Pulling the lever in a hurry: the influence of impulsivity and sensitivity to reward on moral decision-making under time pressure

BACKGROUND

Making timely moral decisions can save a life. However, literature on how moral decisions are made under time pressure reports conflicting results. Moreover, it is unclear whether and how moral choices under time pressure may be influenced by personality traits like impulsivity and sensitivity to reward and punishment.

METHODS

To address these gaps, in this study we employed a moral dilemma task, manipulating decision time between participants: one group (N = 25) was subjected to time pressure (TP), with 8 s maximum time for response (including the reading time), the other (N = 28) was left free to take all the time to respond (noTP). We measured type of choice (utilitarian vs. non-utilitarian), decision times, self-reported unpleasantness and arousal during decision-making, and participants' impulsivity and BIS-BAS sensitivity.

RESULTS

We found no group effect on the type of choice, suggesting that time pressure per se did not influence moral decisions. However, impulsivity affected the impact of time pressure, in that individuals with higher cognitive instability showed slower response times under no time constraint. In addition, higher sensitivity to reward predicted a higher proportion of utilitarian choices regardless of the time available for decision.

CONCLUSIONS

Results are discussed within the dual-process theory of moral judgement, revealing that the impact of time pressure on moral decision-making might be more complex and multifaceted than expected, potentially interacting with a specific facet of attentional impulsivity.

The effects of explicit reasoning on moral judgements

We report four experiments that investigate explicit reasoning and moral judgements. In each experiment, some subjects responded to the "footbridge" version of the trolley problem (which elicits stronger moral intuitions), whereas others responded to the "switch" version (which elicits weaker moral intuitions). Experiments 1-2 crossed the type of trolley problem with four reasoning conditions: control, counter-attitudinal, pro-attitudinal, and mixed reasoning (both types of reasoning). Experiments 3-4 examine whether moral judgements vary based on (a) when reasoners engage in counter-attitudinal reasoning, (b) when they make the moral judgement, and (c) by the type of moral dilemma. These two experiments comprised five conditions: control (judgement only), delay-only (2-minute wait then judgement), reasoning-only (reasoning then judgement), reasoning-delay (reasoning, then 2-minute delay, then judgement), and delayed-reasoning (2-minute delay, then reasoning, then judgement). These conditions were crossed with the type of trolley problem. We find that engaging in some form of counter-attitudinal reasoning led to less typical judgements (regardless of when it occurs), but this effect was mostly restricted to the switch version of the dilemma (and was strongest in the reasoning-delay conditions). Furthermore, neither pro-attitudinal reasoning nor delayed judgements on their own impacted subjects' judgements. Reasoners therefore seem open to modifying their moral judgements when they consider opposing perspectives but might be less likely to do so for dilemmas that elicit relatively strong moral intuitions.

The Oxford Utilitarianism Scale: Psychometric properties of a French adaptation (OUS-Fr)

It is well established that one's sense of morality may be readily influenced by one's culture, education, and life situation. Very few psychometric tools are currently available to measure facets of human morality in different cultures. Therefore, the purpose of the present study was to develop a French adaptation of the Oxford Utilitarianism Scale (OUS-Fr) and formally evaluate its validity. The OUS-Fr was developed through a process of back-translation and administered to a sample of 552 participants. Results from exploratory factor analyses revealed a bidimensional structure with satisfactory loadings that was then also supported in the confirmatory factor analysis check. The OUS-Fr scale demonstrated good psychometric properties, with acceptable internal consistency and coherent results in the convergent validity analyses. These findings contribute to morality measurement literature by providing evidence for the reliability and validity of the French adaptation of the OUS. The OUS-Fr can be viewed as a valuable tool for researchers and practitioners for assessing utilitarian tendencies within the French-speaking population, which could pave the way for cross-cultural understandings that are important for fully understanding the intricacies of human morality.

The long and the short of it: 5-HTTLPR and moral judgement

Differences in moral sentiments are widespread. Increasingly, their biological correlates are investigated to elucidate potential sources of divergent moral attitudes and choices. Serotonin is one such potential modulator. We investigated the effects of a functional serotonergic polymorphism, 5-HTTLPR, which was previously linked to moral choices albeit with inconsistent findings. N = 157 healthy young adults completed a set of congruent and incongruent moral dilemmas. In addition to the traditional moral response score, this set allows by using a process dissociation (PD) approach an estimation a deontological and a utilitarian parameter. While there was no main effect of 5-HTTLPR on any of the three moral judgement parameters, there was an interaction effect between 5-HTTLPR and endocrine status on PD parameters, which was mainly due to the deontological but not the utilitarian parameter. In men and free cycling women, LL homozygotes showed reduced deontological tendencies compared to S allele carriers. Contrariwise, in women using oral contraceptives, LL homozygotes had increased deontology parameter scores. Furthermore, LL genotypes in general reported less difficulty in making harmful choices, which were in addition associated with less negative emotions. The findings suggest that 5-HTTLPR might be involved in modulating cognitive and emotional processes contributing to moral decisions.

