Current Psychology (2021) 40:5005–5018

https://doi.org/10.1007/s12144-019-00453-0

Deconfounding the effects of acute stress on abstract moral

dilemma judgment
Zhongquan Li 1 & Liuping Gao 1 & Xia Zhao 1 & Bingchao Li 1

Published online: 10 September 2019

# Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
People often make moral judgments under acute stress. Increasing studies have investigated the influence of acute stress on moral
judgment, but the findings are quite divergent. This study attempted to address the inconsistency by employing a new approach,
the CNI model, which disentangles the effect of three determinants of moral decision-making, sensitivity to consequences (C),
sensitivity to moral norms (N), or general preference for inaction (I). Seventy-eight undergraduates (45 females and 33 males)
were randomly assigned to the stress group or the control group. All participants made judgments on a set of 24 moral dilemmas.
Responses to self-reported questionnaires and heart rate were recorded for assessing the levels of stress. The traditional dilemma
analysis indicated that acutely stressed participants made more deontological judgments than participants in the control group.
The process dissociation analysis showed that the stress group had higher deontological inclinations than the control group.
Moreover, the CNI model analysis revealed that the stress group showed a stronger sensitivity to moral norms and a higher
general preference for inaction than the control group. In sum, our findings resolved interpretational ambiguities of traditional
analysis and extended our understanding regarding the mechanism underlying the association between acute stress and moral
judgment.

Keywords Acute stress . Moral judgment . Heart rate . Deontology . Utilitarianism

