Socioemotional Dysfunction and the Greater Good: A Case Study

Moral cognition has largely been studied via moral dilemmas in which making a utilitarian choice causes instrumental harm to achieve the greater good. Accordingly, empirical studies of utilitarianism link it with emotional unresponsiveness and brain lesion studies have suggested that socioemotional processes must be intact to generate decisions that refuse to employ harm (at the cost of overall welfare). However, there is also an impartial, altruistic dimension of utilitarianism in which one sacrifices the good of oneself or close others for the overall welfare. In this study, we measured utilitarian choices multidimensionally in a patient with behavioral variant frontotemporal dementia (bvFTD), incorporating dilemmas accounting for both negative and positive dimensions and found that despite socioemotional and executive deficits our patient was highly utilitarian in the positive, self-sacrificial dimension of utilitarianism. This case study challenges the tendency to automatically associate patients with bvFTD with sociopathic, antisocial tendencies, and suggests that altruistic, impartial choices can occur in the absence of socioemotional responsiveness when a more multidimensional empirical measurement of utilitarianism is employed.