Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

Some have objected to human enhancement on the grounds that it violates the autonomy of the enhanced. These objections, however, overlook the interesting possibility that autonomy itself could be enhanced. How, exactly, to enhance autonomy is a difficult problem due to the numerous and diverse accounts of autonomy in the literature. Existing accounts of autonomy enhancement rely on narrow and controversial conceptions of autonomy. However, we identify one feature of autonomy common to many mainstream accounts: reasoning ability. Autonomy can then (...) be enhanced by improving people’s reasoning ability, in particular through cognitive enhancement; given how valuable autonomy is usually taken to be, this gives us extra reason to pursue such cognitive enhancements. Moreover, autonomy-based objections will be especially weak against such enhancements. As we will argue, those who are worried that enhancements will inhibit people’s autonomy should actually embrace those enhancements that will improve autonomy. (shrink)

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

Gilbert and colleagues are to be commended for drawing our attention to the need for a sounder empirical basis, and for more careful reasoning, in the context of the neuroethics debate on Deep Brain Stimulation (DBS) and its potential impact on the dimensions of personality, identity, agency, authenticity, autonomy and self (PIAAAS). While acknowledging this, this extended commentary critically examines their claim that the real-world relevance of the conclusions drawn in the neuroethics literature is threatened by the fact that the (...) concepts at the center of the discussion have “weak empirical grounding”. First, I show that while some possible understandings of multifaceted concepts like identity, authenticity and autonomy may indeed be unsuitable for a purely empirical inquiry, this is not the case of all of them. Secondly, I call into question the authors’ apparent suggestion that reliance on constructs involving an irreducibly normative dimension makes for a suboptimal state of affairs, and that they should ideally be replaced with substitutes taken from the language of neuroscience or social science in order to ensure an adequate empirical grounding for the debate. Such a suggestion, I argue, commits the authors to a controversial reductionist view in metaethics that the valid empirical concerns they raise in the rest of their article do not presuppose, and which could potentially us lead to lose sight of important ethical considerations. (shrink)

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis (...) of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies. (shrink)

There are numerous ways people can improve their cognitive capacities: good nutrition and regular exercise can produce long-term improvements across many cognitive domains, whilst commonplace stimulants such as coffee temporarily boost levels of alertness and concentration. Effects like these have been well-documented in the medical literature and they raise few ethical issues. More recently, however, clinical research has shown that the off-label use of some pharmaceuticals can, under certain conditions, have modest cognition-improving effects. Substances such as methylphenidate and modafinil can (...) improve capacities such as working memory and concentration in some healthy individuals. Unlike their more mundane predecessors, these methods of “cognitive enhancement” are thought to raise a multitude of ethical issues. This paper presents the six principal ethical issues raised in relation to pharmacological cognitive enhancers —issues such as whether: the medical safety-profile of PCEs justifies restricting or permitting their elective or required use; the enhanced mind can be an “authentic” mind; individuals might be coerced into using PCEs;, there is a meaningful distinction to be made between the treatment vs. enhancement effect of the same PCE; unequal access to PCEs would have implications for distributive justice; and PCE use constitutes cheating in competitive contexts. In reviewing the six principal issues, the paper discusses how neuroscientific research might help advance the ethical debate. In particular, the paper presents new arguments about the contribution neuroscience could make to debates about justice, fairness, and cheating, ultimately concluding that neuroscientific research into “personalized enhancement” will be essential if policy is to be truly informed and ethical. We propose an “ethical agenda” for neuroscientific research into PCEs. (shrink)

Emerging reprogenetic technologies may radically change how humans reproduce in the not-so-distant future. One foreseeable consequence of disruptive innovations in the procreative domain is an increase in the reproductive autonomy of intended parents. Regarding the prospective parental liberty of enhancing non-health–related traits of the offspring, one controversy has particularly dominated the literature. Does parents' choice of genetically enhancing the traits of their descendants compromise children's future personal autonomy? In this article, I will analyse the main arguments which posit that reprogenetic (...) enhancement could be at odds with the child's future autonomy. I will argue that these objections are ill-founded. Moreover, I will present other arguments that show that reprogenetic technologies can enhance the autonomy of future children. Autonomy enhancement is a plausible and pro tanto desirable application of emerging reprogenetic technologies. (shrink)

