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Intact moral decision-making in adults with moderate-severe traumatic brain injury

Published online by Cambridge University Press:  03 May 2022

Malcolm Edwards Open the ORCID record for Malcolm Edwards [Opens in a new window] ,
Emily L. Morrow  and
Melissa C. Duff
Malcolm Edwards*
Affiliation:
Meharry Medical College, Nashville, TN, USA
Emily L. Morrow
Affiliation:
Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
Melissa C. Duff
Affiliation:
Meharry Medical College, Nashville, TN, USA Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
*
*Corresponding author. Email: medwards18@email.mmc.edu
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Abstract

Background and aim:

Deficits in decision-making are a common consequence of moderate-severe traumatic brain injury (TBI). Less is known, however, about how individuals with TBI perform on moral decision-making tasks. To address this gap in the literature, the current study probed moral decision-making in a sample of individuals with TBI using a widely employed experimental measure.

Methods/hypothesis:

We administered a set of 50 trolley-type dilemmas to 31 individuals with TBI and 31 demographically matched, neurotypical comparison participants. We hypothesized that individuals with TBI would be more likely to offer utilitarian responses to personal dilemmas than neurotypical peers.

Results:

In contrast to our hypothesis, we observed that individuals with TBI were not more likely to offer utilitarian responses for personal dilemmas.

Conclusion:

Our results suggest that moral decision-making ability is not uniformly impaired following TBI. Rather, neuroanatomical (lesion location) and demographic (age at injury) characteristics may be more predictive of a disruption in moral decision-making than TBI diagnosis or injury severity alone. These results inform the neurobiology of moral decision-making and have implications for characterizing patterns of spared and impaired cognitive abilities in TBI.

Keywords

Moral judgmentmoral decision-makingtraumatic brain injurycognition
Type
Original Article
Information
Brain Impairment , Volume 24 , Issue 3 , December 2023 , pp. 568 - 585
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment

