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.

Moral dilemmas and moral principles: when emotion and cognition unite.

Traditional studies on moral judgement used resolutions of moral dilemmas that were framed in terms of acceptability of the consequentialist action promoting a greater good, thus overlooking the deontological implications (choices cannot be justified by their consequences). Recently, some authors have suggested a parallelism between automatic, unreflective emotional responses and deontological moral judgements. In this study, we developed a novel experimental paradigm in which participants were required to choose between two resolutions of a moral dilemma (consequentialist and deontological). To assess whether emotions are engaged in each of the two resolutions, we asked participants to evaluate their emotional experience through the ratings of valence and arousal. Results showed that emotion is involved not only in deontological but also in consequentialist resolutions. Moreover, response times pointed out a different interplay between emotion and cognition in determining a conflict in the dilemma's resolution. In particular, when people were faced with trolley-like dilemmas we found that decisions leading to deontological resolutions were slower than decisions leading to consequentialist resolutions. We propose that this finding reflects the special (but not accepted) permission provided by the doctrine of the double effect for incidentally causing death for the sake of a good end.

Framing the ultimatum game: gender differences and autonomic responses.

The present study aimed at investigating whether the way offers are framed in the Ultimatum Game (UG) affects behavioral and autonomic responses in men and women. The "I give you" and "I take" expressions were used as gain and loss frames, respectively. Skin conductance and heart rate were recorded as indices of autonomic activation in response to unfair, mid-value, and fair offers. Acceptance rates were higher in men than in women under the gain frame. Moreover, men showed higher acceptance rates under the gain than under the loss frame with mid-value offers, whereas women's choices were not affected by frame. On the physiological level, men produced differential autonomic response patterns during decision-making when offers were presented under gain and loss framing. The "I take" frame, by acting as a loss frame, elicited in men the characteristic defensive response pattern that is evoked by aversive stimulation, in which increases in skin conductance are coupled with increases in heart rate. On the other hand, the "I give you" frame, by acting as a gain frame, elicited in men increases in skin conductance associated with prevailing heart rate deceleratory responses, reflecting a state of enhanced attention and orienting. In contrast, women's autonomic reactivity was not affected by frame, consistent with behavioral results. Phasic changes in heart rate were crucial in revealing differential functional significance of skin conductance responses under different frames in men, thus questioning the assumption that this autonomic measure can be used as an index of negative emotional arousal in the UG.

Temporal dynamics of cognitive-emotional interplay in moral decision-making.

This study investigated the temporal dynamics of emotional and cognitive processing underlying decision-making in moral judgment. Thirty-seven participants were presented with a set of 60 dilemmas varying in whether killing one individual was an intended means to save others (instrumental dilemmas) or a foreseen but unintended consequence (incidental dilemmas). Participants were required to decide between Options A (letting a specific number of people die) and B (killing one person to save a specific number of people). ERPs were recorded to a slide displaying the letters A and B while subjects were deciding between the options, and movement-related potentials were recorded time-locked to the behavioral response, thus allowing the investigation of both stimulus- and response-related processes during decision-making. Ratings of emotional valence and arousal experienced during decision-making were collected after each decision. Compared with incidental dilemmas, instrumental dilemmas prompted a lower number of B choices and significantly more unpleasant decisions. A larger P260 component was found in the frontopolar and frontal areas when subjects were deciding on instrumental than incidental dilemmas, possibly reflecting an immediate affective reaction during the early stage of assessment and formation of preferences between available options. On the other hand, decisions on incidental dilemmas required greater attentional resources during the fairly controlled later processing, as reflected in the larger slow wave amplitudes. In addition, facilitation of action selection and implementation was found for incidental dilemmas during the second stage of decision-making, as supported by the larger amplitudes of both components of the Bereitschaftspotential.

Investigating the impact of offer frame manipulations on responders playing the ultimatum game.

