Neuroethics

I would like to thank Sullivan-Bissett and Noordhof for their stimulating comments on my 2023 paper in Neuroethics. In this reply, I will (1) articulate some deeper disagreements that may underpin our disagreement on the nature of delusion, (2) clarify their misrepresentation of my arguments as a defence of the two-factor theory in particular, and (3) finally conduct a comparison between the Maherian one-factor theory and the two-factor theory, showing that the two-factor theory is better supported by evidence.

In this paper, I examine the connections between bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state.

Psychedelic experiences are often compared to “transformative experiences” due to their potential to change how people think and behave. This study empirically examines whether psychedelic experiences constitute transformative experiences. Given psychedelics’ prospective applications as treatments for mental health disorders, this study also explores neuroethical issues raised by the possibility of biomedically directed transformation—namely, consent and moral psychopharmacology. To achieve these aims, we used both inductive and deductive coding techniques to analyze transcripts from interviews with 26 participants in psychedelic retreats. Results (...) indicate that psychedelic experiences can constitute transformative experiences. Twenty participants reported experiences or insights that were seemingly inaccessible or impossible to attain if not for the psychoactive effects of psychedelics. All participants besides one reported some change in identity, values, beliefs, desires, and behavior—changes in behavior being the most common. Participants also reported feeling capable deciding to use psychedelics in part due to information seeking prior to their retreats. Finally, several participants reported an enhanced capacity for enacting changes in their lives. Our results underscore both the importance of subjective embodiment to transformation and the role of transformative agency in shaping outcomes of the psychedelic experience. We examine our results relative to neuroethical issues and advocate for centering the person in psychedelic research and neuroethical inquiry about psychedelics to avoid pitfalls associated with psychedelics’ potential as moral psychopharmacological agents. (shrink)

We thank all the thoughtful authors for their insightful comments. In this response, we try to address some of themes that emerged from the commentaries. We leave aside some of those comments that...

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

This article investigates the challenges posed by the reliability of knowledge in neurophenomenology and its connection to reality. Neurophenomenological research seeks to understand the intricate relationship between human consciousness, cognition, and the underlying neural processes. However, the subjective nature of conscious experiences presents unique epistemic challenges in determining the reliability of the knowledge generated in this research. Personal factors such as beliefs, emotions, and cultural backgrounds influence subjective experiences, which vary from individual to individual. On the other hand, scientific knowledge (...) aims to uncover universal truths based on empirical observations and objective principles. Reconciling the subjective and objective realms presents a significant challenge in determining the reliability of knowledge generated through neurophenomenological research. This article aims to examine the inherent limitations and challenges of neurophenomenological research to shed light on the complexities involved in understanding the nature of knowledge itself. This article highlights that the ontological implications of the reliability of knowledge in neurophenomenology arise from the question of how subjective experiences relate to objective reality. Understanding the neural correlates and mechanisms behind subjective experiences can provide insight into the underlying ontological nature of consciousness. (shrink)

This chapter reviews fundamental ethical controversy surrounding the ongoing effort to revise the Uniform Determination of Death Act in the United States. Instead of focusing on the process of the revision itself, the chapter explores the underlying ethical debate over brain death that has been ongoing for many decades and finally culminated in this revision. Three issues are focused: the requirement for consent and personal exemptions before applying brain death for the diagnosis of death; redefining the areas of the brain (...) that have ceased to function in the definition of brain death; and codifying the American Academy of Neurology as the authority to issue the standards of the diagnosis of brain death. The chapter concludes that allowing the personal choice of death determination gives a pragmatic compromise to the disputed definition and practice of diagnosing brain death. So long as all risks and imperfections of the diagnosis are accepted through the consenting process, there is nothing ethically objectionable to continuing the current practice of diagnosing brain death as a successful tool to facilitate heart-beating organ donation without violating the dead-donor rule. By contrast, precluding personal choice and imposing legal restrictions to consent and exemptions would further erode public trust. (shrink)

