the American, as in national health systems such as English or Spanish.
The good thing about having maximized the ability to choose is known by all, but what about the bad news? Schwartz highlights the following negative effects:
- Paralysis. With so many options to choose from, people find it difficult to make the choice and often a paralysis occurs as a result of having too many alternatives.
- Reduction of satisfaction. The wide range of possibilities that we have, makes the opportunity cost of each decision very high, that is, the act of choosing involves not choosing other options and that makes us always ask ourselves if we really made the right decision.
- Increased expectations and disappointment. Our expectations about the result increase with the number of alternatives, since the logic tells us that if we can choose between several options some has to conform to us to perfection and the problem emerges when this expectation does not occur.
Schwartz, showing a fish bowl, asks: "What does this fish know? Nothing is possible in this fish bowl... Poor imagination and myopic vision of the world: that's the way I read it the first time... But the more I think, the more I come to the opinion that this fish knows something... because if you break the fishbowl so that everything is possible, you don’t have freedom, you increase the paralysis and you diminish the satisfaction. We all need a fishbowl although certainly this is very limited, perhaps even for the fish... but the absence of the fish tank is a recipe for misery, and perhaps for disaster."