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References

Adams, J. H., Doyle, D., Graham, D. I., Lawrence, A. E., McLellan, D. R., & Gennarelli, T. A., … Sakamoto, T. (1985). The contusion index: A reappraisal in human and experimental non-missile head injury. Neuropathology and Applied Neurobiology, 11(4), 299–308. doi:10.1111/j.1365-2990.1985.tb00027.x.CrossRefGoogle ScholarPubMed
Anderson, S. W., Bechara, A., Damasio, H., Tranel, D., & Damasio, A. R. (1999). Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nature Neuroscience, 2(11), 1032–1037. doi:10.1038/14833.CrossRefGoogle ScholarPubMed
Bartels, D. M., & Pizarro, D. A. (2011). The mismeasure of morals: Antisocial personality traits predict utilitarian responses to moral dilemmas. Cognition, 121(1), 154–161. doi:10.1016/j.cognition.2011.05.010.CrossRefGoogle ScholarPubMed
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). Fitting linear mixed-effects models using lme4. Journal of Statistical Software, 67(1), 1–48.CrossRefGoogle Scholar
Beauchamp, M. H., Dooley, J. J., & Anderson, V. (2013). A preliminary investigation of moral reasoning and empathy after traumatic brain injury in adolescents. Brain Injury, 27(7-8), 896–902. doi:10.3109/02699052.2013.775486.CrossRefGoogle ScholarPubMed
Beauchamp, M. H., Vera-Estay, E., Morasse, F., Anderson, V., & Dooley, J. (2019). Moral reasoning and decision-making in adolescents who sustain traumatic brain injury. Brain Injury, 33(1), 32–39. doi:10.1080/02699052.2018.1531307.CrossRefGoogle ScholarPubMed
Bellesi, G., Barker, E. D., Brown, L., & Valmaggia, L. (2019). Pediatric traumatic brain injury and antisocial behavior: Are they linked? A systematic review. Brain Injury, 33(10), 1272–1292. doi:10.1080/02699052.2019.1641621.CrossRefGoogle ScholarPubMed
Bigler, E. D. (2016). Systems biology, neuroimaging, neuropsychology, neuroconnectivity and traumatic brain injury. Frontiers in Systems Neuroscience, 10, 55. doi:10.3389/fnsys.2016.00055.CrossRefGoogle ScholarPubMed
Bonatti, E., Zamarian, L., Wagner, M., Benke, T., Hollosi, P., Strubreither, W., & Delazer, M. (2008). Making decisions and advising decisions in traumatic brain injury. Cognitive and Behavioral Neurology : Official Journal of the Society for Behavioral and Cognitive Neurology, 21(3), 164–175. doi:10.1097/WNN.0b013e318184e688.CrossRefGoogle ScholarPubMed
Ciaramelli, E., Muccioli, M., Làdavas, E., & di Pellegrino, G. (2007). Selective deficit in personal moral judgment following damage to ventromedial prefrontal cortex. Social Cognitive and Affective Neuroscience, 2(2), 84–92. doi:10.1093/scan/nsm001.CrossRefGoogle ScholarPubMed
Cotrena, C., Branco, L. D., Zimmermann, N., Cardoso, C. O., Grassi-Oliveira, R., & Fonseca, R. P. (2014). Impaired decision-making after traumatic brain injury: The iowa gambling task. Brain Injury, 28(8), 1070–1075. doi:10.3109/02699052.2014.896943.CrossRefGoogle ScholarPubMed
Damasio, A. (2005). Descartes’ error: Emotion, reason, and the human brain (Illustrated, pages 336), New York: G.P. Putnam.Google Scholar
Duff, M. C., Hengst, J., Tranel, D., & Cohen, N. J. (2006). Development of shared information in communication despite hippocampal amnesia. Nature Neuroscience, 9(1), 140–146. doi:10.1038/nn1601.CrossRefGoogle ScholarPubMed
Foot, P. (2002). The problem of abortion and the doctrine of the double effect, In Virtues and vices (pp. 19–32, Oxford University Press, 10.1093/0199252866.003.0002)CrossRefGoogle Scholar
Garrigan, B., Adlam, A. L. R., & Langdon, P. E. (2018). Moral decision-making and moral development: Toward an integrative framework. Developmental Review, 49, 80–100. doi:10.1016/j.dr.2018.06.001.CrossRefGoogle Scholar
Gawronski, B., Armstrong, J., Conway, P., Friesdorf, R., & Hütter, M. (2017). Consequences, norms, and generalized inaction in moral dilemmas: The CNI model of moral decision-making. Journal of Personality and Social Psychology, 113(3), 343–376. doi:10.1037/pspa0000086.CrossRefGoogle ScholarPubMed