It is plausible that current generations owe something to future generations. One possibility is that we have a duty to not harm them. Another possibility is that we have a duty to protect them. In either case, however, to satisfy the duties to future generations from environmental or political degradation, we need to engage in widespread collective action. But, as we are, we have a limited ability to do so, in part because we lack the self-discipline necessary for successful collective (...) action. Given that having an obligation hinges on being able to satisfy it, the apparent duty to future generations is at odds with our apparent inability to satisfy it. Thus, we either need to rethink our duties to future generations or rethink the nature of our abilities. I argue in this chapter that we should rethink the nature of our abilities. Specifically, we should enhance our self-discipline, which is distinct from enhancements of motivation, judgment, or emotion. Even the most intelligent, motivated, and empathetic actor is likely to slip up, which encourages others to withdraw their cooperation. Without the necessary self-discipline to sustain our public cooperative behavior, collective action is likely to fail, leaving us with one alternative: to abandon our duties to future generations. (shrink)

Family members can provide crucial support to individuals participating in clinical trials. In research on the “newest frontier” of Deep Brain Stimulation (DBS)—the use of DBS for psychiatric conditions—family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their (...) family members as interview participants. Using dyadic thematic analysis—an approach that takes both the individuals and the relationship as units of analyses—this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. (shrink)

How many factors, i.e. departures from normality, are necessary to explain a delusion? Maher’s classic one-factor theory argues that the only factor is the patient’s anomalous experience, and a delusion arises as a normal explanation of this experience. The more recent two-factor theory, on the other hand, contends that a second factor is also needed, with reasoning abnormality being a potential candidate, and a delusion arises as an abnormal explanation of the anomalous experience. In the past few years, although there (...) has been an increasing number of scholars offering a variety of arguments in defence of Maher’s one-factor theory, these arguments have not been adequately addressed by two-factor theorists. This paper aims to address this gap by critically examining the arguments on three crucial issues: the intelligibility of delusions, the dissociation between anomalous experiences and delusions, and the empirical evidence of a second factor. I will argue that the Maherian notion of anomalous experience is not sufficient for explaining delusions and the two-factor theory is on the right track in its search for the missing factor in the aetiology of delusions. (shrink)

Is it wrong to distract? Is it wrong to direct others’ attention in ways they otherwise would not choose? If so, what are the grounds of this wrong – and, in expounding them, do we have to at once condemn large chunks of contemporary digital commerce (also known as the attention economy)? In what follows, I attempt to cast light on these questions. Specifically, I argue – following the pioneering work of Jasper Tran and Anuj Puri – that there is (...) a right to attention, and that its existence underlies some of our claims regarding the wrongness of distractions. However, I depart from both these authors in two respects: first, I present a new way of deriving the right to attention, grounding it in the more fundamental right to mental integrity. Second, I remain agnostic on whether the contemporary business practices of capturing attention in exchange for a variety of digital products and services are plagued by routine violations of the right. (shrink)

Laura Specker Sullivan (2022) makes a fairly compelling case for the value of the perspectives of Buddhist practitioners in neuroethics. In this study, Tibetan Buddhist monks have been asked, among other things, whether consciousness, in brain-injured patients in a minimally conscious state, entails a duty to preserve life. In our view, some of the participants’ responses could be used to inform the bioethical debate on death determination.

The collapse of society is inevitable, even if it is in the distant future. When it collapses, it is likely to do so within the lifetimes of some people. These people will have matured in pre-collapse society, experience collapse, and then live the remainder of their lives in the post-collapse world. I argue that this group of people—the transitional generation—will be the worst off from societal collapse, far worse than subsequent generations. As the transitional generation, they will suffer disparately. This (...) intergenerational disparity in suffering is inequitable. Given that other disparities in suffering are worthy of remediation, this intergenerational disparity in suffering is worthy of remediation. However, the only way to do so is to target the mental states of the members of the transitional generation. (shrink)