Personal health monitoring in the armed forces - scouting the ethical dimension : A case study in the Netherlands Armed Forces during the Covid-19 pandemic

BACKGROUND

The field of personal health monitoring (PHM) develops rapidly in different contexts, including the armed forces. Understanding the ethical dimension of this type of monitoring is key to a morally responsible development, implementation and usage of PHM within the armed forces. Research on the ethics of PHM has primarily been carried out in civilian settings, while the ethical dimension of PHM in the armed forces remains understudied. Yet, PHM of military personnel by design takes place in a different setting than PHM of civilians, because of their tasks and the context in which they operate. This case study therefore focusses on obtaining insights into the experiences and related values of different stakeholders regarding an existing form of PHM, the Covid-19 Radar app, in the Netherlands Armed Forces.

METHODS

We carried out an exploratory qualitative study, using semi-structured interviews with twelve stakeholders in the Netherlands Armed Forces. We focussed on participation in the use of PHM, reflections on the practical use and use of data, moral dilemmas and the need for ethics support, all in regard to PHM. The data was analysed using an inductive thematic approach.

RESULTS

Three interlinking categories reflecting ethical dimensions of PHM emerged: (1) values, (2) moral dilemmas, and (3) external norms. The main values identified were: security (in relation to data), trust and hierarchy. Multiple related values were found. Some, but no broadly shared, moral dilemmas were identified and no strong need for ethics support was expressed.

CONCLUSION

This study shed light on key values, provide insights in the experienced and presumed moral dilemmas and bring to mind ethics support considerations when looking at PHM in the armed forces. Some values bring a certain vulnerability to military users when personal and organisational interests are not aligned. Furthermore, some identified values may hinder a careful consideration of PHM because they potentially conceal parts of ethical dimensions of PHM. Ethics support can assist in uncovering and addressing these concealed parts. The findings highlight a moral responsibility for the armed forces to devote attention to the ethical dimensions of PHM.

The Contribution of Moral Case Deliberation to Teaching RCR to PhD Students

Teaching responsible conduct of research (RCR) to PhD students is crucial for fostering responsible research practice. In this paper, we show how the use of Moral Case Deliberation-a case reflection method used in the Amsterdam UMC RCR PhD course-is particularity valuable to address three goals of RCR education: (1) making students aware of, and internalize, RCR principles and values, (2) supporting reflection on good conduct in personal daily practice, and (3) developing students' dialogical attitude and skills so that they can deliberate on RCR issues when they arise. What makes this method relevant for RCR education is the focus on values and personal motivations, the structured reflection on real experiences and dilemmas and the cultivation of participants' dialogical skills. During these structured conversations, students reflect on the personal motives that drive them to adhere to the principles of good science, thereby building connections between those principles and their personal values and motives. Moreover, by exploring personal questions and dilemmas related to RCR, they learn how to address these with colleagues and supervisors. The reflection on personal experiences with RCR issues and questions combined with the study of relevant normative frameworks, support students to act responsibly and to pursue RCR in their day-to-day research practice in spite of difficulties and external constraints.

Tragic Choices and the Virtue of Techno-Responsibility Gaps

There is a concern that the widespread deployment of autonomous machines will open up a number of 'responsibility gaps' throughout society. Various articulations of such techno-responsibility gaps have been proposed over the years, along with several potential solutions. Most of these solutions focus on 'plugging' or 'dissolving' the gaps. This paper offers an alternative perspective. It argues that techno-responsibility gaps are, sometimes, to be welcomed and that one of the advantages of autonomous machines is that they enable us to embrace certain kinds of responsibility gap. The argument is based on the idea that human morality is often tragic. We frequently confront situations in which competing moral considerations pull in different directions and it is impossible to perfectly balance these considerations. This heightens the burden of responsibility associated with our choices. We cope with the tragedy of moral choice in different ways. Sometimes we delude ourselves into thinking the choices we make were not tragic (illusionism); sometimes we delegate the tragic choice to others (delegation); sometimes we make the choice ourselves and bear the psychological consequences (responsibilisation). Each of these strategies has its benefits and costs. One potential advantage of autonomous machines is that they enable a reduced cost form of delegation. However, we only gain the advantage of this reduced cost if we accept that some techno-responsibility gaps are virtuous.

Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study

BACKGROUND

Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university.

EDUCATIONAL ACTIVITY AND SETTING

Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback.

FINDINGS

Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved.

SUMMARY

This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.

