: The idea of enhancing our mental functions through medical means makes many people uncomfortable. People have a vague feeling that altering our brains tinkers with the core of our personalities and the core of ourselves. It changes who we are, and doing so seems wrong, even if the exact reasons for the unease are difficult to define. Many of the standard arguments against neuroenhancements—that they are unsafe, that they violate the distinction between therapy and enhancements, that they undermine equality, (...) and that they will be used coercively—fail to show why the use of any such technologies is wrong in principle. Two other objections—the arguments that such changes undermine our integrity and that they prevent us from living authentic lives—will condemn only a few of the uses that are proposed. The result is that very few uses of these drugs are morally suspect and that most uses are morally permissible. (shrink)

There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.

A key feature of Buchanan is emphasis put on the social impact of biomedical enhancement. This social turn enables Buchanan to reframe the question of the desirability of enhancers. The fundamental question is no longer an individual question but a social question: what would be the advantages and the drawbacks of X in our society? The individual question, in Buchanan’s analysis, is second to the social question. Now, if one accepts that an enhancer may have secondary effects, or drawbacks, the (...) social question requires a cost and benefit analysis. I will argue that there are two flaws in Buchanan’s position: 1) the way in which he envisions the social debate about biomedical enhancement, and a cost and benefit analysis, would only be adequate in a kind of utopia which no actual existing State seems to match; 2) The cost and benefit analysis needs to be complemented not by an individual ethics but by narratives accounting for the experience of the subject. The level on which takes place Buchanan’s discussion covers up an individual experience which needs to be articulated and taken into account. It is this kind of individual, or singular, narrative that I will look for in the work of the post-phenomenological philosopher Jean-Luc Nancy, thus attempting to bridge a gap between two different philosophical traditions and styles of writing. (shrink)

Intellectual autonomy has long been identified as an epistemic virtue, one that has been championed influentially by Kant, Hume and Emerson. Manifesting intellectual autonomy, at least, in a virtuous way, does not require that we form our beliefs in cognitive isolation. Rather, as Roberts and Wood note, intellectually virtuous autonomy involves reliance and outsourcing to an appropriate extent, while at the same time maintaining intellectual self-direction. In this essay, I want to investigate the ramifications for intellectual autonomy of a particular (...) kind of epistemic dependence: cognitive enhancement. Cognitive enhancements involve the use of technology and medicine to improve cognitive capacities in healthy individuals, through mechanisms ranging from smart drugs to brain-computer interfaces. With reference to case studies in bioethics, as well as the philosophy of mind and cognitive science, it is shown that epistemic dependence, in this extreme form, poses a prima facie threat to the retention of intellectual autonomy, specifically, by threatening to undermine our intellectual self-direction. My aim will be to show why certain kinds of cognitive enhancements are subject to this objection from self-direction, while others are not. Once this is established, we’ll see that even some extreme kinds of cognitive enhancement might be not merely compatible with, but constitutive of, virtuous intellectual autonomy. (shrink)

The debate over the propriety of cognitive enhancement evokes both enthusiasm and worry. To gain further insight into the reasons that people may have for endorsing or eschewing pharmacological enhancement, we used empirical tools to explore public attitudes towards PE of twelve cognitive, affective, and social domains. Participants from Canada and the United States were recruited using Mechanical Turk and were randomly assigned to read one vignette that described an individual who uses a pill to enhance a single domain. After (...) reading the vignette, participants were asked how comfortable they were with the individual using the enhancement. People were significantly more comfortable when they read about enhancement of certain CAS domains than others. We found a modest negative correlation between comfort level and the degree to which the PE was perceived as changing core features of the person. We also found a modest correlation between comfort level and the degree to which the PE was perceived as improving success in life. Finally, using a sequential mixed method technique, we found that participants who felt uncomfortable about PE use overwhelmingly focused on a lack of need and, to a lesser degree, expressed concerns about safety; those who felt comfortable about PE use most frequently mentioned the safety of the pill and its ability to provide a positive outcome. The data provide novel insights into public enthusiasms and concerns over the use of PE. (shrink)

Background: Psychiatric interventions are a contested area in medicine, not only because of their history of abuses, but also because their therapeutic goal is to affect emotions, thoughts, beliefs...

