Skip to main content
SpringerLink
Log in
Book cover

Ethical Issues in Behavioral Neuroscience pp 159–188Cite as

Effects of Brain Lesions on Moral Agency: Ethical Dilemmas in Investigating Moral Behavior

  • Chapter
  • First Online:

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 19))

Abstract

Understanding how the “brain produces behavior” is a guiding idea in neuroscience. It is thus of no surprise that establishing an interrelation between brain pathology and antisocial behavior has a long history in brain research. However, interrelating the brain with moral agency—the ability to act in reference to right and wrong—is tricky with respect to therapy and rehabilitation of patients affected by brain lesions. In this contribution, we outline the complexity of the relationship between the brain and moral behavior, and we discuss ethical issues of the neuroscience of ethics and of its clinical consequences. First, we introduce a theory of moral agency and apply it to the issue of behavioral changes caused by brain lesions. Second, we present a typology of brain lesions both with respect to their cause, their temporal development, and the potential for neural plasticity allowing for rehabilitation. We exemplify this scheme with case studies and outline major knowledge gaps that are relevant for clinical practice. Third, we analyze ethical pitfalls when trying to understand the brain–morality relation. In this way, our contribution addresses both researchers in neuroscience of ethics and clinicians who treat patients affected by brain lesions to better understand the complex ethical questions, which are raised by research and therapy of brain lesion patients.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

DBS:

Deep brain stimulation

DLPFC:

Dorsolateral prefrontal cortex

FTD:

Frontotemporal dementia

NMDA:

N-Methyl-D-aspartate

PET:

Positron emission tomography

PFC:

Prefrontal cortex

SPECT:

Single-photon emission computed tomography

ToM:

Theory of mind

VMPFC:

Ventromedial prefrontal cortex

References

  • Abend G (2013) What the science of morality doesn’t say about morality. Phil Soc Sci 43:157–200

    Article  Google Scholar 

  • Absher JR, Vogt BA, Clark DG et al (2000) Hypersexuality and hemiballism due to subthalamic infarction. Neuropsych Neuropsychol Behav Neurol 13(3):220–229

    CAS  Google Scholar 

  • Andrewes DG, Kaye A, Murphy M et al (2003) Emotional and social dysfunction in patients following surgical treatment for brain tumour. J Clin Neurosci 10(4):428–433

    Article  PubMed  Google Scholar 

  • Appiah KA (2010) The honor code: how moral revolutions happen. W.W. Norton & Company, New York

    Google Scholar 

  • Barch DM, Burgess GC, Harms MP et al (2013) Function in the human connectome: task-fMRI and individual differences in behavior. NeuroImage 80:169–189

    Article  PubMed Central  PubMed  Google Scholar 

  • Batts S (2009) Brain lesions and their implications in criminal responsibility. Behav Sci Law 27(2):261–272

    Article  PubMed  Google Scholar 

  • Beauchamp TL, Childress JF (2013) Principles of biomedical ethics, 7th edn. Oxford University Press, Oxford

    Google Scholar 

  • Björklund F, Björnsson G, Eriksson J et al (2012) Recent work: motivational internalism. Analysis 72:124–137

    Article  Google Scholar 

  • Burns JM, Swerdlow RH (2003) Right orbitofrontal tumor with pedophilia symptom and con-structional apraxia sign. Arch Neurol 60:437–440

    Article  PubMed  Google Scholar 

  • Callahan D (2003) Principlism and communitarianism. J Med Ethics 29:287–291

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Catsman-Berrevoets C, Aarsen FK (2010) The spectrum of neurobehavioral deficits in the posterior fossa syndrome in children after cerebellar tumour surgery. Cortex 46:933–946

    Article  PubMed  Google Scholar 

  • Chiang HL, Huang YS, Chen ST et al (2012) Are there ethnic differences in impulsive/compulsive behaviors in Parkinson’s disease? Europ J Neurol 19(3):494–500

    Article  Google Scholar 

  • Cholbi MJ (2006) Belief attribution and the falsification of motive internalism. Philos Psychol 19:607–616

    Article  Google Scholar 

  • Christen M, Alfano M (2013) Outlining the field—a research program for empirically informed ethics. In: Christen M, Fischer J, Huppenbauer M, Tanner C, van Schaik C (eds) Empirically informed ethics. Morality between facts and norms. Library of ethics and applied philosophy. Springer, Berlin, pp 3–28