Gawronski, B., & Beer, J. S. (2017). What makes moral dilemma judgments, utilitarian, or “deontological”? Social Neuroscience, 12(6), 626–632. doi:10.1080/17470919.2016.1248787.Google ScholarPubMed
Greene, J. D., Cushman, F. A., Stewart, L. E., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2009). Pushing moral buttons: The interaction between personal force and intention in moral judgment. Cognition, 111(3), 364–371. doi:10.1016/j.cognition.2009.02.001.CrossRefGoogle ScholarPubMed
Greene, J. D., Morelli, S. A., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2008). Cognitive load selectively interferes with utilitarian moral judgment. Cognition, 107(3), 1144–1154. doi:10.1016/j.cognition.2007.11.004.CrossRefGoogle ScholarPubMed
Greene, J. D., Sommerville, R. B., Nystrom, L. E., Darley, J. M., & Cohen, J. D. (2001). An fMRI investigation of emotional engagement in moral judgment. Science, 293(5537), 2105–2108. doi:10.1126/science.1062872.CrossRefGoogle ScholarPubMed
Harenski, C. L., & Hamann, S. (2006). Neural correlates of regulating negative emotions related to moral violations. Neuroimage, 30(1), 313–324. doi:10.1016/j.neuroimage.2005.09.034.CrossRefGoogle ScholarPubMed
Harenski, C. L., Kim, S. H., & Hamann, S. (2009). Neuroticism and psychopathy predict brain activation during moral and nonmoral emotion regulation. Cognitive, Affective & Behavioral Neuroscience, 9(1), 1–15. doi:10.3758/CABN.9.1.1.CrossRefGoogle ScholarPubMed
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., & REDCap Consortium (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. doi:10.1016/j.jbi.2019.103208.CrossRefGoogle ScholarPubMed
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap) -- A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. doi:10.1016/j.jbi.2008.08.010.CrossRefGoogle ScholarPubMed
Heekeren, H. R., Wartenburger, I., Schmidt, H., Schwintowski, H.-P., & Villringer, A. (2003). An fMRI study of simple ethical decision-making. Neuroreport, 14(9), 1215–1219. doi:10.1097/01.wnr.0000081878.45938.a7.CrossRefGoogle ScholarPubMed
Kahane, G., Everett, J. A. C., Earp, B. D., Farias, M., & Savulescu, J. (2015). Utilitarian, judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good. Cognition, 134, 193–209. doi:10.1016/j.cognition.2014.10.005.CrossRefGoogle Scholar
Koenigs, M., & Tranel, D. (2007). Irrational economic decision-making after ventromedial prefrontal damage: Evidence from the ultimatum game. The Journal of Neuroscience, 27(4), 951–956. doi:10.1523/JNEUROSCI.4606-06.2007.CrossRefGoogle ScholarPubMed
Koenigs, M., Young, L., Adolphs, R., Tranel, D., Cushman, F., Hauser, M., & Damasio, A. (2007). Damage to the prefrontal cortex increases utilitarian moral judgements. Nature, 446(7138), 908–911. doi:10.1038/nature05631.CrossRefGoogle Scholar
Levine, B., Black, S. E., Cheung, G., Campbell, A., O’Toole, C., & Schwartz, M. L. (2005). Gambling task performance in traumatic brain injury: Relationships to injury severity, atrophy, lesion location, and cognitive and psychosocial outcome. Cognitive and Behavioral Neurology : Official Journal of the Society for Behavioral and Cognitive Neurology, 18(1), 45–54.CrossRefGoogle ScholarPubMed
Long, A., & Long, B. (2013). Hemigway editor (3.0). Computer Software, 38, Long LLC. Retrieved from https://hemingwayapp.com/.Google Scholar
Luo, Q., Nakic, M., Wheatley, T., Richell, R., Martin, A., & Blair, R. J. R. (2006). The neural basis of implicit moral attitude -- An IAT study using event-related fMRI. Neuroimage, 30(4), 1449–1457. doi:10.1016/j.neuroimage.2005.11.005.CrossRefGoogle ScholarPubMed
Malec, J. F., Brown, A. W., Leibson, C. L., Flaada, J. T., Mandrekar, J. N., Diehl, N. N., & Perkins, P. K. (2007). The mayo classification system for traumatic brain injury severity. Journal of Neurotrauma, 24(9), 1417–1424. doi:10.1089/neu.2006.0245.CrossRefGoogle ScholarPubMed
Martins, A. T., Faísca, L. M., Esteves, F., Muresan, A., & Reis, A. (2012). Atypical moral judgment following traumatic brain injury. 478–487. Retrieved from https://search.proquest.com/docview/1031022007?rfr_id=info%3Axri%2Fsid%3Aprimo.Google Scholar
