Abstract
Recent studies indicate that emotional processes, mediated by the ventromedial prefrontal cortex (VMPC), are of great importance for moral judgment. Neurological patients with VMPC dysfunction have been shown to generate increased utilitarian moral judgments, i.e. are more likely to endorse emotionally aversive actions in order to maximize aggregate welfare, when faced with emotionally salient personal moral dilemmas. Patients with alcohol dependence (AD) also exhibit impairments in functions mediated by the prefrontal cortex, but whether they exhibit increased utilitarian moral reasoning has not previously been investigated. The aim of this study was to investigate moral judgment in AD patients (n = 20) compared to healthy controls (n = 20) matched by sex, age and education years. Each subject responded to a battery of 50 hypothetical dilemmas categorized as non-moral, moral impersonal and moral personal. They also responded to a questionnaire evaluating explicit knowledge of social and moral norms. Results confirmed our hypothesis that AD patients generated increased utilitarian moral judgment compared to controls when faced with moral personal dilemmas. Crucially, there was no difference in their responses to non-moral or impersonal moral dilemmas, nor knowledge of explicit social and moral norms. One possible explanation is that damage to the VMPC, caused by long term repeated exposure to alcohol results in emotional dysfunction, predisposing to utilitarian moral judgment. This work elucidates a novel aspect of the neuropsychological profile of AD patients, namely a tendency to generate utilitarian moral judgment when faced with emotionally salient moral personal dilemmas.
Highlights
Charles Darwin wrote, ‘‘Of all the differences between man and the lower animals, the moral sense or conscience is by far the most important’’ [1]
There was no difference regarding responses to impersonal moral judgments (t = 0.707; P = 0.485), but subjects with mild depression exhibited a trend toward responding more utilitarian compared to subjects without depression (t = 1.90; P = 0.066). The results of this case-control study of alcohol dependence (AD) patients and healthy controls confirmed the hypothesis that AD patients generate increased utilitarian moral judgments when faced with moral personal dilemmas, compared to healthy controls
The subjects responded to a battery of dilemmas divided into non-moral, moral impersonal and moral personal dilemmas, and 15 items evaluating knowledge of explicit social and moral norms
Summary
Charles Darwin wrote, ‘‘Of all the differences between man and the lower animals, the moral sense or conscience is by far the most important’’ [1]. A contrasting dilemma is the ‘‘footbridge’’ dilemma in which a runaway trolley once again threatens to kill five people laying on the railroad tracks. In this dilemma the only way to save five lives is to sacrifice one person by pushing him off a footbridge down on the tracks, stopping the runaway trolley. Greene and colleagues [7] used functional magnetic resonance imaging (fMRI) to investigate the role of emotion in moral judgment, and why people in general find it morally acceptable to sacrifice one person to save five persons in the ‘‘switch’’ but not in the ‘‘footbridge’’ dilemma. In order to investigate this question they created two sets of moral dilemmas entitled impersonal and personal, containing the relevant features of the ‘‘switch’’ and ‘‘footbridge’’ dilemmas respectively. It should be noted that the nature of the distinction between personal and impersonal dilemma has been questioned (for discussion, see [15,16])
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