This introduction just aims to be a fast foreword to the special topic now turned into an e-book. The Editorial "Decision-Making Experiments under a Philosophical Analysis: Human Choice as a Challenge for Neuroscience" alongside with my opinion article "Neurophilosophical considerations on decision making: Pushing-up the frontiers without disregarding their foundations" play the real role of considering in more details the articles and the whole purpose of this e-book. What I must highlight in this foreword is that our intention (...) with such a project was to deepen into the very foundations of our current paradigms in decision neuroscience and to philosophically moot its foundations and repercussions. Normal Science (a term coined by Philosopher Thomas Kuhn) works under a research consensus among a scientific community: A shared paradigm, consolidated methods, widespread convictions. Pragmatically, winning formulas must be kept, although, not at any cost. What differentiates a gifted and revolutionary scientist from a more bureaucratic colleague is the capacity and willingness of constantly reevaluating, depurating and refining his/her own paradigm. That is best strategy to avoid that a paradigm itself would gradually come under challenge. In my view, some achievements, in this sense, were brought about in our project. The e-book will be inspiring and informative for both neuroscientists that are concerned with the very foundations of their works and for philosophers that are not blind to empirical evidence. Kant once said: “Thoughts without content are empty, intuitions without concepts are blind”. Paraphrasing Kant we could say: Philosophy without science is empty, science without philosophy is blind. (shrink)

Rapid advances in neuroscience may enable us to identify the neural correlates of ordinary decision making. Such knowledge opens up the possibility of acquiring highly accurate information about people’s competence to consent to medical procedures and to participate in medical research. Currently we are unable to determine competence to consent with accuracy and we make a number of unrealistic practical assumptions to deal with our ignorance. Here I argue that if we are able to detect competence to consent and (...) if we are able to develop a reliable neural test of competence to consent, then these assumptions will have to be rejected. I also consider and reject three lines of argument that might be developed by a defender of the status quo in order to protect our current practices regarding judgments of competence in the face of the availability of information about the neural correlates of ordinary human decision making. (shrink)

By the late 1990s, several converging trends in economics, psychology, and neuroscience had set the stage for the birth of a new scientific field known as “neuroeconomics”. Without the availability of an extensive variety of experimental designs for dealing with individual and social decision-making provided by experimental economics and psychology, many neuroeconomics studies could not have been developed. At the same time, without the significant progress made in neuroscience for grasping and understanding brain functioning, neuroeconomics would have never seen (...) the light of day. The paper is an overview of the main significant advances in the knowledge of brain functioning by neuroscience that have contributed to the emergence of neuroeconomics and its rise over the past two decades. These advances are grouped over three non-independent topics referred to as the “emo-rational” brain, “social” brain, and “computational” brain. For each topic, it emphasizes findings considered as critical to the birth and development of neuroeconomics while highlighting some of prominent questions about which knowledge should be improved by future research. In parallel, it shows that the boundaries between neuroeconomics and several recent sub-fields of cognitive neuroscience, such as affective, social, and more generally, decision neuroscience, are rather porous. (shrink)

How do affect and cognition interact in managerial decision making? Over the last decades, scholars have investigated how managers make decisions. However, what remains largely unknown is the interplay of affective states and cognition during the decision-making process. We offer a systematization of the contributions produced on the role of affect and cognition in managerial decision making by considering the recent cross-fertilization of management studies with the neuroscience domain. We implement a Systematic Literature Review of 23 selected (...) contributions dealing with the role of affect and cognition in managerial decisions that adopted neuroscience techniques/points of view. Collected papers have been analyzed by considering the so-called reflexive (X-) and reflective (C-) systems in social cognitive neuroscience and the type of decisions investigated in the literature. Results obtained help to support an emerging “unified” mind processing theory for which the two systems of our mind are not in conflict and for which affective states have a driving role toward cognition. A research agenda for future studies is provided to scholars who are interested in advancing the investigation of affect and cognition in managerial decision making, also through neuroscience techniques – with the consideration that these works should be at the service of the behavioral strategy field. (shrink)

Memory, attention, and decision-making are three major areas of cognitive neuroscience. They are however frequently studied in isolation, using a range of models to understand them. This book brings a unified approach to understanding these three processes, showing how these fundamental functions can be understood in a common and unifying framework.

