AbstractThis study assesses the impact of accountability, the status quo, and anticipated costs and benefits on judgement of the acceptability of a drug in the US pharmaceuticals market. Several effects are documented: (1) subjects were more accepting of a drug, the lower the anticipated risks of side effects and the greater the anticipated benefits; (2) subjects were especially unwilling to accept risk when the drug was not yet on the market and when they felt accountable for their decisions; (3) accountable subjects confronted by an off‐the‐market drug that posed moderate or high risk were also especially likely to procrastinate, to buckpass, and to think in integratively complex ways about the problem, notwithstanding the fact that many more lives would be saved than lost. We explain these results by positing that perceptual‐cognitive processes (loss aversion) and political processes (blame avoidance) mutually reinforce each other when decision makers are accountable for choices that raise the possibility of changing the status quo in ways that impose losses on identifiable constituencies. We conclude by commenting on the complex normative issues that arise in labelling response tendencies as biases. Choices that look irrational within one ethical or political framework sometimes appear quite reasonable with an