The present study was designed to test the impact of frame manipulations on the decision-making of responders playing the ultimatum game. Experiment 1 investigated responders' event-related potentials (ERPs) measured in response to the offers as a function of the frame (i.e., negative: "the proposer keeps" versus positive: "the proposer offers"). While no difference in acceptation rate was found as a function of the offer's frame, electrophysiological results suggest that the stronger negative affective response to the offers in the negative frame (N400) was successfully reappraised by the responders (P600), possibly explaining why the offer frame manipulation did not modulate acceptation rates. No framing effect was found when the ultimatum game was played in its one-shot version (Experiment 2), suggesting that repeated measurements did not affect responders' behavior. However, an offer framing effect was found in female (but not in male) responders, when the complexity of the game statement increased, presumably recruiting more cognitive resources and taxing the reappraisal process (Experiment 3). Taken together, these results suggest that framing manipulations are associated with complex affective and cognitive processes, supporting the cognitive-affective tradeoff model.

Brain correlates of risky decision-making.

Understanding the neurocognitive basis of risk-taking behavior is an important issue, especially in economic decision-making. Classical behavioral studies have shown that risk-attitude changes across different contexts, but little is so far known about the brain correlates of processing of outcomes across such context shifts. In this study, EEG was recorded while subjects performed a gambling task. Participants could choose between a risky and a safer option, within two different contexts: one in which options yielded gains and losses of the same magnitude (Zero Expected Value context) and another in which gains were larger than losses (Positive Expected Value context). Based on their risk-attitude, two groups were compared: subjects who are risk-seekers in the zero Expected Value context (Zero-Oriented group) and subjects who are risk-seekers in the positive Expected Value condition (Positive-Oriented group). The Feedback Related Negativity (FRN) reflects this distinction, with each group being insensitive to magnitude of outcomes in the condition in which they were risk-prone. P300 amplitude mirrored the behavioral results, with larger amplitudes in the condition in which each group showed a higher risk-tendency. Source analyses highlighted the involvement of posterior cingulate cortex in risky decision-making. Taken together, the findings make a contribution to the clarification of the neurocognitive substrates of risky decision-making.

Recalling pain experienced during a colonoscopy: pain expectation and variability.

OBJECTIVES: This study investigated the relationship between participants' expected levels of pain intensity before a colonoscopy, pain intensity experienced while they were undergoing this medical procedure (real-time pain), and their retrospective evaluation of this experience. DESIGN: Correlational design. Regression analyses were performed and mediational models were tested. METHODS: Ninety patients who were about to undergo a colonoscopy were asked to report the pain intensity on a scale ranging from 0 (no pain) to 10 (extreme pain). They reported the expected intensity of pain before the examination, their real-time intensity of pain every 60 s during the colonoscopy, and their global retrospective evaluation of the pain experienced when the procedure was over. RESULTS: Results confirmed that, regardless of participants' gender, the variability of the real-time pain distribution was a significant predictor of the accuracy of recall (i.e. the discrepancy between recalled pain and mean real-time pain). Moreover, participants' pain expectations preceding the examination were a significant predictor of the accuracy of recall. It was further demonstrated that the effect of patients' expectations on the discrepancy was mediated by the real-time pain variability. CONCLUSIONS: The results of the present study provide useful indications about what the target of interventions aimed at reducing the bias in pain recall should be.

Sociocognitive factors associated with nonadherence to medication after hospital discharge.

Poor adherence to prescribed medication is a well-known problem and continues to be a major challenge in all medical specialties. Unlike previous studies that have mainly focused on nonadherence behaviors in specific diseases, this study sought to examine socio-cognitive factors associated with nonadherence behavior in a sample of a general clinical population. A questionnaire investigating socio-demographic and cognitive factors and a telephone follow-up interview were administered to 84 patients recruited in a General Medicine Unit before their discharge. Half of the participants were informed about that follow-up procedure. One month after hospital discharge, 42% of uninformed patients reported nonadherence behaviors, as against 21% of informed patients. Middle-aged patients and short-term treatments were associated significantly more often with nonadherence. Among cognitive factors, patients' perceived risks and benefits of nonadherence, personal susceptibility to diseases, subjective health value, and reported memory failures were significantly associated with adherence. We conclude that a patient's perception may be more important than medication load, illness severity, and complexity of regimen in influencing medication adherence, and that a telephone call follow-up helps in monitoring medication adherence after hospital discharge.