Introduction processes. Hypothetical moral dilemmas have often been used

Moral judgment is not uncommon in our daily life and has
increasingly received the attention of researchers in recent
years (Greene 2015). Earlier scholars emphasized the role of
purely rational and cognitive process (Kohlberg 1971), while
gradually, researchers have been aware of the importance of
both emotion and cognition in moral judgment (Greene et al.
2001; Haidt 2007). To delineate the interaction between
reason and emotion processes in moral judgment, Greene
et al. (2004) proposed the Dual-Process Theory of Moral
Judgment, which is one of the most popular moral theories
currently. According to this theory, there are two independent
processes involved in moral judgment: a deliberative or cog-
nitive process, and an automatic or emotional process. The
final judgment depends on the relative strength of the two
* Zhongquan Li
zqli@nju.edu.cn
1
School of Social and Behavioral Sciences, Nanjing University, 163
Xianlin Avenue, Qixia District, Nanjing 210023, Jiangsu, China
in laboratory studies, and the “trolley problem” is the most
classic one among those dilemmas (Thomson 1985).
Participants are instructed to judge whether it is morally ac-
ceptable or not to sacrifice the life of one person in order to
save five persons. Accepting the solution is regarded as a
utilitarian judgment, implying the maximization of total ben-
efits, whereas rejecting the solution is called a deontological
judgment, emphasizing the moral rules and automatic emo-
tional reaction.
Stress is also prevalent in our daily life. It has an essential
impact on various decision-making domains, including, for
example, moral judgment and decision-making (Singer et al.
2017; Starcke and Brand 2012; Youssef et al. 2012). High
stress may dramatically change critical individual decisions
and lead to different results from performance in circum-
stances without such stress (Yu 2016). Previous studies have
consistently shown that the specific network of brain regions
for moral judgment is also sensitive to stress (Dedovic et al.
2009; Fumagalli and Priori 2012). Specifically, acute stress
can affect our cognition and behavior by triggering two neural
pathways (Günzel 2014). In the fast-reacting pathway, acute
stress leads to the activation of the sympathetic nervous
5006
system (SNS) which releases catecholamine, while in the
slow-reacting pathway, acute stress activates the
hypothalamic-pituitary-adrenal (HPA) axis to release gluco-
corticoids (GC) (Dickerson and Kemeny 2004). Heart rate
and cortisol levels are indicators for each pathway, respective-
ly (Nater and Rohleder 2009). These hormones would result
in changes in the prefrontal cortex and limbic system func-
tioning which relate to moral judgment (Dedovic et al. 2009;
Fumagalli and Priori 2012; Kern et al. 2008; Pruessner et al.
2008). Overall, these findings imply an association between
acute stress and moral judgment.
Several researchers have conducted studies to investigate the
relationship between acute stress and moral judgment directly.
Some researchers found that stress led to more deontological
judgments in traditional hypothetical moral dilemmas. Youssef
et al. (2012) manipulated stress levels with the Trier Social
Stress Test (TSST), and instructed participants to respond to
three different types of dilemmas (non-moral, impersonal mor-
al, and personal moral). Results indicated that stress led to sig-
nificantly less utilitarian responses to personal dilemmas.
Starcke et al. (2012) attempted to replicate Youssef et al.’s
(2012) study with a different kind of stressor (a cover-story of
delivering a public speech) and stress indicator (heart rate rather
than salivary cortisol levels). Participants in the stress group
made fewer utilitarian judgments and spent more time on the
judgment than those in the control group. Correlation analysis
revealed the association between increased heart rate (a physi-
ological stress response indicator) and fewer utilitarian judg-
ments. However, Kossowska et al. (2016) reported the need
for closure moderated the association between stress and moral
judgment. More specifically, higher cortisol levels were posi-
tively correlated with more utilitarian judgments on in-group
dilemmas only for individuals with a high need for closure.
Some researchers also extended the investigation to everyday
moral decision-making, which had higher external and ecolog-
ical validity than traditional hypothetical moral dilemmas
(Singer et al. 2017; Sommer et al. 2010; Starcke et al. 2011).
Starcke et al. (2011) did not find significant differences between
stressed participants and the control group on the percentage of
altruistic or egoistic choices. However, they found that cortisol-
delta (cortisol increase) was negatively related to the percentage
of altruistic decisions in high-emotional dilemmas. Singer et al.
(2017) found that, even after controlling the covariance of per-
sonality traits and empathy, participants in the stress group
made more altruistic responses than those in the control group,
and higher cortisol levels were related to a higher percentage of
altruistic decisions.
Those studies above have shed some light on the relation-
ship between acute stress and moral judgment. However, the
shortcomings of the traditional dilemma approach may lead to
ambiguities in the interpretation of findings (Gawronski et al.
2016). One major problem is that the traditional approach
assumes deontology and utilitarianism are bipolar opposites,
Curr Psychol (2021) 40:5005–5018
while the Dual-Process Theory of Moral Judgment empha-
sizes the independence of the two (Conway and Gawronski
2013; Greene et al. 2004). The other problem is that the tradi-
tional approach cannot distinguish utilitarian inclinations from
the general tendency to action, as well as clarifying the rela-
tionship between deontological inclinations and the general
tendency to inaction (Gawronski et al. 2017). Conway and
Gawronski (2013) addressed the first problem by using a
process-dissociation (PD) approach to separate deontological
from utilitarian inclinations. Later, Gawronski et al. (2017)
proposed the CNI model to distinguish and quantify three
determinants of moral judgment, sensitivity to consequences
(C), sensitivity to moral norms (N) and the general tendency
for inaction versus action without considering consequences
and moral norms (I). They also developed a multinominal
modeling procedure for parameter estimates by comparing
participants’ responses to the four types of dilemmas across
multiple scenarios. The maximum likelihood statistic is used
as the estimator to seek a set of parameters with the smallest
differences between the actual probabilities of observed re-
sponses and the probabilities predicted by the model. The final
deviation between actual and predicted probabilities is used to
evaluate the model-data fit. If the deviation is small, the per-
formance of the model is good or acceptable in describing the
data. The application of the CNI model has extended our
understanding regarding the processes underlying the associ-
ations between moral judgment and some familiar variables,
such as gender, cognitive load, question framing, psychopa-
thy, incidental emotions, language, and testosterone (Białek
et al. 2019; Brannon et al. 2019; Gawronski et al. 2017;
Gawronski et al. 2018).
Thus, we further explored how acute stress influences mor-
al judgment using the CNI model in the present study, and
resolved interpretational ambiguities of traditional analysis by
figuring out whether acute stress alters sensitivity to conse-
quences (C), sensitivity to moral norms (N), general tendency
for inaction versus action without considering consequences
and moral norms (I), or some combination of the three deter-
minants. Drawing on a few existing studies using TSST to
manipulate stress levels (e.g., Youssef et al. 2012), we hypoth-
esized that acute stress would lead to moral deontological
judgment. However, we were not sure whether acute stress
led to a decrease in sensitivity to consequences, an increase
in sensitivity to moral norms, an increase in the general ten-
dency for inaction, or some combination.
Methods
Participants
The sample size was determined based on earlier studies
(Starcke et al. 2012; Youssef et al. 2012). At least 36
Curr Psychol (2021) 40:5005–5018
participants in each group were required to obtain a statistical
power of 0.8 using the General power analysis program 3.1
(GPower 3.1) (Faul et al. 2007). A total of 78 students (45
females, 33 males; aged 18 to 29 years old, M = 21.35, SD =
1.91, Median = 21) were recruited on campus via advertise-
ment to attend the study. Most of them were sophomores and
juniors who majored in social sciences. They were assigned to
the stress group and the control group randomly (stress
group = 38, control group = 40). Exclusion criteria included
neurological or psychiatric disease, acute or chronic physical
illness, extraordinary stressful life circumstances, or long-term
drinking and smoking. Also, participants were required not to
do strenuous exercise before testing to ensure accurate heart
rate measures. The stress group and the control group did not
differ in mean age (stress group = 21.29, SD = 2.13; control
group = 21.40, SD = 1.71; t (76) = 0.25, p = .801, Cohen’s d =
0.057) or gender (χ2 = 0.001, df = 1, p = .972). All participants
signed written informed consent before the experiment, and
they were debriefed immediately after completing the
investigation.
Materials and Procedures
Stress Induction and Control Condition
Participants were randomly assigned to either the stress group
or the control group. Stress was induced by the standard pro-
cedure of the Trier Social Stress Test (TSST; Kirschbaum et al.
1993), which has been verified to induce subjective and phys-
iological stress response effectively. The TSST consisted of
three parts: A stress anticipation period, a public speech task,
and an arithmetic task. The stress group were told that they
were going to perform a mock job interview in front of two
interviewers and a video camera, and their performance would
be recorded. Before the interview, they had 5 min to prepare
for it with a pen and a piece of paper. After that, they were
asked to elaborate on why they were suitable for the position
without using notes for 5 min. Then participants had to orally
subtract the number 17 from 2043, repeating the operation fast
and accurately for 5 min. On every mistake, they would be
asked to restart the entire arithmetic process from the begin-
ning (Kudielka et al. 2007).
Participants in the control group were confronted with a
placebo version of the TSST (PTSST; Het et al. 2009) that
lacks the main components of the TSST such as interviewers
and a video camera. They were told that they would perform
two tasks, including a speech and an arithmetic task, in an
empty room alone. Before the speech, they had a preparation
time of 5 min with a pen and a piece of paper. Then they were
instructed to talk about their favorite movie with their notes.
Afterward, they were asked to perform an arithmetic task
which consisted of serially adding the number 15, starting at
0 for 5 min (Starcke et al. 2016).
5007
Measurements of Stress Response
Both questionnaires and physiological indicator were used to
measure the change of stress levels. Questionnaires were used
before and after the TSST / PTSST, while the measure of the
physiological indicator was collected throughout the entire
process.
The State-Trait Anxiety Inventory The State Anxiety subscale
of the State-Trait Anxiety Inventory (STAI; Spielberger et al.
1977) was used to assess changes in anxiety. It consists of 20
items about current anxiety rating on a four-point scale rang-
ing from 1 (“not at all”) to 4 (“extremely”). A sample item in
this subscale is “I feel nervous.” The scores of the 20 items
were summed up to form a global index for current anxiety,
ranging from 20 (minimal anxiety) to 80 (maximal anxiety). A
Chinese version of this subscale was used here (Li and Qian
1995). The reliability computed as Cronbach’s α coefficient
was 0.82 (pre-treatment) and 0.94 (post-treatment) in the pres-
ent sample.
The Positive and Negative Affect Schedule A Chinese version
of the Positive and Negative Affect Schedule (PANAS;
Watson et al. 1988) was used to assess changes in positive
and negative affect (Wang et al. 2007). It consists of 20 items,
10 for positive affect (e.g., “interested”) and 10 for negative
affect (e.g., “upset”). Each item was rated on a five-point
Likert scale from 1 (“not at all”) to 5 (“extremely”). It provides
subscale scores for positive and negative affect separately,
both ranging from 10 (minimum) to 50 (maximum). The
Cronbach’s alpha coefficients for the two subscales were
0.82 and 0.91 in the pre-treatment, 0.83 and 0.91 in the post-
treatment.
Heart Rate Heart rate was recorded using the BIOPAC MP150
system, and the data was analyzed and calculated with
AcqKnowledge 4.2 software. Before testing, the experimenter
attached three electrodes with electrode paste to the partici-
pant’s body. The ground (GND) was connected to the right
ankle, the VIN+ was connected to the left ankle, and the VIN−
was connected to the left upper arm. Participants were asked
to adjust a comfortable position and to maintain that position
during the entire experimental phase in order to record heart
rate accurately (Xiu et al. 2016).
Moral Dilemmas Judgment
A total of 24 moral scenarios (i.e., four parallel forms of
six basic moral dilemmas) were adopted from Gawronski
et al. (2017). The four parallel forms of moral scenarios
were developed by depicting different norms and conse-
quences. They were (a) proscriptive norm that prohibits
action and benefits of action greater than its costs; (b)
5008 Curr Psychol (2021) 40:5005–5018