As neuroscience progresses, we will not only gain a better understanding of how our brains work, but also a better understanding of how to modify them, and as a result, our mental states. An important question we are faced with is whether the state could be justified in implementing such methods on criminal offenders, without their consent, for the purposes of rehabilitation and reduction of recidivism; a practice that is already legal in some jurisdictions. By focusing on a prominent type (...) of view of free action, which I call bypassing views, this paper evaluates how such interventions may negatively impact the freedom of their subjects. The paper concludes that there will be a tension between the goals of rehabilitation and reduction of recidivism, on the one hand, and the negative impact such interventions may have on free action, on the other. Other things equal, the better that a particular intervention is at achieving the former, the more likely it is to result in the latter. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty (...) in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

This article makes the case that our digital devices create illusions of agency. There are times when users feel as if they are in control when in fact they are merely responding to stimuli on the screen in predictable ways. After the introduction, the second section of the article offers examples of illusions of agency that do not involve human–computer interaction in order to show that such illusions are possible and not terribly uncommon. The third and fourth sections of the (...) article cover relevant work from empirical psychology, including the cues that are known to generate the sense of agency. The fifth section of the article shows that our devices are designed to deliver precisely those cues. In the sixth section, the argument is completed with evidence that users frequently use their smartphones without the sort of intentional supervision involved in genuine agency. This sixth section includes the introduction of Digital Environmental Dependency Syndrome (DEDS) as a possible way of characterizing extended use of the smartphone without genuine agency. In the final section of the article, there is a discussion of questions raised by the main claim, including suggestions for reducing occurrences of illusions of agency through software design. (shrink)

On the moral model of addiction, addicts are morally responsible and blameworthy for their addictive behaviours. The model is sometimes resisted on the grounds that blaming addicts is incompatible with treating addiction in a compassionate and non-punitive way. I argue the moral model is consistent with addressing addiction compassionately and non-punitively and better accounts for both the role of addicts’ agency in the recovery process. If an addict is responsible for their addictive behaviours, and that behaviour is in some way (...) bad or wrong, then that addict is blameworthy. If not, then they are not. But, if their addictive behaviour or behaviour which contributes to and perpetuates their condition of addiction, is not bad or wrong, then addiction is not an issue of moral concern. Addicts are blameworthy, but attributions of blame need not be followed by harsh treatment or punishment. Because blame and harsh treatment or punishment can be separated, there is no good reason to reject the moral model of addiction. (shrink)

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients are situated. A second (...) goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

This paper engages in what might be called anticipatory virtue epistemology, as it anticipates some virtue epistemological risks related to a near-future version of brain-computer interface technology that Michael Lynch (2014) calls 'neuromedia.' I analyze how neuromedia is poised to negatively affect the intellectual character of agents, focusing specifically on the virtue of intellectual perseverance, which involves a disposition to mentally persist in the face of challenges towards the realization of one’s intellectual goals. First, I present and motivate what I (...) call ‘the cognitive offloading argument’, which holds that excessive cognitive offloading of the sort incentivized by a device like neuromedia threatens to undermine intellectual virtue development from the standpoint of the theory of virtue responsibilism. Then, I examine the cognitive offloading argument as it applies to the virtue of intellectual perseverance, arguing that neuromedia may increase cognitive efficiency at the cost of intellectual perseverance. If used in an epistemically responsible manner, however, cognitive offloading devices may not undermine intellectual perseverance but instead allow us to persevere with respect to intellectual goals that we find more valuable by freeing us from different kinds of menial intellectual labor. (shrink)

When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes (...) part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

Many theorists have defended the claim that collective entities can attain genuine agential status. If collectives can be agents, this opens up a further question: can they be conscious? That is, is there something that it is like to be them? Eric Schwitzgebel argues that yes, collective entities, may well be significantly conscious. Others, including Kammerer, Tononi and Koch, and List reject the claim. List does so on the basis of Tononi’s Integrated Information Theory of consciousness. I argue here that (...) List’s rejection is too quick, and that groups can, at least in principle, display the kind of informational integration we might think is necessary for consciousness. However, group consciousness will likely differ substantially from the individual experiences that give rise to it. This requires the defender of group consciousness to face up to a similar combination problem as the panpsychist. (shrink)

