The impact of hindsight bias on the diagnosis of perioperative events by anesthesia providers: A multicenter randomized crossover study.

STUDY OBJECTIVE: Hindsight bias is the tendency to overestimate the predictability of an event after it has already occurred. We aimed to evaluate whether hindsight bias influences the retrospective interpretation of clinical scenarios in the field of anesthesiology, which relies on clinicians making rapid decisions in the setting of perioperative adverse events. DESIGN: Two clinical scenarios were developed (intraoperative hypotension and intraoperative hypoxia) with 3 potential diagnoses for each. Participants completed a crossover study reviewing one case without being informed of the supposed ultimate diagnosis (i.e., no 'anchor' diagnosis), referred to as their foresight case, and the other as a hindsight case wherein they were informed in the leading sentence of the scenario that 1 of the 3 conditions provided was the ultimate diagnosis (i.e., the diagnosis the participant might 'anchor' to if given this information at the start). Participants were randomly assigned to (1) which scenario (hypotension or hypoxia) was presented as the initial foresight case and (2) which of the 3 potential diagnoses for the second case (the hindsight case, which defaulted to whichever case the participant was not assigned for the first case) was presented as the ultimate diagnosis in the leading sentence in a 2 (scenario order) x 3 (hindsight case anchor) between-subjects factorial design (6 possible randomization assignments). SETTING: Two academic medical centers. PARTICIPANTS: Faculty, fellow, and resident anesthesiologists and certified nurse anesthetists (CRNAs). INTERVENTIONS: None. MEASUREMENTS: After reading each clinical scenario, participants were asked to rate the probability (%) of each of three potential diagnoses to have caused the hypotension or hypoxia. Compositional data analysis (CoDA) was used to compare whether diagnosis probabilities differ between the hindsight and the foresight case. MAIN RESULTS: 113 participants completed the study. 59 participants (52%) were resident anesthesiologists. Participants randomized to the hypotension scenario as a hindsight case were 2.82 times more likely to assign higher probability to the pulmonary embolus diagnosis if provided as an anchor (95% CI, 1.35-5.90; P = 0.006) and twice as likely to assign higher probability to the myocardial infarction diagnosis if provided as an anchor (95% CI, 1.12-3.58; P = 0.020). Participants randomized to the hypoxia scenario as a hindsight case were 1.78 times more likely to assign higher probability to the mainstem bronchus intubation diagnosis if provided in the anchor statement (95% CI, 1.00-3.14; P = 0.048) and 3.72 times more likely to assign higher probability to the pulmonary edema diagnosis if provided as an anchor (95% CI, 1.88-7.35; P < 0.001). CONCLUSIONS: Hindsight bias influences the clinical diagnosis probabilities assigned by anesthesia providers. Clinicians should be educated on hindsight bias in perioperative medicine and be cognizant of the effect of hindsight bias when interpreting clinical outcomes.

Can knowledgeable experts assess costs and outcomes as if they were ignorant? An experiment within precision medicine evaluation.

OBJECTIVES: The purpose of this study is to evaluate the validity of the standard approach in expert judgment for evaluating precision medicines, in which experts are required to estimate outcomes as if they did not have access to diagnostic information, whereas in fact, they do. METHODS: Fourteen clinicians participated in an expert judgment task to estimate the cost and medical outcomes of the use of exome sequencing in pediatric patients with intractable epilepsy in Thailand. Experts were randomly assigned to either an "unblind" or "blind" group; the former was provided with the exome sequencing results for each patient case prior to the judgment task, whereas the latter was not provided with the exome sequencing results. Both groups were asked to estimate the outcomes for the counterfactual scenario, in which patients had not been tested by exome sequencing. RESULTS: Our study did not show significant results, possibly due to the small sample size of both participants and case studies. CONCLUSIONS: A comparison of the unblind and blind approach did not show conclusive evidence that there is a difference in outcomes. However, until further evidence suggests otherwise, we recommend the blind approach as preferable when using expert judgment to evaluate precision medicines because this approach is more representative of the counterfactual scenario than the unblind approach.

The function of REM and NREM sleep on memory distortion and consolidation.