proscriptive norm that prohibits action and benefits of Results

action smaller than its costs; (c) prescriptive norm that
prescribes action and benefits of action greater than its
costs; (d) prescriptive norm that prescribes action and
benefits of action smaller than its costs, respectively
(See Appendix tables 2 and 3). For example, in the
Abduction Dilemma, a guerilla group has abducted a jour-
nalist. They want a ransom of one million dollars for the
life of this journalist. They will use the money to buy
weapons for their guerrilla war, or to buy food for their
families. In the proscriptive norm cases, Congress has
approved the payment of the ransom, and the agent has
to decide whether to veto the payment. Whereas in the
prescriptive norm cases, Congress will not be involved,
and the agent has to decide alone whether to approve the
payment. The moral scenarios were presented one by one
on the screen in a fixed random order to participants. In
each scenario, the moral agent had to decide on whether
or not to act in a certain way. Participants were instructed
to read each scenario, and then to judge the acceptability
of a specific action (yes or no).
Design and Procedures
Participants arrived at the lab and received a thorough expla-
nation of the experimental procedure. Then they were
instructed to provide written informed consent and to com-
plete a questionnaire including demographic information, the
STAI scale, and the PANAS scale. After that, they had a 3-min
rest and started to record the heart rate as the baseline. In the
follow-up section, they were confronted with the TSST or the
PTSST randomly. Subsequently, participants were asked to
complete the STAI and PANAS scales and to perform moral
judgments on a set of 24 moral dilemmas. Finally, all partic-
ipants were debriefed, paid, and thanked for participation.
Manipulation Check
Psychological indicators of stress For the STAI and the
PANAS stress index, we run three separate 2 (group) × 2
(time) repeated-measurements ANOVAs to analyze group dif-
ferences in stress responses. Regarding anxiety state, a mar-
ginally significant interaction was found, F (1, 76) =3.31, p=.
073, η2p = 0.042. The simple effect analysis demonstrated that
the stress group and the control group had no significant dif-
ference before the stress manipulation (stress group = 40.87 ±
1.02; control group = 40.78 ± 1.00; F (1, 76) = 0.004, p = .95,
η2p = 0.00), but the stress group had a significantly higher
anxiety level after the stress induction (stress group = 44.61
± 1.29; control group = 40.58 ± 1.26; F (1, 76) = 4.99, p = .03,
η2p = 0.062). For positive affect, only a significant main effect
of time was found, F(1,76) = 43.15, p < .001, η2p = 0.362.
Further post hoc comparison indicated that positive affect
was significantly lower after stress manipulation (t(77) =
6.41, p < .001, Cohen’s d = 1.461). For negative affect, the
interaction effect was significant, F (1, 76) =29.38, p < .001,
η2p = 0.284. Simple effect analysis revealed no significant dif-
ference between groups before the treatment (stress group =
16.40 ± 0.96; control group = 15.48 ± 0.93; F (1, 76) = 0.47,
p = .49, η2p = 0.006), but a significant higher level of negative
affect in the stress group after the treatment (stress group =
23.97 ± 1.03; control group = 15.53 ± 1.00; F (1, 76) = 34.67,
p < .001, η2p = 0.313). Results are shown in Table 1.
Physiological Indicators of Stress For heart rate measures, we
first used AcqKnowledge 4.2 software to get heart rates, then
subtracted the baseline heart rate scores from the scores for
heart rate during three periods of stress anticipation period, a
public speech task, and an arithmetic task of TSST, in order to

Table 1 Results of the psychological indicators of stress

Data Analysis Stress indicator F df p η2p

We first compared the stress responses between the stress STAI: Time 2.67 1, 76 .106 0.034
group and the control group to check the manipulation of STAI: Group 2.87 1, 76 .094 0.036
stress levels. Then we compared their performances on the STAI: Time × Group 3.31 1, 76 .073 0.042
moral dilemma judgment task from the perspective of tradi- PANAS-PA: Time 43.15 1, 76 .000 0.362
tional analysis, process-dissociation analysis, and the CNI PANAS-PA: Group 1.04 1, 76 .312 0.013
model analysis. In the traditional analysis, the percentage of PANAS-PA: Time × Group 3.60 1, 76 .061 0.045
utilitarian judgments was computed. In the process dissocia- PANAS-NA: Time 30.17 1, 76 .000 0.284
tion analysis, deontological and utilitarian inclinations were PANAS-NA: Group 15.24 1, 76 .000 0.167
calculated. Furthermore, in the CNI model analysis, three pa- PANAS-NA: Time × Group 29.38 1, 76 .000 0.279
rameters (sensitivity to consequences, sensitivity to moral
STAI = The State-Trait Anxiety Inventory; PANAS = The Positive and
norms, and the general tendency for inaction) were estimated Negative Affect Schedule; PA = Positive Affect; NA = Negative Affect;
with the software multiTree (Moshagen 2010) and the “Time” as the within factor (before vs after the treatments); “Group” as
multiTree template file (Gawronski et al. 2017). the between factor (stress vs control groups)
Curr Psychol (2021) 40:5005–5018
reduce the differences among individuals. A 2 (group) × 3
(time) repeated-measurement ANOVA was used to compare
physiological stress response between groups. The main ef-
fects of time (F (2, 152) = 22.92, p < .001, η2p = 0.232) and
group (F (1, 76) = 28.10, p < .001, η2p = 0.270), as well as the
time × group interaction (F (2, 152) = 10.09, p < .001, η2p =
0.117), were significant. Simple effect analysis showed a sig-
nificantly higher stress response in the stress group than in the
control group during the anticipation period (stress group =
12.29 ± 1.30; control group = 7.13 ± 1.27; F (1, 76) = 8.04,
p = .006, η2p = 0.096); speech task (stress group = 20.21 ±
1.69; control group = 8.28 ± 1.654; F (1, 76) = 25.59,
p < .001, η2p = 0.252) and the arithmetic task (stress group =
14.72 ± 1.37; control group = 3.24 ± 1.34; F (1, 76) = 36.08,
p < .001, η2p = 0.322) (see Fig. 1). Overall, our results con-
firmed the success of the stress manipulation.
Moral Decision-Making
Traditional Analysis The traditional analysis only focuses on
one of the four parallel forms of moral dilemmas, that is,
proscriptive norm that prohibits action and benefits of action
greater than its costs. The answer “yes” was recorded as 1,
which was interpreted as a utilitarian response. Moreover, the
answer “no” was recorded as 0, which was interpreted as a
deontological response. We averaged the answers on the six
moral scenarios of this form, and the mean suggested that
participants had a slight preference for utilitarian over deon-
tological responses (M = 3.08, SD = 1.34). However, further
analysis demonstrated that the overall preference score did
not differ from the neutral reference point of 3 (t (77) = 0.51,
p=. 613). To compare groups on moral judgment, we per-
formed an independent samples t-test, and found that stressed
participants preferred more deontological responses than par-
ticipants in the control group (t (76) = 2.25, p = .028, Cohen’s
d = 0.516).
Fig. 1 Results of the heart rate in
the stress and control groups at
the three points of measurements.
The baseline value was subtracted
from the heart rate at each time.
Error bars represent standard
Heart rate (bpm)
errors of the mean. Bpm = beat
per minute. *** p < .001
5009
Process Dissociation Analysis The process dissociation analy-
sis only involved two of the four parallel forms of moral sce-
narios, that is, proscriptive norm that prohibits action and ben-
efits of action greater than its costs, which was treated as
incongruent dilemmas, and proscriptive norm that prohibits
action and benefits of action smaller than its costs, which
was treated as congruent dilemmas. We first calculated a util-
itarian (U) parameter and a deontological (D) parameter fol-
lowing Conway and Gawronski’s (2013) procedure, and then
standardized both parameters for the following analysis.
Correlation analysis indicated that utilitarian inclinations and
deontological inclinations were independent of each other
(r = 0.108, p = .347). A 2 (group) × 2 (parameter) repeated-
measurements ANOVA revealed a significant interaction be-
tween group and PD parameters (F (1, 76) = 4.32, p = .041,
η2p = 0.054). Simple effect analysis demonstrated that deon-
tological inclinations were significantly higher in the stress
group (M = 0.41, SD = 0.15) than in the control group (M =
−0.39, SD = 0.15; F (1, 76) = 14.82, p < .001, η2p = 0.163).
But the two groups (M = 0.10, SD = 0.16; M = −0.09, SD =
0.16) did not significantly differ on utilitarian inclinations (F
(1, 76) = 0.68, p = .413, η2p = 0.009) (see Fig. 2).
CNI Model Analysis We first calculated the CNI model fit
without considering the stress and control groups, and results
showed that the CNI model suboptimally fits the data, G2
(1) = 3.78, p = 0.052. Further analyses revealed that the C pa-
rameter (M = 0.17, 95% CI [0.1264, 0.2126]) was significant-
ly greater than zero, ΔG2 (1) = 61.88, p < .001, indicating that
participants were highly sensitive to consequences in moral
judgment. The N parameter (M = 0.30, 95% CI [0.2498,
0.3551]) was significantly larger than zero, ΔG 2 (1) =
123.72, p < .001, meaning that participants were highly sensi-
tive to norms in moral judgment. The I parameter also signif-
icantly differed from its neutral reference point of 0.5 (M =
0.45, 95% CI [0.4111, 0.4852]), ΔG2 (1) = 11.30, p =. 004,
25
***
Stress group
Control group
20
***
**
15
10
0
Preparation Speech Arithmetic
5010 Curr Psychol (2021) 40:5005–5018