The enhancement of athletic performance using procedures that increase physical ability, such as anabolic steroids, is a familiar phenomenon. Yet recent years have also witnessed the rise of direct interventions into the brain, referred to as “neuro-doping”, that promise to also enhance sports performance. This paper discusses one potential objection to neuro-doping, based on the contribution to athletic achievement, particularly within endurance sports, of effortfully overcoming inner challenges. After introducing the practice of neuro-doping, and the controversies surrounding it, I describe (...) two major mechanisms some have proposed to explain how it might produce its putative performance-enhancing effects. I then clarify the notion of effort, and its relationship to neuro-doping. I also briefly address common concerns about access and safety. My central argument invokes considerations of effort to maintain that we have at least a significant reason for prohibiting the use of neuro-doping in officially regulated endurance competitions – though only conditional upon a specific set of empirical assumptions. I consider three possible objections: that neuro-doping is no different from widely accepted enhancement methods, that it can make athletic competition fairer, and that a broader range of factors can compensate for a reduced scope for effort than I recognize. I ultimately conclude that these objections do not refute the argument from effort, while stressing nonetheless that this argument applies more clearly to hypothetical improved forms of neuro-doping than to existing ones, and is not meant to offer a final overall verdict on how neuro-doping should be regulated. (shrink)

What can neuroscience tell us, if anything, about the capacities of cows to think about the future? The question is important if having the right to a future requires the ability to think about one’s future. To think about one’s future involves the mental state of prospection, in which we direct our attention to things yet to come. I distinguish several kinds of prospection, identify the behavioral markers of future thinking, and survey what is known about the neuroanatomy of future-directed (...) bovine beliefs and desires. I suggest, in conclusion, that instead of asking whether a cow’s prospection is conscious, ask whether it is like ours—with “ours” understood to include all human beings. (shrink)

This paper draws on work in the sciences of the mind to cast doubt on some assumptions that have often been made in the study of self-control. Contra a long, Aristotelian tradition, recent evidence suggests that highly self-controlled individuals do not have a trait very similar to continence: they experience relatively few desires that conflict with their evaluative judgments and are not especially good at directly and effortfully inhibiting such desires. Similarly, several recent studies have failed to support the view (...) that self-control capacities are constituted, at least in part, by excellent inhibitory executive function ability. I propose an alternative “indirect harmony” hypothesis about trait self-control. According to this hypothesis, if there is a character trait of being highly self-controlled, it consists in motivational harmony within the mind that is brought about through the effective use of indirect resistance strategies that prevent occurrent motivational conflict from emerging in the first place. If this hypothesis is correct, high trait self-control in actual humans does not fit neatly into the traditional categories of either continence or temperance. I conclude by drawing out several implications this hypothesis has for future research on trait self-control and its relation to executive functions. (shrink)

The decline in autobiographical memory function in people with Alzheimer’s dementia has been argued to cause a loss of self-identity. Prior research suggests that people perceive changes in moral traits and loss of memories with a “social-moral core” as most impactful to the maintenance of identity. However, such research has so far asked people to rate from a third-person perspective, considering the extent to which hypothetical others maintain their identity in the face of various impairments. In the current study, we (...) examined the impact of perspective, comparing first- and third-person perspectives, as well as memory type. This online study asked 201 participants to consider hypothetical scenarios in which either themselves or another person experienced different types of memory failures associated with a diagnosis of AD. For each scenario, participants rated the degree to which the depicted individual remained the same person, and how impactful the impairment was. Social semantic memory failures – involving failures to recognise a loved one – were rated as most detrimental to self-continuity, and procedural memory failures the least. Averaged across all memory types, people considered their own and their partner’s self-continuity to be more resilient to memory failures than that of a parent or stranger. However, this pattern was reversed for some memory types: forgetting semantic or episodic information about close relationships was rated as more detrimental from a first-person than third-person perspective. Our findings suggest that perspective and type of memory impairment interact to impact judgements about the extent to which people maintain their identity when they experience dementia, and highlight the importance of social relationships to maintaining a sense of self. (shrink)

