Cognition 134 (2015) 121–127

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The drunk utilitarian: Blood alcohol concentration predicts utilitarian responses in moral dilemmas Aaron A. Duke a,b,⇑, Laurent Bègue b a b

Department of Psychiatry, Yale University, United States Department of Psychology, University of Grenoble-Alpes, France

a r t i c l e

i n f o

Article history: Received 27 January 2014 Revised 9 September 2014 Accepted 12 September 2014

Keywords: Utilitarian Moral dilemma Moral judgment Alcohol intoxication Ethanol Dual-process model

a b s t r a c t The hypothetical moral dilemma known as the trolley problem has become a methodological cornerstone in the psychological study of moral reasoning and yet, there remains considerable debate as to the meaning of utilitarian responding in these scenarios. It is unclear whether utilitarian responding results primarily from increased deliberative reasoning capacity or from decreased aversion to harming others. In order to clarify this question, we conducted two field studies to examine the effects of alcohol intoxication on utilitarian responding. Alcohol holds promise in clarifying the above debate because it impairs both social cognition (i.e., empathy) and higher-order executive functioning. Hence, the direction of the association between alcohol and utilitarian vs. non-utilitarian responding should inform the relative importance of both deliberative and social processing systems in influencing utilitarian preference. In two field studies with a combined sample of 103 men and women recruited at two bars in Grenoble, France, participants were presented with a moral dilemma assessing their willingness to sacrifice one life to save five others. Participants’ blood alcohol concentrations were found to positively correlate with utilitarian preferences (r = .31, p < .001) suggesting a stronger role for impaired social cognition than intact deliberative reasoning in predicting utilitarian responses in the trolley dilemma. Implications for Greene’s dual-process model of moral reasoning are discussed. Ó 2014 Elsevier B.V. All rights reserved.

1. Introduction The hypothetical moral dilemma known as the trolley problem has increasingly become a methodological cornerstone in the psychological study of moral reasoning. However, recent research raises some important questions about the underlying psychological processes that differentiate the utilitarian and non-utilitarian choices presented within the trolley problem. In its most ubiquitous form, the trolley problem involves the presentation of two vignettes: the classic ‘‘switch’’ problem (Foot, 1967) ⇑ Corresponding author at: 1 Long Wharf Dr., Suite 007, New Haven, Connecticut 06511, United States. Tel.: +1 202 697 3125. E-mail address: [email protected] (A.A. Duke). http://dx.doi.org/10.1016/j.cognition.2014.09.006 0010-0277/Ó 2014 Elsevier B.V. All rights reserved.

and the ‘‘footbridge’’ problem (Thomson, 1976). In both scenarios respondents are asked whether they would be willing to sacrifice one life to save five others facing certain death by a runaway trolley. However, the form of this utilitarian judgment is very different in the two scenarios. In the switch problem, five lives can be saved only by pressing a switch to divert the trolley onto a separate track with a single person on it. In the footbridge problem, the trolley can only be stopped by pushing a large man from a footbridge onto the tracks to block the oncoming trolley. The majority of individuals presented with the switch problem endorse pressing the switch; however, this pattern is reversed for the footbridge problem (Cushman, Young, & Hauser, 2006; Greene, Sommerville, Nystrom, Darley, & Cohen, 2001). The discrepancies between