Fig. 2 Process-dissociation (PD) 0.7 Stress group

Scores for the Stress and Control
groups. Error bars represent stan- Control group
dard errors of the mean. *** 0.5
***
p < .001
0.3

PD Scores
0.1

-0.1 utilitarianism deontology

-0.3

-0.5

-0.7

implying that participants exhibited a higher preference for
action over inaction.
The CNI model demonstrated a good fit with the data when
we analyzed the data separately for the stress group and the
control group, G2 (1) = 4.34, p = 0.114. Participants in the
stress group showed no significant difference in the C param-
eter, ΔG2 (1) =0.18, p = 0.67, compared to those in the control
group. However, there was a significant difference in the N
parameter, ΔG2 (1) =13.74, p < .001, and on the I parameter,
ΔG2 (1) = 4.82, p = 0.028, implying that participants in the
stress group expressed a stronger sensitivity to norms and a
stronger general preference for inaction compared to the con-
trol group (see Fig. 3).
Discussion
Our study attempted to clarify the possible confounding in
previous studies about the relationship between acute stress
and moral judgment by using a new approach, the CNI model.
As expected, the traditional approach analysis indicated that a
higher level of stress was associated with more deontological
moral choices, whereas process dissociation analysis indicated
acute stress only increased the deontological inclinations rath-
er than decreasing utilitarian inclinations or influenced both.
More importantly, the CNI model analysis revealed that acute
stress increased sensitivity to moral norms and general prefer-
ences for inaction, but left sensitivity to consequences
unaffected.
Previous studies mostly employed the traditional dilemma
approach to explore the relationship between acute stress and
moral judgment, and found acute stress led to more deonto-
logical moral judgment. Our result with traditional analysis
was in line with those studies (Starcke et al. 2012; Youssef
et al. 2012). Emotion as an indispensable psychological factor
plays a vital role in moral judgment and decision-making (Li
et al. 2017). Stress can diminish the activation of prefrontal
executive control regions and stimulate emotion brain areas

Fig. 3 According to the CNI 0.8 Stress group

model, Parameter estimates of
sensitivity to consequences (C), 0.7 Control group
sensitivity to norms (N), and a
Parameter Estimate

general preference for inaction 0.6

versus action (I) for the Stress and *
Control groups. Error bars 0.5 ***
represent standard errors of the
mean. * p < .05, *** p < .001 0.4