Many heads are more utilitarian than one

Moral judgments have a very prominent social nature, and in everyday life, they are continually shaped by discussions with others. Psychological investigations of these judgments, however, have rarely addressed the impact of social interactions. To examine the role of social interaction on moral judgments within small groups, we had groups of 4 to 5 participants judge moral dilemmas first individually and privately, then collectively and interactively, and finally individually a second time. We employed both real-life and sacrificial moral dilemmas in which the character's action or inaction violated a moral principle to benefit the greatest number of people. Participants decided if these utilitarian decisions were morally acceptable or not. In Experiment 1, we found that collective judgments in face-to-face interactions were more utilitarian than the statistical aggregate of their members compared to both first and second individual judgments. This observation supported the hypothesis that deliberation and consensus within a group transiently reduce the emotional burden of norm violation. In Experiment 2, we tested this hypothesis more directly: measuring participants' state anxiety in addition to their moral judgments before, during, and after online interactions, we found again that collectives were more utilitarian than those of individuals and that state anxiety level was reduced during and after social interaction. The utilitarian boost in collective moral judgments is probably due to the reduction of stress in the social setting.

[Alcohol in nursing homes.]

A part of the residents of nursing homes drink alcohol. This regularly leads to moral questions and discussions. An explorative qualitative study has been done to gather insight into the experiences and views of residents and staff regarding alcohol consumption in nursing homes. Aim of this publication was to support care professionals in nursing homes to deal with moral challenges related to alcohol consumption. With interviews and a focus group with residents and staff, experiences, values and moral dilemmas were collected. While residents viewed alcohol consumption as a private matter, opinions of staff were not uniform. Staff is confronted with various moral questions based on different values, such as Respect for Autonomy, Quality of Life, Authenticity and (collective) Safety. This study advises staff to use the value scheme in case of concrete moral questions as a tool to careful analyse which values and norms are at stake and balance what could be an appropriate response.

How to weigh lives. A computational model of moral judgment in multiple-outcome structures

When is it allowed to carry out an action that saves lives, but leads to the loss of others? While a minority of people may deny the permissibility of such actions categorically, most will probably say that the answer depends, among other factors, on the number of lives saved versus lives lost. Theories of moral reasoning acknowledge the importance of outcome trade-offs for moral judgments, but remain silent on the precise functional form of the psychological mechanism that determines their moral permissibility. An exception is Cohen and Ahn's (2016) subjective-utilitarian theory of moral judgment, but their model is currently limited to decisions in two-option life-and-death dilemmas. Our goal is to study other types of moral judgments in a larger set of cases. We propose a computational model based on sampling and integrating subjective utilities. Our model captures moral permissibility judgments about actions with multiple effects across a range of scenarios involving humans, animals, and plants, and is able to account for some response patterns that might otherwise be associated with deontological ethics. While our model can be embedded in a number of competing contemporary theories of moral reasoning, we argue that it would most fruitfully be combined with a causal model theory.

Defining ethical challenge(s) in healthcare research: a rapid review

BACKGROUND

Despite its ubiquity in academic research, the phrase 'ethical challenge(s)' appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of 'ethical challenge(s)' and closely related terms as used in current healthcare research literature.

METHODS

Rapid review to identify peer-reviewed reports examining 'ethical challenge(s)' in any context, extracting data on definitions of 'ethical challenge(s)' in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher's Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.

RESULTS

393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of 'ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to 'ethical challenge(s)' within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.

CONCLUSIONS

Only 12/72 studies contained an explicit definition of 'ethical challenge(s)', with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.

Using conflict negativity to index psychological tension between impartiality and status-upholding principles

People often endorse the moral principle that all human lives are equally valuable. At the same time, people often privilege high-status individuals over low-status individuals. These two inclinations come into conflict in a scenario involving the potential killing of a high-status person to save the lives of multiple low-status people. In the present study, participants viewed a series of sacrificial dilemmas in which the social status of the victims and beneficiaries was varied. We measured participants' choice (sacrifice vs. don't sacrifice), response time, and electroencephalographic activity, with an emphasis on conflict negativity (CN). Overall, we found no effects of victim/beneficiaries status on choice and response time. However, participants displayed a more pronounced CN effect when contemplating a high-status victim/low-status beneficiaries tradeoff than a low-status-victim/high-status beneficiaries tradeoff. Further analyses revealed that this effect was primarily driven by participants who endorsed deontological principles (e.g., "Some rules must never be broken, no matter the consequences"). In contrast, those who endorsed utilitarian principles displayed equivalent levels of conflict negativity, regardless of the social status of victims and beneficiaries. These findings shed light on the role of conflict in the phenomenology of moral decision making.

COVID-19, uncertainty, and moral experiments

Pandemics like COVID-19 confront us with decisions about life and death that come with great uncertainty, factual as well as moral. How should policy makers deal with such uncertainty? We suggest that rather than to deliberate until they have found the right course of action, they better do moral experiments that generate relevant experiences to enable more reliable moral evaluations and rational decisions.

