Running title: Prefrontal damage impairs judgment of intent Damage to ventromedial prefrontal cortex impairs judgment of harmful intent

events (Bechara et al., 1997; Damasio et al., 1990), we predicted that patients with VMPC damage would fail to perceive the emotional significance of harmful intentions (e.g., unobservable mental states), and therefore deliver abnormal moral judgments in the case that judgments depend on emotional responses to such abstract representational content. We predicted that, as a direct result, VMPC patients would instead judge actions primarily on the basis of the actions’ outcomes, which are represented concretely in the world. In particular, we predicted patients with VMPC damage would judge attempted harms as more morally permissible than control participants, and, consequently, use the neutral outcome as the relevant moral metric. Notably, moral judgment of accidental harms (neutral intent, negative outcome) also requires the processing of an unobservable mental state; however, in this case, the mental state is a neutral intent, which does not necessarily elicit an emotional response that is critical for moral judgment. We therefore predicted that VMPC patients would show a selective deficit only when moral judgment requires an emotional response to mental state content. In other words, we predicted a deficit for attempted harms, and not accidental harms. This pattern of results would 8 indicate that in the absence of a normally functioning VMPC, and normal emotional responses subserved by the VMPC that are typically associated with perceiving harmful intentions, individuals will deliver abnormal moral judgments. Results A 2 (intent: neutral vs. negative) x 2 (outcome: neutral vs. negative) x 3 (group: VMPC vs. BDC vs. NC) mixed effects ANOVA of participants’ moral judgments yielded main effects of intent (F(1,21)=136.0 p=1.2x10), outcome (F(1,21)=94.4 p=3.2x10), and an interaction between intent and outcome (F(1,21)=7.0 p=0.015) (Figure 3). Importantly, these effects were observed in the context of interaction effects involving the participant group variable, specifically, a two-way interaction between intent and participant group (F(1,21)=9.7 p=0.001) and a three-way interaction between intent, outcome, and participant group (F(1,21)=3.9 p=0.036). There were no statistically significant interaction effects involving the participant group variable for reaction time (intent x participant group, F(1,21)=1.4 p=0.27; belief x outcome by participant group, F(1,21)=0.50 p=0.61; see also Supplemental Analyses). To interpret these interaction effects, planned comparisons were conducted, yielding significant differences between participant groups only for attempted harms. VMPC participants judged attempted harms as more permissible than BDC participants (t(14)=4.0, p=0.001) and NC participants (t(15)=4.6, p=3.3x10). There was no difference between BDC and NC participants in their moral judgments of attempted harms (t(13)=0.73, p=0.48) or any other condition. Moreover, there were no other significant differences for any pair of participant groups (VMPC, BDC, NC) on any of the other conditions: non-harm, accidental harm, or successful attempt to harm. Importantly, there were no differences between VMPC participants and either comparison 9 group on non-harms (BDC: t(14)=-0.40, p=0.70; NC: t(15)=-0.21, p=0.84), accidental harms (BDC: t(14)=-0.16, p=0.89; NC: t(15)=-0.71, p=0.49), or successful attempts to harm (BDC: t(14)=0.94, p=0.37; NC: t(15)=1.6, p=0.13). VMPC participants’ judgments did reflect a difference between attempted harms and non-harms (t(8)=2.97, p=0.018), and a difference between accidental harms and successful attempts to harm (t(8)=6.2, p=2.5x10). Thus, VMPC participants were able to distinguish between these conditions by representing the content of negative beliefs and intentions. The difference between attempted harms and non-harms also emerged in the NC group (t(6)=7.3, p=3.5x10) and the BDC group (t(7)=12.7, p=4.5x10), as did the difference between accidental harms and successful attempts to harm (NC: t(6)=2.7, p=0.038, BDC: (t(7)=4.9, p=0.002). Notably, VMPC participants also judged attempted harms as significantly more permissible than accidental harms (t(8)=3.7, p=0.006), a pattern that was significantly different from the pattern observed in the BDC participant group (F(1,14)=5.3 p=0.037) and the NC participant group (F(5,10)=12.0 p=0.003). Moral judgments of accidental and attempted harms in the BDC and NC groups reflected a difference in the opposite direction, though this difference did not reach significance (combined analysis for BDC and NC groups: t(14)=1.3, p=0.2). Strikingly, all nine VMPC participants showed the same reversal of judgments of attempted and accidental harms; this pattern was significantly different from the pattern of judgments in the BDC and NC participant groups (Kruskal-Wallis test, H=8.3, 2 d.f., p=0.016). Furthermore, this difference was significant for the comparison between both VMPC and BDC participants (MannWhitney U test, U=13.5, p=0.01), and between VMPC and NC participants (U=13.5, p=0.006).