In work on the ethics of cognitive enhancement use, there is a pervasive concern that such enhancement will—in some way—make us less authentic. Attempts to clarify what this concern amounts to and how to respond to it often lead to debates on the nature of the “true self” and what constitutes “genuine human activity”. This paper shows that a new and effective way to make progress on whether certain cases of cognitive enhancement problematically undermine authenticity is to make use of (...) considerations from the separate debate on the nature of authentic emotion. Drawing in particular on Wasserman and Liao, the present paper offers new conditions that can help us assess the impact of cognitive enhancements on authenticity. (shrink)

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of (...) medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being. (shrink)

In many jurisdictions, an offender’s remorse is considered to be a relevant factor to take into account in mitigation at sentencing. The growing philosophical interest in the use of neurointerventions in criminal justice raises an important question about such remorse-based mitigation: to what extent should technologically facilitated remorse be honoured such that it is permitted the same penal significance as standard instances of remorse? To motivate this question, we begin by sketching a tripartite account of remorse that distinguishes cognitive, affective (...) and motivational elements of remorse. We then describe a number of neurointerventions that might plausibly be used to enhance abilities that are relevant to these different elements of remorse. Having described what we term the ‘moral value’ view of the justification of remorse-based mitigation, we then consider whether using neurointerventions to facilitate remorse would undermine its moral value, and thus make it inappropriate to honour such remorse in the criminal justice system. We respond to this question by claiming that the form of moral understanding that is incorporated into a genuinely remorseful response grounds remorse’s moral value. In view of this claim, we conclude by arguing that neurointerventions need not undermine remorse’s moral value on this approach, and that the remorse that such interventions might facilitate could also be authentic to the recipient of the neurointerventions that we discuss. (shrink)

Mere inability, which refers to what persons are naturally unable to do, is traditionally thought to be distinct from unfreedom, which is a social type of constraint. The advent of biomedical enhancement, however, challenges the idea that there is a clear division between mere inability and unfreedom. This is because bioenhancement makes it possible for some people’s mere inabilities to become matters of unfreedom. In this paper, I discuss several ways that this might occur: first, bioenhancement can exacerbate social pressures (...) to enhance one’s abilities; second, people may face discrimination for not enhancing; third, the new abilities made possible due to bioenhancement may be accompanied by new inabilities for the enhanced and unenhanced; and finally, shifting values around abilities and inabilities due to bioenhancement may reinforce a pre-existing ableism about human abilities. As such, we must give careful consideration to these potential unfreedom-generating outcomes when it comes to our moral evaluations of bioenhancement. (shrink)

This paper argues for a revised concept of authenticity entailing two demands that must be balanced. The first demand moves authenticity from the position of a strictly self-regarding virtue towards the position of a fully social virtue, acknowledging the crucial feature of steadiness, i.e. self-consistency, as being precisely what we ‘naturally’ lack. Nevertheless, the value of personal authenticity in a modern, open society comes from the fact that it brings about not only steadiness, but also the public development of a (...) variety of existential options that can be understood as Millian ‘original experiments in living’. Thus the second demand of authenticity is a demand for ‘experimental’ authenticity which covers the whole spectrum of technologies of the self, from Nietzschean ‘brief habits’, to the use of enhancement technologies. (shrink)

Bioconservative bioethicists (e.g., Kass, 2002, Human Dignity and Bioethics, 297–331, 2008; Sandel, 2007; Fukuyama, 2003) offer various kinds of philosophical arguments against cognitive enhancement—i.e., the use of medicine and technology to make ourselves “better than well” as opposed to merely treating pathologies. Two notable such bioconservative arguments appeal to ideas about (1) the value of achievement, and (2) authenticity. It is shown here that even if these arguments from achievement and authenticity cut ice against specifically pharmacologically driven cognitive enhancement, they (...) do not extend over to an increasingly viable form of technological cognitive enhancement – namely, cognitive enhancement via augmented reality. An important result is that AR-driven cognitive enhancement aimed at boosting performance in certain cognitive tasks might offer an interesting kind of “sweet spot” for proponents of cognitive enhancement, allowing us to pursue many of the goals of enhancement advocates without running into some of the most prominent objections from bioconservative philosophers. (shrink)

Ideas about freedom and related concepts like autonomy and self-determination play a prominent role in the moral debate about human enhancement interventions. However, there is not a single understanding of freedom available, and arguments referring to freedom are simultaneously used to argue both for and against enhancement interventions. This gives rise to misunderstandings and polemical arguments. The paper attempts to disentangle the different distinguishable concepts, classifies them and shows how they relate to one another in order to allow for a (...) more structured and clearer debate. It concludes in identifying the individual underpinnings and the social conditions of choice and decision-making as particularly salient dimensions of freedom in the ethical debate about human enhancement. (shrink)

