This paper explores the differences between bringing about self-change by way of antidepressants versus psychotherapy from an ethical point of view, taking its starting point in the concept of authenticity. Given that the new antidepressants (SSRIs) are able not only to cure psychiatric disorders but also to bring about changes in the basic temperament structure of the person—changes in self-feeling—does it matter if one brings about such changes of the self by way of antidepressants or by way of psychotherapy? Are (...) antidepressants a less good alternative than psychotherapy because antidepressants are in some way less authentic than psychotherapy? And, if so, what does this mean exactly? In this paper I try to show that the self-change brought about by way of antidepressants challenges basic assumptions of authentic self-change that are deeply ingrained in our Western culture: that changes in self should be brought about by laborious ‘self-work’ in which one explores the deep layers of the self (the unconscious) and comes to realise who one really is and should become. To become oneself has been held to presuppose such a journey. While the assumed importance of self-work appears to be badly founded on closer inspection, the notions of exploring and knowing oneself appear to be more promising in fleshing out an ethical distinction between psychopharmacological and psychotherapeutic practice with the help of the concept of authenticity. Psychotherapy, to a much greater extent than psychopharmacological interventions, involves the whole profile of the self in its attempts to effect a change, not only in the temperament but also in the character of the person in question, and this is important from an ethical point of view. In the article, the concepts of self-change, authenticity, temperament and character are presented and used in order to understand and flesh out the relevant ethical differences between the practice of psychotherapy and the use of antidepressants. Looping, collective effects of psychopharmacological self-change in a cultural context are also considered in this context. (shrink)

Disability activists influenced by queer theory and advocates of “human enhancement” have each disputed the idea that what is “normal” is normatively significant, which currently plays a key role in the regulation of pre-implantation genetic diagnosis (PGD). Previously, I have argued that the only way to avoid the implication that parents have strong reasons to select children of one sex (most plausibly, female) over the other is to affirm the moral significance of sexually dimorphic human biological norms. After outlining the (...) logic that generates this conclusion, I investigate the extent to which it might also facilitate an alternative, progressive, opening up of the notion of the normal and of the criteria against which we should evaluate the relative merits of different forms of embodiment. This paper therefore investigates the implications of ideas derived from queer theory for the future of PGD and of PGD for the future of queerness. (shrink)

Recent years have seen the emergence of a new brand of moral philosopher. Straddling the gap between academia on the one hand, and the world of law, medicine, and politics on the other, bioethicists have appeared, offering advice on ethical issues to a wider public than the philosophy classroom. Some bioethicists, like Peter Singer, have achieved wide notoriety in the public realm with provocative arguments that challenge widely held beliefs about the relative moral status of animals, human foetuses and newborn (...) babies. Other bioethicists practice their trade with greater protection from public scrutiny, confining their thoughts to committees in government circles, universities, charitable institutions, or hospitals. But what exactly is it that bioethicists have to offer in such contexts? What sort of expertise do bioethicists have that justifies their employment on these committees, or the time and space accorded to their views on television and the radio, or in newspapers and magazines? In spite of being an expanding group of professionals who attract large sums of private and public funding, bioethicists are sometimes met with suspicion or even hostility, both inside and outside academia. One common criticism is that the presence of bioethicists is unproductive in practical bioethical debate. In light of this criticism one might wonder why the relevant funding bodies have not spotted the hoax and withdrawn their funding. Certainly, if bioethicists.. (shrink)

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical (...) medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology. (shrink)

This paper presents a functional genealogy of essentialist authenticity. The essentialist account maintains that authenticity is the result of discovering and realizing one’s ‘true self’. The genealogy shows that essentialist authenticity can serve the function of supporting continuity in one’s individual characteristics. A genealogy of essentialist authenticity is not only methodologically interesting as the first functional genealogy of a contingent concept. It can also deepen the functional understanding of authenticity used in neuroethics, provide a possible explanation for the prevalence of (...) the idea of an essentialist true self and justify the use of the ideal of authenticity. First, essentialist authenticity is defined and explained through the work of Jean-Jacques Rousseau. Second, a general need to have steady characteristics is derived from basic human practices. Third, circumstances that make it more challenging to steady oneself are identified and shown to have become more prevalent in the age of modernity when the ideal of authenticity emerged. Finally, it is shown how essentialist authenticity helps to steady the self. (shrink)