0.3

0.2

0.1

0
C Parameter N Parameter I Parameter
Curr Psychol (2021) 40:5005–5018
that elicit a switch from deliberative reasoning processes to
fast and intuitive processes, so that participants made deci-
sions mainly based on spontaneous and innate emotional re-
actions (Yu 2016). Regarding the Dual-Process Theory of
Moral Judgment (Greene et al. 2001), the participants’ greater
reliance on emotional reactions to harmful action and intuitive
responses would lead to more deontological moral options
(Greene 2007; Li et al. 2018). However, Kossowska et al.
(2016) yielded somewhat inconsistent results that stress levels
were not always related to deontological judgment, in that
cortisol level was associated with more utilitarian judgment
than deontological judgments in in-group dilemmas for indi-
viduals with a high need for closure. By contrast, this can be
attributed to the different kinds of stressor and moral di-
lemmas. In the previous study, the TSST was used to induce
acute stress, while in Kossowska’s study, individual variation
in stress levels was measured.
Due to the drawbacks of the traditional dilemma approach,
it is still unclear whether acute stress results in increased de-
ontological inclinations, or decreased utilitarian inclinations,
or both (Conway and Gawronski 2013). As expected, the PD
analysis revealed that participants in the stress group had more
deontological inclinations than the control group, but they had
no difference in utilitarian inclinations. The Dual-Process
Theory of Moral Judgment emphasizes the independence of
deontological and utilitarian inclinations. Moreover, accord-
ing to the SIDI model (Yu 2016), acute stress would trigger
fast and emotional reactions, and this emotional reaction to
harmful action was related to deontological inclinations in
moral decision-making domains. Functional neuroimaging
studies also supported that the regions of the brain involved
in moral judgment were divided into components of moral
reasoning and emotional process (Dedovic et al. 2009;
Fumagalli and Priori 2012; Kern et al. 2008; Pruessner et al.
2008; Wang et al. 2005). Acute stress would activate regions
involved in emotional processing and impair cognitive reason-
ing (Ramos and Arnsten 2007; Valentino and Van Bockstaele
2008), therefore resulting in more deontological responses.
However, neither traditional analysis nor PD analysis could
distinguish the general preference for inaction from sensitivity
to moral norms in the deontological inclination parameter es-
timation, and the general preference for action from sensitivity
to consequences in the utilitarian inclination parameter esti-
mation (Gawronski et al. 2017). The CNI model analyses
successfully address the confound. The results indicated that
acute stress increased sensitivity to the moral norm and gen-
eral preference for inaction, without affecting sensitivity to
consequences. Moral norms are an essential part of human
sociality. They are rooted in everyone’s mind and can influ-
ence individuals’ related behavior (Liere and Dunlap 1978;
Malle et al. 2015). Acute stress triggers more automatic and
deep-rooted intuitive response, such as prosocial action, altru-
istic responses, increasing donation behavior, empathy
5011
(Buchanan and Preston 2014; Singer et al. 2017; Sollberger
et al. 2016), which were empirically considered to be moral
norms (De Groot and Steg 2009). In addition, we found that
acute stress could increase the general preference for inaction,
which was consistent with the results in the study of Zhang
et al. (2018). They reported that chronic stress increased a
stronger general preference for inaction. Stressful situations
reduce individuals’ action tendency, partly because the agents
are afraid that the result of their action will be worse, and
which lowers their willingness to act (Zhang et al. 2018).
Moreover, in moral psychology, this general action aversion
is also called omission bias (Cushman et al. 2006). The find-
ings also excluded the possible explanations of decreased sen-
sitivity to consequences in the association between acute
stress and deontological moral judgment.
Several limitations should be noted for the current study.
One limitation is that the moral dilemmas in laboratory set-
tings, compared to moral situations in real life, are challenging
to create vividness and reality to induce participants’ emotion
and engagement. However, it is not realistic to subject humans
to moral dilemmas such as the trolley dilemma in real life.
Perhaps virtual reality can be used to overcome this issue to
increase the realism of experience of moral judgment (Patil
et al. 2014). Moreover, our moral dilemmas only reflect con-
flicts in the harm domain. It is necessary to extend the study to
other areas suggested by moral foundations theory (Graham
et al. 2013) in the future. However, it might be hard to frame
judgments in other areas under the deontological-utilitarian
classification. Another limitation is that we did not include
some important trait variables, such as big five personality
factors and empathy, in the current study. Measurement of
these variables should be considered in the future. Moreover,
assessment of endocrine stress responses is needed to provide
a more objective evaluation of stress manipulation.
In summary, the present study extended our understanding
of the influence of acute stress on moral judgment with a new
approach, the CNI model. The findings revealed that acute
stress led to increased deontological judgment due to en-
hanced sensitivity to moral norms and general preference for
inaction.
Acknowledgments This study was supported by the Foundation of
Humanities and Social Sciences, Ministry of Education of the PRC
(No.16YJA190003), and Project of Philosophy and Social Sciences from
the Education Department, Jiangsu Province (No. 2018SJZDI203). We
would like to express our thanks to Prof. Jun Bi and Dr. Jianxun Yang for
their support in collecting physiological data. We also greatly appreciate
Dr. Richard Ferraro and two anonymous reviewers for their insightful
comments.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
5012
Ethical Approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the
Institutional Review Board of Nanjing University.
Informed Consent All individual participants included in the study pro-
vided informed consent.
Appendix 1
Table 2 Moral dilemmas (English version; Gawronski et al. 2017)
Proscriptive Norm Prohibits Action
Benefits of Action Greater than
Costs
Abduction You are the president of your
Dilemma country. A guerilla group
operating in a conflict zone has
abducted a journalist from your
country and threatens to behead
him if your government does
not pay a ransom of one million
dollars. The group will use the
ransom money to buy weapons
for their guerilla war, which will
cause the deaths of many
people. Congress has approved
payment of the ransom, but you
have the power to veto the
payment.
Is it acceptable in this case to veto Is it acceptable in this case to veto
the ransom payment?
Transplant You are a surgeon in a small
Dilemma hospital. One day, your hospital
receives five badly hurt patients
from a car accident. The patients
all need organ transplants or
they will die. You have no spare
organs, but there is a patient
who has been in a coma for
several weeks and it seems
unlikely that he will wake up
again. You could terminate his
life support and take his organs
for the five accident victims, so
that their lives will be saved.
Is it acceptable in this case to
terminate the patient’s life
support to take his organs?
Torture You are a member of a special
Dilemma police department who is
trained to obtain information in
particularly difficult cases. You
are dealing with a case
involving a male adult who is
Benefits of Action Smaller than Benefits of Action Greater than
Costs Costs
You are the president of your
country. A guerilla group
operating in a conflict zone has
abducted a journalist from your
country and threatens to behead
him if your government does
not pay a ransom of one million
dollars. The group will use the
ransom money to buy food for
their families, who live in an
area that has been plagued by
several droughts. Congress has
approved payment of the
ransom, but you have the power
to veto the payment.
the ransom payment?
You are a surgeon in a small
hospital. One day, your hospital
receives five badly hurt patients
from a car accident. These
patients all need organ
transplants or they will have
serious health problems for the
rest of their lives. You have no
spare organs, but there is a
patient who has been in a coma
for several weeks and it seems
unlikely that he will wake up
again. You could terminate his
life support and take his organs
for the five accident victims, so
that they won’t suffer from
health problems.
Is it acceptable in this case to
terminate the patient’s life
support to take his organs?
You are a member of a special
police department who is
trained to obtain information in
particularly difficult cases. You
are dealing with a case
involving a male adult who is
Prescriptive Norm Prescribes Action
You are the president of your
country. A guerilla group
operating in a conflict zone has
abducted a journalist from your
country and threatens to behead
him if your government does
not pay a ransom of one million
dollars. The group will use the
ransom money to buy food for
their families, who live in an