McNabb, C., & Francis, K. (2020). Moral decision-making in the time of COVID-19: Moral Judgments, moralisation, and everyday behavior. Frontiers in Psychology, 12, 769177. doi:10.3389/fpsyg.2021.769177.Google Scholar
Moll, J., Eslinger, P. J., & de Oliveira-Souza, R. (2001). Frontopolar and anterior temporal cortex activation in a moral judgment task: Preliminary functional MRI results in normal subjects. Arquivos de Neuro-Psiquiatria, 59(3-B), 657–664. doi:10.1590/S0004-282X2001000500001.CrossRefGoogle Scholar
Moll, J., de Oliveira-Souza, R., Eslinger, P. J., Bramati, I. E., Mourão-Miranda, J., Andreiuolo, P. A., & Pessoa, L. (2002). The neural correlates of moral sensitivity: A functional magnetic resonance imaging investigation of basic and moral emotions. The Journal of Neuroscience, 22(7), 2730–2736.CrossRefGoogle ScholarPubMed
Moretto, G., Làdavas, E., Mattioli, F., & di Pellegrino, G. (2010). A psychophysiological investigation of moral judgment after ventromedial prefrontal damage. Journal of Cognitive Neuroscience, 22(8), 1888–1899. doi:10.1162/jocn.2009.21367.CrossRefGoogle ScholarPubMed
Morrell, R. F., Merbitz, C. T., Jain, S., & Jain, S. (1998). Traumatic brain injury in prisoners. Journal of Offender Rehabilitation, 27(3-4), 1–8. doi:10.1300/J076v27n03_01.CrossRefGoogle Scholar
Morrow, E. L., Dulas, M. R., Cohen, N. J., & Duff, M. C. (2020). Relational memory at short and long delays in individuals with moderate-severe traumatic brain injury. Frontiers in Human Neuroscience, 14, 270. doi:10.3389/fnhum.2020.00270.CrossRefGoogle Scholar
Morrow, E. L., Patel, N. N., & Duff, M. C. (2021). Disability and the COVID-19 pandemic: A survey of individuals with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 102(6), 1075–1083. doi:10.1016/j.apmr.2021.01.064.CrossRefGoogle ScholarPubMed
Newcombe, V. F. J., Outtrim, J. G., Chatfield, D. A., Manktelow, A., Hutchinson, P. J., Coles, J. P., … Menon, D. K. (2011). Parcellating the neuroanatomical basis of impaired decision-making in traumatic brain injury. Brain: A Journal of Neurology, 134(Pt 3), 759–768. doi:10.1093/brain/awq388.CrossRefGoogle ScholarPubMed
Oppenheimer, D. M., Meyvis, T., & Davidenko, N. (2009). Instructional manipulation checks: Detecting satisficing to increase statistical power. Journal of Experimental Social Psychology, 45(4), 867–872. doi:10.1016/j.jesp.2009.03.009.CrossRefGoogle Scholar
Patil, I. (2015). Trait psychopathy and utilitarian moral judgement: The mediating role of action aversion. Journal of Cognitive Psychology, 27(3), 349–366. doi:10.1080/20445911.2015.1004334.CrossRefGoogle Scholar
Porcelli, A. J., & Delgado, M. R. (2017). Stress and decision making: Effects on valuation, learning, and risk-taking. Current Opinion in Behavioral Sciences, 14, 33–39. doi:10.1016/j.cobeha.2016.11.015.CrossRefGoogle ScholarPubMed
Prehn, K., Wartenburger, I., Mériau, K., Scheibe, C., Goodenough, O. R., Villringer, A., … Heekeren, H. R. (2008). Individual differences in moral judgment competence influence neural correlates of socio-normative judgments. Social Cognitive and Affective Neuroscience, 3(1), 33–46. doi:10.1093/scan/nsm037.CrossRefGoogle ScholarPubMed
Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. The Psychiatric Clinics of North America, 37(1), 1–11. doi:10.1016/j.psc.2013.11.004.CrossRefGoogle ScholarPubMed
Sarapata, M., Herrmann, D., Johnson, T., & Aycock, R. (1998). The role of head injury in cognitive functioning, emotional adjustment and criminal behaviour. Brain Injury, 12(10), 821–842. doi:10.1080/026990598122061.CrossRefGoogle ScholarPubMed
Schofield, P. W., Butler, T. G., Hollis, S. J., Smith, N. E., Lee, S. J., & Kelso, W. M. (2006). Traumatic brain injury among Australian prisoners: Rates, recurrence and sequelae. Brain Injury, 20(5), 499–506. doi:10.1080/02699050600664749.CrossRefGoogle ScholarPubMed
Schwartz, J. A., Fitter, B., & Jodis, C. A. (2020). The impact of brain injury on within-individual changes in moral disengagement: Implications for criminal and antisocial behavior. Journal of Experimental Criminology, 16(3), 407–429. doi:10.1007/s11292-020-09439-6.CrossRefGoogle Scholar
