Objective Discrete choice experiments (DCEs) are widely used in healthcare to estimate willingness-to-pay (WTP) but may be affected by hypothetical bias (HB), especially in morally sensitive contexts. While cheap-talk is proposed as a mitigation strategy, its effectiveness in health-related DCEs involving moral trade-offs remains unclear. This study examines how cheap-talk influences WTP in such settings. Methods A split-sample DCE on organ transplantation policies was conducted, involving trade-offs between cost and morally salient outcomes: saving lives (“being alive”) and improving quality of life (“having a life”). Respondents (N = 651) were randomly assigned to one of three survey arms: control (no manipulation), cheap-talk, or cheap-talk with follow-up question. Multinomial logit model in WTP space with a Taboo Trade-off Aversion (TTOA) specification was used to estimate treatment effects and interactions with religiosity. Results Exposure to the cheap-talk script reduced WTP for saving lives, indicating increased attention to financial considerations. WTP for quality-of-life improvements and avoiding taboo trade-offs remained unchanged. Religious respondents reported higher WTP to avoid taboo trade-offs in the control arm, but this gap disappeared under cheap-talk, showing that deliberation moderates monetary expressions among religious individuals without altering underlying convictions. Conclusions Cheap-talk promotes more reflective decision-making in morally sensitive health-related choices, particularly among individuals with strong moral or religious convictions. It reduces elevated WTP for taboo trade-offs, while its effect on other respondents is limited. Future research should combine stated and revealed preference data and explore models that account for non-compensatory moral decision rules to better capture complex moral preferences DCEs.

Objectives: Taboo trade-offs can explain some of the (moral) difficulties in healthcare decision-making. The moral psychology literature suggests that individuals are averse to making trade-offs between attributes belonging to different values, such as (sacred) human lives versus (secular) money. We demonstrate and empirically test a discrete choice model designed to capture Taboo Trade-off Aversion (TTOA) behaviors in the healthcare domain. Methods: The linear-additive Random Utility Maximization (RUM) model is extended to capture TTOA behaviors by including penalties for taboo trade-offs. Using two Discrete Choice Experiments (DCEs) focusing on taboo trade-offs in public health policies, we empirically compare conventional linear-additive RUM models with TTOA models to explore differences in model and behavioral results. Results: We observe TTOA in both DCEs. In one DCE, the TTOA model separates TTOA effects from attribute-related parameters, showing inflated parameters in conventional RUM models when TTOA behavior is present. This discrepancy affected Willingness-To-Pay (WTP) estimates, with WTP to save an incremental patient life approximately 3.5 times higher in conventional RUM models compared to the TTOA models. The presence and magnitude of TTOA varied considerably across respondents. Latent Class (LC) models reveal that some respondent groups perceive trade-offs as taboo significantly, while others do not. Conclusions: Accounting for TTOA in RUM models may lead to more accurate behavioral information when choice behaviors are affected by taboo trade-offs. Researchers and policymakers can use TTOA models to obtain a more nuanced understanding of public acceptability in morally salient policy decisions – ultimately helping to navigate, rather than avoid, taboo trade-offs.