During rapid eye movement (REM) sleep, newly consolidated memories can be distorted to adjust the existing memory base in memory integration. However, only a few studies have demonstrated the role of REM sleep in memory distortion. The present study aims to clarify the role of REM sleep in the facilitation of memory distortion, that is, hindsight bias, compared to non-rapid eye movement (NREM) sleep and wake states. The split-night paradigm was used to segregate REM and NREM sleep. The hypotheses are (1) hindsight bias-memory distortion-is more substantial during REM-rich sleep (late-night sleep) than during NREM-rich sleep (early-night sleep); (2) memory stabilization is more substantial during NREM-rich sleep (early-night sleep) than during REM-rich sleep (late-night sleep); and (3) memory distortion takes longer time than memory stabilization. The results of the hindsight bias test show that more memory distortions were observed after the REM condition in comparison to the NREM condition. Contrary to the hindsight bias, the correct response in the word-pair association test was observed more in the NREM than in the REM condition. The difference in the hindsight bias index between the REM and NREM conditions was identified only one week later. Comparatively, the difference in correct responses in the word-pair association task between the conditions appeared three hours later and one week later. The present study found that (1) memory distortion occurs more during REM-rich sleep than during NREM-rich sleep, while memory stabilization occurs more during NREM-rich sleep than during REM-rich sleep. Moreover, (2) the newly encoded memory could be stabilized immediately after encoding, but memory distortion occurs over several days. These results suggest that the roles of NREM and REM sleep in memory processes could be different.

Visual hindsight bias for abnormal mammograms in radiologists.

Purpose: Hindsight bias-where people falsely believe they can accurately predict something once they know about it-is a pervasive decision-making phenomenon, including in the interpretation of radiological images. Evidence suggests it is not only a decision-making phenomenon but also a visual perception one, where prior information about an image enhances our visual perception of the contents of that image. The current experiment investigates to what extent expert radiologists perceive mammograms with visual abnormalities differently when they know what the abnormality is (a visual hindsight bias), above and beyond being biased at a decision level. Approach: N=40 experienced mammography readers were presented with a series of unilateral abnormal mammograms. After each case, they were asked to rate their confidence on a 6-point scale that ranged from confident mass to confident calcification. We used the random image structure evolution method, where the images repeated in an unpredictable order and with varied noise, to ensure any biases were visual, not cognitive. Results: Radiologists who first saw an original image with no noise were more accurate in the max noise level condition [area under the curve (AUC)=0.60] than those who first saw the degraded images (AUC=0.55; difference: p=0.005), suggesting that radiologists' visual perception of medical images is enhanced by prior visual experience with the abnormality. Conclusions: Overall, these results provide evidence that expert radiologists experience not only decision level but also visual hindsight bias, and have potential implications for negligence lawsuits.

Outcome effects, moral luck and the hindsight bias.

In a series of ten preregistered experiments (N = 2043), we investigate the effect of outcome valence on judgments of probability, negligence, and culpability - a phenomenon sometimes labelled moral (and legal) luck. We found that harmful outcomes, when contrasted with neutral outcomes, lead to an increased perceived probability of harm ex post, and consequently, to a greater attribution of negligence and culpability. Rather than simply postulating hindsight bias (as is common), we employ a variety of empirical means to demonstrate that the outcome-driven asymmetry across perceived probabilities constitutes a systematic cognitive distortion. We then explore three distinct strategies to alleviate the hindsight bias and its downstream effects on mens rea and culpability ascriptions. Not all strategies are successful, but some prove very promising. They should, we argue, be considered in criminal jurisprudence, where distortions due to the hindsight bias are likely considerable and deeply disconcerting.

The role of perceptual difficulty in visual hindsight bias for emotional faces.

Visual hindsight bias, also known as the "saw-it-all-along" effect, is the tendency to overestimate one's perceptual abilities with the aid of outcome knowledge. Recently, Giroux et al. (2022, Emotion, https://doi.org/10.1037/emo0001068 ) reported robust visual hindsight bias for emotional faces except for happy. We examined whether the difficulty of emotional processing could explain their finding. As in Giroux et al., participants saw a blurred image of an emotional face (happy, angry, or neutral) that progressed to clear and were instructed to stop the clearing process when they were able to identify the emotion (foresight trials). They then were shown the clearest image of each face and determined the emotion, followed by a memory task where they were asked to adjust the blur levels to indicate the point at which they had identified the emotion earlier (hindsight trials). Experiment 1 replicated Giroux et al.'s finding, showing that participants stopped the image at a higher degree of blur during the hindsight trials than they had during the foresight trials (i.e., a visual hindsight bias) for the angry and neutral faces but not happy faces. Experiment 2 manipulated the perceptual difficulty of angry and happy faces. While the easy faces replicated the results of Experiment 1, both angry and happy faces produced strong bias when made difficult. A multinomial processing tree model suggests that visual hindsight bias for emotional faces, while robust, is sensitive to perceptual processing difficulties across emotions.