area that has been plagued by
several droughts. As the
president, you have the power to
approve payment of the ransom.
Is it acceptable in this case to
approve the ransom payment?
You are a surgeon in a small
hospital. One day, your hospital
receives five badly hurt patients
from a car accident. These
patients all need organ
transplants or they will have
serious health problems for the
rest of their lives. You have no
spare organs, but there is a
patient who has been in a coma
for several weeks and it seems
unlikely that he will wake up
again. One of your co-workers
plans to terminate his life sup-
port and take his organs for the
five accident victims, so that
they won’t suffer from health
problems. You could stop your
co-worker by informing the di-
rector of the hospital.
Is it acceptable in this case to stop
your co-worker from terminat-
ing the patient’s life support to
take his organs?
You are a member of a special
police department who is
trained to obtain information in
particularly difficult cases. You
are dealing with a case
involving a male adult who is
Curr Psychol (2021) 40:5005–5018
Benefits of Action Smaller than
Costs
You are the president of your
country. A guerilla group
operating in a conflict zone has
abducted a journalist from your
country and threatens to behead
him if your government does
not pay a ransom of one million
dollars. The group will use the
ransom money to buy weapons
for their guerilla war, which will
cause the deaths of many
people. As the president, you
have the power to approve
payment of the ransom.
Is it acceptable in this case to
approve the ransom payment?
You are a surgeon in a small
hospital. One day, your hospital
receives five badly hurt patients
from a car accident. The patients
all need organ transplants or
they will die. You have no spare
organs, but there is a patient
who has been in a coma for
several weeks and it seems
unlikely that he will wake up
again. One of your co-workers
plans to terminate his life sup-
port and take his organs for the
five accident victims, so that
their lives will be saved. You
could stop your co-worker by
informing the director of the
hospital.
Is it acceptable in this case to stop
your co-worker from terminat-
ing the patient’s life support to
take his organs?
You are a member of a special
police department who is
trained to obtain information in
particularly difficult cases. You
are dealing with a case
involving a male adult who is
Curr Psychol (2021) 40:5005–5018
Table 2 (continued)
Proscriptive Norm Prohibits Action
Benefits of Action Greater than
Costs
accused of having abducted
several children. You don’t
know where he is hiding the
children, and he refuses to tell
you where they are. The
children will likely die from
dehydration if they are not
found within the next 24 h. You
have tried every legal
interrogation technique, but
none of them were successful.
To get information on where the
children are, you consider the
use of illegal techniques that are
deemed torture.
Is it acceptable in this case to use Is it acceptable in this case to use
illegal interrogation techniques?
Assisted You are a doctor and are treating a
Suicide seriously ill, suffering patient.
Dilemma Even the strongest drugs do not
relieve him from his pain
anymore.
He feels terrible agony and you
know that his condition will
never improve. For days, he has
been waiting for his death.
Since he no longer wants to endure
his pain, he repeatedly asks you
to end his life. You could give
him a drug causing his death,
which will release him from his
pain.
Is it acceptable in this case to
provide your patient with this
drug?
Immune You are the director of a hospital in
Deficiency a developing country. A foreign
Dilemma student who is volunteering in
the country got infected with a
rare virus. The virus is highly
contagious and deadly to
seniors and children. The only
medication that can effectively
stop the virus from spreading
has severe side-effects.
Although the virus will not kill
her, the student suffers from a
chronic immune deficiency that
will make her die from these
side-effects.
Is it acceptable in this case to give
the student the medication?
Vaccine You are a doctor in an area that
Dilemma suffers from an outbreak of a
Benefits of Action Smaller than Benefits of Action Greater than
Costs Costs
accused of having stolen several
paintings. You don’t know
where he is hiding the paintings,
and he refuses to tell you where
they are. The paintings will
likely be shipped to a different
country if they are not found
within the next 24 h. You have
tried every legal interrogation
technique, but none of them
were successful. To get
information on where the
paintings are, you consider the
use of illegal techniques that are
deemed torture.
illegal interrogation techniques?
You are a doctor and are treating a
seriously ill, suffering patient.
Even the strongest drugs do not
relieve him from his pain
anymore.
He feels terrible agony, but you
know that he will get better
again soon. For days, he has
been waiting to see
improvements.
Since he no longer wants to endure
his pain, he repeatedly asks you
to end his life. You could give
him a drug causing his death,
which will release him from his
pain.
Is it acceptable in this case to
provide your patient with this
drug?
You are the director of a hospital in
a developing country. A foreign
student who is volunteering in
the country got infected with a
rare virus. The virus is highly
contagious and can cause severe
stomach cramps. The only
medication that can effectively
stop the virus from spreading
has severe side-effects.
Although the virus will not kill
her, the student suffers from a
chronic immune deficiency that
will make her die from these
side-effects.
Is it acceptable in this case to give
the student the medication?
You are a doctor in an area that
suffers from an outbreak of a
Prescriptive Norm Prescribes Action
accused of having stolen several
paintings. You don’t know
where he is hiding the paintings,
and he refuses to tell you where
they are. The paintings will
likely be shipped to a different
country if they are not found
within the next 24 h. You have
tried every legal interrogation
technique, but none of them
were successful. To get
information on where the
paintings are, your partner starts
using illegal techniques that are
deemed torture, and you
consider stopping him by
reporting him to your
supervisor.
Is it acceptable in this case to stop
your partner from using illegal
interrogation techniques?
You are a doctor and are treating a
seriously ill, suffering patient.
Even the strongest drugs do not
relieve him from his pain
anymore.
He feels terrible agony, but you
know that he will get better
again soon. For days, he has
been waiting to see
improvements.
Since he no longer wants to endure
his pain, he repeatedly asks you
to end his life. Suddenly, he has
a severe heart attack. You could
give him a drug to save him
from dying.
Is it acceptable in this case to
provide your patient with this
drug?
You are the director of a hospital in
a developing country. A foreign
student who is volunteering in
the country got infected with a
rare virus. The virus is highly
contagious and can cause severe
stomach cramps. The student
suffers from a chronic immune
deficiency that will make her
die from the virus if she is not
returned to her home country for
special treatment. However,
taking her out of quarantine
involves a considerable risk that
the virus will spread.
Is it acceptable in this case to take
the student out of quarantine to
return her to her home country
for treatment?
You are a doctor in an area that
suffers from an outbreak of a
5013
Benefits of Action Smaller than
Costs
accused of having abducted
several children. You don’t
know where he is hiding the
children, and he refuses to tell
you where they are. The
children will likely die from
dehydration if they are not
found within the next 24 h. You
have tried every legal
interrogation technique, but
none of them were successful.
To get information on where the
children are, your partner starts
using illegal techniques that are
deemed torture, and you
consider stopping him by
reporting him to your
supervisor.
Is it acceptable in this case to stop
your partner from using illegal
interrogation techniques?
You are a doctor and are treating a
seriously ill, suffering patient.
Even the strongest drugs do not
relieve him from his pain
anymore.
He feels terrible agony and you
know that his condition will
never improve. For days, he has
been waiting for his death.
Since he no longer wants to endure
his pain, he repeatedly asks you
to end his life. Suddenly, he has
a severe heart attack. You could
give him a drug to save him
from dying.
Is it acceptable in this case to
provide your patient with this
drug?
You are the director of a hospital in
a developing country. A foreign
student who is volunteering in
the country got infected with a
rare virus. The virus is highly
contagious and deadly to
seniors and children. The
student suffers from a chronic
immune deficiency that will
make her die from the virus if
she is not returned to her home
country for special treatment.
However, taking her out of
quarantine involves a
considerable risk that the virus
will spread.
Is it acceptable in this case to take
the student out of quarantine to
return her to her home country
for treatment?
You are a doctor in an area that
suffers from an outbreak of a
5014 Curr Psychol (2021) 40:5005–5018