Progress in neuroscience will allow us to reveal the neuronal correlates of psychological processes involved in ethically relevant notions such as informed consent. Informed consent involves decision making, the psychological and neural processes of which have been investigated extensively in neuroscience. The neuroscience of decision making may be able to contribute to an ethics of informed consent by providing empirical and thus descriptive criteria. Since, however, descriptive criteria must be distinguished from normative criteria, the neuroscience of decision (...) making cannot replace the ethics of informed consent. Instead, the neuroscience of decision making could complement the current ethics, resulting in what can be called neuroethics of informed consent. It is concluded that current progress in the neurosciences could complement and change the way in which we approach ethical problems in neuropsychiatry. (shrink)

Decision-making is an intricate subject in neuroscience. It is often argued that laboratorial research is not capable of dealing with the necessary complexity to study the issue. Whereas philosophers in general neglect the physiological features that constitute the main aspects of thought and behaviour, I advocate that cutting-edge neuroscientific experiments can offer us a framework to explain human behaviour in its relationship with will, self-control, inhibition, emotion and reasoning. It is my contention that self-control mechanisms can modulate more basic (...) stimuli. Assuming the aforementioned standpoints, I show the physiological mechanisms underlying social assessment and decision-making. I also establish a difference between veridical and adaptive decision-making, useful to create experimental designs that can better mimic the complexity of our day-by-day decisions in more ecologically relevant laboratorial research. Moreover, I analyse some experiments in order to develop an epistemological reflection about the necessary neural mechanisms to social assessment and decision-making. (shrink)

In this publication, we will use the principal concepts of John of the Cross, the famous mystic of the XVI th century, as a framework to go over, in a non-reductionist way, three challenges in contemporary neuroscience of decision-making. Firstly, the dark night and the purgative paths will be related to discontinuity in decision-making. Secondly, the passive and active paths will be associated to brain plasticity, architecture, and levels of decision. Thirdly, the illumination, which can be felt (...) when a solution is reached, has to do with positive emotions and can be inspired by the science of love of John of the Cross. We shall lastly conclude by emphasizing the usefulness of his work to illuminate the neuroscience of decision-making. (shrink)

It is by now a well-supported hypothesis in cognitive neuroscience that there exists a functional network for the moral appraisal of situations. However, there is a surprising disagreement amongst researchers about the significance of this network for moral actions, decisions, and behavior. Some researchers suggest that we should uncover those ethics [that are built into our brains ], identify them, and live more fully by them, while others claim that we should often do the opposite, viewing the cognitive neuroscience of (...) morality more like a science of pathology. To analyze and evaluate the disagreement, this paper will investigate some of its possible sources. These may include theoretical confusions about levels of explanation in cognitive science, or different senses of ‘morality’ that researchers are looking to explain. Other causes of the debate may come from empirical assumptions about how possible or preferable it is to separate intuitive moral appraisal from moral decisions. Although we will tentatively favor the ‘Set Aside’ approach, the questions outlined here are open areas of ongoing research, and this paper will be confined to outlining the position space of the debate rather than definitively resolving it. (shrink)