Many of us have experienced a peculiar feeling of freedom, of the world being open before us. This is the feeling that is captured by phrases like “the freedom of the open road” and “free spirits,” and, to quote Phillip Larkin, “free bloody birds” going “down the long slide / To happiness, endlessly.” This feeling is associated with the ideas that my life could go in many different directions and that there is a vast range of things that I could (...) become. It arises in concert with a wide range of human experiences, including experiences of artistic creation, play, fun, and resistance to authority. This freedom of openness and spontaneity, which I call spontaneous freedom, is central to our ordinary talk about freedom. Yet it is a phenomenon largely ignored in discussions of freedom in contemporary moral philosophy. This is because moral philosophers are primarily concerned to identify the sort of freedom that is a prerequisite for moral responsibility, and so focus on deliberate, voluntary action rooted in rational choice. When moral philosophers do discuss spontaneous freedom, it is often to disparage it as, in the words of Harry Frankfurt, the freedom of “the wanton” whose liberty is merely that of “anarchic impulsive behavior.” My dissertation develops a theory of spontaneous freedom and of the role it does and should play in our lives, including our moral and political lives. I argue that, to do full justice to the human aspiration for freedom, moral and political theory must recognize the value of spontaneity. Through a study of characters from stories and films by Virginia Woolf, Saki, Akira Kurosawa, and Aman Sethi, I develop a phenomenological account of the nature of spontaneous freedom. I argue that we experience spontaneous freedom when we experience our actions as arising out of ourselves but not fixed in advance either by the decisions of other agents or by our own preexisting commitments or plans. I further argue that spontaneous freedom is valuable because it allows for the distinctive pleasure of feeling that one’s life is unforetold and that one is among the sources of novelty in the world, a feeling that is central to artistic creativity. It also affords solace from the anxiety associated with the inevitability of death. As with many experiences, like falling in love or seeing an alpine lake, experiences of spontaneous freedom are most valuable when they are veridical. But even the subjective experience of spontaneous freedom, I suggest, activates our awareness of and openness to possibility. Achieving this awareness, at least on occasion, is valuable because it provides us with a sense of our own psychological potential and sharpens a skill that contributes to practical deliberation. My claim that spontaneous freedom is valuable conflicts with a popular account of the self. According to that account—endorsed by a number of moral philosophers but most famously associated with Christine Korsgaard—the ideal self is one that is well-ordered, actively constituted through rational deliberation. Such integrity theories of the self are attractive because they provide an account of agency according to which ideal moral agents invariably endorse their own actions and beliefs. Integrity theories view freedom as involving rational, deliberative control of one’s actions. But I argue that integrity theories forbid well-constituted moral agents to seek out experiences of spontaneous freedom: such agents must act in a manner that they antecedently and reflectively endorse, while spontaneous freedom requires acting in a manner not antecedently fixed by one’s own decisions. Insofar as spontaneous freedom is a kind of freedom that we do and should value, my account exerts pressure on this standard view of agency and the self. My account of spontaneous freedom also has important political implications. One version of liberal theory holds that the only sort of political freedom worth having is the freedom of each individual to effectively exercise choice compatibly with every other individual doing likewise. On this picture, I have all of the freedom that I could want if I am able to choose autonomously and act in accordance with my choices. But I argue that a community that secures this liberal variety of freedom does not yet provide its members with all the freedom for which people rightly yearn. When public and private institutions arrange our circumstances in ways that make the courses of our lives predictable, our own choices about how to act may be largely settled by the plans and decisions of other agents. This in turn makes it difficult for us to regard our futures as open in the way that is characteristic of experiences of spontaneous freedom. States should promote spontaneous freedom by providing the material and social preconditions for us to feel that our lives could head in radically different and unanticipated directions. (shrink)

Industry control over the production and distribution of pharmaceutical safety and efficacy data has become a serious public health and health care funding concern. Various recent scandals, several involving the use of flawed representations of scientific data in the most influential medical journals, highlight the urgency of enhancing pharmaceutical knowledge governance. This paper analyzes why this is a human rights concern and what difference a human rights analysis can make. The paper first identifies the challenges associated with the current knowledge (...) deficit. It then discusses, based on an analysis of case law, how various human rights associated interests can be invoked to support the claim that states have an obligation to actively contribute to independent knowledge governance, for example through ensuring clinical trials transparency. The paper further discusses a conceptual use of human rights, as a methodology which requires a comprehensive analysis of the different interwoven historical, economic, cultural, and social factors that contribute to the problem. Such an analysis reveals that historically grown drug regulations have, in fact, contributed directly to industry control over pharmaceutical knowledge production. This type of finding should inform needed reforms of drug regulation. The paper ends with a recommendation for a comprehensive global response to the problem of pharmaceutical knowledge governance. (shrink)

