With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain (...) can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

In recent years, direct brain interventions have shown increased success in manipulating neurobiological processes often associated with moral reasoning and decision-making. As current DBIs are refined, and new technologies are developed, the state will have an interest in administering DBIs to criminal offenders for rehabilitative purposes. However, it is generally assumed that the state is not justified in directly intruding in an offender’s brain without valid consent. Thomas Douglas challenges this view. The state already forces criminal offenders to go to (...) jail without their consent. This represents a serious interference with an offender’s rights. If criminal offenders are already morally liable to incarceration, why is the state not also entitled to administer DBIs without consent for the purposes of rehabilitation? Douglas argument focuses on the right to ‘bodily integrity’. He argues that there is no compelling reason to believe that bodily rights that protect an offender from non-consensual DBIs are stronger than rights that protect an offender from incarceration. This paper will extend Douglas’ analysis. It will consider the more fundamental right to ‘mental integrity’. The right to mental integrity defends an inner sphere of liberty. It protects critical capacities necessary for the exercise of autonomous human agency—without which a vast majority of moral rights could not exist. Thus, the right to mental integrity is ultimately more important for a moral assessment of DBIs. The right strongly suggests that both presently, and in the future, there may be many cases in which the state is not entitled to administer DBIs to criminal offenders without valid consent. (shrink)

P.F. Strawson’s work on moral responsibility is well-known. However, an important implication of the landmark “Freedom and Resentment” has gone unnoticed. Specifically, a natural development of Strawson’s position is that we should understand being morally responsible as having externalistically construed pragmatic criteria, not individualistically construed psychological ones. This runs counter to the contemporary ways of studying moral responsibility. I show the deficiencies of such contemporary work in relation to Strawson by critically examining the positions of John Martin Fischer and Mark (...) Ravizza, R. Jay Wallace, and Philip Pettit for problems due to individualistic assumptions. (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)

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)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 21-22, August 2011.

Research into human ageing is a growing field of research with two central foci: geriatric medicine works to reduce the incidence and severity of age-related diseases and disabilities by devising adequate therapeutic and preventive strategies. A second focus, this time in the emerging field of biogerontology, is to bring about a general retardation of the ageing process and by this increase the average and maximum human lifespan. This contribution looks into the second focus, i.e. the possibility of age retardation which, (...) for the time being, is merely hypothetical. After outlining research strategies studying age retardation in animal experiments, it will ask how extending human life by technological interventions might play out on the individual, familial and social level. The central concern here will be autonomy-linked issues, seeing that in debates concerning the ethical implications of age-retarding techniques the argument from autonomy is one of the main arguments in favour of the prolongation of human life. In particular, this contribution will assess whether the argument from autonomy does, in fact, unequivocally support the recourse to age-retarding techniques. (shrink)

Research with psychiatric patients raises frequently discussed, ethical questions, one of which is: Can psychiatric patients give consent to participation in research at all? To answer this and similar questions adequately, it is - according to our thesis - necessary to analyze first, which theoretical assumptions are made in established practice. -/- To solve the question after the possibility of consent, compatible understandings of ‘disease’, ‘illness’ and ‘autonomy’ are crucial, but there is no consensual use of these terms in philosophy. (...) Therefore we first are going to explain different concepts of ‘autonomy’ and ‘disease’. Subsequent to this we will test how the different conceptualizations of ‘autonomy’ and ‘disease’ can be related to each other and how the reasonable combinations shape possible answers to the opening question. It will become apparent that an adequate analysis of ‘autonomy’ and ‘disease’ raises ethical dilemma in psychiatry, for which we shall suggest possible solutions. (shrink)

Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes to the systematic differentiation of (...) soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism. (shrink)