Pay Your Debts: Moral Dilemmas of International Debt

Should a government repay its international debts even if this imposes severe hardships on its citizens? Drawing on moral psychology, we investigate when people think a government is morally obligated to pay its debts. Participants read about a government that has to decide whether to default on its debt payments or cut vital programs. Across conditions, we varied the number of jobs at stake and whether a full or partial default is required to save them. Overall, most participants judged that a government should pay its debt even when the damage to the debtor is greater than the benefit to the lender. As the damage to the debtor became extreme, participants increasingly said the government should default, but they still judged that defaulting is morally wrong. In Experiment 2, we find in a national sample of Americans that political conservatives were more opposed to default than liberals. We discuss implications for policy, public opinion, and public welfare during economic downturns.

SUPPLEMENTARY INFORMATION

The online version of this article (10.1007/s11109-020-09675-6) contains supplementary material, which is available to authorized users.

Moral distress in health care: when is it fitting?

Nurses and other medical practitioners often experience moral distress: they feel an anguished sense of responsibility for what they take to be their own moral failures, even when those failures were unavoidable. However, in such cases other people do not tend to think it is right to hold them responsible. This is an interesting mismatch of reactions. It might seem that the mismatch should be remedied by assuring the practitioner that they are not responsible, but I argue that this denies something important that the phenomenon of moral distress tells us. In fact, both the practitioners' tendencies to hold themselves responsible and other people's reluctance to hold the practitioners responsible get something right. The practitioners may be right that they are responsible in the sense of having failed to meet a binding moral requirement, even when the requirement was impossible to meet. This makes moral distress a fitting response because it correctly represents their own action as a wrongdoing. However, others may meanwhile be right that the practitioners are not responsible in the sense of being culpable and blameworthy. To blame others, or oneself, for certain failures, including those that are unavoidable, would be unfair. My claim depends on distinguishing between the fittingness and the fairness of holding someone (including oneself) responsible for moral failure. Having drawn the distinction, I suggest that moral distress should be addressed in a way that both recognizes it as a fitting response and avoids the unfairness of blame.

Not all who ponder count costs: Arithmetic reflection predicts utilitarian tendencies, but logical reflection predicts both deontological and utilitarian tendencies

Conventional sacrificial moral dilemmas propose directly causing some harm to prevent greater harm. Theory suggests that accepting such actions (consistent with utilitarian philosophy) involves more reflective reasoning than rejecting such actions (consistent with deontological philosophy). However, past findings do not always replicate, confound different kinds of reflection, and employ conventional sacrificial dilemmas that treat utilitarian and deontological considerations as opposite. In two studies, we examined whether past findings would replicate when employing process dissociation to assess deontological and utilitarian inclinations independently. Findings suggested two categorically different impacts of reflection: measures of arithmetic reflection, such as the Cognitive Reflection Test, predicted only utilitarian, not deontological, response tendencies. However, measures of logical reflection, such as performance on logical syllogisms, positively predicted both utilitarian and deontological tendencies. These studies replicate some findings, clarify others, and reveal opportunity for additional nuance in dual process theorist's claims about the link between reflection and dilemma judgments.

Women smelling men's masked body odors show enhanced harm aversion in moral dilemmas

Among the most unnoticeable stimuli providing social information, body odors are powerful social tools that can modulate behavioral and neural processing. It has recently been shown that body odors can affect moral decision-making, by increasing the activations in neural areas processing social and emotional information during the decision process. The aim of the present study was twofold: 1) to test whether body odors selectively affect decisions to real dilemmatic moral scenario (incongruent) vs. fake (congruent) dilemmas, and 2) to characterize whether the impact of masked body odors is modulated by four conceptual factors: personal force, intentionality, benefit recipient and evitability. Women chose between utilitarian (sacrificing a person's life in order to save other lives) or deontological actions (deciding against the harmful action) in 64 moral dilemmas under the exposure of a neutral fragrance (masker) or a masked male body odor. Our results showed that the masked male body odor did not specifically affect the answers to real and fake dilemmas but instead, its effect is modulating whether the agent harms the victim in a direct or indirect manner (personal force) to save herself or only other people (benefit recipient). In particular, when exposed to the masked body odor participants gave more deontological answers when the harm was indirect and only other people were saved. These data support the hypothesis that body odors induce participants to perceive the individuals described in moral dilemmas as more real, triggering harm avoidance.

Effects of childhood trauma on adult moral decision-making: Clinical correlates and insights from bipolar disorder

BACKGROUND

Childhood adversity has been shown to exert profound effects on basic psychological processes well into adulthood. Some of these processes, such as those related to reward and emotion, play critical roles in moral decision-making. As a population with high rates of childhood trauma as well as heterogenous clinical presentation, individuals with bipolar disorder (BD) constitute an enriched group in which to examine the correlates of trauma and other clinical variables with moral cognition.

METHODS

62 euthymic BD patients and 27 controls responded to moral dilemma scenarios and completed the Childhood Trauma Questionnaire.

RESULTS

Results revealed a main effect of diagnosis on moral decision-making only when both personal force and an intention were required, indicating a more utilitarian style in BD patients relative to controls. Several interesting patterns also emerged regardless of diagnostic status. Higher ratings of physical neglect were significantly associated with higher ratings of acceptability (a utilitarian tendency) across dilemma types, and a similar pattern was observed at the trend level for experiences of emotional neglect. Significant main effects on moral decision-making were also observed for sex, illness duration, and history of psychotic features in the BD sample.