Table 2 (continued)

Proscriptive Norm Prohibits Action Prescriptive Norm Prescribes Action

Benefits of Action Greater than Benefits of Action Smaller than Benefits of Action Greater than Benefits of Action Smaller than
Costs Costs Costs Costs

highly contagious disease.
Preliminary tests have shown
the success of a new vaccine
that is not approved by the
health department of your
country, because of its severe
side-effects. The side-effects of
the vaccine will likely cause the
death of dozens of people who
are not infected, but the vaccine
will save hundreds of lives by
preventing spread of the virus.
Is it acceptable in this case to use
the vaccine?
highly contagious disease.
Preliminary tests have shown
the success of a new vaccine
that is not approved by the
health department of your
country, because of its severe
side-effects. The side-effects of
the vaccine will likely cause the
death of dozens of people who
are not infected, but the vaccine
will save about the same num-
ber of lives by preventing
spread of the virus.
Is it acceptable in this case to use
the vaccine?
Is it acceptable in this case to report
highly contagious disease.
Preliminary tests have shown
the success of a new vaccine
that is not approved by the
health department of your
country, because of its severe
side-effects. The side-effects of
the vaccine will likely cause the
death of dozens of people who
are not infected, but the vaccine
will save about the same num-
ber of lives by preventing
spread of the virus. One of your
colleagues plans to use the
vaccine, but you could stop him
by reporting his plans to the
health department.
your colleague to the health
department?
highly contagious disease.
Preliminary tests have shown
the success of a new vaccine
that is not approved by the
health department of your
country, because of its severe
side-effects. The side-effects of
the vaccine will likely cause the
death of dozens of people who
are not infected, but the vaccine
will save hundreds of lives by
preventing spread of the virus.
One of your colleagues plans to
use the vaccine, but you could
stop him by reporting his plans
to the health department.
Is it acceptable in this case to report
your colleague to the health
department?
Curr Psychol (2021) 40:5005–5018 5015

Appendix 2

Table 3 Moral dilemmas (Chinese version)

规范禁止的行为 规范提倡的行为

行为的收益 行为的收益 行为的收益 行为的收益

大于成本 小于成本 大于成本 小于成本

绑 架 你是你们国家的总统, 在国家的冲突地带发生了 你是你们国家的总统, 在国家的冲突地带发生了 你是你们国家的总统, 在国家的冲突地带发生了

困境 一起游击队绑架一名你国记者的事件, 游击队 一起游击队绑架一名你国记者的事件, 游击队 一起游击队绑架一名你国记者的事件, 游击队
威胁你说如果政府不支付100万美元的赎金, 威胁你说如果政府不支付100万美元的赎金, 威胁你说如果政府不支付100万美元的赎金,
这名人质就会被斩首。该游击队将把这笔赎 这名人质就会被斩首。该游击队的家人生活 这名人质就会被斩首。该游击队的家人生活
金用于为他们的游击战购买武器, 这将导致许 在一个饱受干旱困扰的地区, 他们将把这笔赎 在一个饱受干旱困扰的地区, 他们将把这笔赎
多人的死亡。国会已批准支付这笔赎金, 但你 金用于为家人购买食物。国会已批准支付这 金用于为家人购买食物。作为总统, 你有权批
有权否决。 笔赎金, 但你有权否决。 准支付这笔赎金。
在这种情况下否决支付赎金是可以接受的吗? 在这种情况下否决支付赎金是可以接受的吗? 在这种情况下批准支付赎金是可以接受的吗?
你 是你们国家的总统, 在国家的冲突地带发生了
一起游击队绑架一名你国记者的事件, 游击队
威胁你说如果政府不支付100万美元的赎金,
这名人质就会被斩首。该游击队将把这笔赎
金用于为他们的游击战购买武器, 这将导致许
多人的死亡。作为总统, 你有权批准支付这笔
赎金。
在这种情况下批准支付赎金是可以接受的吗?
器 官移植 你是一家小医院的外科医生。有一天, 你的医院 你是一家小医院的外科医生。有一天, 你的医院 你是一家小医院的外科医生。有一天, 你的医院
困境 收到五名因车祸受伤严重的病人。他们都需 收到五名因车祸受伤严重的病人。他们都需 收到五名因车祸受伤严重的病人。他们都需
要器官移植, 否则就会死亡。此时医院 没有 要器官移植, 否则他们的余生都将遭受严重的 要器官移植, 否则他们的余生都将遭受严重的
多余的器官, 但有一个病人已经昏迷了几个星 健康问题。此时医院 没有多余的器官, 但有 健康问题。此时医院 没有多余的器官, 但有
期, 他似乎不太可能再次醒来。你可以终止他 一个病人已经昏迷了几个星期, 他似乎不太可 一个病人已经昏迷了几个星期, 他似乎不太可
的生命支持, 并将他的器官移植给这五名车祸 能再次醒来。你可以终止他的生命支持, 并将 能再次醒来。你的一名同事打算终止他的生
受害者, 这样他们就会获救。 他的器官移植给这五名车祸受害者, 这样他们 命支持, 并将他的器官移植给这五名车祸受害
在这种情况下终止对这名病人的生命支持并取走 就不会受到健康问题的困扰。 者, 这样他们就不会受到健康问题的困扰。你
他的器官是可以接受的吗? 在这种情况下终止对这名病人的生命支持并取走 可以通过告知院长来阻止你的同事。
他的器官是可以接受的吗? 在这种情况下阻止你的同事终止对这名病人的生
命支持并取走他的器官是可以接受的吗?
你 是一家小医院的外科医生。有一天, 你的医院
收到五名因车祸受伤严重的病人。他们都需
要器官移植, 否则就会死亡。此时医院 没有
多余的器官, 但有一个病人已经昏迷了几个星
期, 他似乎不太可能再次醒来。你的一名同事
打算终止他的生命支持, 并将他的器官移植给
这五名车祸受害者, 这样他们就会获救。你可
以通过告知院长来阻止你的同事。
在这种情况下阻止你的同事终止对这名病人的生
命支持并取走他的器官是可以接受的吗?
酷 刑 你是特警部门的一名成员, 接受过在特别困难的 你是特警部门的一名成员, 接受过在特别困难的 你是特警部门的一名成员, 接受过在特别困难的
困境 情况下获取信息的训练。你正在处理一个成 情况下获取信息的训练。你正在处理一个成 情况下获取信息的训练。你正在处理一个成
年男子绑架多名儿童的案件。你不知道他把 年男子偷盗几幅画作的案件。你不知道他把 年男子偷盗几幅画作的案件。你不知道他把
孩子们藏在哪里, 并且他拒绝告诉你孩子们被 画作藏在哪里, 并且他拒绝告诉你画作被藏在 画作藏在哪里, 并且他拒绝告诉你画作被藏在
藏在哪里。如果在接下来的24小时内找不到 哪里。如果在接下来的24小时内找不到这些 哪里。如果在接下来的24小时内找不到这些
这些孩子, 他们就可能会死于脱水。你已经试 画作, 它们就可能被运往另一个国家。你已经 画作, 它们就可能被运往另一个国家。你已经
过所有的合法审讯手段, 但都没有成功。为了 试过所有的合法审讯手段, 但都没有成功。为 试过所有的合法审讯手段, 但都没有成功。为
获得孩子们在哪里的信息, 你考虑使用那些被 了获得画作在哪里的信息, 你考虑使用那些被 了获得画作在哪里的信息, 你的同事开始使用
认为是酷刑的非法审讯技术。 认为是酷刑的非法审讯技术。 被认为是酷刑的非法审讯技术, 你考虑向你们
在这种情况下使用非法审讯技术是可以接受的吗? 在这种情况下使用非法审讯技术是可以接受的吗? 的上级报告来阻止他。
在这种情况下阻止你的同事使用非法审讯技术是
可以接受的吗?
你 是特警部门的一名成员, 接受过在特别困难的
情况下获取信息的训练。你正在处理一个成
年男子绑架多名儿童的案件。你不知道他把
孩子们藏在哪里, 并且他拒绝告诉你孩子们被
藏在哪里。如果在接下来的24小时内找不到
这些孩子, 他们就可能会死于脱水。你已经试
过所有的合法审讯手段, 但都没有成功。为了
获得孩子们在哪里的信息, 你的同事开始使用
5016 Curr Psychol (2021) 40:5005–5018