    Google Scholar 

  • Christen M, Müller S (2011) Single cases promote knowledge transfer in the field of DBS. Front Integr Neurosci 5 (Article 13)

    Google Scholar 

  • Christen M, Regard M (2012) Der “unmoralische Patient”. Eine Analyse der Nutzung hirnverletzter Menschen in der Moralforschung. Nervenheilkunde 31:209–214

    Google Scholar 

  • Ciaramelli E, Muccioli M, Làdavas E et al (2007) Selective deficit in personal moral judgment following damage to ventromedial prefrontal cortex. Soc Cog Affect Neurosci 2:84–92

    Article  Google Scholar 

  • Clouser KD, Gert B (1990) A critique of principlism. J Med Philos 15:219–236

    Article  CAS  PubMed  Google Scholar 

  • Cosgrove GR, Rauch SL (1995) Psychosurgery. Neurosurg Clin North A 6:167–176

    CAS  Google Scholar 

  • D’Astous M, Cottin S, Roy M et al (2013) Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up. J Neurol Neurosurg Psychiat 84(11):1208–1213

    Article  PubMed  Google Scholar 

  • Dalmau J, Gleichman AJ, Hughes EG et al (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7:1091–1098

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Dalmau J, Tuzun E, Wu HY et al (2007) Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 61:25–36

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Damasio AR (1994) Descartes’ error. Putnam, New York

    Google Scholar 

  • Demetriades P, Rickards H, Cavanna AE (2011) Impulse control disorders following deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: clinical aspects. Parkinson’s Disease, doi: 10.4061/2011/658415

    Google Scholar 

  • De Ridder D, Langguth B, Plazier M et al (2009) Moral Dysfunction and potential treatments. In: Verplaetse J et al (eds) The moral brain. Springer, Berlin, pp 155–183

    Chapter  Google Scholar 

  • Devinsky O, Barr WB, Vickrey BG et al (2005) Changes in depression and anxiety after resective surgery for epilepsy. Neurology 65:1744–1749

    Article  CAS  PubMed  Google Scholar 

  • Dougherty DD, Baer L, Cosgrove GR et al (2002) Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psych 159:269–275

    Article  Google Scholar 

  • Eslinger PJ, Damasio A (1985) Severe disturbance of higher cognition after bilateral frontal lobe ablation: Patient EVR. Neurology 35:1731–1741

    Article  CAS  PubMed  Google Scholar 

  • Eslinger PJ, Flaherty-Craig CV, Benton AL (2004) Developmental outcomes after early prefrontal cortex damage. Brain Cog 55:84–103

    Article  Google Scholar 

  • Feinstein JS, Rudrauf D, Khalsa SS et al (2010) Bilateral limbic system destruction in man. J Clin Exp Neuropsychol 32(1):88–106

    Article  PubMed Central  PubMed  Google Scholar 

  • Feldman RP, Alterman RL, Goodrich JT (2001) Contemporary psychosurgery and a look to the future. J Neurosurg 95:944–956

    Article  CAS  PubMed  Google Scholar 

  • Foong J, Flugel D (2007) Psychiatric outcome of surgery for temporal lobe epilepsy and presurgical considerations. Epilepsy Res 75:84–96

    Article  CAS  PubMed  Google Scholar 

  • Frazzetto G, Anker S (2009) Neuroculture. Nature Rev Neurosci 10(11):815–821

    Article  CAS  Google Scholar 

  • Frías Ibáñez A, Malea Fernández A, Dorado García M et al (2008) Orbitofrontal syndrome after a cerebral aneurysm operation. A case report. Actas España Psiquiatrica 36(6):362–365

    Google Scholar 

  • Fumagalli M, Priori A (2012) Functional and clinical neuroanatomy of morality. Brain 135(7):2006–2021

    Article  PubMed  Google Scholar 

  • Gillon R (2003) Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. J Med Ethics 29:307–312

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Gorman DG, Cummings JL (1992) Hypersexuality following septal injury. Arch Neurol 49:308–310