Decision making is an area of profound importance to a wide range of specialities - for psychologists, economists, lawyers, clinicians, managers, and of course philosophers. Only relatively recently, though, have we begun to really understand how decision making processes are implemented in the brain, and how they might interact with our emotions. 'Emotion and Reason' presents a groundbreaking new approach to understanding decision making processes and their neural bases. The book presents a sweeping survey of the science (...) of decision making. It examines the brain mechanisms involved in making decisions, and controversially proposes that many of our perceptual actions are essentially decision making processes. Whether looking, listening, hearing, or moving, we choose to attend to certain stimuli, at the expense of others. In some psychiatric disorders the inability to respond selectively to certain stimuli can be harmful - such pathologies of decision making are additionally considered. Berthoz also considers how many decision making processes involve an internal dialogue with our other self, and how this dialogue with our "doppelganger" might be represented in the brain. He considers the important implications that a neuroscience of decision making can have for the judiciary - how we apportion blame and responsibility; for economics - with discussion of the growing field of neuroeconomics; and for theories of management. Lastly he examines decision making and creativity - if perception relies in part on decision making processes, how might this alter our view of the artistic process. Written by a neuroscientist of international fame and accessible for both scientists and non-scientists, this book is the most exhaustive examination of the science of decision making yet. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making (...) would be better understood as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there (...) is strong reason to believe that neuroscience might assist clinicians in adjudicating difficult cases in the future. This article focuses on the assessment of capacity in brain injury patients who have profound communication impairments, however, the overarching aim of the article is to highlight the potential use of neuroscience to improve our understanding of the relationship between cognition and decision-making capacity. (shrink)

This is a unique book, drawing together the profound insights of Eastern philosophy (Advaita Vedanta), Western depth-psychology (Jungian), and spirituality (Ignatian) as applied to decision-making. Mention is made of Plato, C. G. Jung, Ira Progoff, Viktor Frankl, and Bernard Lonergan, amongst others. Powerful and practical tools and techniques for making wise decisions are offered. There are sections on Descartes's famous square, the ego and the Self, the I Ching and synchronicity, archetypes, neuroscience and the triune brain, biases and blind (...) spots which can derail decision-making, together with chapters on creativity, the "aha" experience, and the Enneagram with its nine decision-making styles. Dr. Costello is at pains to point out that heart (emotions), head (reason), and hands (action/doing) must be integrated before effective decision-making can take place and bear fruition. (shrink)

Can findings from psychology and cognitive neuroscience about the neural mechanisms involved in decision-making can tell us anything useful about the commonly-understood mental phenomenon of making voluntary choices? Two philosophical objections are considered. First, that the neural data is subpersonal, and so cannot enter into illuminating explanations of personal level phenomena like voluntary action. Secondly, that mental properties are multiply realized in the brain in such a way as to make them insusceptible to neuroscientific study. The paper argues that (...) both objections would be weakened by the discovery of empirical generalisations connecting subpersonal properties with the personal level. It gives three case studies that furnish evidence to that effect. It argues that the existence of such interrelations are consistent with a plausible construal of the personal-subpersonal distinction. Furthermore, there is no reason to suppose that the notion subpersonal representation relied on in cognitive neuroscience illicitly imports personal-level phenomena like consciousness or normativity, or is otherwise explanatorily problematic. (shrink)

Neuroscience has illuminated the neural basis of decision-making, providing evidence that supports specific models of decision-processes. These models typically are quite mechanical, the realization of abstract mathematical “diffusion to bound” models. While effective decision-making seems to be essential for sophisticated behavior, central to an account of freedom, and a necessary characteristic of self-governing systems, it is not clear how the simple models neuroscience inspires can underlie the notion of self-governance. Drawing from both philosophy and neuroscience I explore (...) ways in which the proposed decision-making architectures can play a role in systems that can reasonably be thought of as “self-governing”. (shrink)

Decision making is an area of profound importance to a wide range of specialities - for psychologists, economists, lawyers, clinicians, managers, and of course philosophers. Only relatively recently, though, have we begun to really understand how decision making processes are implemented in the brain, and how they might interact with our emotions.'Emotion and Reason' presents a groundbreaking new approach to understanding decision making processes and their neural bases. The book presents a sweeping survey of the science of (...) decision making. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for (...) simple medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

Severe brain injury is a leading cause of death and disability. Following severe brain injury diagnosis is difficult and errors frequently occur. Recent findings in clinical neuroscience may offer a solution. Neuroimaging has been used to detect preserved cognitive function and awareness in some patients clinically diagnosed as being in a vegetative state. Remarkably, neuroimaging has also been used to communicate with some vegetative patients through a series of yes/no questions. Some have speculated that, one day, this method may allow (...) severely brain-injured patients to make medical decisions. Yet, skepticism is rife, due in part to the inherent difficulty of assessing decision-making capacity through neuroimaging communication. In this thesis, I provide the first systematic analysis of this problem. I present and defend a strategy for assessing decision-making capacity in brain-injured patients who can only communicate through neuroimaging. (shrink)

McCarthy and Howard (2023) advocate for supported decision making for patients with intellectual and developmental disabilities (IDD). Departing from the “mental prosthesis” model of supported deci...