Pragmatic, constructive, and reconstructive memory influences on the hindsight bias.

In hindsight, when the outcome of an uncertain scenario is already known, we typically feel that this outcome was always likely; hindsight judgments of outcome probabilities exceed foresight judgments of the same probabilities without outcome knowledge. We extend prior accounts of hindsight bias with the influence of pragmatic communication inherent in the task and the consolidation of self-generated responses across time. In a novel 3 × 2 within-participants design, with three sequential judgments of outcome probabilities in two scenarios, we replicated the within-participants hindsight bias observed in the classic memory design and the between-participants hindsight bias in a hypothetical design simultaneously. Moreover, we reversed the classic memory design and showed that subjective probabilities also decreased when participants encountered foresight instructions after hindsight instructions, demonstrating that previously induced outcome knowledge did not prevent unbiased judgments. The constructive impact of self-generated and communicated judgments ("saying is believing") was apparent after a 2-week consolidation period: Not outcome knowledge, but rather the last pragmatic response (either biased or unbiased) determined judgments at the third measurement. These findings highlight the short-term malleability of hindsight influences in response to task pragmatics and has major implications for debiasing.

Retrospective Perceptions of Grooming in Same-Sex versus Opposite-Sex Child Sexual Abuse.

Research on child sexual abuse (CSA) has predominantly focused on opposite-sex (e.g., male adult-female child) adult-child pairs, neglecting same-sex (e.g., male adult-male child) adult-child pairs. Grooming behaviors are an early indicator of CSA and while it is important to recognize grooming to prevent abuse, research has shown that detecting these behaviors is a difficult task. Despite this difficulty, people retrospectively overestimate their ability to recognize abuse once it is clear that abuse has occurred. The current study investigated how outcome information (abuse did or did not occur) and the sex of the adult-child pair influenced perceptions of adult-child interactions. Participants evaluated vignettes depicting grooming and non-grooming behaviors in same-sex and opposite-sex adult-child conditions. Participants who were told CSA occurred provided higher likelihood ratings that abuse occurred than participants who were not given information about the abuse. There was some evidence that gender pairings influenced retrospective perceptions of these interactions.

Perspective-taking and hindsight bias: When the target is oneself and/or a peer.

President Trump reacted to a reporter's query about the coronavirus outbreak by stating that the reporter was a "lousy journalist", underscoring the importance of perspective-taking in social exchanges. Egocentrism is the belief that others share the same perspective as your own and hampers the perspective-taking of another naive person. An issue is whether it is seen in hindsight bias where we overestimate what we knew beforehand. Via a foreseeability-inevitability platform, participants were randomly assigned to make self-judgments for problem-solving from a foresight (no answers) or three hindsight (answers) conditions. In two hindsight conditions, participants were asked to ignore or not to ignore the answers. In the last condition, participants predicted for an unfamiliar peer asked to ignore the answers. Next, all participants made judgments again from the perspective of the peer. Predominately in hindsight, participants showed significant changes responding but with an appropriate baseline comparison showed essentially the same hindsight bias in judgments for themselves and the peer. Ignoring or not ignoring the answers produced the same outcome. This sharing of perspective-taking dovetails with individuals' believing their hindsight knowledge is commonly present among others. Although participants in hindsight believed their foreseeable predictions for the peer were more accurate or realistic, it was more challenging to predict for the peer than themselves. Implications for individuals' judgments about Donald Trump 's decision-making for COVID-19 are discussed. Researchers should examine perspective-taking in hindsight bias as everyday social interaction involves reasoning about others.

Auditory hindsight bias in school-age children.

We report two experiments investigating hindsight bias in children, focusing on a rarely studied age range of 8-13 years. In Experiment 1, we asked children to complete both an auditory hindsight task and a visual hindsight task. Children exhibited hindsight bias in both tasks, and the bias decreased with age. In Experiment 2, we further explored children 's auditory hindsight bias by contrasting performance in hypothetical and memory designs (which previous research with adults had found to involve different mechanisms-fluency vs. memory reconstruction). Children exhibited auditory hindsight bias in both tasks, but only in the hypothetical design was the bias magnitude modulated by a priming manipulation designed to increase fluency, replicating and extending the pattern found in adults to children.