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. RCOPE is an instrument designed to categorize (...) religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control. (shrink)

No agreement exists among ethical theories on what cancount as a right moral motivation. This hampers us from knowingwhether an intervention in motivation biology can be considered positivefor human morality. To overcome this difficulty, this paper identifiesminimal requirements for moral enhancement that could be accepted bythe major moral theories. Subsequently four possible scenarios are presentedwhere the most promising neural interventions on moral motivationare implemented, by means of drugs, electromagnetic stimulation ofbrain, or biotechnological brain implants. The ultimate goal of this paperis (...) to evaluate the results of each one of these interventions according totheir capacity to fulfill the identified requirements. (shrink)

In Search of Immortality: The Political Economy of Anti-aging Medicine Content Type Journal Article Category Original Paper Pages 267-279 DOI 10.1007/s12376-009-0020-x Authors Alan Petersen, Monash University Sociology Program, School of Political and Social Inquiry Clayton VIC 3800 Australia Kate Seear, Monash University Sociology Program, School of Political and Social Inquiry Clayton VIC 3800 Australia Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 3.

If moral enhancement is possible, the caring capacity of human beings should be considered one of the first and most important traits for augmentation. To assess the plausibility of enhancing care, I will explore how the concept and its associated human dispositions are socially constructed, and identify some of the critical points and complexities. Scientific advances regarding neuro-enhancing substances that allegedly make humans more caring will be considered and assessed against the main principles that govern the ethics of care approach. (...) I argue that given the relational and contextual nature of care, its enhancement, if targeted at the individual level, can be more disadvantageous than helpful, by overlooking the “webs of care” people are situated in, and the role of social institutions in shaping behaviours, duties, attitudes, and principles. (shrink)

The importance of online social spaces is growing. New Web 2.0 resources allow the creation of social networks by any netizen with minimal technical skills. These communities can be extremely narrowly focussed. In this paper, I identify two potential costs of membership in narrowly focussed virtual communities. First, that narrowly focussed communities can polarise attitudes and prejudices leading to increased social cleavage and division. Second, that they can lead sick individuals to revel in their illness, deliberately indulging in their disease (...) and denying the edicts of the medical profession. I specifically examine illness communities centred on the now defunct Multiple Personality Disorder. I highlight these potential problems and point to some technologies that may help combat them. (shrink)

Leopards break into the temple and drink to the dregs what is in the sacrificial pitchers; this is repeated over and over again; finally it can be calculated in advance, and it becomes part of the ceremony.–Franz KaflaFor more than two decades, significant controversies have been brewing over the efficacy and safety of Selective Serotonin Reuptake Inhibitors and other treatments for depression, and also over the expansion of their use for the treatment of a variety of other conditions. These controversies (...) culminated, in June 2004, with alawsuit intended by Eliot Spitzer, Attorney General of the State of New York. The lawsuit accused pharmaceutical giant GlaxoSmith-Kline of “repeated and persistent fraud by misrepresentation, concealing and otherwise failing to disclose to physicians information in its control concerning the safety and effectiveness of its antidepressant medication paroxetine” in treating children and adolescents suffering from depression. (shrink)

This study is rooted in the research traditions of cultivation theory, construct accessibility, and availability heuristic. Based on a survey with 221 subjects, this study finds that familiarity with direct-to-consumer (DTC) print advertisements for antidepressant brands is associated with inflated perceptions of the prevalence and lifetime risk of depression. The study concludes that DTC advertising potentially has significant effects on perceptions of depression prevalence and risk. Interpersonal experiences with depression coupled with DTC advertising appear to significantly predict individuals’ perceived lifetime (...) risk of depression. The study ultimately demonstrates that DTC advertising may play a role in constructing social reality of diseases and medicine. The findings strongly suggest that the social cognitive effects of DTC advertising are far-reaching, impacting pharmaceutical marketing strategy as well as presenting issues regarding public health and the business ethics of advertising drugs to consumers. (shrink)