Unrepresented patients are individuals who lack decision makingcapacity and have no family or friends to make medical decisions for them. This population is growing in number in the United States, particularly within emergency and intensive care settings. While some bioethical discussion has taken place in response to the question of who ought to make decisions for these patients, the issue of how surrogate medical decisions ought to be made for this population remains unexplored. In this paper, we argue that (...) standard applications of surrogate decision making principles in health care are not well suited to many unrepresented patients with long-term mental health diagnosis. We argue that when applied to this population, the substituted judgment standard, designed to preserve patient preferences and values, may lead to the exclusion of their preferences. We argue further that the application of the best interest standard runs the risk of leading to harmful cases of overtreatment or undertreatment. We offer an alternative interpretation of the best interest principle that is better able to promote the well-being of unrepresented patients, especially for those who lack capacity because of mental disorders. This alternative is based on the practices and principles of harm reduction and includes three components: emphasis on considering the expressed preferences of unrepresented patients, a focus on reducing harm as well as the delivery of clinical benefits, and a recognition of the importance of promoting trust. (shrink)

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness (...) of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Decision-making is an intricate subject in neuroscience. It is often argued that laboratorial research is not capable of dealing with the necessary complexity to study the issue. Whereas philosophers in general neglect the physiological features that constitute the main aspects of thought and behaviour, I advocate that cutting-edge neuroscientific experiments can offer us a framework to explain human behaviour in its relationship with will, self-control, inhibition, emotion and reasoning. It is my contention that self-control mechanisms can modulate more basic (...) stimuli. Assuming the aforementioned standpoints, I show the physiological mechanisms underlying social assessment and decision-making. I also establish a difference between veridical and adaptive decision-making, useful to create experimental designs that can better mimic the complexity of our day-by-day decisions in more ecologically relevant laboratorial research. Moreover, I analyse some experiments in order to develop an epistemological reflection about the necessary neural mechanisms to social assessment and decision-making. (shrink)

Background Moral decision-making consists of a complex process requiring individuals to evaluate potential consequences of personal and social decisions, including applied organizational contexts.Methods This research aims to investigate the behavioral (offer responses and reaction times, RTs) and electrophysiological (EEG) correlates underlying moral decision-making during three different choice conditions (professional fit, company fit, and social fit) and offers (fair, unfair, and neutral).Results An increase of delta and theta frontal activity (related to emotional behavior and processes) and beta frontal and (...) central activity (linked to cognitive and attentional processes) was found. A left beta, delta, and theta frontal activity was observed for fair offers in professional fit conditions, while increased right frontal delta and theta activity was found in response to unfair offers in company fit conditions. Also, an increase of left delta and theta parietal activity for unfair offers in social fit condition was detected. Finally, higher accepted responses were found for fair and neutral offers in professional and social fit conditions, with increased RTs for unfair offers suggesting decisions’ cognitive load and complexity.Conclusions By revealing a greater involvement of left and right frontal areas in decision-making processes based on choices and offers, personal interest evaluations and emotional values, and of parietal areas in more prosocial and altruistic moral behavior, current findings provide information about the neural and behavioral correlates underlying company moral behavior. (shrink)