    Article  CAS  PubMed  Google Scholar 

  • Grafman J, Schwab K, Warden D et al (1996) Frontal lobe injuries, violence, and aggression: a report of the Vietnam Head Injury Study. Neurology 46:1231–1238

    Article  CAS  PubMed  Google Scholar 

  • Guangming Z, Wenjing Z, Guoquiang C et al (2009) Psychiatric symptom changes after corticoamygdalo-hippo-campectomy in patients with medial temporal lobe epilepsy through Symptom Checklist 90 Revised. Surgical Neurol 72:587–591

    Article  Google Scholar 

  • Guarnieri R, Araújo D, Carlotti CG Jr et al (2005) Suppression of obsessive-compulsive symptoms after epilepsy surgery. Epilepsy Behav 7:316–319

    Article  CAS  PubMed  Google Scholar 

  • Hannan S, Cross JH, Scott RC et al (2009) The effects of epilepsy surgery on emotions, behavior, and psychosocial impairment in children and adolescents with drug-resistant epilepsy: a prospective study. Epilepsy Behav 15:318–324

    Article  PubMed  Google Scholar 

  • Harlow JM (1868) Recovery from the passage of an iron bar through the head. Publ Mass Med Soc 2:327–347

    Google Scholar 

  • Harris J (2003) In praise of unprincipled ethics. J Med Ethics 29:303–306

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Hawkins KA, Trobst KK (2000) Frontal lobe dysfunction and aggression: conceptual issues and research findings. Aggr Viol Behav 5(2):147–157

    Article  Google Scholar 

  • Hedgecoe AM (2004) Critical bioethics: beyond the social science critique of applied ethics. Bioethics 18(2):120–143

    Article  PubMed  Google Scholar 

  • Hill D, Pond DA, Mitschell W et al (1957) Personality changes following temporal lobectomy for epilepsy. J Med Sci 103:18–27

    CAS  Google Scholar 

  • Hornak J, Bramham J, Rolls ET et al (2003) Changes in emotion after circumscribed surgical lesions of the orbitofrontal and cingulate cortices. Brain 126:1691–1712

    Article  CAS  PubMed  Google Scholar 

  • Irle E, Exner C, Thielen K et al (1998) Obsessive-compulsive disorder and ventromedial frontal lesions: clinical and neuropsychological findings. Am J Psych 155:255–263

    CAS  Google Scholar 

  • Jonsen AR (1995) Casuistry: an alternative or complement to principles? Kennedy Inst Ethics J 5:237–251

    Article  PubMed  Google Scholar 

  • Koenigs M, Young L, Adolphs R et al (2007) Damage to the prefrontal cortex increases utilitarian moral judgments. Nature 446:908–911

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Kohlberg L (1981/1984) Essays on moral development, vol I/II. Harper & Row, San Francisco

    Google Scholar 

  • Kubu CS, Ford PJ (2012) Beyond mere symptom relief in deep brain stimulation: an ethical obligation for multi-faceted assessment of outcome. AJOB Neurosci 3(1):44–49

    Article  PubMed Central  PubMed  Google Scholar 

  • Lendt M, Helmstaedter C, Kuczaty S et al (2000) Behavioral disorders in children with epilepsy: early improvement after surgery. J Neurol Neuro-surg Psych 69:739–744

    Article  CAS  Google Scholar 

  • Lough S, Kipps CM, Treise C et al (2006) Social reasoning, emotion and empathy in frontotemporal dementia. Neuropsychologia 44(6):950–958

    Article  PubMed  Google Scholar 

  • Mace CJ, Trimble MR (1991) Psychosis following temporal lobe surgery: a report of six cases. J Neurol Neurosurg Psych 54:639–644

    Article  CAS  Google Scholar 

  • Macmillan M (2000) An odd kind of fame. Stories of Phineas Gage. MIT-Press, Cambridge, Mass

    Google Scholar 

  • Mataró M, Jurado MA, García-Sánchez C et al (2001) Long-term effects of bilateral frontal brain lesion: 60 years after injury with an iron bar. Arch Neurol 58(7):1139–1142

    Article  PubMed  Google Scholar 

  • Mendez MF, Shapira JS (2011) Pedophilic behavior from brain diseases. J Sex Med 8:1092–1100