LIMITATIONS

The present study is limited by the self-reported nature of the CTQ and by the small number of trials of moral dilemmas. In addition, practical and clinical implications of the moral dilemmas paradigm are limited due to its abstract nature.

CONCLUSIONS

Our results indicate that certain clinical features as well as childhood maltreatment (in particular neglect) may significantly impact moral decision making in adult life. Surprisingly, childhood trauma was associated with a more utilitarian style, which is in the opposite direction from previous effects shown in PTSD. Although speculative, our results suggest that there may be a protective quality associated with utilitarian moral decision-making tendencies.

Selective changes in moral judgment by noninvasive brain stimulation of the medial prefrontal cortex

Multiple cortical networks intervene in moral judgment, among which the dorsolateral prefrontal cortex (DLPFC) and the medial prefrontal structures (medial PFC) emerged as two major territories, which have been traditionally attributed, respectively, to cognitive control and affective reactions. However, some recent theoretical and empirical accounts disputed this dualistic approach to moral evaluation. In the present study, to further assess the functional contribution of the medial PFC in moral judgment, we modulated its cortical excitability by means of transcranial direct current stimulation (tDCS) and tracked the change in response to different types of moral dilemmas, including switch-like and footbridge-like moral dilemmas, with and without personal involvement. One hundred participants (50 males) completed a questionnaire to assess the baseline levels of deontology. Next, participants were randomly assigned to receive anodal, sham, or cathodal tDCS over the medial prefrontal structures and then were asked to address a series of dilemmas. The results showed that participants who received anodal stimulation over the medial PFC provided more utilitarian responses to switch-like (but not footbridge-like) dilemmas than those who received cathodal tDCS. We also found that neurostimulation modulated the influence that deontology has on moral choices. Specifically, in the anodal tDCS group, participants' decisions were less likely to be influenced by their baseline levels of deontology compared with the sham or cathodal groups. Overall, our results seem to refute a functional role of the medial prefrontal structures purely restricted to affective reactions for moral dilemmas, providing new insights on the functional contribution of the medial PFC in moral judgment.

Reducing the Risk of Gynecologic Cancer in Hereditary Breast Ovarian Cancer Syndrome Mutation Carriers: Moral Dilemmas and the Principle of Double Effect

Hereditary breast ovarian cancer (HBOC) syndrome is an autosomal dominant disease linked to mutations in the BRCA1 and BRCA2 genes in 90 percent of affected families. Female mutation carriers are highly susceptible to aggressive, often disseminated, usually fatal pelvic-abdominal carcinomatosis. This cancer risk can be markedly reduced by surgical removal of the internal gynecologic organs before the end of the fourth decade of life and by using estrogen-progestin formulations marketed for many years as combined oral contraceptives (COCs). Both risk-reducing methods are associated with unfavorable effects. Relying on the principle of double effect, this essay argues for the ethical justification of prophylactic surgery and the use of COC to reduce the risk of gynecologic cancer in HBOC syndrome mutation carriers. Summary: Hereditary breast ovarian cancer syndrome is an autosomal dominant disease linked to mutations in the BRCA1 and BRCA2 genes in most affected families. Female mutation carriers are highly susceptible to aggressive, often disseminated, usually fatal pelvic-abdominal carcinomatosis. This cancer risk can be markedly reduced by surgical removal of the internal gynecologic organs before the end of the fourth decade of life and by using estrogen-progestin formulations marketed for many years as combined oral contraceptives. Both risk-reducing methods are associated with unfavorable effects. Relying on the principle of double effect, this essay argues for the ethical justification for those unfavorable effects.

Sacrificial utilitarian judgments do reflect concern for the greater good: Clarification via process dissociation and the judgments of philosophers

Researchers have used "sacrificial" trolley-type dilemmas (where harmful actions promote the greater good) to model competing influences on moral judgment: affective reactions to causing harm that motivate characteristically deontological judgments ("the ends don't justify the means") and deliberate cost-benefit reasoning that motivates characteristically utilitarian judgments ("better to save more lives"). Recently, Kahane, Everett, Earp, Farias, and Savulescu (2015) argued that sacrificial judgments reflect antisociality rather than "genuine utilitarianism," but this work employs a different definition of "utilitarian judgment." We introduce a five-level taxonomy of "utilitarian judgment" and clarify our longstanding usage, according to which judgments are "utilitarian" simply because they favor the greater good, regardless of judges' motivations or philosophical commitments. Moreover, we present seven studies revisiting Kahane and colleagues' empirical claims. Studies 1a-1b demonstrate that dilemma judgments indeed relate to utilitarian philosophy, as philosophers identifying as utilitarian/consequentialist were especially likely to endorse utilitarian sacrifices. Studies 2-6 replicate, clarify, and extend Kahane and colleagues' findings using process dissociation to independently assess deontological and utilitarian response tendencies in lay people. Using conventional analyses that treat deontological and utilitarian responses as diametric opposites, we replicate many of Kahane and colleagues' key findings. However, process dissociation reveals that antisociality predicts reduced deontological inclinations, not increased utilitarian inclinations. Critically, we provide evidence that lay people's sacrificial utilitarian judgments also reflect moral concerns about minimizing harm. This work clarifies the conceptual and empirical links between moral philosophy and moral psychology and indicates that sacrificial utilitarian judgments reflect genuine moral concern, in both philosophers and ordinary people.