To what extent do we know our own minds when making decisions? Variants of this question have preoccupied researchers in a wide range of domains, from mainstream experimental psychology to cognitive neuroscience and behavioral economics. A pervasive view places a heavy explanatory burden on an intelligent cognitive unconscious, with many theories assigning causally effective roles to unconscious influences. This article presents a novel framework for evaluating these claims and reviews evidence from three major bodies of research in which unconscious factors (...) have been studied: multiple-cue judgment, deliberation without attention, and decisions under uncertainty. Studies of priming and the role of awareness in movement and perception are also given brief consideration. The review highlights that inadequate procedures for assessing awareness, failures to consider artifactual explanations of “landmark” results, and a tendency to uncritically accept conclusions that fit with our intuitions have all contributed to unconscious influences being ascribed inflated and erroneous explanatory power in theories of decision making. The review concludes by recommending that future research should focus on tasks in which participants' attention is diverted away from the experimenter's hypothesis, rather than the highly reflective tasks that are currently often employed. (shrink)

This is a new edition of a classic textbook in health care ethics, one that offers an alternative to the principle-based approach from Beauchamp and Childress (Principles of Biomedical Ethics, now in its seventh edition from OUP) and traditional Catholic approaches of Ashley and O'Rourke. In the early chapters Devettere spells out the meaning of ethics and the importance of prudential reasoning in seeking the good life. The rest of the book deals with issues and cases, including determinations of life (...) and death, reproduction and research and genetics, and the distribution of health care. In this fourth edition Devettere updates all chapters and adds new cases and new sections on the following: neuroscience, social psychology, overriding advance directives, studies on the fetus, the palliative care movement, cardiopulmonary resuscitation, pharmacists and reproductive issues, prenatal life and abortion, neonatal testing and mandatory vaccinations, the US governments' STD research in Guatemala, the emergence of biobanks, facial transplantations, genetic testing, legal issues around the Affordable Care Act, and more. This is an accessible and comprehensive textbook covering all aspects of the field. (shrink)

The mental prosthesis model (Silvers and Francis 2009) suggests that interpersonal “prosthetic” thinking could support decision making for people with limited cognitive capacities, and positions th...

This study compares the neural substrate of moral decision making processes between Korean and American participants. By comparison with Americans, Korean participants showed increased activity in the right putamen associated with socio-intuitive processes and right superior frontal gyrus associated with cognitive control processes under a moral-personal condition, and in the right postcentral sulcus associated with mental calculation in familiar contexts under a moral-impersonal condition. On the other hand, American participants showed a significantly higher degree of activity in the bilateral (...) anterior cingulate cortex (ACC) associated with conflict resolution under the moral-personal condition, and in the right medial frontal gyrus (MFG) associated with simple cognitive branching in non-familiar contexts under the moral-impersonal condition when a more lenient threshold was applied, than Korean participants. These findings support the ideas of the interactions between the cultural background, education, and brain development, proposed in the field of cultural psychology and educational psychology. The study introduces educational implications relevant to moral psychologists and educators. (shrink)

Is the sense of smell a source of aesthetic perception? Traditional philosophical aesthetics has centered on vision and audition but eliminated smell for its subjective and inherently affective character. This article dismantles the myth that olfaction is an unsophisticated sense. It makes a case for olfactory aesthetics by integrating recent insights in neuroscience with traditional expertise about flavor and fragrance assessment in perfumery and wine tasting. My analysis concerns the importance of observational refinement in aesthetic experience. I argue that the (...) active engagement with stimulus features in perceptual processing shapes the phenomenological content, so much so that the perceptual structure of trained smelling varies significantly from naive smelling. In a second step, I interpret the processes that determine such perceptual refinement in the context of neural decision-making processes, and I end with a positive outlook on how research in neuroscience can be used to benefit philosophical aesthetics. (shrink)

Several recent criticisms of the somatic marker hypothesis (SMH) identify multiple ambiguities in the way it has been formulated by its chief proponents. Here we provide evidence that this hypothesis has also been interpreted in various different ways by the scientific community. Our diagnosis of this problem is that SMH lacks an adequate computational-level account of practical decision making. Such an account is necessary for drawing meaningful links between neurological- and psychological-level data. The paper concludes by providing a simple, (...) five-step model of practical decision making. Recasting SMH in terms of this model generates more precise and empirically tractable computational-level hypotheses about the various ways that somatic markers might influence practical decisions. (shrink)