A genetic profile of oxytocin receptor improves moral acceptability of outcome-maximizing harm in male insurance brokers.

In recent years, conflicting findings have been reported in the scientific literature about the influence of dopaminergic, serotonergic and oxytocinergic gene variants on moral behavior. Here, we utilized a moral judgment paradigm to test the potential effects on moral choices of three polymorphisms of the Oxytocin receptor (OXTR): rs53576, rs2268498 and rs1042770. We analyzed the influence of each single polymorphism and of genetic profiles obtained by different combinations of their genotypes in a sample of male insurance brokers (n = 129), as compared to control males (n = 109). Insurance brokers resulted significantly more oriented to maximize outcomes than control males, thus they expressed more than controls the utilitarian attitude phenotype. When analyzed individually, none of the selected variants influenced the responses to moral dilemmas. In contrast, a composite genetic profile that potentially increases OXTR activity was associated with higher moral acceptability in brokers. We hypothesize that this genetic profile promotes outcome-maximizing behavior in brokers by focusing their attention on what represents a greater good, that is, saving the highest number of people, even though at the cost of sacrificing one individual. Our data suggest that investigations in a sample that most expresses the phenotype of interest, combined with the analysis of composite genetic profiles rather than individual variants, represent a promising strategy to find out weak genetic influences on complex phenotypes, such as moral behavior.

People's attitude toward xenotransplantation: affective reactions and the influence of the evaluation context.

BACKGROUND: One of the major issues in transplantation is to find a strategy to overcome the scarcity of human organs. One of the interventions under investigation is represented by xenotransplantation. The present study aimed to understand the role of psychological factors on people's perception of xenotransplantation. In particular, we tested a condition in which different alternatives (e.g., human vs. pig donors) are presented together allowing people to compare among them (joint evaluation) and two conditions in which people are presented with only one of the two alternatives and cannot compare them (separate evaluation). METHODS: The study was conducted with three different groups of participants: patients waiting for liver transplantation (N = 31 in joint evaluation and N = 30 in each of the two separate evaluation conditions); students (N = 30 in join evaluation and N = 30 in each of the two separate evaluation conditions); and healthy adults (N = 30 in joint evaluation and N = 30 in each of the two separate evaluation conditions). Participants were presented with hypothetical scenarios and asked how good (or bad) were their feelings toward one or two types of donor (e.g., human and pig). RESULTS: Patients showed a skeptical attitude toward xenotransplantation both when it was evaluated together with the human donor (P < 0.01) or when it was evaluated separately (P < 0.01). Differently, when asked to evaluate each donor separately healthy adults and students showed similar affective reactions toward the two alternatives (human organ and xenograft). CONCLUSIONS: The present study demonstrates that the evaluation context may increase the impact of affective reactions and reduce healthy people's ability to use information on the potential benefit of a novel biomedical technology. Regardless of the evaluation context, patients always rely on affective reactions and show an overall preference for the human organ.

Predicting outcomes of decisions in the brain.

When making decisions, the outcomes of different choices play an important role. Feedback is mainly processed in terms of gains and losses. It is as yet unclear whether this distinction holds for predictable as well as unpredictable outcomes. Using ERPs, the present study aimed to determine whether predictable and unpredictable outcomes are coded differently in the brain. Participants had to choose between one of two options: the certain option was always associated with a gain of 10 euro, while the uncertain option entailed a gain of 30 euro or a loss of 10 euro, with a probability of 50% each. Overall, subjects showed a clear preference for the certain option, a tendency which became more pronounced during the course of the experiment. An early ERP component, the P200, reflected the predictability of outcomes, which was critical for the subsequent decisions. The later feedback related negativity (FRN) reflected the known distinction between gains and losses, while the N500 again reflected differential processing of predictable and unpredictable outcomes. Neither FRN nor the N500 were significantly related to behaviour. Predictability appears to play a central role in outcome evaluation.