Momentary versus Retrospective Sexual Consent Perceptions.

Perceiving potential indicators of a person's willingness is an integral component of sexual consent. Preliminary qualitative evidence using vignettes suggested that consent perceptions can change over the course of a sexual scenario. In the present study, we extended previous research by directly comparing momentary and retrospective sexual consent perceptions using a quantitative study design. Employing a staggered vignette protocol, we examined participants' (n = 962; 72.0% female) momentary perceptions of fictional characters' sexual consent and compared them with participants' retrospective perceptions of the characters' consent. We hypothesized that participants would demonstrate a hindsight bias in that they would retrospectively indicate they thought the fictional characters were first willing to engage in sexual behavior earlier than when they did momentarily. We found that differences in participants' momentary versus retrospective perceptions of characters' sexual consent varied by the type of behavior. As we expected, participants demonstrated a hindsight bias for making out. Contrary to our hypothesis, participants were hesitant to retrospectively report that the characters were willing to engage in the other sexual behaviors (e.g., oral, vaginal, anal sex) at a point earlier than their momentary perceptions. That momentary and retrospective sexual consent perceptions significantly differ corroborates previous recommendations that sexual consent be conceptualized as an ongoing process.

Older and younger adults' hindsight bias after positive and negative outcomes.

After learning about facts or outcomes of events, people overestimate in hindsight what they knew in foresight. Prior research has shown that this hindsight bias is more pronounced in older than in younger adults. However, this robust finding is based primarily on a specific paradigm that requires generating and recalling numerical judgments to general knowledge questions that deal with emotionally neutral content. As older and younger adults tend to process positive and negative information differently, they might also show differences in hindsight bias after positive and negative outcomes. Furthermore, hindsight bias can manifest itself as a bias in memory for prior given judgments, but also as retrospective impressions of inevitability and foreseeability. Currently, there is no research on age differences in all three manifestations of hindsight bias. In this study, younger (N = 46, 18-30 years) and older adults (N = 45, 64-90 years) listened to everyday-life scenarios that ended positively or negatively, recalled the expectation they previously held about the outcome (to measure the memory component of hindsight bias), and rated each outcome's foreseeability and inevitability. Compared with younger adults, older adults recalled their prior expectations as closer to the actual outcomes (i.e., they showed a larger memory component of hindsight bias), and this age difference was more pronounced for negative than for positive outcomes. Inevitability and foreseeability impressions, however, did not differ between the age groups. Thus, there are age differences in hindsight bias after positive and negative outcomes, but only with regard to memory for prior judgments.

Hindsight bias in metamemory: outcome knowledge influences the recollection of judgments of learning.

Hindsight bias describes people's tendency to overestimate how accurately they have predicted an event's outcome after obtaining knowledge about it. Outcome knowledge has been shown to influence various forms of judgments, but it is unclear whether outcome knowledge also produces a hindsight bias on Judgments of Learning (JOLs). Three experiments tested whether people overestimated the accuracy of their memory predictions after obtaining knowledge about their actual memory performance. In all experiments, participants studied 60 cue-target word pairs, made a JOL for each word pair, and tried to recall the targets in a cued-recall test. In Experiments 1a and 1b, people recollected their original JOLs after attempting to recall each target, that is, after they obtained outcome knowledge for all items. In Experiments 2 and 3, people recollected their original JOLs in a separate phase after attempting to recall half the targets so that they had outcome knowledge for some but not all items. In all experiments, recollected JOLs were closer to actual memory performance than original JOLs for items with outcome knowledge only. Thus, outcome knowledge produced a hindsight bias on JOLs. Our results demonstrate that people overestimate the accuracy of their memory predictions in hindsight.

Cheaters claim they knew the answers all along.

Cheating has become commonplace in academia and beyond. Yet, almost everyone views themselves favorably, believing that they are honest, trustworthy, and of high integrity. We investigate one possible explanation for this apparent discrepancy between people's actions and their favorable self-concepts: People who cheat on tests believe that they knew the answers all along. We found consistent correlational evidence across three studies that, for those particular cases in which participants likely cheated, they were more likely to report that they knew the answers all along. Experimentally, we then found that participants were more likely to later claim that they knew the answers all along after having the opportunity to cheat to find the correct answers - relative to exposure to the correct answers without the opportunity to cheat. These findings provide new insights into relationships between memory, metacognition, and the self-concept.

Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework.

OBJECTIVE: The prevailing paradigm in suicide prevention continues to contribute to the nihilism regarding the ability to prevent suicides in healthcare settings and a sense of blame following adverse incidents. In this paper, these issues are discussed through the lens of clinicians' experiences as second victims following a loss of a consumer to suicide, and the lens of health care organisations. METHOD: We discuss challenges related to the fallacy of risk prediction (erroneous belief that risk screening can be used to predict risk or allocate resources), and incident reviews that maintain a retrospective linear focus on errors and are highly influenced by hindsight and outcome biases. RESULTS: An argument that a Restorative Just Culture should be implemented alongside a Zero Suicide Framework is developed. CONCLUSIONS: The current use of algorithms to determine culpability following adverse incidents, and a linear approach to learning ignores the complexity of the healthcare settings and can have devastating effects on staff and the broader healthcare community. These issues represent 'inconvenient truths' that must be identified, reconciled and integrated into our future pathways towards reducing suicides in health care. The introduction of Zero Suicide Framework can support the much-needed transition from relying on a retrospective focus on errors (Safety I) to a more prospective focus which acknowledges the complexities of healthcare (Safety II), when based on the Restorative Just Culture principles. Restorative Just Culture replaces backward-looking accountability with a focus on the hurts, needs and obligations of all who are affected by the event. In this paper, we argue that the implementation of Zero Suicide Framework may be compromised if not supported by a substantial workplace cultural change. The process of responding to critical incidents implemented at the Gold Coast Mental Health and Specialist Services is provided as an example of a successful implementation of Restorative Just Culture-based principles that has achieved a culture change required to support learning, improving and healing for our consumers, their families, our staff and broader communities.

Metacognitive hindsight bias.

Hindsight bias (HB) is the tendency to see known information as obvious. We studied metacognitive hindsight bias (MC-HB)-a shift away from one's original confidence regarding answers provided before learning the actual facts. In two experiments, participants answered general-knowledge questions in social scenarios and provided their confidence in each answer. Subsequently, they learned answers to half the questions and then recalled their initial answers and confidence. Finally, they reanswered, as a learning check. We measured confidence accuracy by calibration (over/underconfidence) and resolution (discrimination between incorrect and correct answers), expecting them to improve in hindsight. In both experiments, participants displayed robust HB and MC-HB for resolution despite attempts to recall the initial confidence in one's answer. In Experiment 2, promising anonymity to participants eliminated MC-HB, while social scenarios produced MC-HB for both resolution and calibration-indicative of overconfidence. Overall, our findings highlight that in social contexts, recall of confidence in hindsight is more consistent with answers' accuracy than confidence initially was. Social scenarios differently affect HB and MC-HB, thus dissociating these two biases.

Outcome Bias in Clinical Negligence Medico-legal Cases.

Independent medical experts provide reports in clinical negligence claims brought against doctors and other health care professionals. They are asked to provide an opinion on whether the doctor has breached their duty of care to the patient, commonly described as the "Bolam Principle". By the time a patient litigates against a health care professional, the clinical sequence and outcome are known. Experts provide their opinions with the benefit of this knowledge. To determine whether knowledge of the outcome affects the expert's opinion, 42 independent general practice experts were asked to indicate whether a general practitioner had breached their duty of care in six clinical case scenarios. 21 were told the clinical outcome. Experts who knew the outcome were less likely to support the general practitioner's course of action, although this did not reach statistical significance. General practitioners demonstrated considerable "dove" or "hawk" variability when giving opinions on the same scenario.

Preclinical curriculum of prospective case-based teaching with faculty- and student-blinded approach.