International institutions such as UNESCO are deliberating on a new standard setting instrument for neurotechnologies. This will likely lead to the adoption of a soft law document which will be the first global document specifically tailored to neurotechnologies, setting the tone for further international or domestic regulations. While some stakeholders have been consulted, these developments have so far evaded the broader attention of the neuroscience, neurotech, and neuroethics communities. To initiate a broader debate, this target article puts to discussion twenty-five (...) considerations and desiderata for recognition by a future instrument. They are formulated at different levels of abstraction, from the big picture to technical details, seek to widen the perspective of preparatory reports and transcend the narrow debate about “neurorights” which overshadows many richer and more relevant aspects. These desiderata are not an exhaustive enumeration but a starting point for discussions about what deserves and what requires protection by an international instrument. (shrink)

Working through the lens of Donna Haraway's cyborg theory and directed at the example of Prozac, I address the dramatic rise of new technoscience in medicine and psychiatry. Haraway's cyborg theory insists on a conceptualization and a politics of technoscience that does not rely on universal “Truths” or universal “Goods” and does not attempt to return to the “pure” or the “natural.” Instead, Haraway helps us mix politics, ethics, and aesthetics with science and scientific recommendations, and she helps us understand (...) that (without recourse to universal truth or universal good) questions of legitimacy in science come down to local questions of effect and inclusion. What, in the case of my example, are the effects of Prozac? And for whom? Who is included and empowered to create legitimate psychiatric knowledge? Who is excluded and why? And, what political strategies will increase the democratic health of psychiatric science and practice? (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)

Timothy Brown invites us to think about the ways in which people who are being treated with deep brain stimulation might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators". We agree that it is important to develop conceptual frameworks that (...) both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three... (shrink)

What is that makes an act subject to either praise or blame? The question has often been taken to depend entirely on the free will debate for an answer, since it is widely agreed that an agent’s act is subject to praise or blame only if it was freely willed, but moral theory, action theory, and moral psychology are at least equally relevant to it. In the last quarter-century, following the lead of Harry Frankfurt’s (1971) seminal article “Freedom of the (...) Will and the Concept of a Person,” the interdisciplinary nature of the question has been emphasized by various authors. Going beyond the boundaries of the traditional free will debate, they have attempted to describe the requirements for agent accountability by appeal to theories of personality, rational agency, and ethical choice. The approach has been a breath of fresh air in the often-stagnant free will debate, bringing new considerations to bear and provoking new lines of argument, and it is an approach that we will adopt in this paper. In the following pages, we hope to show that an under-noticed phenomenon of moral psychology, inverse akrasia, exemplified by Huckleberry Finn, has something to contribute to the understanding of agency and accountability. After presenting the phenomenon in section I, we will move in section II to a quick survey of a family of Frankfurt-inspired views and a critique of them based on the phenomenon in sections III and IV. A new theory will be offered in section V, and potential objections addressed in the final section of the paper. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what (...) they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (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)

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)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.

Some philosophers and theologians have argued against the idea of Human Enhancement, saying that human beings should not play God. A closer look, however, might reveal that the question of who is playing Whom is far from being so clear-cut. This chapter will address the idea of human enhancement from the standpoint of theistic theology, arguing that human enhancement and theistic theology may not be so very incompatible, after all.