Mentalizing in economic decision-making.

In the Ultimatum Game, participants typically reject monetary offers they consider unfair even if the alternative is to gain no money at all. In the present study, ERPs were recorded while subjects processed different offers of a proposer. In addition to clearly fair and unfair offers, mid-value offers which cannot be easily classified as fair or unfair and therefore involve more elaborate decision making were analyzed. A fast initial distinction between fair and other kinds of offers was reflected by amplitude of the feedback related negativity (FRN). Mid-value offers were associated with longer RTs, and a larger N350 amplitude. In addition, source analyses revealed a specific involvement of the superior temporal gyrus and the inferior parietal lobule during processing of mid-value offers compared to offers categorized clearly as fair or unfair, suggesting a contribution of mentalizing about the intention of the proposer to the decision making process. Taken together, the present findings support the idea that economic decisions are significantly affected by non-rational factors, trying to narrow the gap between formal theory and the real decisional behaviour.

Strengthening acceptance for xenotransplantation: the case of attraction effect.

BACKGROUND: Despite being still at the experimental level, xenotransplantation may become an effective strategy to overcome the scarcity of human organs. However, at the present time there is considerable resistance to this kind of biomedical technology. The aim of the present study was to identify novel strategies to reduce patients' negative affective reactions towards xenotransplantation helping them to understand the advantages of xenotransplantation in a more analytical fashion and increase their acceptance for this approach. METHODS: The study was conducted in a group of patients with liver cirrhosis waiting for liver transplantation. They were presented with hypothetical scenarios and asked to choose among either two or three alternative types of donor defined by their species (e.g., livers from humans vs. other species) and availability (low for human donors and high for livers from non-human species). RESULTS: Patients were unwilling to accept xenotransplantation if they were presented with livers from humans (chosen by 97.5% of participants) vs. livers from genetically modified pigs (2.5%). On the other hand, a different group of patients was significantly more willing to accept xenotransplantation if they were presented with three different types of donors: respectively, human beings (74.4%), genetically modified pigs (25.6%) and genetically modified dogs. In addition, human livers were judged significantly more attractive than genetically modified livers from pigs, monkeys, dogs, or sheep and pig livers were rated as significantly more attractive than livers from monkeys, dogs, or sheep (for all comparisons P < 0.01). CONCLUSIONS: These results demonstrate that paradigms from other fields, like decision-making, might help to communicate more effectively the potential of xenotransplantation, modulating patients' affective reactions and allowing them to understand the potential strengths of this biomedical technology.

Assessing emotions conveyed and elicited by patient narratives and their impact on intention to participate in colorectal cancer screening: A psychophysiological investigation.

In the context of colorectal cancer screening, we aimed to compare the effectiveness of different emotion-laden narratives, to investigate the specific emotions elicited at both subjective and physiological levels, and to test the effects of emotions explicitly expressed by the narrative character. Study 1 used a between-participants design comparing four conditions: relief-based narrative, regret-based narrative, control (test-uptake only) narrative, and standard invitation material (no-narrative condition). Study 2 used a mixed design, with the narrative content as a within-participants factor and whether emotions were expressed by the narrative character or not as between-participants factor. The main outcome measures were: intention to undergo testing (Studies 1 and 2), knowledge, risk perception, proportion of informed choices (Study 1), subjective emotional responses, changes in skin conductance, heart rate, and corrugator muscle activity (Study 2). In Study 1, relative to the non-narrative condition (51%), only the relief-based narrative significantly increased intention to undergo testing (86%). Relative to the standard invitation material, the narrative conditions did not decrease knowledge, alter risk perception, or decrease the proportion of informed choices. In Study 2, the relief-based narrative elicited the lowest self-reported negative affect, and received greater implicit attention, as suggested by the larger heart rate decrease. Making the emotions experienced by the narrative character explicit decreased negative affect, as indicated by the lower skin conductance and corrugator responses during reading. Our findings provide support for the use of a relief-based narrative with emotions expressed by the character in addition to the standard information material to promote colorectal cancer screening.