BACKGROUND: Case-based teaching with real patient cases provides benefit of simulating real-world cognition. However, while clinical practice involves a prospective approach to cases, preclinical instruction typically involves full disclosure of case content to faculty, introducing hindsight bias into faculty teaching in medical curricula. METHODS: During 2015-2018, we piloted an optional medical school curriculum involving 6-7 one-hour sessions over a 3-month period each year. New groups enrolled each year from first- and second-year classes. A facilitator provided a blinded physician discussant and blinded students with case information during and not in advance of each session, allowing prospective case-based discussions. Cases were based on real patients treated in the Department of Medicine. Clinical material was presented in the chronologic sequence encountered by treating physicians. Content covered a median of 5 patient visits/case (range: 2-10) spanning over months. A 14-item survey addressing components of the reporter-interpreter-manager-educator (RIME) scheme was developed and used to compare self-reported clinical skills between course participants and non-participant controls during the 2016 course iteration. RESULTS: This elective curriculum at Stanford School of Medicine involved 170 preclinical students (22.7% of 750 eligible). During the 2016 course iteration, a quasi-experimental study compared self-reported clinical skills between 29 course participants (response rate: 29/49 [59.2%]) and 35 non-participant controls (response rate: 35/132 [26.5%]); students self-assessed clinical skills via the RIME-based survey developed for the course. Two-sample t-tests compared the change in pre- and post-course skills between course participants and non-participants. Of 15 Department of Medicine faculty members invited as discussants, 12 (80%) consented to participate. Compared with controls, first-year participants self-assessed significantly greater improvement in understanding how clinicians reason through cases step-by-step to arrive at diagnoses (P = 0.049), work through cases in longitudinal settings (P = 0.049), and share information with patients (P = 0.047). Compared with controls, second-year participants self-assessed significantly greater improvement (P = 0.040) in understanding how clinicians reason through cases step-by-step to arrive at diagnoses. CONCLUSIONS: Prospective case-based discussions with blinding of faculty and students to clinical content circumvents hindsight bias and may impart real-world cognitive skills as determined by student self-report.

Hindsight bias critically impacts on clinicians' assessment of care quality in retrospective case note review.

Objective To determine whether hindsight bias impacts on retrospective case note review using a five point scoring system based on modern clinical governance toolkits. Design Survey. Setting Clinicians of varying grades invited to complete a short internet survey. Participants Ninety three clinicians were invited to complete an anonymous survey in which they reviewed three case vignettes for the purposes of a fictional clinical governance meeting. For each vignette, participants were randomised to an outcome in which the patient made a full recovery or alternatively died shortly after discharge. Main outcome measure. Participants submit scores from 1 to 5 to indicate the quality of care provided to patients prior to their discharge. These scores were compared to determine whether judgements about the quality of antecedent care were biased by the description of a patient death. Results In two out of three case vignettes clinicians exhibited marked hindsight bias. In a case of a patient with a swollen leg, identical antecedent care was scored as poor by participants when the patient died the next day, but good when the patient recovered (p<0.00001). In a case of headache, care was scored as poor when the patient died but adequate when the patient made a full recovery (p=0.0003). A third case of chest pain did not exhibit hindsight bias. Seniority of clinician had no impact on the tendency to exhibit hindsight bias when reviewing case notes. Conclusion In some cases, clinicians are markedly more critical of identical healthcare when a patient dies compared to when a patient survives. Hindsight bias while reviewing care when a patient survives might prevent identification of learning arising from errors. Additionally, we predict hindsight bias combined with a legal duty of candour will cause families to be informed that patients died because of healthcare error when this is not a fact.

Social Decision Making in Adolescents and Young Adults: Evidence From the Ultimatum Game and Cognitive Biases.

During adolescence and early adulthood, individuals deal with important developmental changes, especially in the context of complex social interactions. Previous studies demonstrated that those changes have a significant impact on the social decision making process, in terms of a progressive increase of intentionality comprehension of others, of the sensitivity to fairness, and of the impermeability to decisional biases. However, neither adolescents nor adults reach the ideal level of maximization and of rationality of the homo economicus proposed by classical economics theory, thus remaining more close to the model of the "bounded rationality" proposed by cognitive psychology. In the present study, we analyzed two aspects of decision making in 110 participants from early adolescence to young adulthood: the sensitivity to fairness and the permeability to decisional biases (Outcome Bias and Hindsight Bias). To address these questions, we adopted a modified version of the Ultimatum Game task, where participants faced fair, unfair, and hyperfair offers from proposers described as generous, selfish, or neutral. We also administered two behavioral tasks testing the influence of the Outcome Bias and of the Hindsight Bias in the evaluation of the decision. Our behavioral results highlighted that the participants are still partially consequentialist, as the decisional process is influenced by a complex balance between the outcome and the psychological description of the proposer. As regards cognitive biases, the Outcome Bias and the Hindsight Bias are present in the whole sample, with no relevant age differences.