I draw on neurobiological evidence to defend the rationalist thesis that moral judgments are essentially dependent on reasoning, not emotions (conceived as distinct from inference). The neuroscience reveals that moral cognition arises from domain-general capacities in the brain for inferring, in particular, the consequences of an agent’s action, the agent’s intent, and the rules or norms relevant to the context. Although these capacities entangle inference and affect, blurring the reason/emotion dichotomy doesn’t preferentially support sentimentalism. The argument requires careful consideration of (...) the empirical evidence (from neuroimaging to psychopathology) and philosophical analysis of the commitments of rationalism versus sentimentalism in ethics. (shrink)

The profound changes in personality, mood, and other features of the self that neural interventions can induce can be disconcerting to patients, their families, and caregivers. In the neuroethical debate, these concerns are often addressed in the context of possible threats to the narrative self. In this paper, I argue that it is necessary to consider a dimension of impacts on the narrative self which has so far been neglected: neural interventions can lead to a loss of meaning of actions, (...) feelings, beliefs, and other intentional elements of our self-narratives. To uphold the coherence of the self-narrative, the changes induced by neural interventions need to be accounted for through explanations in intentional or biochemical terms. However, only an explanation including intentional states delivers the content to directly ascribe personal meaning, i.e., subjective value to events. Neural interventions can deprive events of meaning because they may favor a predominantly biochemical account. A loss of meaning is not inherently negative but it can be problematic, particularly if events are affected one was not prepared or willing to have stripped of meaning. The paper further examines what it is about neural interventions that impacts meaning by analyzing different methods. To which degree the pull towards a biochemical view occurs depends on the characteristics of the neural intervention. By comparing Deep Brain Stimulation, Prozac, Ritalin, psychedelics, and psychotherapy, the paper identifies some main factors: the rate of change, the transparency of the causal chain, the involvement of the patient, and the presence of an acute phenomenological experience. (shrink)

The aim of this paper is to relate the critical core of Jesus Conill’s last book, Bodily Intimacy and the Human Person. From Nietzsche to Ortega and Zubiri, with the problem of nihilism, as a structure that survives in our contemporary societies, especially in the context of neurosciences, technology and our way of relating to both. After outlining the key insights of the book, especially its innovative conception of bodily intimacy, I will retrieve some contributions from Nietzsche’s notes regarding nihilism, (...) to show that after the “death of God”, other instances take his place, the logics of nihilism remain intact and underly the majority approach of neurosciences. I will conclude that the elements presented by Conill for a strong intimacy and subjectivity will be necessary for the task, still pending, of overcoming nihilism. (shrink)

When talking about personal identity in the context of medical ethics, ethicists tend to borrow haphazardly from different philosophical notions of personal identity, or to abjure these abstract metaphysical concerns as having nothing to do with practical questions in medical ethics. In fact, however, part of the moral authority for respecting a patient’s self-regarding decisions can only be made sense of if we make certain assumptions that are central to a particular, psychological picture of personal identity, namely, that patients will (...) remain psychologically connected to a certain degree with their future selves. I draw this out, show problems with approaches in medical ethics based on alternate theories of personal identity that do not recognise this, and explore some important implications. Namely, I show how this recognition can better explain the circumstances under which we should respect advance directives and why, and how it can better make sense of patient fears that they will not "survive" personality-altering deep brain stimulation procedures, and provide guidance on approaching patient decisions concerning this type of procedure in a manner that captures and addresses such concerns. (shrink)