Genetically-Driven Enhancement of Dopaminergic Transmission Affects Moral Acceptability in Females but Not in Males: A Pilot Study.

Moral behavior has been a key topic of debate for philosophy and psychology for a long time. In recent years, thanks to the development of novel methodologies in cognitive sciences, the question of how we make moral choices has expanded to the study of neurobiological correlates that subtend the mental processes involved in moral behavior. For instance, in vivo brain imaging studies have shown that distinct patterns of brain neural activity, associated with emotional response and cognitive processes, are involved in moral judgment. Moreover, while it is well-known that responses to the same moral dilemmas differ across individuals, to what extent this variability may be rooted in genetics still remains to be understood. As dopamine is a key modulator of neural processes underlying executive functions, we questioned whether genetic polymorphisms associated with decision-making and dopaminergic neurotransmission modulation would contribute to the observed variability in moral judgment. To this aim, we genotyped five genetic variants of the dopaminergic pathway [rs1800955 in the dopamine receptor D4 (DRD4) gene, DRD4 48 bp variable number of tandem repeat (VNTR), solute carrier family 6 member 3 (SLC6A3) 40 bp VNTR, rs4680 in the catechol-O-methyl transferase (COMT) gene, and rs1800497 in the ankyrin repeat and kinase domain containing 1 (ANKK1) gene] in 200 subjects, who were requested to answer 56 moral dilemmas. As these variants are all located in genes belonging to the dopaminergic pathway, they were combined in multilocus genetic profiles for the association analysis. While no individual variant showed any significant effects on moral dilemma responses, the multilocus genetic profile analysis revealed a significant gender-specific influence on human moral acceptability. Specifically, those genotype combinations that improve dopaminergic signaling selectively increased moral acceptability in females, by making their responses to moral dilemmas more similar to those provided by males. As females usually give more emotionally-based answers and engage the "emotional brain" more than males, our results, though preliminary and therefore in need of replication in independent samples, suggest that this increase in dopamine availability enhances the cognitive and reduces the emotional components of moral decision-making in females, thus favoring a more rationally-driven decision process.

[The framing effect: medical implications]. / Effetto framing: implicazioni in ambito medico.

Over the last 20 years, many studies explored how the way information is presented modifies choices. This sort of effect, referred to as "framing effects", typically consists of the inversion of choices when presenting structurally identical decision problems in different ways. It is a common assumption that physicians are unaffected (or less affected) by the surface description of a decision problem, because they are formally trained in medical decision making. However, several studies showed that framing effects occur even in the medical field. The complexity and variability of these effects are remarkable, making it necessary to distinguish among different framing effects, depending on whether the effect is obtained by modifying adjectives (attribute framing), goals of a behavior (goal framing), or the probability of an outcome (risky choice framing). A further reason for the high variability of the framing effects seems to be the domain of the decision problem, with different effects occurring in prevention decisions, disease-detection decisions, and treatment decisions. The present work reviews the studies on framing effects, in order to summarize them and clarify their possible role in medical decision making.

Long-term decrease in subjective perceived efficacy of immunosuppressive treatment after heart transplantation.

BACKGROUND: Mild, long-term non-compliance with immunosuppressive treatment after organ transplantation is common, and can result in early mortality. One possible source of non-compliance is the belief that the treatment is ineffective or unnecessary. This study investigates patients perception of the efficacy of their immunosuppressive treatment in a sample of heart transplant patients. METHODS: A questionnaire was given to 67 heart transplant recipients. The first part of the questionnaire addressed health-related behavior and attitude toward the immunosuppressive medication, using self-report questions. In the second part of the questionnaire, participants evaluated the perceived risk of rejection associated with non-compliant behaviors described in 8 scenarios. RESULTS: The data from the self-report questions showed a mild level of behavioral non-compliance, increasing over time, and a mild level of medication non-compliance. One third of the medication non-compliant patients chose the inefficacy or non-necessity of the treatment as a main cause of non-compliance. The second part of the questionnaire showed that subjective perceived efficacy of the immunosuppressive treatment decreased over time. CONCLUSIONS: Medication non-compliance is fostered by many factors. One of these is the belief that the treatment is ineffective or unnecessary. This belief increases over time, and could be the result of a non-clinical selective-attention bias.