The ethics of separating conjoined twins: two arguments against

I argue that the separation of conjoined twins in infancy or early childhood is unethical (rare exceptions aside). Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to achieve an irreplaceably good quality of life-the goods of conjoinment-that separation takes away. Evaluation of this possibility requires maturation past early childhood. Regarding the second type, I point out that with conceivable but unrecorded exceptions, these cases will consistently involve sacrifice separation. I present an argument that sacrifice separation is unethical, but in some cases a moral dilemma may exist in which separation and refraining from separation are both unethical. Perhaps in such cases a decision can be made on non-moral grounds; however, the possibility of such a decision serves not to mitigate but to underscore the fact that the separation is unethical. My conclusion, which applies to all three types of cases, is that it is unethical to separate conjoined twins before their developing personalities give some reliable indication as to whether they desire separation and whether they will achieve those goods of conjoinment.

Judging the morality of utilitarian actions: How poor utilitarian accessibility makes judges irrational

Is it acceptable and moral to sacrifice a few people’s lives to save many others? Research on moral dilemmas in psychology, experimental philosophy, and neuropsychology has shown that respondents judge utilitarian personal moral actions (footbridge dilemma) as less appropriate than equivalent utilitarian impersonal moral actions (trolley dilemma). Accordingly, theorists (e.g., Greene et al., 2001) have argued that judgments of appropriateness in personal moral dilemmas are more emotionally salient and cognitively demanding (taking more time to be rational) than impersonal moral dilemmas. Our novel findings show an effect of psychological accessibility (driven by partial contextual information; Kahneman, 2003) on utilitarian moral behavior and response time for rational choices. Enhanced accessibility of utilitarian outcomes through comprehensive information about moral actions and consequences boosted utility maximization in moral choices, with rational choices taking less time. Moreover, our result suggests that previous results indicating emotional interference, with rational choices taking more time to make, may have been artifacts of presenting partial information.

Moral dilemmas of community pharmacists: a narrative study

Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing. Objective To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy. Methods Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure Themes of moral dilemmas. Results Twenty-two themes were identified in 128 narratives. These moral dilemmas arose predominantly during pharmacists’ contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators. Conclusion The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.

Is utilitarian sacrifice becoming more morally permissible?

A central tenet of contemporary moral psychology is that people typically reject active forms of utilitarian sacrifice. Yet, evidence for secularization and declining empathic concern in recent decades suggests the possibility of systematic change in this attitude. In the present study, we employ hypothetical dilemmas to investigate whether judgments of utilitarian sacrifice are becoming more permissive over time. In a cross-sectional design, age negatively predicted utilitarian moral judgment (Study 1). To examine whether this pattern reflected processes of maturation, we asked a panel to re-evaluate several moral dilemmas after an eight-year interval but observed no overall change (Study 2). In contrast, a more recent age-matched sample revealed greater endorsement of utilitarian sacrifice in a time-lag design (Study 3). Taken together, these results suggest that today's younger cohorts increasingly endorse a utilitarian resolution of sacrificial moral dilemmas.

Effect of professional expertise and exposure to everyday life decision-making on moral choices

Moral sense is defined as a feeling of fairness or unfairness of an action that knowingly causes harm to people other than the subject. It is crucial in determining human behavior and becomes pivotal in operational environments. Here we assessed whether professional daily life experience in an operational environment affects moral judgment by asking 41 military pilots of the Italian Air Force (P) and 69 controls (C) to solve 40 moral dilemmas. We found that P gave more morally acceptable utilitarian responses to moral dilemmas. Interestingly, men and women in P equally accepted utilitarian resolutions of moral dilemmas, whereas in C women were less prone than men to accept utilitarian responses. We conclude that professional daily life experience of P, in an operational environment, affects moral judgment and mitigates gender predisposition towards moral dilemmas.