In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders — the diagnoses for which treatment with antidepressants is most commonly indicated — is also explored (...) by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society. (shrink)

The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)

The generic idea that the human should enhance seems uncontroversial. However, there is a great controversy about the meaning of enhance and the means that should be used. The possibilities of enhance humans through the use of biotechnology are a central theme of the current bioethical debate. Human Enhancement is the concept used to translate the idea that a biotransformation would generate a bioenhancement. In this article, we present a proposal for a factual-elementary framework of the generic concept of human (...) enhancement, in order to highlight the differences between a normative terminology and a descriptive terminology. Then, we contest the radical polarization that creates a harmful bias in the debate, arguing that what is at issue is a decision making based on non-universal value judgments. (shrink)

Book review of the book Inquiring into Human Enhancement: Interdisciplinary and International Perspectives (2015), edited by Simone Bateman, Sylvie Allouche, Jean Gayon, Michela Marzano and Jérôme Goffette. Closing the summary of the book's chapters, the reviewer asks: when imagining HE for the future, especially in utopian directions, might we not seek to increase human wisdom, for instance, rather than just human intellect? Why are human enhancement visions so often limited by egotistical, if well-intended, desires that might go horribly wrong, as (...) in the story of Dr. Jekyll and Mr. Hyde? (shrink)

This article presents a critical analysis of the views of Michael Sandel on human enhancement in his book The Case Against Perfection (2007). Sandel argues that the use of biotechnologies for human enhancement is driven by a will to mastery or hybris, leading to an ‘explosion of responsibility’ and a disappearance of solidarity. I argue that Sandel is using a traditional concept of solidarity which leaves little room for individual differences and which is difficult to reconcile with the modern trend (...) towards individual autonomy and cultural heterogeneity. With reference to the sociology of Giddens, I argue that the ‘explosion of responsibility’ can be considered an expression of the insecurity in modern society and the need for reflexivity in personal and social life. I argue that the need for reflexivity is a driving social and cultural force behind the interest in human enhancement, and that this trend can go together with a commitment to take care of the needs of others. I agree with Sandel that there is a risk that human enhancement may develop into ‘hybris’, particularly when enhancement is driven by scientism and a naturalist reduction of human values to neurological processes. Enhancement based on scientism will threaten solidarity defined by Honneth as an interactive relationship aimed at the mutual recognition of individual identities in relation to a shared value horizon. I will call for a reflective approach in which human enhancement technologies are explored in the context of a ‘system of reference’. Such a reflective approach will help to protect against the hybris of scientism and to maintain solidarity with vulnerable groups. (shrink)

The ethics of human enhancement has been a hotly debated topic in the last 15 years. In this debate, some advocate examining science fiction stories to elucidate the ethical issues regarding the current phenomenon of human enhancement. Stories from science fiction seem well suited to analyze biomedical advances, providing some possible case studies. Of particular interest is the work of screenwriter Andrew Niccol (Gattaca, S1m0ne, In Time, and Good Kill), which often focuses on ethical questions raised by the use of (...) new technologies. Examining the movie In Time (2011), the aim of this paper is to show how science fiction can contribute to the ethical debate of human enhancement. In Time provides an interesting case study to explore what could be some of the consequences of radical life-extension technologies. In this paper, we will show how arguments regarding radical life-extension portrayed in this particular movie differ from what is found in the scientific literature. We will see how In Time gives flesh to arguments defending or rejecting radical life-extension. It articulates feelings of unease, alienation and boredom associated with this possibility. Finally, this article will conclude that science fiction movies in general, and In Time in particular, are a valuable resource for a broad and comprehensive debate about our coming future. (shrink)

In this short think-piece we trace the newly emerging and rapidly expanding dimensions and dynamics of the “neuro-complex.” What this amounts to, we suggest, are a series of bio or neuro “convergences” of sorts regarding the brain and mental worlds, which in turn are traceable through what we term the bio-psych, pharma-psych, subjectivity-selves, wellness-enhancement, and the neuroculture-neurofutures relational nexuses. These issues are then illustrated through two brief case studies regarding brain scanning technologies and the problems and prospects of cognitive enhancement. (...) The paper concludes with some final reflections on these matters and a call for further research in this rich and challenging domain as the neuro-complex continues to expand in expected and unexpected, yet equally rich and fascinating, ways. (shrink)