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people’s willingness to sacrifice one to save five across the two scenarios has been used by researchers to support a dual-process theory of moral reasoning (e.g., Greene et al., 2001) in which automatic emotional processes pull for deontological decisions (i.e., ‘‘do no harm’’) and controlled ‘rational’ processes pull for utilitarian decisions (i.e., ‘‘the greater good’’). Greene and colleagues have argued that the increased resistance towards pushing the large man off of a bridge in the footbridge scenario is driven by the fact that it is more personal and direct, leading to a stronger emotional response in most individuals (Greene, 2009) and that utilitarian decision making in this scenario requires increased deliberative reflective reasoning (Paxton, Ungar, & Greene, 2012). 1.1. More deliberation or less empathy? Indeed, several studies seem to suggest that utilitarian moral judgment is more grounded on calculation and consideration of different outcomes. Cognitive load interferes with the formation of utilitarian judgment (Trémolière, Neys, & Bonnefon, 2012), and people are less likely to provide utilitarian responses to moral dilemmas when under time pressure constraints (Suter & Hertwig, 2011). Moreover, individuals with a high working memory capacity and people who are deliberative thinkers appear as more likely to choose utilitarian solutions (Bartels, 2008; Feltz & Cokely, 2008; Moore, Clark, & Kane, 2008). These findings have been used to support the notion that the utilitarian choice is the morally ‘correct’ choice because it is more rational (derived from deliberative reasoning) and less emotionally-mediated. Indeed, the utilitarian choice is often labeled as ‘‘appropriate’’ and contrasted with the ‘‘inappropriate’’ non-utilitarian choice (e.g., Greene et al., 2001; Tassy, Oullier, Mancini, & Wicker, 2013; Valdesolo & DeSteno, 2006). However, recent research has begun to question one of the key assumptions implicit within this conclusion – that that endorsement of the utilitarian response option on the trolley problem implies increased deliberative reasoning. Several recent studies have suggested that the utilitarian response may be more a function of decreased aversion to harming others and deficits in social processing than to increased deliberative reasoning capacities per se (Wiech et al., 2013). Psychopathic personality characteristics, particularly decreased levels of empathy, have been shown to correlate with choosing the utilitarian response option (Bartels & Pizarro, 2011; Conway & Gawronski, 2013; Gao & Tang, 2013; Gleichgerrcht & Young, 2013; Glenn, Koleva, Iyer, Graham, & Ditto, 2010; Koenigs, Kruepke, Zeier, & Newman, 2012; Wiech et al., 2013; Young, Koenigs, Kruepke, & Newman, 2012). In a series of three studies, Côté, Piff, and Willer (2013) demonstrated that reduced empathy mediates the relationship between being upper class and making more utilitarian judgments in the trolley problem. Utilitarian decision making in the trolley problem has also been linked to Machiavellianism, the belief that life is meaningless (Bartels & Pizarro, 2011), decreased sense of responsibility (Franklin, McNally, & Riemann, 2009), higher levels of testosterone (Carney & Mason, 2010; Montoya et al., 2013), increased levels of

anger (Choe & Min, 2011; Ugazio, Lamm, & Singer, 2012), and lower levels of serotonin (Crockett, Clark, Hauser, & Robbins, 2010; Siegel & Crockett, 2013). Thus we can see that there is empirical evidence supporting both the associations between impaired empathy and increased deliberation with utilitarian responses in the trolley dilemma. The utility of the trolley dilemma and the ethical implications of many associated findings are impacted by the relative importance of higher-order cognition and deficient empathy on individuals’ preferences for the utilitarian response option. One approach to teasing apart the relative strength of these influences is to study populations with conditions known to impair both higher-order cognitive abilities and affective empathy. According to Greene’s dual-process theory, decreased higher-order functioning (e.g., ‘‘executive functioning’’) should lead to decreased utilitarian preference, while decreased emotionality should lead to increased utilitarian preference. Researchers have examined a number of populations that fall within this category including individuals with brain lesions, dementia, and chronic alcohol/drug dependence. The pattern of findings is remarkably consistent: an increased preference for utilitarian responses across individuals with brain lesions within the ventromedial prefrontal cortex (VMPFC; Ciaramelli, Muccioli, Ladavas, & Di Pellegrino, 2007; Koenigs et al., 2007; Moretto, Làdavas, Mattioli, & Di Pellegrino, 2010; Thomas, Croft, & Tranel, 2011), frontotemporal dementia (Mendez, Anderson, & Shapira, 2005), and alcohol/drug dependence (Carmona-Perera, Clark, Young, Pérez-García, & Verdejo-García, 2014; CarmonaPerera, Reyes del Paso, Pérez-García, & Verdejo-García, 2013; Khemiri, Guterstam, Franck, & Jayaram-Lindström, 2012). 1.2. Current investigation While the studies identified above suggest that chronic alcohol dependence can lead to preferences towards utilitarian judgments; no study to date has examined the acute effects of alcohol on responses to moral dilemmas. In the present investigation, we assessed the association between the acute effects of alcohol as measured by blood alcohol concentration (BAC) and utilitarian responding in the trolley problem in two field studies. In Study 1, we looked at patterns of association between BAC and both the switch and footbridge versions of the trolley problem. We predicted that the relation would be highest within the footbridge scenario given the lower base rate of utilitarian preferences in this scenario (Navarrete, McDonald, Mott, & Asher, 2012) and the expectation that alcohol would increase rather than decrease utilitarian responding. In Study 2, we introduced two possible mediators related to alcohol intoxication also supported by the literature as being relevant in moral decision-making: behavioral disinhibition (Van den Bos, Müller, & Damen, 2011) and elevated mood (Valdesolo & DeSteno, 2006). Given that the psychopharmacological properties of alcohol are known to increase various disinhibited behaviors (Bartholow & Heinz, 2006; Bègue & Subra, 2008; Bègue et al., 2009; Giancola, 2000), we expected that alcohol’s effects on utilitarian decision making may be partially mediated by its