This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with natural balance. It (...) is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (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)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Arguments in the neuroenhancement debate are sometimes based upon idealistic scenarios involving the assumption of using a drug that has no or negligible side effects. At least it is often implicitly assumed – as technology and scientific knowledge advances - that there soon will be a drug with no or negligible side effects. We will review evidence from neuroscience, complex network research and evolution theory and demonstrate that - at least in terms of psychopharmacological intervention – on the basis of (...) our understanding of brain function it seems inconceivable that there ever will be a drug that has the desired effect without undesirable side effects. We will illustrate this by reference to enhancing edge detection in V2 in monkeys and demonstrate that even for this localised single neuron coded function there would be numerous side effects. Taking the more realistic case of pharmacological enhancement that is inevitably associated with side effects will change consequentialist arguments for neuroenhancement and have implications for the conception of autonomy, specifically in the case of performance enhancement. We conclude that a neuroethics debate that aims to inform policy decisions should take these findings into account. We hope that our article will precipitate more interdisciplinary research in neuroscience and philosophy. (shrink)

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

Ethical analyses of the effects of neural interventions commonly focus on changes to personality and behavior, interpreting these changes in terms of authenticity and identity. These phenomena have led to debate among ethicists about the meaning of these terms for ethical analysis of such interventions. While these theoretical approaches have different criteria for ethical significance, they agree that patients’ reports are concerning because a sense of self is valuable. In this paper, I question this assumption. I propose that the Buddhist (...) theory of no‐self offers a novel approach to making ethical sense of patients’ claims following deep brain stimulation. This alternative approach is based on the value of insight into patterns of cause and effect among mental states and actions. (shrink)

Since Prozac emerged on the market at the end of 1987, there has been a dramatic increase in antidepressant use and in its discussion by popular media. Yet there has been little analysis of the gendered character of this phenomenon despite feminist traditions scrutinizing the medical control of women’s bodies. The authors begin to fill this gap through a detailed content analysis of the 83 major articles on Prozac and its “chemical cousins” appearing in large-circulation periodicals in Prozac’s first 12 (...) years. They find that popular talk about Prozac and its competing brands is largely degendered, presented as manifestly gender neutral, yet replete with latent gendered messages. These are about women with neurochemical imbalances but also about the need to discipline elite female bodies, to enhance their productivity and flexibility. This new form of female “fitness” mirrors demands of the New Economy and indicates how psychiatric discourse contributes to the historically specific shaping of gendered bodies. (shrink)

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts (...) of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. (shrink)

This study brings together socio-theoretical and ethnographic approaches to psychiatry, demonstrating the role of the clinic as a major consolidator of ideologies as well as the site where personal miseries are registered as markers of social failure. It focuses on innovation in psychiatric taxonomies, changes in the figurative language of the emotions, changes in conceptualizations of the self and how all of these relate to changing socio-economic events and circumstances.

This study brings together socio-theoretical and ethnographic approaches to psychiatry, demonstrating the role of the clinic as a major consolidator of ideologies as well as the site where personal miseries are registered as markers of social failure. It focuses on innovation in psychiatric taxonomies, changes in the figurative language of the emotions, changes in conceptualizations of the self and how all of these relate to changing socio-economic events and circumstances.

The use of Ritalin and other stimulant drug treatments for attention-deficit hyperactivity disorder (ADHD) raises distinctive moral dilemmas for parents; these moral dilemmas have not been adequately addressed in the bioethics literature. This paper draws upon data from a qualitative empirical study to investigate parents' use of the moral ideal of authenticity as part of their narrative justifications for dosing decisions and actions. I show that therapeutic decisions and actions are embedded in valued cultural ideals about masculinity, self-actualization and success, (...) as well as in moral conceptions of authenticity and personal freedom. I argue that this investigation of parents' moral justifications and dosing dilemmas raises questions about the validity of authenticity as a transcendent moral principle. Moreover, this study demonstrates that in order to be relevant, bioethical analysis of neurocognitive enhancement must engage with ground-up studies of moral principles and decision-making in context. (shrink)

In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve their capacity (...) for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions. (shrink)