Outcome-focused judgements of moral dilemmas in schizophrenia

Previous research on moral judgement in healthy adults suggests a complex interplay of automatic, emotional and deliberative processing. We aimed to advance understanding of these processes by examining moral judgement in individuals with schizophrenia, a population characterised by social-cognitive deficits and interpersonal difficulties. Forty-five patients with schizophrenia and 27 healthy controls judged high-conflict moral dilemmas in response to 3rd-person (i.e. "Is it morally okay to [perform X]?") and 1st-person (i.e. "Would you [perform X]?") probes. Controls were less utilitarian for 3rd-person than 1st-person probes, while this discrepancy did not hold for patients. Utilitarianism in patients correlated with higher levels of interpersonal conflict. Findings suggest that people with schizophrenia focus equally on outcomes across moral-judgement conditions that ought normally to elicit an outcome-action discrepancy, suggesting that they are less influenced by an automatic aversive response to harmful acts in dilemma scenarios, consistent with a dual-process model of moral judgement.

Does Moral Case Deliberation Help Professionals in Care for the Homeless in Dealing with Their Dilemmas? A Mixed-Methods Responsive Study

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation (MCD) is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people's perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization.

Obligatory Effort [Hishtadlut] as an Explanatory Model: A Critique of Reproductive Choice and Control

Studies on reproductive technologies often examine women's reproductive lives in terms of choice and control. Drawing on 48 accounts of procreative experiences of religiously devout Jewish women in Israel and the US, we examine their attitudes, understandings and experiences of pregnancy, reproductive technologies and prenatal testing. We suggest that the concept of hishtadlut-"obligatory effort"-works as an explanatory model that organizes Haredi women's reproductive careers and their negotiations of reproductive technologies. As an elastic category with negotiable and dynamic boundaries, hishtadlut gives ultra-orthodox Jewish women room for effort without the assumption of control; it allows them to exercise discretion in relation to medical issues without framing their efforts in terms of individual choice. Haredi women hold themselves responsible for making their obligatory effort and not for pregnancy outcomes. We suggest that an alternative paradigm to autonomous choice and control emerges from cosmological orders where reproductive duties constitute "obligatory choices."

Oscillatory correlates of moral decision-making: Effect of personality

The role of emotion in moral decision-making is still a matter of debate. Greene, Sommerville, Nystrom, Darley, and Cohen (2001) argue that 'personal' moral judgments are driven by emotional responses, while 'impersonal' judgments are largely driven by cognitive processes. In this study, oscillatory correlates of decision-making were compared in moral personal, moral impersonal, and nonmoral conditions, as well as in trials associated with utilitarian (i.e., favoring the 'greater good' over individual rights) and non-utilitarian choices. Event-related synchronization in delta and theta bands was greater in the right temporal lobe in personal than in both nonmoral and impersonal moral condition. Graph-theoretical analysis of connectivity patterns showed the prominent role of the orbitofrontal and cingulate cortices in personal moral decision-making, implying greater emotional and self-processing. Higher conscientiousness and intellect and lower behavioral activation were associated with greater difference in oscillatory responses between utilitarian and non-utilitarian choices in personal than in impersonal condition, indicating that sensitivity to moral issues and the ability to grasp the nuances of moral situation are essential for understanding the implications of utilitarian choices in personal and impersonal conditions.

Evaluation of the legal consequences of action affects neural activity and emotional experience during the resolution of moral dilemmas

In any modern society killing is regarded as a severe violation of the legal codes that is subjected to penal judgment. Therefore, it is likely that people take legal consequences into account when deciding about the hypothetical killing of one person in classic moral dilemmas, with legal concerns contributing to decision-making. In particular, by differing for the degree of intentionality and emotional salience, Footbridge- and Trolley-type dilemmas might promote differential assignment of blame and punishment while implicating the same severity of harm. The present study was aimed at comparing the neural activity, subjective emotional reactions, and behavioral choices in two groups of participants who either took (Legal group) or did not take (No Legal group) legal consequences into account when deciding on Footbridge-type and Trolley-type moral dilemmas. Stimulus- and response-locked ERPs were measured to investigate the neural activity underlying two separate phases of the decision process. No difference in behavioral choices was found between groups. However, the No Legal group reported greater overall emotional impact, associated with lower preparation for action, suggesting greater conflict between alternative motor responses representing the different decision choices. In contrast, the Legal group showed an overall dampened affective experience during decision-making associated with greater overall action readiness and intention to act, reflecting lower conflict in responding. On these bases, we suggest that in moral dilemmas legal consequences of actions provide a sort of reference point on which people can rely to support a decision, independent of dilemma type.

'Utilitarian' judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good

•

‘Utilitarian’ judgments in moral dilemmas were associated with egocentric attitudes and less identification with humanity.

•

They were also associated with lenient views about clear moral transgressions.

•

‘Utilitarian’ judgments were not associated with views expressing impartial altruist concern for others.

•

This lack of association remained even when antisocial tendencies were controlled for.

•

So-called ‘utilitarian’ judgments do not express impartial concern for the greater good.