    Article  PubMed  Google Scholar 

  • Mendez MF (2010) The unique predisposition to criminal violations in frontotemporal dementia. J Am Acad Psych Law 38(3):318–323

    Google Scholar 

  • Mendez MF (2009) The neurobiology of moral behavior: review and neuropsychiatric implications. CNS Spectrum 14(11):608–620

    Google Scholar 

  • Mendez MF, Shapira JS (2009) Altered emotional morality in frontotemporal dementia. Cogn Neuropsych 14(3):165–179

    Article  Google Scholar 

  • Meyers CA, Berman SA, Scheibel RS et al (1992) Acquired antisocial personality disorder associated with unilateral left orbital frontal lobe damage. J Psych Neurosci 17(3):121–125

    CAS  Google Scholar 

  • Müller S, Heinz A (2013) Stigmatisierung oder Entstigmatisierung durch Biologisierung psychischer Krankheiten? Nervenheilkunde 12:955–961

    Google Scholar 

  • Müller S, Christen M (2011) Deep brain stimulation in Parkinsonian patients—ethical evaluation of cognitive, affective, and behavioral sequelae. AJOB Neurosci 2(1):3–13

    Article  Google Scholar 

  • Nakaji P, Meltzer HS, Singel SA et al (2003) Improvement of aggressive and anti-social behaviour after resection of temporal lobe tumors. Pediatrics 112(5):e430–e433

    Article  PubMed  Google Scholar 

  • Narvaez D (2005) The neo-Kohlbergian tradition and beyond: schemas, expertise and character. In: Carlo G, Pope-Edwards C (eds) Moral motivation through the lifespan. University of Nebraska Press, Lincoln, pp 119–163

    Google Scholar 

  • Nichols S, Knobe J (2007) Moral responsibility and determinism: the cognitive science of folk intuitions. Noûs 41(4):663–685

    Article  Google Scholar 

  • Nyffeler T, Regard M (2001) Kleptomania in a patient with a right frontolimbic lesion. Neuropsych Neuropsychol Behav Neurol 14(1):73–76

    CAS  Google Scholar 

  • Parkinson C, Sinnott-Armstrong W, Koralus PE et al (2011) Is morality unified? Evidence that distinct neural systems underlie moral judgments of harm, dishonesty, and disgust. J Cog Neurosci 23(10):3162–3180

    Article  Google Scholar 

  • Pascual L, Rodrigues P, Gallardo-Pujol D (2013) How does morality work in the brain? A functional and structural perspective of moral behavior. Front Integr Neurosci 7:65

    Article  PubMed Central  PubMed  Google Scholar 

  • Persson I, Savulescu J (2012) Unfit for the future: the need for moral enhancement. Uehiro series in practical ethics. Oxford University Press, Oxford

    Google Scholar 

  • Piaget J (1932) The moral judgment of the child. Kegan Paul, Trench, Trubner and Co., London

    Google Scholar 

  • Pierre-Kahn A, Recassens C, Pinto G et al (2005) Social and psycho-intellectual outcome following radical removal of craniopharyngiomas in childhood: a prospective series. Child´s Nerv Sys 21:817–824

    Google Scholar 

  • Rest JR (1986) Moral development: advances in research and theory. Praeger, New York

    Google Scholar 

  • Roskies A (2006) Patients with ventromedial frontal damage have moral beliefs. Philos Psychol 19:617–627

    Article  Google Scholar 

  • Rück C, Karlsson A, Steele D et al (2008) Capsulotomy for obsessive-compulsive disorder. Arch Gen Psych 65(8):914–922

    Article  Google Scholar 

  • Sade B, Budur K, Lee DK et al (2006) Major depression with psychosis after resection of a giant middle fossa hemangiopericytoma. Surg Neurol 65:290–292

    Article  PubMed  Google Scholar 

  • Sands SA, Milner JS, Goldberg J et al (2005) Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg 103(4 suppl):302–311

    PubMed  Google Scholar 

  • Schneider F, Habel U, Volkmann J et al (2003) Deep brain stimulation of the subthalamic nucleus enhances emotional processing in Parkinson disease. Arch Gen Psych 60(3):296–302

    Article  Google Scholar 

  • Shamay-Tsoory SG, Tomer R, Goldsher D et al (2004) Impairment in cognitive and affective empathy in patients with brain lesions. J Clin Exp Neuro-psycho-l 26(8):1113–1127