Ethical decision-making theories in behavioural ethics management have been developed through the social sciences, psychology, social psychology, and cognitive neurosciences. These theories are either cognitive, non-cognitive or an integration of both. Other scholars have recommended redefining what ethical means through moral philosophy and theology. Buddhism is a religion, a philosophy, a psychology, an ethical system and an art of living. The divine states in Buddhism are virtues that could be developed by anyone regardless of their religion or non-religion through (...) Buddhist meditation. They are so called because they enable individuals to develop ‘God-like qualities’. The theoretical insights of the divine states indicate how to eliminate negative emotions, such as anger, fear, delusion and envy, by cultivating love and compassion towards both the self and others. Accordingly, this paper contributes to EDM by redefining what ethical means through the meanings managers who practise Buddhist meditation assign to divine states in their lived experience of EDM in organisations in Sri Lanka. The sample consisted of 17 Buddhists, 1 Hindu, 1 Muslim and 1 no-religion. Data were collected using semi-structured in-depth interviews and was analysed with IPA. The findings indicated that how the managers made meaning of an ethical decision was influenced by their loving-kindness, compassion, sympathetic joy and equanimity. The findings also indicated that the managers justified the reasons for their decisions subsequently through the benefits to themselves as well as their employees. Accordingly, this study supports the view that EDM is an integrated approach. (shrink)

Social norms play an essential role in human interactions and the development of the evolution of human history. Extensive studies corroborate that compliance with social norms typically requires a punishment threat as almost always specific individuals have self-interests that tempt them to violate the norm. Neural imaging studies demonstrate that lateral orbitofrontal cortex and right dorsolateral prefrontal cortex (rDLPFC) are activated when individuals decide to increase social norm compliance when punishment is possible. Moreover, rDLPFC is affirmed to be involved in (...) social norm compliance with or without external punishment threats in a series of transcranial direct current stimulation (tDCS) research. However, these neuroscience studies are based on the ultimatum game in which the decision-making power between the proposer and the responder is unequal, and no studies support the causal relationship between rDLPFC and voluntary cooperative norms compliance among the equal decision-making power of subjects. Whether modulating the excitability of rDLPFC, which plays a role in norm compliance, alters the extent of compliance with voluntary cooperative norms under equal decision-making power and how norms from different types with asymmetric endowment influence compliance remain unknown. The present study aimed to provide evidence of a direct link between the neural and behavioral results through the application of tDCS over rDLPFC on compliance with voluntary cooperative norms under equal decision-making power. Results verified that activating rDLPFC altered voluntary cooperative norms compliance of all our participants and significant effect over different initial endowments was observed. The role of norm.own and norm.other in compliance was changed in the anodal treatment. Findings validate that enhancing the excitability of the rDLPFC using tDCS leads to high compliance in voluntary cooperation and this effect is specific to equal decision-making power rather than unequal decision-making power. (shrink)

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

Joshua Greene and his colleagues have proposed a dual-process theory of moral decision-making to account for the effects of emotional responses on our judgments about moral dilemmas that ask us to contemplate causing direct personal harm. Early formulations of the theory contrast emotional and cognitive decision-making, saying that each is the product of a separable neural system. Later formulations emphasize that emotions are also involved in cognitive processing. I argue that, given the acknowledgement that emotions inform cognitive (...) class='Hi'>decision-making, a single-process theory can explain all of the data that have been cited as evidence for Greene’s theory. The emotional response to the thought of causing harm may differ in degree, but not in kind, from other emotions influencing moral decision-making. (shrink)