The idea that humans should abandon their individuality and use technology to bind themselves together into hivemind societies seems both farfetched and frightening – something that is redolent of the worst dystopias from science fiction. In this article, we argue that these common reactions to the ideal of a hivemind society are mistaken. The idea that humans could form hiveminds is sufficiently plausible for its axiological consequences to be taken seriously. Furthermore, far from being a dystopian nightmare, the hivemind society (...) could be desirable and could enable a form of sentient flourishing. Consequently, we should not be so quick to deny it. We provide two arguments in support of this claim – the axiological openness argument and the desirability argument – and then defend it against three major objections. (shrink)

Conducting research on animals is supposed to be valuable because it provides information on how human mechanisms work. But for the use of animal models to be ethically justified, it must be epistemically justified. The inference from an observation about an animal model to a conclusion about humans must be warranted for the use of animals to be moral. When researchers infer from animals to humans, it’s an extrapolation. Often non-human primates are used as animal models in laboratory behavioral research. (...) The target populations are humans and other non-human primates. I argue that the epistemology of extrapolation renders the use of non-human primates in laboratory behavioral research unreliable. If the model is relevantly similar to the target, then the experimental conditions introduce confounding variables. If the model is not relevantly similar to the target, then the observations of the model cannot be extrapolated to the target. Since using non-human primates in as animal models in laboratory behavioral research is not epistemically justified, using them as animal models in laboratory behavioral research is not ethically justified. (shrink)

This chapter addresses the claim that, as new types of neurointervention get developed allowing us to enhance various aspects of our mental functioning, we should work to prevent the use of such interventions from ever becoming the “new normal,” that is, a practice expected—even if not directly required—by employers. The author’s response to that claim is that, unlike compulsion or most cases of direct coercion, indirect coercion to use such neurointerventions is, per se, no more problematic than the pressure people (...) all find themselves under to use modern technological devices like computers or mobile phones. Few people seem to believe that special protections should be introduced to protect contemporary Neo-Luddites from such pressures. That being said, the author acknowledges that separate factors, when present, can indeed render indirect coercion to enhance problematic. The factors in question include lack of safety, fostering adaptation to oppressive circumstances, and having negative side effects that go beyond health. Nonetheless, the chapter stresses that these factors do not seem to be necessary correlates of neuroenhancement. (shrink)

Within the United States, the most prominent justification for criminal punishment is retributivism. This retributivist justification for punishment maintains that punishment of a wrongdoer is justified for the reason that she deserves something bad to happen to her just because she has knowingly done wrong—this could include pain, deprivation, or death. For the retributivist, it is the basic desert attached to the criminal’s immoral action alone that provides the justification for punishment. This means that the retributivist position is not reducible (...) to consequentialist considerations nor in justifying punishment does it appeal to wider goods such as the safety of society or the moral improvement of those being punished. A number of sentencing guidelines in the U.S. have adopted desert as their distributive principle, and it is increasingly given deference in the “purposes” section of state criminal codes, where it can be the guiding principle in the interpretation and application of the code’s provisions. Indeed, the American Law Institute recently revised the Model Penal Code so as to set desert as the official dominate principle for sentencing. And courts have identified desert as the guiding principle in a variety of contexts, as with the Supreme Court’s enthroning retributivism as the “primary justification for the death penalty.” While retributivism provides one of the main sources of justification for punishment within the criminal justice system, there are good philosophical and practical reasons for rejecting it. One such reason is that it is unclear that agents truly deserve to suffer for the wrongs they have done in the sense required by retributivism. In the first section, I explore the retributivist justification of punishment and explain why it is inconsistent with free will skepticism. In the second section, I then argue that even if one is not convinced by the arguments for free will skepticism, there remains a strong epistemic argument against causing harm on retributivist grounds that undermines both libertarian and compatibilist attempts to justify it. I maintain that this argument provides sufficient reason for rejecting the retributive justification of criminal punishment. I conclude in the third section by briefly sketching my public health-quarantine model, a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. I argue that the model is not only consistent with free will skepticism and the epistemic argument against retributivism, it also provides the most justified, humane, and effective way of dealing with criminal behavior. (shrink)