Persons have a curious dual nature. On the one hand, they are subjects, whose actions must be explained in terms of beliefs, desires, plans, and goals. At the same time, however, they also are physical objects, whose actions must be explicable in terms of physical laws. So far no satisfying account of this duality has been offered. Both Cartesian dualism and the modern materialist alternatives (reductionist and antireductionist) have failed to capture the full range of our experience of persons. I (...) argue that an exciting new approach to this difficulty can be found by considering developments in clinical psychology. The clinical debate between those endorsing biological models of mental illness and those endorsing psychodynamic models mirrors broader debates in the philosophy of mind. The possible resolution of this debate through the development of integrated psychobiological models suggests a promising way to reconcile the dual nature of persons in a far more appealing way than any yet proposed. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Aldous Huxley’s Brave New World is a famous dystopia, frequently called upon in public discussions about new biotechnology. It is less well known that 30 years later Huxley also wrote a utopian novel, called Island. This paper will discuss both novels focussing especially on the role of psychopharmacological substances. If we see fiction as a way of imagining what the world could look like, then what can we learn from Huxley’s novels about psychopharmacology and how does that relate to the (...) discussion in the ethical and philosophical literature on this subject? The paper argues that in the current ethical discussion the dystopian vision on psychopharmacology is dominant, but that a comparison between Brave New World and Island shows that a more utopian view is possible as well. This is illustrated by a discussion of the issue of psychopharmacology and authenticity. The second part of the paper draws some further conclusions for the ethical debate on psychopharmacology and human enhancement, by comparing the novels not only with each other, but also with our present reality. It is claimed that the debate should not get stuck in an opposition of dystopian and utopian views, but should address important issues that demand attention in our real world: those of evaluation and governance of enhancing psychopharmacological substances in democratic, pluralistic societies. (shrink)

This article explores contemporary biopolitics in the light of Michel Foucault's oft quoted suggestion that contemporary politics calls `life itself' into question. It suggests that recent developments in the life sciences, biomedicine and biotechnology can usefully be analysed along three dimensions. The first concerns logics of control - for contemporary biopolitics is risk politics. The second concerns the regime of truth in the life sciences - for contemporary biopolitics is molecular politics. The third concerns technologies of the self - for (...) contemporary biopolitics is ethopolitics. The article suggests that, in these events, human beings have become `somatic individuals': personhood is increasingly being defined in terms of corporeality, and new and direct relations are established between our biology and our conduct. At the same time, this somatic and corporeal individuality has become opened up to choice, prudence and responsibility, to experimentation, to contestation and so to a politics of `life itself'. (shrink)