Rethinking the focusing effect in decision-making.

According to Legrenzi et al. [Cognition 49 (1993) 37], in making a choice people consider only the alternatives explicitly represented in their mental model of the decision situation. Their idea has found empirical support in the "focusing effect": Individuals focus on the alternatives explicitly stated in the problem context, and do not take into account other possibilities. In their original study, Legrenzi and colleagues considered only one factor to account for the explicit representation of an alternative--i.e., its explicit verbal formulation in the decision problem. Recent theories of relevance and information gain can help articulate their original idea, suggesting that individuals explicitly represent relevant alternatives, whether or not they are explicitly formulated in the decision problem. In three experiments we first replicated Legrenzi et al.'s original experiment, and then showed that the explicit verbal mention of an alternative is neither sufficient nor necessary to focus on it. The results suggest that individuals are able to consider relevant alternatives, even when they are not made explicit in the verbal formulation of a decision problem.

If it makes you feel bad, don't do it! Egoistic rather than altruistic empathy modulates neural and behavioral responses in moral dilemmas.

According to Greene et al.'s dual-process theory, the differential involvement of emotional processes would explain the different patterns of moral judgments people typically produce when faced with Trolley- and Footbridge-type dilemmas. As a relevant factor, dispositional empathy is known to motivate prosocial behaviors, thus playing a central role in moral judgment and behavior. The present study was aimed at investigating how behavioral and neural correlates of moral decision-making are modulated by the cognitive and affective dimensions of empathy. Thirty-seven participants were presented with 30 Footbridge-type and 30 Trolley-type dilemmas. Participants were required to decide between two options: letting some people die (non-utilitarian) vs. killing one person to save more people (utilitarian). Event-related potentials (ERPs) were recorded stimulus-locked to a "decision slide". Response choices and ratings of valence and arousal were also collected. Trait empathy was measured through the Interpersonal Reactivity Index (IRI), assessing both the cognitive and affective dimensions. Scores on the Empathic Concern affective subscale of the IRI positively predicted unpleasantness experienced during decision-making for all dilemmas. On the other hand, for Footbridge-type dilemmas only, scores on the Personal Distress affective subscale predicted negatively the mean percentages of utilitarian choices and positively the mean amplitudes of the P260, an ERP component reflecting an immediate emotional reaction during decision-making. It is concluded that "self-oriented" feelings of anxiety and unease, rather than "other-oriented" feelings of concern, affect behavioral choices and emotion-related cortical activity in Footbridge-type moral dilemmas.

Framing the ultimatum game: the contribution of simulation.

It has now become widely accepted that economic decisions are influenced by cognitive and emotional processes. In the present study, we aimed at disentangling the neural mechanisms associated with the way in which the information is formulated, i.e., framing effect, in terms of gain or loss, which influences people's decisions. Participants played a fMRI version of the Ultimatum Game (UG) where we manipulated bids through two different frames: the expression "I give you" (gain) focusing on money the respondent would receive if she/he agreed with the proponent, and the expression "I take" (loss) focusing on the money that would be removed from the respondent in the event that she/he accepted the offer. Neuroimaging data revealed a frame by response interaction, showing an increase of neural activity in the right rolandic operculum/insular cortex, the anterior cingulate, among other regions, for accepting the frame "I take" vs. rejecting, as compared to accepting the frame "I give you" vs. rejecting. In addition, the left occipito-temporal junction was activated for "I take" vs. "I give you" for offer 5, corresponding to the equal offer made unpleasant by the presence of the frame "I take," where is the proposer that takes the money. Our data extend the current understanding of the neural substrates of social decision making, by disentangling the structures sensitive to the way in which the information is formulated (i.e., framing effect), in terms of gain or loss.