Certain of our traits are thought more central to who we are: they comprise ourindividual identity. What makes these traits privileged in this way? What accounts for theiridentity centrality? Although considerations of identity play a key role in many different areas of moral philosophy, I argue that we currently have no satisfactory account of the basis of identity centrality. Nor should we expect one. Rather, we should adopt an error theory: we should concede that there is nothing in reality corresponding (...) to the perceived distinction between the central and peripheral traits of a person. (shrink)

Debate concerning human enhancement often revolves around the question of whether there is a common “nature” that all human beings share and which is unwarrantedly violated by enhancing one’s capabilities beyond the “species-typical” norm. I explicate Thomas Aquinas’s influential theory of human nature, noting certain key traits commonly shared among human beings that define each as a “person” who possesses inviolable moral status. Understanding the specific qualities that define the nature of human persons, which includes self-conscious awareness, capacity for intellective (...) thought, and volitional autonomy, informs the ethical assessment of various forms of enhancement. Some forms of cognitive and physical enhancement may be desirable from the perspective of what constitutes the “flourishing” of human persons in our fundamental nature; while other forms of enhancement, such as emotive or so-called “moral” enhancement, run the risk of detracting from human flourishing when evaluated from the virtue-theoretic perspective Aquinas promotes. (shrink)

It is an imperative within health care, medicine, and public health to restore, preserve, and enhance health. Therefore, it is important to determine what kinds of enhancement are increases in health and what kinds are not. Taking as its point of departure two conceptions of health, namely, “manifest health” and “fundamental health,” the paper discusses various means used to enhance ability and well-being, and if those means, such as wheelchairs, implants, medicines, stimulants, or narcotics, enhance health. The fact that some (...) means that enhance ability or well-being are not usually considered health enhancing, for example, narcotics, constitutes a problem. The paper ends with a discussion of some suggestions about how to distinguish between those enhancements that are health related and those that are not. One plausible idea holds that an enhancement is health related when the substance, or aid, increases ability or well-being, is integrated into the body, and does not harm the individual’s fundamental health. (shrink)

This paper critically compares the philosophy of Günther Anders and the contemporary transhumanists, like Julian Savulescu, Ingmar Persson, or Thomas Douglas. The Andersian concepts of moral blindness, promethean gap, and promethean shame will be discussed in order to understand human beings’ outdatedness; parallel to this, we will also expose the transhumanist analysis on the unfitness of human beings in evolutive and cognitive terms. We will show that much of the transhumanist analysis is a reformulation of the Andersian thesis, now under (...) scientific terminology. Finally, we will approach the transhumanist proposal of moral enhancement, explaining and confronting some critics raised on the grounds of freedom and moral responsibility. (shrink)

Authenticity has been recognized as a central concept in the ethics of human enhancement. In the last decade, a plethora of novel distinctions, specifications, and definitions of authenticity have been added to the debate. This chapter takes a step back and maps the different accounts of authenticity to provide a nuanced taxonomy of authenticity and reveal the emerging underlying structures of this concept. I identify three kinds of conditions for authentic creation and change of the true self (coherence, endorsement, and (...) relations) as well as ways how the true self should be expressed (in one’s self-conception, self-presentation, and one’s body, emotions, and actions). Based on this analysis, I discuss the hopes and concerns human enhancement raises for authenticity. Enhancement technologies do not threaten or foster authenticity across the board but affect different dimensions of authenticity individually. Finally, I turn to the value of authenticity and argue that the debate on authenticity in the ethics of human enhancement would profit from a more extended discussion on the comparative value of the individual dimensions of authenticity. (shrink)

In one version of the Narcissus myth, Narcissus spurns a young suitor, Aminias, who is heartbroken as a result. Narcissus offers Aminias a sword to deal with his misery, which Aminias duly uses to...

