Abstract

This study used fMRI to investigate the neural substrates of moral cognition in
health resource allocation decision problems. In particular, it investigated the
cognitive and emotional processes that underpin utilitarian approaches to health
care rationing such as Quality Adjusted Life Years (QALYs). Participants viewed
hypothetical medical and nonmedical resource allocation scenarios which described
equal or unequal allocation of resources to different groups. In addition, participants
were assigned to 1 of 2 treatments in which they either did or did not receive
advanced instructions about the principles of utilitarianism. In all cases, participants
were asked to judged the proposed allocations as “fair” or “unfair.” More
brain activity was observed within the superior parietal lobe, angular gyrus, middle
temporal gyrus, and bilateral caudate nucleus when participants viewed scenarios
depicting equal divisions of resources. Conversely, unequal resource divisions were
associated with more activity in the inferior frontal gyrus and insula cortex.
Furthermore, instructions about the principles of utilitarianism led to significant
activation differences within the inferior frontal gyrus and the middle frontal gyrus.
Significant differences in activity were also found within the inferior frontal cortex
and anterior insula between medical and nonmedical scenarios. The implications
for cognitive control mechanisms and the cognitive and neural bases of utilitarian
ethical judgment are discussed.