Neuroenhancement offers the prospect of improving the cognitive, emotional and motivational functions of healthy individuals. Of all the conceivable interventions, psychopharmacology provides the most readily available ones, such as antidepressants which are thought to make people “better than well”. However, up until now, whether they possess such an enhancing ability remains controversial and therefore in this systematic review we will evaluate the effect and safety of modern antidepressants in healthy individuals. A search of MEDLINE and EMBASE databases and cross-references was (...) carried out and the pharmaceutical industry was contacted for suitable data. Trials published in any language through the third week of July 2007 were regarded. Included were single or double blind randomised or quasi-randomised controlled trials that compared a placebo to one or more of the following antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, moclobemide, paroxetine, reboxetine, sertraline or venlafaxine in any dose or dosing schedule. Eligible studies were those involving healthy people of any age and either sex who showed no evidence of a psychiatric disorder, cognitive decline or other disease. One hundred thirty-five articles met our inclusion criteria reporting single dose trials and trials with repeated drug administration. Sixty-five of these articles were eligible for a statistical analysis. Based on a linear mixed model, a meta-analysis and a fixed effects meta-regression were performed. Pooling of results by meta-analysis was stratified by the outcome measures mood, emotional processing, wakefulness, attention, memory, and executive functions. On a significance level of p < 0.05 the following significant results emerged: After a single dose of an antidepressant, a significant effect was shown in two of the analysed outcomes. Firstly, there was a small yet significant negative effect on wakefulness. On memory, a positive effect after several measurements was found, but this result could be traced to the results of the one study out of all included studies, which had that many assessment points. The analysis of trials with repeated drug administration yielded the following effects: on mood, a non-significant positive effect was detected that was continuously increasing and reached significance at the last assessment point. Regarding attention, a fluctuating effect was found, while for memory, the fact that the two groups started with a group difference confounded the results. For wakefulness there was no significant effect in any particular assessment point, while for emotional processing and executive functions, the small number of studies did not allow for any effect to emerge. In summary, no consistent evidence for enhancing effects of antidepressants could be found. There is little evidence so far to support the popular opinion that antidepressants have a positive effect on the mood of healthy individuals after repeated administration. No evidence of a significant adverse event profile could be found. The studies included in this systematic review not only provide insufficient evidence for or against any effect in healthy people, but they are inapt to be used for answering this question. This may be explained by the fact that most of them were not designed to examine neuroenhancement effects. The growing public interest in neuroenhancement stands in stark contrast to the paucity of data on enhancement effects of available psychopharmacological agents. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining how different trial (...) designs may be of different degrees of utility, depending on how changes to PIAAAS following DBS are manifested. In particular, we suggest that the trial designs Gilbert et al. call for may not be able to tell us whether or not DBS directly causes changes to personality. However, we suggest that this is not the most significant question about this phenomenon; the most significant question is whether these changes should matter morally, however they are caused. We go on to suggest that neuroethical analyses of novel neuro-interventions should be carried out in accordance with the levels of evidence hierarchy outlined by the Centre for Evidence-Based Medicine, and explain different ways in which neuroethical analyses of changes to PIAAAS can be evidence-based on this framework. In the second half of the paper, we explain how philosophical neuroethics can play an important role in contributing to mechanism-based reasoning about potential effects on PIAAAS following DBS, a form of evidence that is also incorporated into the CEBM levels of evidence hierarchy. (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable to (...) the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (shrink)

This article begins with arguments evident at the time of writing about the 5th revision of the Diagnostic and Statistical Manual of the American Psychiatric Association. The historical lineages of those arguments are international and not limited to the USA. The concern with psychiatric diagnosis both internationally and in the USA came to the fore at the end of the Second World War with the construction of the American Psychiatric Association’s Diagnostic and Statistical Manual and the World Health Organization’s classification (...) of ‘Diseases, Injuries and Causes of Death’. However, the linkage between categories of morbidity, assumptions about natural biological categories and treatment specificity with ‘magic bullets’ emerged in the middle of the 19th century in physical medicine. This article explores the legitimacy of current psychiatric diagnoses in the light of that international, not national, history of medical knowledge. In conclusion it explores judgements about current cultural imperialism and an older picture of Eurocentrism, which is now being refracted in more recent globalizing knowledge-claims about mental disorder. (shrink)

. Cognitive science challenges our understandings of self and freedom. In this article, adapted from a chapter in Minding God: Theology and the Cognitive Sciences , I review some of the scientific literature with regard to issues of self and freedom. I argue that our sense of self is a construct and heavily dependent on the kind of brain that we have. Furthermore, understanding the issue of freedom requires an understanding of the findings of cognitive science. Human beings are constrained (...) to be free; our biology in no small way determines the kinds of freedom that we are able to have. (shrink)

Cognitive science challenges our understandings of self and freedom. In this article, adapted from a chapter in Minding God: Theology and the Cognitive Sciences (Peterson 2003), I review some of the scientific literature with regard to issues of self and freedom. I argue that our sense of self is a construct and heavily dependent on the kind of brain that we have. Furthermore, understanding the issue of freedom requires an understanding of the findings of cognitive science. Human beings are constrained (...) to be free; our biology in no small way determines the kinds of freedom that we are able to have. (shrink)