Moral reasoning,moral decision-making,and empathy in Korsakoff’s syndrome

Korsakoff’s syndrome (KS) is a neuropsychiatric disorder, caused by a vitamin B1 deficiency. Although it is known that patients with KS display diminished theory of mind functioning and frequently exhibit marked antisocial interactions little attention has so far focused on the integrity of moral decision-making abilities, moral reasoning, and empathy. In an experimental cross-sectional design, 20 patients diagnosed with KS, and twenty age-, education-, and gender-equivalent healthy participants performed tests assessing moral decision-making, moral reasoning maturity, empathy, and executive functioning. Participants were administered the Moral Behaviour Inventory (MBI) for everyday moral dilemmas, and ten cartoons of abstract moral dilemmas. Responses were scored according to the Kohlberg stages of moral reasoning. Empathy and executive functioning were assessed with the Interpersonal Reactivity Index (IRI) and the Frontal Assessment Battery (FAB). In contrast to frontal traumatic brain injury patients, KS patients did not display a utilitarian bias, suggesting preserved moral decision-making abilities. Of interest, KS patients had significantly lower levels of moral reasoning maturity on everyday moral dilemmas, and abstract moral dilemmas. In patients, empathy was moderately related to the level of moral maturity on both tasks, while executive functioning was not. In conclusion, KS patients have preserved moral decision-making abilities, but their moral reasoning abilities are poorer in everyday and abstract situations. Lower moral reasoning abilities and lower levels of empathy together may be responsible for adverse social functioning in KS.     

Doing Ethics or Changing for the Better?

In this paper, classical pragmatism is used as a method, not as a substantial ethical theory, to develop “moral pragmatics.” Moral pragmatics offers a constructive approach for making progress where traditional ethical theories converge, and it innovates ethical deliberation. Assuming widespread agreement that real moral problems need practical solutions, the paper addresses two related problems: the missing link between ethical theories and moral practice, and the question of who is in charge of finding such solutions. It argues that “conscience” can create a link between ethical knowledge and moral practice, and that this partly discharges “the ethicist” from the task of solving problems that are not really, or not only, hers. Two specific methodological innovations are suggested that go beyond admonitions to render ethics sensitive to context. Instead, a reevaluation of “casuistry” and a sensitivity for “finding the right words” give an idea of how to achieve this goal.