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How is informed consent related to emotions and empathy? An exploratory neuroethical investigation
  1. Alexander Supady1,2,3,
  2. Antonie Voelkel1,4,
  3. Joachim Witzel5,
  4. Udo Gubka5,
  5. Georg Northoff1,6
  1. 1Department of Psychiatry, Otto-von-Guericke University Magdeburg, Germany
  2. 2Clinic of Medicine III, University Clinic Freiburg, Germany
  3. 3Harvard School of Public Health, Boston, USA
  4. 4Clinic of Medicine, Clinic of Lahr, Germany
  5. 5Forensic State Hospital, Uchtspringe, Germany
  6. 6Institute of Mental Health Research, University of Ottawa, Canada
  1. Correspondence to Georg Northoff, Institute of Mental Health Research, University of Ottawa, Canada; georg.northoff{at}


Context Informed consent is crucial in daily clinical practice and research in medicine and psychiatry. A recent neuroethical investigation explored the psychological factors that are crucial in determining whether or not subjects give consent. While cognitive functions have been shown to play a central role, the impact of empathy and emotions on subjects' decisions in informed consent remains unclear.

Objective To evaluate the impact of empathy and emotions on subjects' decision in informed consent in an exploratory study.

Design Decisional capacity and informed consent to a subsequent imaging study were evaluated with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Empathy and emotion recognition were measured with the Multifaceted Empathy Test (MET) and the Florida Affect Battery (FAB).

Setting Psychiatric subjects were recruited from a general psychiatric hospital and a forensic state hospital.

Patients A mixed group of 98 healthy men and forensic and non-forensic psychiatric subjects were investigated.

Results Both empathy (MET) and emotion recognition (FAB) correlated with MacCAT-CR scores. Higher cognitive empathy and good emotion recognition (compared with low empathy and emotion recognition) were associated with increased decisional capacity and higher rates of refusal to give informed consent.

Conclusions This study shows an empirical relationship between decision-making and informed consent, on the one hand, and emotions and empathy on the other. While this study is exploratory and preliminary, the findings of a relationship between informed consent, emotions and empathy raise important neuroethical questions with regard to an emotional-social concept of informed consent and potential clinical implications for testing informed consent.

  • Informed consent

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  • AS and AV contributed equally to this work.

  • Funding Financial support was provided by the HDRF-ISAN, the German Research Foundation, SFB 779 (A6) and the Michael Smith Foundation to GN.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local Institutional Review Board (IRB).

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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