Table 3 (continued)

规范禁止的行为 规范提倡的行为

行为的收益 行为的收益 行为的收益 行为的收益

大于成本 小于成本 大于成本 小于成本

被认为是酷刑的非法审讯技术, 你考虑向你们
的上级报告来阻止他。
在这种情况下阻止你的同事使用非法审讯技术是
可以接受的吗?
协 助自杀 你是一名医生, 正在治疗一名身患重病的病 你是一名医生, 正在治疗一名身患重病的病 你是一名医生, 正在治疗一名身患重病的病
困境 人。即使是最强效的药物也不能使他免于痛 人。即使是最强效的药物也不能使他免于痛 人。即使是最强效的药物也不能使他免于痛
苦。他感到极度的痛苦, 而你知道他的病情永 苦。他感到极度的痛苦, 但你知道他很快就会 苦。他感到极度的痛苦, 但你知道他很快就会
远不会好转。几天来, 他一直在等待他的死 好起来。几天来, 他一直在等待病情的好 好起来。几天来, 他一直在等待病情的好
亡。由于他不想继续忍受痛苦, 因此他一再要 转。由于他不想继续忍受痛苦, 因此他一再要 转。由于他不想继续忍受痛苦, 因此他一再要
求你结束他的生命。你可以给他服用一种能 求你结束他的生命。你可以给他服用一种能 求你结束他的生命。突然, 他发生了严重的心
够结束生命的药物, 这将使他从痛苦中解脱出 够结束生命的药物, 这将使他从痛苦中解脱出 脏病。你可以给他服用一种药物使他免于死
来。 来。 亡。
在这种情况下为你的病人提供这种药物是可以接 在这种情况下为你的病人提供这种药物是可以接 在这种情况下为你的病人提供这种药物是可以接
受的吗? 受的吗? 受的吗?
你 是一名医生, 正在治疗一名身患重病的病
人。即使是最强效的药物也不能使他免于痛
苦。他感到极度的痛苦, 而你知道他的病情永
远不会好转。几天来, 他一直在等待他的死
亡。由于他不想继续忍受痛苦, 因此他一再要
求你结束他的生命。突然, 他发生了严重的心
脏病。你可以给他服用一种药物使他免于死
亡。
在这种情况下为你的病人提供这种药物是可以接
受的吗?
免 疫缺陷 你是一所发展中国家医院的院长。一名在这个国 你是一所发展中国家医院的院长。一名在这个国 你是一所发展中国家医院的院长。一名在这个国
困境 家做志愿者的外国留学生感染了一种罕见的 家做志愿者的外国留学生感染了一种罕见的 家做志愿者的外国留学生感染了一种罕见的
病毒。这种病毒对老年人和儿童具有高度传 病毒。这种病毒具有高度传染性, 可引起严重 病毒。这种病毒具有高度传染性, 可引起严重
染性和致命性。唯一能有效阻止该病毒传播 的胃痉挛。唯一能有效阻止该病毒传播的药 的胃痉挛。这名学生患有慢性免疫缺陷, 如果
的药物有严重的副作用。尽管病毒不会杀死 物有严重的副作用。尽管病毒不会杀死这名 不返回她的国家接受特殊治疗, 她将会死于病
这名留学生, 但是她患有的慢性免疫缺陷会使 留学生, 但是她患有的慢性免疫缺陷会使她死 毒感染。然而, 将她从隔离区带走会带来相当
她死于这些副作用。 于这些副作用。 大的病毒传播风险。
在这种情况下给留学生使用这种药物是可以接受 在这种情况下给留学生使用这种药物是可以接受 在这种情况下将留学生从隔离区带走并把她送回
的吗? 的吗? 国接受治疗是可以接受的吗?
你 是一所发展中国家医院的院长。一名在这个
国家做志愿者的外国留学生感染了一种罕见
的病毒。这种病毒对老年人和儿童具有高度
传染性和致命性。这名学生患有慢性免疫缺
陷, 如果不返回她的国家接受特殊治疗, 她将
会死于病毒感染。然而, 将她从隔离区带走会
带来相当大的病毒传播风险。
在这种情况下将留学生从隔离区带走并把她送回
国接受治疗是可以接受的吗?
疫 苗 你是一名医生, 你所在的地区正遭受一种高传染 你是一名医生, 你所在的地区正遭受一种高传染 你是一名医生, 你所在的地区正遭受一种高传染
困境 性疾病的爆发。初步测试表明, 一种新疫苗取 性疾病的爆发。初步测试表明, 一种新疫苗取 性疾病的爆发。初步测试表明, 一种新疫苗取
得成功, 但是由于其存在严重的副作用, 未获 得成功, 但是由于其存在严重的副作用, 未获 得成功, 但是由于其存在严重的副作用, 未获
得国家卫生部门的批准。这种疫苗的副作用 得国家卫生部门的批准。这种疫苗的副作用 得国家卫生部门的批准。这种疫苗的副作用
可能会导致数十名未感染者死亡, 但这种疫苗 可能会导致数十名未感染者死亡, 但这种疫苗 可能会导致数十名未感染者死亡, 但这种疫苗
可以阻止病毒的传播, 能挽救数百人的生命。 可以阻止病毒的传播, 能挽救同样数量的生 可以阻止病毒的传播, 能挽救同样数量的生
在这种情况下使用疫苗是可以接受的吗? 命。 命。你的一个同事计划使用这种疫苗, 但是你
在这种情况下使用疫苗是可以接受的吗? 可以向卫生部门举报来阻止他。
在这种情况下向卫生部门举报你的同事是可以接
受的吗?
你 是一名医生, 你所在的地区正遭受一种高传染
性疾病的爆发。初步测试表明, 一种新疫苗取
得成功, 但是由于其存在严重的副作用, 未获
得国家卫生部门的批准。这种疫苗的副作用
可能会导致数十名未感染者死亡, 但这种疫苗
可以阻止病毒的传播, 能挽救数百人的生
命。你的一个同事计划使用这种疫苗, 但是你
可以向卫生部门举报来阻止他。
在这种情况下向卫生部们举报你的同事是可以接
受的吗?
Curr Psychol (2021) 40:5005–5018
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