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ability to induce behavioral disinhibition. A second possible mediator, elevated mood, was included because it is one of the primary motivators of alcohol use (Kuntsche & Cooper, 2010) and has been linked to increased utilitarian preferences in previous research (Valdesolo & DeSteno, 2006; see also Strohminger, Lewis, & Meyer, 2011).

2. Methods In our first field study, participants were 61 men (n = 37) and women (n = 23) from various occupational backgrounds (26% were students) recruited at a bar in Grenoble, France. One participant was excluded from the study because he did not follow the instructions properly. For the 60 remaining participants, ages ranged from 15 to 47 (M = 26.98, SD = 6.97) and 61.7% were male. In our second field study, participants were 42 men (n = 27) and women (n = 15) recruited at a different bar in Grenoble, France with ages ranging from 18 to 27 years (M = 22.21, SD = 2.12). In each study, participants were handed a booklet containing either one or two vignettes describing the trolley problem. After reading each vignette, participants were asked to rate on a 5-point Likert scale the likelihood that they would be willing to either flip a switch that diverts the trolley so that it kills one person instead of five (switch dilemma) or push the individual off a bridge to save five people working on the tracks (footbridge dilemma). A drawing accompanied the text of each vignette in order to facilitate understanding of the story. In Study 1, each participant responded to both the switch and footbridge dilemmas (presented in random order), while participants in Study 2 only responded to the footbridge dilemma. Study 2 also included an additional two questions measuring self-reported state behavioral disinhibition and elevated mood. Participants were asked to rate on a 5-point Likert scale how much they agreed with the following statements: ‘‘I feel disinhibited, ready to do things that I ordinarily do not do’’ and ‘‘I’m feeling in a good mood.’’ These single-item measures were selected over measures that are more comprehensive in order to maximize recruitment and completion rates, which in our experience, decrease proportionate to a field study’s time requirements, particularly when in active social settings such as barrooms. Following the collection of each individual’s responses, we estimated his or her BAC using a breathalyzer (Draeger 5100S), debriefed them about the nature of the studies, and obtained for consent to use the individuals’ data. Both studies employed a quasi-experimental paradigm relying on natural variation in alcohol consumption of bar-goers. While this design limited our ability to make strong causal inferences, it was necessary given ethical and practical considerations.1 The research complied with all ethical guidelines for research on human participants in France. 1 For example, an alcohol administration study would require us to screen for contra-indicated medical conditions such as pregnancy, which in turn, would have made recruitment extremely difficult in a barroom setting.