    Article  CAS  Google Scholar 

  • Shannon KM, Penn RD, Kroin JS et al (1998) Stereotactic pallidotomy for the treatment of Parkinson’s disease. Efficacy and adverse effects at 6 months in 26 patients. Neurology 50:434–438

    Article  CAS  PubMed  Google Scholar 

  • Shook JR (2012) Neuroethics and the possible types of moral enhancement. AJOB Neurosci 3(4):3–14

    Article  Google Scholar 

  • Singer P (2005) Ethics and intuitions. J Ethics 9:331–352

    Article  Google Scholar 

  • Spencer S, Huh L (2008) Outcomes of epilepsy surgery in adults and children. Lancet Neurol 7:525–537

    Article  PubMed  Google Scholar 

  • Steinlin M, Imfeld S, Zulauf P et al (2003) Neuropsychological long-term sequelae after posterior fossa tumour resection during childhood. Brain 126:1998–2008

    Article  PubMed  Google Scholar 

  • Stelling MW, McKay SE, Carr A et al (1986) Frontal lesions and cognitive function in craniopharyngioma survivors. Am J Dis Child 140:710–714

    CAS  PubMed  Google Scholar 

  • Tanner C, Christen M (2013) Moral intelligence—a framework for understanding moral competences. In: Christen M, Fischer J, Huppenbauer M, Tanner C, van Schaik C (eds) Empirically informed ethics. Morality between facts and norms. Library of ethics and applied philosophy. Springer, Berlin, pp 119–136

    Google Scholar 

  • Téllez-Zenteno JF, Dhar R, Hernandez-Ronquillo L et al (2007) Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 130:334–345

    Article  PubMed  Google Scholar 

  • Tranel D, Bechara A, Denburg NL (2002) Asymmetric functional roles of right and left ventromedial prefrontal cortices in social conduct, decision-making, and emotional processing. Cortex 38:589–612

    Article  PubMed  Google Scholar 

  • Uttal WR (2001) The new phrenology. The limits of localizing cognitive processes in the brain. MIT Press, Cambridge

    Google Scholar 

  • Varadkar S, Bien CG, Kruse CA et al (2014) Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol 13(2):195–205

    Article  PubMed Central  PubMed  Google Scholar 

  • Welt L (1888) Über Charakterveränderungen des Menschen infolge von Läsionen des Stirnhirns. Deutsches Archiv für klinische Medicin 42:339–390

    Google Scholar 

  • Wilson SJ, Bladin PF, Saling MM et al (2005) Characterizing psychosocial outcome trajectories following seizure surgery. Epilepsy Behav 6:570–580

    Article  PubMed  Google Scholar 

  • Witt JA, Hollmann K, Helmstaedter (2008) The impact of lesions and epilepsy on personality and mood in patients with symptomatic epilepsy: a pre- to postoperative follow-up study. Epilepsy Res 82:139–146

    Google Scholar 

Download references

Acknowledgments

Funding: This research has been partly supported by the German Research Foundation (DFG), Germany (MU 3321/1-1).

Author information

Authors and Affiliations

  1. University of Zurich, University Research Priority Program Ethics, Zollikerstrasse 117, 8008, Zürich, Switzerland

    Markus Christen

  2. Charité—Universitätsmedizin Berlin, Forschungsbereich Mind and Brain, Charitéplatz 1, 10117, Berlin, Germany

    Sabine Müller

Authors
  1. Markus Christen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabine Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Markus Christen .

Editor information

Editors and Affiliations

  1. National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia, Canada

    Grace Lee

  2. National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia, Canada

    Judy Illes

  3. Faculty of Veterinary Medicine, University Utrecht, Utrecht, The Netherlands

    Frauke Ohl

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Christen, M., Müller, S. (2014). Effects of Brain Lesions on Moral Agency: Ethical Dilemmas in Investigating Moral Behavior. In: Lee, G., Illes, J., Ohl, F. (eds) Ethical Issues in Behavioral Neuroscience. Current Topics in Behavioral Neurosciences, vol 19. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2014_342

Download citation

Publish with us

Policies and ethics

Search

Navigation