Within the United States, the most prominent justification for criminal punishment is retributivism. This retributivist justification for punishment maintains that punishment of a wrongdoer is justified for the reason that she deserves something bad to happen to her just because she has knowingly done wrong—this could include pain, deprivation, or death. For the retributivist, it is the basic desert attached to the criminal’s immoral action alone that provides the justification for punishment. This means that the retributivist position is not reducible (...) to consequentialist considerations nor in justifying punishment does it appeal to wider goods such as the safety of society or the moral improvement of those being punished. A number of sentencing guidelines in the U.S. have adopted desert as their distributive principle, and it is increasingly given deference in the “purposes” section of state criminal codes, where it can be the guiding principle in the interpretation and application of the code’s provisions. Indeed, the American Law Institute recently revised the Model Penal Code so as to set desert as the official dominate principle for sentencing. And courts have identified desert as the guiding principle in a variety of contexts, as with the Supreme Court’s enthroning retributivism as the “primary justification for the death penalty.” While retributivism provides one of the main sources of justification for punishment within the criminal justice system, there are good philosophical and practical reasons for rejecting it. One such reason is that it is unclear that agents truly deserve to suffer for the wrongs they have done in the sense required by retributivism. In the first section, I explore the retributivist justification of punishment and explain why it is inconsistent with free will skepticism. In the second section, I then argue that even if one is not convinced by the arguments for free will skepticism, there remains a strong epistemic argument against causing harm on retributivist grounds that undermines both libertarian and compatibilist attempts to justify it. I maintain that this argument provides sufficient reason for rejecting the retributive justification of criminal punishment. I conclude in the third section by briefly sketching my public health-quarantine model, a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. I argue that the model is not only consistent with free will skepticism and the epistemic argument against retributivism, it also provides the most justified, humane, and effective way of dealing with criminal behavior. (shrink)

One way to determine whether a mental condition should be considered a disorder is to first give necessary and sufficient conditions for something to be a disorder and then see if it meets these conditions. But this approach has been criticized for begging normative questions. Concerning autism (and other conditions), a neurodiversity movement has arisen with essentially two aims: (1) advocate for the rights and interests of individuals with autism, and (2) de-pathologize autism. We argue that denying autism’s disorder status (...) could undermine autism’s exculpatory role in cases where individuals with autism are charged with a crime. Our argument raises a dilemma for the neurodiversity movement: advocating for the rights and interests of individuals with autism may require viewing autism as a condition that can be inherently disabling (at least for some individuals). If this is right, autism’s disorder status might be maintained (again, at least for some individuals) without deriving this result from any general account of disorder. (shrink)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section 2, we consider (...) whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

What can neuroscience tell us, if anything, about the capacities of cows to think about the future? The question is important if having the right to a future requires the ability to think about one’s future. To think about one’s future involves the mental state of prospection, in which we direct our attention to things yet to come. I distinguish several kinds of prospection, identify the behavioral markers of future thinking, and survey what is known about the neuroanatomy of future-directed (...) bovine beliefs and desires. I suggest, in conclusion, that instead of asking whether a cow’s prospection is conscious, ask whether it is like ours—with “ours” understood to include all human beings. (shrink)

Recently, Joshua Greene has argued that we need a metamorality to solve moral problems for which evolution has not prepared us. The metamorality that he proposes is a utilitarian account that he calls deep pragmatism. Deep pragmatism is supposed to arbitrate when the values espoused by different groups clash. To date, no systematic appraisal of this argument for a metamorality exists. We reconstruct Greene’s case for deep pragmatism as a metamorality and consider three lines of objection to it. We argue (...) that, in the end, only one of these objections seriously threatens Greene’s position. Greene has to commit to the nonexistence of moral truth in order for his argument for the need of a metamorality to get off the ground. This, however, leads to a tension in his overall argument for deep pragmatism: ultimately, it casts his rejection of antiutilitarian moral intuitions into doubt. (shrink)

