Moral decision making and moral judgment in multiple sclerosis

Objective: Moral cognition has been insufficiently studied in people with multiple sclerosis (pwMS). This study investigated moral decision making and judgment using ecologically valid moral dilemmas in relapsing-remitting multiple sclerosis (MS) and progressive MS phenotypes, exploring associations with clinical and psychological variables. Method: Twenty-one individuals with relapsing-remitting MS and 21 with progressive MS completed a battery of moral dilemmas (instrumental, incidental, and ecological) and questionnaires assessing quality of life, mood, alexithymia, and empathy. Data from pwMS were compared to those of 56 age- and education-matched healthy controls. Group differences were analyzed using Mann-Whitney U tests, and effect sizes (r) were reported. Results: Compared to healthy controls, pwMS showed significantly higher moral acceptability in instrumental (U = 633.0, p = .001, r = 0.39), incidental (U = 745.5, p = .035, r = 0.23), and ecological dilemmas (U = 563.0, p < .001, r = 0.44). Moral permissiveness was positively correlated with disability (Expanded Disability Status Scale: rho = 0.36, p = .019) and negatively with physical quality of life (Multiple Sclerosis Quality of Life-Physical: rho = -0.33, p = .034) and inhibitory control (Stroop Test: rho = 0.47, p = .002). Empathy scores were inversely correlated with moral acceptability across all dilemmas (p < .05). Conclusions: PwMS exhibit increased moral permissiveness, particularly in relation to clinical disability, physical functioning, and executive control. These findings contribute to characterizing the sociocognitive profile of MS and support the inclusion of moral cognition in future research, though implications for patient care remain preliminary.