There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement technologies. Yet, the search for an adequate and shared understanding of enhancement has always remained an important part of the debate. It was initially undertaken with the intention of defining the ethical boundaries of enhancement, often by attempting to distinguish enhancements from medical treatments. One of the more recent (...) approaches comes from Julian Savulescu, Anders Sandberg, and Guy Kahane. With their welfarist account, they define enhancement in terms of its contribution to individual well-being: as any state of a person that increases the chances of living a good life in the given set of circumstances. The account aims to contribute both to a shared and clear understanding of enhancement and to answering the question of whether we should enhance in certain ways or not. I will argue that it cannot live up to either claim, in particular because of its inherent normativity and its failure to adequately define well-being. Nevertheless, it can make a valuable contribution to an ethics of enhancement. As I will show, the welfarist account refocuses the debate on a central value in health care: well-being, which can be a relevant aspect in assessing the permissibility of biomedical interventions – especially against the background of new bioethical challenges. To fulfil this function, however, a more differentiated understanding of well-being is needed. (shrink)

Pre-natal genetic enhancement affords us unprecedented capacity to shape our skills, talents, appearance and perhaps subsequently the quality of our lives in terms of overall happiness, success and wellbeing. Despite its powerful appeal, some have raised important and equally persuasive concerns against genetic enhancement. Sandel has argued that compassion and humility, themselves grounded in the unpredictability of talents and skills, would be lost. Habermas has argued that genetically altered individuals will see their lives as dictated by their parents’ design and (...) therefore will not acquire an appropriate self-understanding. How should we view enhancement efforts in light of these concerns? I propose that we begin by adopting a defeasibility stance. That is, I ask whether our belief that genetic enhancements serve in the best interests of the child is reason to genetically enhance, underscoring a sort of epistemic vulnerability. I utilize the epistemological notions of defeasible reasons, undercutting and overriding defeaters in order to better understand and systematically evaluate the force of such concerns. I argue that close examination of both objections using this framework shows that we have reason to enhance, a reason that is defeasible but as yet, undefeated. (shrink)

Consider that an individual improves her capacities by neuroscientific means. It turns out that, besides altering her in the way(s) she intended, the enhancement also changes her personality in significant way(s) she did not foresee. Yet the person endorses her new self because the neuroenhancement she underwent changed her. Can the person’s approval of her new personality be autonomous? While questions of autonomy have already gathered a significant amount of attention in philosophical literature on human enhancement, the problem just described—henceforth (...) referred to as the question whether selfvalidating neuroenhancement can be autonomous—would not appear to have received due consideration. This article takes a step towards remedying the shortage. I start by explicating the main points of departure of its argument. In the subsequent sections of the article, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with autonomy. On the basis of the consideration, I propose that self-validating neuroenhancement can be autonomous. (shrink)

The development of AI tools, such as large language models and speech emotion and facial expression recognition systems, has raised new ethical concerns about AI’s impact on human relationships. While much of the debate has focused on human-AI relationships, less attention has been devoted to another class of ethical issues, which arise when AI mediates human-to-human relationships. This paper opens the debate on these issues by analyzing the case of romantic relationships, particularly those in which one partner uses AI tools, (...) such as ChatGPT, to resolve a conflict and apologize. After reviewing some possible, non-exhaustive, explanations for the moral wrongness of using AI tools in such cases, I introduce the notion of second-person authenticity: a form of authenticity that is assessed by the other person in the relationship (e.g., a partner). I then argue that at least some actions within romantic relationships should respect a standard of authentic conduct since the value of such actions depends on who actually performs them and not only on the quality of the outcome produced. Therefore, using AI tools in such circumstances may prevent agents from meeting this standard. I conclude by suggesting that the proposed theoretical framework could also apply to other human-to-human relationships, such as the doctor-patient relationship, when these are mediated by AI; I offer some preliminary reflections on such applications. (shrink)

Many find it intuitive that those who use enhancements like steroids and Adderall in Olympic weightlifting and education are due less praise than those who perform equally well without using these enhancements. Nonetheless, it is not easy to coherently explain why one might be justifiably due less praise for using these technologies to enhance one’s performance. Justifications for this intuition which rely on concerns regarding authenticity, cheating, or shifts in who is responsible for the performance face serious problems. Santoni de (...) Sio et al., however, have recently defended a justification for this intuition which avoids the problems competing justifications face; the nature-of-activities justification. This justification relies on a conceptual analysis of the nature of activities and does not require the defense of any particular ethical stance concerning the use of enhancements. Santoni de Sio et al. claim that the success of the nature-of-activities account requires distinguishing between practice-oriented activities and goal-directed activities. I, however, show that this distinction is both deeply problematic and unnecessary. After exposing the weaknesses of Santoni de Sio et al.’s original account, I defend a simpler and less problematic version of the nature-of-activities account. The revised account is capable of both justifying this intuition of less praise and allowing one to determine when enhancements should be deemed permissible, impermissible, or obligatory for a given activity. (shrink)