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3. Results Correlations and descriptive statistics for study variables are presented in Tables 1 and 2 for the two respective studies. Consistent with past research (e.g. Côté et al., 2013; Greene, Morelli, Lowenberg, Nystrom, & Cohen, 2008; Greene, Nystrom, Engell, Darley, & Cohen, 2004; Greene et al., 2001; Valdesolo & DeSteno, 2006) in Study 1, participants were more likely to make a utilitarian decision in the switch dilemma (M = 2.07, SD = 1.13) than in the footbridge dilemma (M = 3.53, SD = 1.05; t(59) = 8.77, p < .001). BAC was positively correlated to endorsement of the utilitarian response in the footbridge dilemma (r = .29, p = .023), but not in the switch dilemma (r = .17, p = .17). In Study 2, we found a similarly significant correlation between BAC and utilitarian preference in the footbridge dilemma (r = .32, p = .039) in addition to significant correlations between self-reported behavioral disinhibition and utilitarian preference (r = .37, p = .015). Self-reported positive mood, however, was not found to correlate with utilitarian preference (r = .01) in Study 2. Follow-up testing on whether disinhibition mediated the effect of BAC on utilitarianism failed to reveal a statistically significant mediation effect (ab = .13, p = .12; Baron & Kenny, 1986) suggesting that self-reported behavioral disinhibition does not account for the relation between BAC and utilitarian responses in the footbridge dilemma. Across both studies, age and gender were not significantly correlated with endorsing the utilitarian response option. Mean levels of endorsement for the footbridge dilemma were consistent across studies, t(100) = 0.49, p = .62 as were BACs t(100) = 0.18, p = .86, and proportion of male participants t(100) = 0.27, p = .79. The only significant difference identified between studies involved the participants in Study 1 being older (M = 26.98, SD = 6.97) than those in Study 2 (M = 22.21, SD = 2.15), Welch’s t (72.38) = 4.94, p < .001. Given the similarities across studies, we combined the data in order to provide an overall estimate. The bivariate correlation between BAC and utilitarianism in the footbridge dilemma remained significant (r = .31, p < .001) and is slightly larger than what Cohen identified as a ‘‘medium’’ effect size (Cohen, 1992). The association between BAC and utilitarian preferences in the footbridge dilemma was also significant in a multivariate regression model controlling for demographic influences (age and gender), b = 10.45, SE = 3.22, p < .002.

4. Discussion In two field studies, we tested whether the acute effects of alcohol as measured by BAC correlate to endorsing the utilitarian decision in the footbridge trolley dilemma. Both studies found significant correlations between BAC and willingness to push a man to his death in order to save the lives of five others. In Study 2, we tested whether the relation between BAC and endorsement of the utilitarian response option was mediated by either self-reported behavioral disinhibition or positive mood. We observed that disinhibition was related to utilitarianism, which

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Table 1 Correlations and descriptive statistics for Study 1. Switch Switch Footbridge BAC Age Gender

.31* .18 .13 .17

Footbridge – .29* .05 .05

BAC

– .29* .39**

Age

Range

Mean

SD

– .22

1–5 1–5 0–0.14 15–47 0–1

3.533 2.067 0.040 26.98 0.62

1.07 1.13 0.04 6.97 0.49

Note: Gender is coded as 0 = female and 1 = male; BAC = breath alcohol content. * p < .05. ** p < .01.

Table 2 Correlations and descriptive statistics for Study 2. Footbridge Footbridge BAC Age Gender Disinhibition Positive mood

– .32* .02 .14 .37* .01

BAC – .41** .45** .46** .32**

Age

– .45** .21 .14

Gender

Range

Mean

SD

– .42** .14

1–5 0–0.16 18–27 0–1 1–5 1–5

2.19 0.038 22.21 0.64 2.67 4.21

1.38 0.05 2.15 0.48 1.07 1.01

Note: Gender is coded as 0 = female and 1 = male; BAC = breath alcohol content. * p < .05. ** p < .01.

finding is consistent with prior research (Van den Bos et al., 2011); however, we did not find that the acute effects of alcohol on utilitarianism was mediated by self-reported disinhibition. We also failed to replicate previous findings linking positive mood to increased utilitarian responding (Strohminger et al., 2011; Valdesolo & DeSteno, 2006). 4.1. Implications for dual-process theory The finding that the acute effects of alcohol as measured by BAC correlate to utilitarian decision making has some interesting implications for Greene’s dual-process theory of moral reasoning. Alcohol intoxication is associated with increased emotional reactivity and selective attention towards emotional cues (Euser & Franken, 2012; Giancola, Josephs, Parrott, & Duke, 2010; Ray, Mun, Buckman, Udo, & Bates, 2012; Sayette et al., 2012), which according to Greene’s dual-process conceptualization, should lead to increased deontological (non-utilitarian) inclinations, the opposite of what was observed here. Moreover, it has been postulated that increased activation of higher order cognitions (i.e., the deliberative system) leads to increased utilitarian reasoning; however, alcohol intoxication is known for its ability to impair higher order cognitive reasoning (Giancola, 2000) and yet still demonstrated a significant correlation with utilitarian decision making in the present investigation. The most likely culprit in terms of a common thread linking utilitarian decision-making and alcohol intoxication is a decreased aversion to harming others. Alcohol intoxication is a very robust risk factor for aggressive behavior (e.g., Exum, 2006), and the evidence seems to suggest that decreased harm aversion may be a robust predictor of utilitarian preference in the footbridge dilemma. This finding helps to resolve the paradox previously