Shansky, R. M., & Murphy, A. Z. (2021). Considering sex as a biological variable will require a global shift in science culture. Nature Neuroscience, 24(4), 457–464. doi:10.1038/s41593-021-00806-8.CrossRefGoogle ScholarPubMed
Shenhav, A., & Greene, J. D. (2010). Moral judgments recruit domain-general valuation mechanisms to integrate representations of probability and magnitude. Neuron, 67(4), 667–677. doi:10.1016/j.neuron.2010.07.020.CrossRefGoogle ScholarPubMed
Slaughter, B., Fann, J. R., & Ehde, D. (2003). Traumatic brain injury in a county jail population: Prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury, 17(9), 731–741. doi:10.1080/0269905031000088649.CrossRefGoogle Scholar
Sommer, M., Rothmayr, C., Döhnel, K., Meinhardt, J., Schwerdtner, J., Sodian, B., & Hajak, G. (2010). How should I decide? The neural correlates of everyday moral reasoning. Neuropsychologia, 48(7), 2018–2026. doi:10.1016/j.neuropsychologia.2010.03.023.CrossRefGoogle ScholarPubMed
Taber-Thomas, B. C., Asp, E. W., Koenigs, M., Sutterer, M., Anderson, S. W., & Tranel, D. (2014). Arrested development: Early prefrontal lesions impair the maturation of moral judgement. Brain: A Journal of Neurology, 137(Pt 4), 1254–1261. doi:10.1093/brain/awt377.CrossRefGoogle ScholarPubMed
Thomas, B. C., Croft, K. E., & Tranel, D. (2011). Harming kin to save strangers: Further evidence for abnormally utilitarian moral judgments after ventromedial prefrontal damage. Journal of Cognitive Neuroscience, 23(9), 2186–2196. doi:10.1162/jocn.2010.21591.CrossRefGoogle Scholar
Timonen, M., Miettunen, J., Hakko, H., Zitting, P., Veijola, J., von Wendt, L., & Räsänen, P. (2002). The association of preceding traumatic brain injury with mental disorders, alcoholism and criminality: The Northern Finland 1966 birth cohort study. Psychiatry Research, 113(3), 217–226. doi:10.1016/s0165-1781(02)00269-x.CrossRefGoogle ScholarPubMed
Turkstra, L. S., Mutlu, B., Ryan, C. W., Despins Stafslien, E. H., Richmond, E. K., Hosokawa, E., & Duff, M. C. (2020). Sex and gender differences in emotion recognition and theory of mind after TBI: A narrative review and directions for future research. Frontiers in Neurology, 11, 59. doi:10.3389/fneur.2020.00059.CrossRefGoogle ScholarPubMed
Williams, W. H., Chitsabesan, P., Fazel, S., McMillan, T., Hughes, N., Parsonage, M., & Tonks, J. (2018). Traumatic brain injury: A potential cause of violent crime? The Lancet. Psychiatry, 5(10), 836–844. doi:10.1016/S2215-0366(18)30062-2.CrossRefGoogle ScholarPubMed
Wood, R. L., & Thomas, R. H. (2013). Impulsive and episodic disorders of aggressive behaviour following traumatic brain injury. Brain Injury, 27(3), 253–261. doi:10.3109/02699052.2012.743181.CrossRefGoogle ScholarPubMed
Wszalek, J. (2021). A public law model for cognitive-communication risk, In Neurodisability and the criminal justice system (pp. 34–50, Edward Elgar Publishing, 10.4337/9781789907636.00010)Google Scholar
Wszalek, J. A. (2021). Cognitive communication and the law: A model for systemic risks and systemic interventions. Journal of Law and the Biosciences, 8(1), lsab005. doi:10.1093/jlb/lsab005.CrossRefGoogle Scholar
Wszalek, J. A., & Turkstra, L. S. (2015). Language impairments in youths with traumatic brain injury: Implications for participation in criminal proceedings. The Journal of Head Trauma Rehabilitation, 30(2), 86–93. doi:10.1097/HTR.0000000000000130.CrossRefGoogle ScholarPubMed
Wszalek, J. A., & Turkstra, L. S. (2019). Comprehension of social-legal exchanges in adults with and without traumatic brain injury. Neuropsychology, 33(7), 934–946. doi:10.1037/neu0000567.CrossRefGoogle ScholarPubMed
Ylvisaker, M., & Freeney, T. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego: Singular Pub. Group.Google Scholar
Young, L., & Saxe, R. (2009). An FMRI investigation of spontaneous mental state inference for moral judgment. Journal of Cognitive Neuroscience, 21(7), 1396–1405. doi:10.1162/jocn.2009.21137.CrossRefGoogle ScholarPubMed
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