This article focuses on both daily forms of weakness of will as discussed in the philosophical debate and psychopathological phenomena as impairments of decision making. We argue that both descriptions of dysfunctional decision making can be organized within a common theoretical framework that divides the decision making process in three different stages: option generation, option selection, and action initiation. We first discuss our theoretical framework, focusing on option generation as an aspect that has been neglected by previous (...) models. In the main body of this article, we review how both philosophy and neuropsychiatry have provided accounts of dysfunction in each decision-making stage, as well as where these accounts can be integrated. Also, the neural underpinnings of dysfunction in the three different stages are discussed. We conclude by discussing advantages and limitations of our integrative approach. (shrink)

Decision-making has a high practical relevance for daily performance. Its relation to other cognitive abilities such as executive control and memory is not fully understood. Here we asked whether training of either attentional filtering or memory storage would influence decision-making as indexed by repetitive assessments of the Iowa Gambling Task (IGT). The IGT was developed to assess and simulate real-life decision-making (Bechara et al., 2005). In this task, participants gain or lose money by developing advantageous or disadvantageous (...) decision strategies. On five consecutive days we trained 29 healthy young adults (20-30 years) either in working memory storage or attentional filtering and measured their IGT scores after each training session. During memory training (MT) subjects performed a computerized delayed match-to-sample task where two displays of bars were presented in succession. During filter training (FT) participants had to indicate whether two simultaneously presented displays of bars matched or not. Whereas in MT the relevant target stimuli stood alone, in FT the targets were embedded within irrelevant distractors (bars in a different color). All subjects within each group improved their performance in the trained cognitive task. For the IGT, we observed an increase over time in the amount of money gained in the FT group only. Decision-making seems to be influenced more by training to filter out irrelevant distractors than by training to store items in working memory. Selective attention could be responsible for the previously noted relationship between IGT performance and working memory and is therefore more important for enhancing efficiency in decision-making. (shrink)

Medical decision-making on behalf of intellectually and developmentally disabled (IDD) patients amounts to a critical challenge, one which has been widely discussed by bioethicists, medical, and le...

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from (...) an acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)

Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents—their being neither children nor adults—in a variety of ways. However, recently there has been a (...) trend to rely heavily, and often exclusively, on emerging neuroscientific and psychological data to answer these questions. Using data from magnetic resonance imaging and functional MRI studies on the adolescent brain, authors have argued both that the adolescent brain isn't sufficiently mature to broadly confer capacity on this population and that the adolescent brain is sufficiently mature to assume adolescent capacity. Scholars then accept these data as sufficient for concluding that adolescents should or should not have decision-making authority. Two critical mistakes are being made here. The first is the expectation that neuroscience or psychology is or will be able to answer all our questions about capacity. The second, and more concerning, mistake is the conflation of decision-making capacity with decision-making authority. (shrink)

Evidence accumulation has been the core component in recent development of perceptual and value-based decision-making theories. Most studies have focused on the evaluation of evidence between alternative options. What remains largely unknown is the process that prepares evidence: how may the decision-maker sample different sources of information sequentially, if they can only sample one source at a time? Here we propose a normative framework in prescribing how different sources of information should be sampled proactively to facilitate the (...) class='Hi'>decision process: beliefs for different noisy sources are updated in a Bayesian manner and participants can proactively allocate resource for sampling (i.e. saccades) among different sources to maximize the information gain in such process. We show that our framework can account for human participants’ actual choice and saccade behaviors in a two-alternative value-based decision-making task. Moreover, our framework makes novel predictions about the empirical eye movement patterns. (shrink)

Emerging evidence suggests that the long-established distinction between habit-based and goal-directed decision-making mechanisms can also be sustained in humans. Although the habit-based system has been extensively studied in humans, the goal-directed system is less well characterized. This review brings to that task the distinction between conceptual and nonconceptual representational mechanisms. Conceptual representations are structured out of semantic consituents - the use of which requires an ability to perform some language-like syntactic processing. Decision making - as investigated by neuroscience (...) and psychology - is normally studied in isolation from questions about concepts as studied in philosophy and cognitive psychology. We ask what role concepts play in the "goal-directed" decision-making systems. We argue that one fruitful way of studying this system in humans is to investigate the extent to which it deploys conceptual representations. (shrink)

BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination (...) at a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)