identified in studies of individuals with VMPFC damage who acted more emotionally during a laboratory task, yet had higher preference for utilitarian choices in the footbridge dilemma (see Koenigs & Tranel, 2007). It has been suggested that prosocial moral sentiments are actually the result of the integration of both cognitive and emotional systems, ostensibly occurring within the VMPFC (Moll & de Oliveira-Souza, 2007). Support for this integration hypothesis was recently buttressed by two studies looking at the temporal dynamics of dual-process theories of moral decision-making (Koop, 2013), whose author concluded that the evidence does not support a default-intervention model in which emotional responses are activated by default and deliberative processes have the ability to override these responses, but rather concluded that both systems are activated simultaneously (see also Moore et al., 2008). Ironically, Greene himself admits that he does not believe in ‘‘a sharp distinction between ‘cognition’ and emotion,’’ (Greene, 2010, p. 362), yet this is precisely what his dual-process theory is based upon. 4.2. Moral sentiments and social deliberations Thus, the primary deficit within Greene’s model is the failure to fully appreciate the complexity of social sentiment as an interactive byproduct of both higher and lower-order neural systems. For example, researchers have recognized the need to distinguish between cognitive (i.e., ‘theory of mind’) and affective aspects of empathic concern (Cox et al., 2012; Lamm, Batson, & Decety, 2007). Moreover, an aversion to harming others is not always driven by emotional arousal as demonstrated in a recent pharmacological challenge study (Sylvia et al., 2013). Our current study’s results linking alcohol to utilitarian preference can be interpreted within the context of the

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alcohol myopia model, which suggests that alcohol’s disinhibitory capacities are at least partially driven by a reduced ability to attend to and process social cues (Giancola et al., 2010). Thus, the alcohol myopia model argues that it is alcohol’s ability to impair cognitive functioning that leads, for example, to increased aggression (Giancola, Duke, & Ritz, 2011). Research suggests that impairments in social cognition are responsible for utilitarian preferences in autism-spectrum disorders (Gleichgerrcht et al., 2013), which finding is consistent with the link between utilitarianism and the well-recognized social deficits already mentioned in individuals with psychopathic traits and brain damage. The rationally superior position of the utilitarian response in the footbridge dilemma is further suspect when the scenarios are interpreted through a broader social lens. Specifically, the true moral intentions of the individual who pushes the fat man off the bridge in the footbridge scenario cannot be known by others. If it is the case, as the research has suggested, that the probability that the ‘pusher’ was motivated by a profound character flaw such as psychopathy is just as high as high as the probability of more altruistic motives, it may be rational for members of the community to assume the worst-case scenario and to retaliate against the pusher. This notion is supported by a recent study where participants rated individuals willing to carry out counter-intuitive utilitarian actions as having deficient empathy and suspect moral character, even when they recognized the utilitarian justification for the action (Uhlmann, Zhu, & Tannenbaum, 2013). Tannenbaum and colleagues have shown that ‘‘strong moral reactions can occur when relatively harmless acts provide highly diagnostic information about moral character’’ (Tannenbaum, Uhlmann, & Diermeier, 2011, p. 1249) as would likely be the case in the footbridge dilemma. Thus, the decision to not push the large man off the footbridge seems rationally self-interested when viewed through a broader social lens. Haidt’s moral foundations theory (Haidt, 2012) also seems to support this notion. Van Leeuwen and Park (2009) found that perceiving one’s social world as dangerous is correlated with adherence to what Haidt and colleagues refer to as the ‘‘binding moral foundations’’ of loyalty, authority, and sanctity, which are distinct from the moral foundations of care and fairness. Thus, as the threat to negative social backlash from making a utilitarian judgment increases, it makes sense that individuals would prioritize judgments that are less concerned with aggregate social welfare and more concerned with the appropriateness of one’s actions as judged by one’s group. 4.3. Conclusions While Greene and colleague’s dual-process theory of moral reasoning has led to important gains and increased interest in the field of moral psychology, there have been an increasing number of concerns about whether utilitarian preferences in the trolley dilemma are indeed a result of a more predominant rational capacity as has been suggested. Evidence suggests that utilitarian preferences in the footbridge dilemma may be more strongly related to decreased capacity for empathy. Alcohol intoxication is