Public attitudes concerning cognitive enhancements are significant for a number of reasons. They tell us about how socially acceptable these emerging technologies are considered to be, but they also provide a window into the ethical reasons that are likely to get traction in the ongoing debates about them. We thus see Conrad et al’s project of empirically investigating the effect of metaphors and context in shaping attitudes about cognitive enhancements as both interesting and important. We sketch what we suspect is (...) a central theme that runs through these public attitudes, but that Conrad el al’s paper elides. We were disappointed that they did not more directly explore the efficacy of frames and metaphors associated with the values of authenticity and self-expression. This seems like a missed opportunity. Based on the premise that individualistic values enjoy centrality in Western and especially North American culture (e.g. Taylor 1989), we hypothesize that metaphors and frames informed by those values will be especially effective in shaping public attitudes. That is, when various kinds of novel enhancement are described as allowing people to more fully express themselves, or as helping people overcome obstacles to being authentic and true to their inner sense of themselves, those enhancements will be considered justified, and their use more likely to be viewed as socially acceptable by the public. We support our contention by drawing on work by Elliott (2004, 2011, c.f. Kadlac 2018), and discuss how this study, and others modeled on it, might shed light on our hypothesis. (shrink)

A prominent objection to non-cognitive moral bio-enhancements is that they would compromise the recipient’s ‘freedom to fall’. I begin by discussing some ambiguities in this objection, before outlining an Aristotelian reading of it. I suggest that this reading may help to forestall Persson and Savulescu’s ‘God-Machine’ criticism; however, I suggest that the objection still faces the problem of explaining why the value of moral conformity is insufficient to outweigh the value of the freedom to fall itself. I also question whether (...) the objection is compatible with Neil Levy’s parity principle. Accordingly, I go on to consider an alternative relational freedom-based objection to NCMBEs that aims to explain the fundamental moral importance of the freedom that NCMBEs would violate. I argue that although this strategy might allow the critic of NCMBEs to bypass a powerful criticism of Harris’ objection, it also weakens the freedom-based objection’s compatibility with the parity principle. (shrink)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

The established two tracks of neuroenhancement, moral and cognitive enhancements, rest on the characterization of commonsense morality as a set of static psychological dispositions. In this paper, I challenge this way of describing commonsense morality. I draw a parallel between commonsense psychology and commonsense morality, and I propose that the right way to characterize commonsense morality is as an empirically evaluable theory, with a structure similar to a scientific theory. I argue further that psychological dispositions to react in certain ways (...) require the tacit endorsement of a commonsense moral theory. By adopting this view, I argue that the way to change our psychological dispositions is by changing the background theory that produces them. I conclude that when commonsense morality is construed as an empirically evaluable theory, the cleft between the abilities that support scientific progress and the abilities that promote moral progress closes and it becomes evident that the way to promote both types of advancements is through cognitive enhancement. (shrink)

According to what Douglas calls ‘the consent requirement’, neuro-correctives can only permissibly be provided with the valid consent of the offender who will undergo the intervention. Some of those who endorse the consent requirement have claimed that even though the requirement prohibits the imposition of mandatory neurocorrectives on criminal offenders, it may yet be permissible to offer offenders the opportunity to consent to undergoing such an intervention, in return for a reduction to their penal sentence. I call this the neurocorrective (...) offer. In this chapter I consider the coercion-based objection to the neurocorrective offer, which claims that offenders cannot provide valid consent to undergoing a neurocorrective on the basis of this offer because it is inherently coercive. Having outlined early formulations of this argument, I point out that there are in fact two different versions of this objection, which appeal to different understandings of the concepts of coercion, consent and voluntariness. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the characterization of placebo analgesia (...) as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)