A growing body of research has focused on so-called ‘utilitarian’ judgments in moral dilemmas in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. However, the relation between such ‘utilitarian’ judgments and genuine utilitarian impartial concern for the greater good remains unclear. Across four studies, we investigated the relationship between ‘utilitarian’ judgment in such sacrificial dilemmas and a range of traits, attitudes, judgments and behaviors that either reflect or reject an impartial concern for the greater good of all. In Study 1, we found that rates of ‘utilitarian’ judgment were associated with a broadly immoral outlook concerning clear ethical transgressions in a business context, as well as with sub-clinical psychopathy. In Study 2, we found that ‘utilitarian’ judgment was associated with greater endorsement of rational egoism, less donation of money to a charity, and less identification with the whole of humanity, a core feature of classical utilitarianism. In Studies 3 and 4, we found no association between ‘utilitarian’ judgments in sacrificial dilemmas and characteristic utilitarian judgments relating to assistance to distant people in need, self-sacrifice and impartiality, even when the utilitarian justification for these judgments was made explicit and unequivocal. This lack of association remained even when we controlled for the antisocial element in ‘utilitarian’ judgment. Taken together, these results suggest that there is very little relation between sacrificial judgments in the hypothetical dilemmas that dominate current research, and a genuine utilitarian approach to ethics.

Incidental emotions in moral dilemmas: the influence of emotion regulation

Recent theories have argued that emotions play a central role in moral decision-making and suggested that emotion regulation may be crucial in reducing emotion-linked biases. The present studies focused on the influence of emotional experience and individual differences in emotion regulation on moral choice in dilemmas that pit harming another person against social welfare. During these "harm to save" moral dilemmas, participants experienced mostly fear and sadness but also other emotions such as compassion, guilt, anger, disgust, regret and contempt (Study 1). Fear and disgust were more frequently reported when participants made deontological choices, whereas regret was more frequently reported when participants made utilitarian choices. In addition, habitual reappraisal negatively predicted deontological choices, and this effect was significantly carried through emotional arousal (Study 2). Individual differences in the habitual use of other emotion regulation strategies (i.e., acceptance, rumination and catastrophising) did not influence moral choice. The results of the present studies indicate that negative emotions are commonly experienced during "harm to save" moral dilemmas, and they are associated with a deontological bias. By efficiently reducing emotional arousal, reappraisal can attenuate the emotion-linked deontological bias in moral choice.

Polysubstance dependent patients display a more utilitarian profile in moral decision-making than alcohol-dependent patients, depressive patients and controls

BACKGROUND

Addiction has been shown to be associated with the endorsement of utilitarian moral judgments. Ventro-medial prefrontal cortex (VMPFC) dysfunction may explain these findings.

METHODS

100 subjects were recruited: 25 polysubstance dependent patients, 25 alcohol dependent patients, 25 patients with major depressive disorders, and 25 normal controls. Subjects were assessed with a battery of 24 moral dilemmas: 8 impersonal dilemmas (no physical contact involved); 8 personal pareto (direct action that does not make the harmed individual worse off) and 8 personal non-pareto (direct action that does make the harmed individual worse off). The Iowa Gambling Task was used to document a possible connection between VMPFC dysfunction and responses to the moral dilemmas.

RESULTS

Polysubstance dependent patients endorsed more utilitarian choices than controls on all types of dilemmas and more than depressed patients on impersonal and personal pareto dilemmas. Alcohol dependent patients had intermediate results between polysubstance dependent patients and controls but these differences were not significant. All patients showed significantly poorer performance compared to controls on the Iowa Gambling Task, but there was no significant association between Iowa Gambling Tasks scores and moral dilemma choices.

CONCLUSION

Polysubstance dependent patients made more utilitarian choices when responding to moral dilemmas than depressed patients and normal controls, while alcoholic patients showed intermediate results. The absence of correlation between performance on the Iowa Gambling Task and the number of more utilitarian choices indicates that moral dilemma and decision making under uncertainty tap into separate mechanisms.

The impact of one night of sleep deprivation on moral judgments

Recent studies have shown the existence of a relationship between sleep and moral judgment. In this study, we investigated whether one night of sleep deprivation affects the ability to judge the appropriateness of moral dilemmas. Forty-eight students had to judge 30 moral dilemmas at test, after a night of home sleep, and another 30 dilemmas at retest, following one night of continuous wakefulness. The 60 dilemmas (20 moral impersonal, 20 moral personal, and 20 non-moral) were selected from Greene's dilemmas. Both groups judged the appropriateness of personal and impersonal dilemmas in the same way. A close to significant effect of sleep deprivation was observed on the reaction times for impersonal moral dilemmas, to which the deprived subjects responded faster (p = .05) than the control subjects. However, this was not the case for personal ones, for which no difference was significant. This result shows a greater ease/speed in responding to the (impersonal) dilemmas, which induce low emotional engagement after sleep deprivation, although the willingness to accept moral violations is not affected. This suggests that one night of sleep loss selectively influences the response speed only for moral impersonal dilemmas, probably due to disinhibition processes. The quality of moral judgment dilemmas does not seem to be easily influenced by a single night of sleep deprivation, but only by a longer lack of sleep.