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associated with both decreased higher-order cognitive functioning and increased emotional disinhibition, therefore, this relation has important implications for Greene’s dual-process model. Across two field studies, we demonstrated that BAC was significantly and positively correlated with utilitarian preference in the footbridge dilemma, suggesting that impaired social processing is likely a stronger predictor of utilitarian preferences than the integrity of one’s higher-order cognitive system. As the first studies to assess the relation between the acute effects of alcohol and utilitarian responding, our findings should be expanded upon through experimental replication and the explicit assessment of hypothesized mediators such as executive functioning (Giancola, 2000) and social awareness (Hull, Levinson, Young, & Sher, 1983). Future studies might also utilize more comprehensive measures of behavioral disinhibition and positive affect given our failure to find mediation effects using sub-optimal, single-item measures of these constructs. Finally, further attention deserves to be spent addressing the links between moral judgments in hypothetical dilemmas and moral behavior in real-life situations (Teper, Inzlicht, & Page-Gould, 2011) as well as the relative contribution of the pharmacological and extrapharmacological effects of alcohol on moral thought (Moss & Albery, 2009). References Baron, R. M., & Kenny, D. A. (1986). Moderator-mediator variables distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. Bartels, D. M. (2008). Principled moral sentiment and the flexibility of moral judgment and decision making. Cognition, 108, 381–417. Bartels, D. M., & Pizarro, D. A. (2011). The mismeasure of morals: Antisocial personality traits predict utilitarian responses to moral dilemmas. Cognition, 121, 154–161. Bartholow, B. D., & Heinz, A. (2006). Alcohol and aggression without consumption: Alcohol cues, aggressive thoughts, and hostile perception bias. Psychological Science, 17, 30–37. Bègue, L., & Subra, B. (2008). Alcohol and aggression: Perspectives on controlled and uncontrolled social information processing. Social and Personality Psychology Compass, 2, 511–538. Bègue, L., Subra, B., Arvers, P., Muller, D., Bricout, V., & Zorman, M. (2009). The message, not the bottle: Extrapharmacological effects of alcohol on aggression. Journal of Experimental Social Psychology, 45, 137–142. Carmona-Perera, M., Clark, L., Young, L., Pérez-García, M., & VerdejoGarcía, A. (2014). Impaired decoding of fear and disgust predicts utilitarian moral judgment in alcohol-dependent individuals. Alcoholism: Clinical and Experimental Research, 38(1), 179–185. Carmona-Perera, M., Reyes del Paso, G. A., Pérez-García, M., & VerdejoGarcía, A. (2013). Heart rate correlates of utilitarian moral decisionmaking in alcoholism. Drug and Alcohol Dependence, 133(2), 413–419. Carney, D., & Mason, M. F. (2010). Decision making and testosterone: When the ends justify the means. Journal of Experimental Social Psychology, 46, 668–671. Choe, S. Y., & Min, K. H. (2011). Who makes utilitarian judgments? The influences of emotions on utilitarian judgments. Judgment and Decision Making, 6(7), 580–592. Ciaramelli, E., Muccioli, M., Ladavas, E., & Di Pellegrino, G. (2007). Selective deficit in personal moral judgment following damage to ventromedial prefrontal cortex. Social Cognitive and Affective Neuroscience, 2, 84–92. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. Conway, P., & Gawronski, B. (2013). Deontological and utilitarian inclinations in moral decision making: A process dissociation approach. Journal of Personality and Social Psychology, 104(2), 216. Côté, S., Piff, P. K., & Willer, R. (2013). For whom do the ends justify the means? Social class and utilitarian moral judgment. Journal of Personality and Social Psychology, 104, 490–503.

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