The human body is a remarkable example of the process of evolution which ultimately created a sentient being with cognitive, motor, and information-processing abilities. The body can also be thought of as an amazing feat of engineering, and specifically as an example of molecular nanotechnology, positioning trillions of cells throughout the body, and creating the billions of unique individuals that have existed since the beginning of humanity. On the other hand, from an engineering perspective, there are numerous limitations associated with (...) the human body and the process of evolution to effect changes in the body is exceedingly slow. For example, our skeletal structure is only so strong, our body is subject to disease, and we are programmed by our DNA to age. Further, it took millions of years for _Homo sapiens_ to evolve and hundreds of thousands of years for hominids to invent the most basic technology. To allow humans to go beyond the capabilities that evolution provided _Homo sapiens_, current research is leading to technologies that could significantly enhance the cognitive and motor abilities of humans and eventually create the conditions in which humans and technology could merge to form a cybernetic being. Much of this technology is being developed from three fronts: due to medical necessity, an interest within the military to create a cyborg soldier, and the desire among some people to self-enhance their body with technology. This article discusses the processes of biological evolution which led to the current anatomical, physiological, and cognitive capabilities of humans and concludes with a discussion of emerging technologies which are directed primarily at enhancing the cognitive functions performed by the brain. This article also discusses a timeframe in which the body will become increasingly equipped with technology directly controlled by the brain, then as a major paradigm shift in human evolution, humans will merge with the technology itself. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

In this paper, the authors explore the question of whether cognitive enhancement via direct neurostimulation, such as through deep brain stimulation, could be reasonably characterized as a form of transformative experience. This question is inspired by a qualitative study being conducted with people at risk of developing dementia and in intimate relationships with people living with dementia (PLWD). They apply L.A. Paul’s work on transformative experience to the question of cognitive enhancement and explore potential limitations on the kind of claims (...) that can legitimately be made about individual well-being and flourishing, as well as limit the kind of empirical work—including the authors’ own—that can hope to enlighten ethical discourse. In this paper, the authors advance the following theses: (1) it is sometimes reasonable to characterize cognitive enhancement as a transformative experience; (2) the testimonies of people intimately acquainted with dementia may still be relevant to evaluating cognitive enhancement even though cognitive enhancement may be a transformative experience; and (3) qualitative studies may still be useful in the ethical analysis of cognitive enhancement, but special attention may need to be given to how these are conducted and what kind of insights can be drawn from them. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

A central question in contemporary ethics and political philosophy concerns which entities have moral status. In this article, I provide a detailed analysis of the view that moral status comes in degrees. I argue that degrees of moral status can be specified along two dimensions: (i) the weight of the reason to protect an entity’s morally significant rights and interests; and/or (ii) the rights and interests that are considered morally significant. And I explore some of the complexities that arise when (...) we link degrees of moral status to the weight of reasons to protect bundles and/or the content and size of these bundles, in particular regarding the attribution of moral status to nonparadigmatic entities (e.g. people with severe cognitive disabilities, children, embryos and foetuses, robots, non-human animals, ecosystems, and rivers). (shrink)

The relationship between the Sophiology of Sergius Bulgakov and the neo-patristic movement within Orthodoxy is well-known. The neo-patristic synthesis won the day, and it is the dominant theological tradition within Orthodoxy. It is time for a serious reappraisal of Bulgakov’s theology by the Orthodox and non-Orthodox Christian theologians because Christian theology is faced with a looming bioethical issue, cybernetic enhancement technology. This technology raises a cybernetic-ethical version of the Sorites paradox that leads us to inquire at “what point do technological (...) enhancements take away or replace our humanity?” and “are cyborg enhancements ethical from an Orthodox Christian perspective?” Bulgakov’s Sophiology may provide important tools for assessing cyborg enhancements and answering these questions. This paper argues that Bulgakov’s Sophiology, particularly his theology of human creativity and belief that we can and should anticipate the spiritual bodies that we will have in the general resurrection, offers a framework for assessing the morality of technological alterations to our present bodily existence from an Orthodox perspective. (shrink)

Brain-machine interfaces are a growing field of research and application. The increasing possibilities to connect the human brain to electronic devices and computer software can be put to use in medicine, the military, and entertainment. Concrete technologies include cochlear implants, Deep Brain Stimulation, neurofeedback and neuroprosthesis. The expectations for the near and further future are high, though it is difficult to separate hope from hype. The focus in this paper is on the effects that these new technologies may have on (...) our ‘symbolic order’—on the ways in which popular categories and concepts may change or be reinterpreted. First, the blurring distinction between man and machine and the idea of the cyborg are discussed. It is argued that the morally relevant difference is that between persons and non-persons, which does not necessarily coincide with the distinction between man and machine. The concept of the person remains useful. It may, however, become more difficult to assess the limits of the human body. Next, the distinction between body and mind is discussed. The mind is increasingly seen as a function of the brain, and thus understood in bodily and mechanical terms. This raises questions concerning concepts of free will and moral responsibility that may have far reaching consequences in the field of law, where some have argued for a revision of our criminal justice system, from retributivist to consequentialist. Even without such a (unlikely and unwarranted) revision occurring, brain-machine interactions raise many interesting questions regarding distribution and attribution of responsibility. (shrink)

Humans often seek to improve themselves, whether through self-discipline or through the use of science and technology. At some point in the future, techniques might become available that will change humans to such a degree that they might have to be regarded as something other than human: posthuman. This essay tries to define the point at which such a human-to-posthuman metamorphosis may occur. This is achieved by discerning what is it that makes human substance distinct, i.e. what is the human (...) essence. This is accomplished by examining the features of the human body, looking at the mode of human existence in society and trying to grasp the importance of the body–soul relationship. Throughout the process, humans are compared to animals as well as entities from literature, film, and the gaming world. These are used as case studies to shape and test the ideas developed throughout the essay. This essay's conclusions might become useful when decisions will have to be made as to the legal status of posthumans,... (shrink)

Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many kinds of welfare technology break (...) with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)