This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that ‘liberal’ (...) approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust. (shrink)

Artificial devices that functionally replace internal organs are likely to be more common in the future. They are becoming more and more technologically feasible, increases in chronic diseases that can compromise various organs are anticipated, and donor organs will remain necessarily limited. More people in the future may have bodies that are partly nonorganic. How might artificial organs affect how we experience and conceptualize our bodies and how we understand the relation of the body to the experiencing, acting subject, or (...) self? Here, I focus on artificial heart devices (AHDs), including total artificial hearts (TAHs) and ventricular assist devices (VADs). While other devices, such as pacemakers and implantable cardiac defibrillators, assist the heart, I focus on devices that replace rather than assist organic function. AHDs, I argue, may have two opposing effects. On the one hand, having an AHD could alter experience, seemingly confirming that selves are shaped by the specifics of embodiment. On the other hand, AHDs are likely to encourage people to regard bodies as machines that are separable from the self. AHDs thus both confirm and undermine a body-self dualism. People with these devices may come to regard their bodies as machinelike even while having an artificial part alters their subjective experience. (shrink)

Biomedical moral enhancement, or BME for short, aims to improve people’s moral behaviors through augmenting, via biomedical means, their virtuous dispositions such as sympathy, honesty, courage, or generosity. Recently, it has been challenged, on particularist grounds, however, that the manifestations of the virtuous dispositions can be morally wrong. For instance, being generous in terrorist financing is one such case. If so, biomedical moral enhancement, by enhancing people’s virtues, might turn out to be counterproductive in terms of people’s moral behaviors. In (...) this paper, we argue, via a comparison with moral education, that the case for the practice of biomedical moral enhancement is not weakened by the particularists’ stress on the variable moral statuses of the manifestations of our virtues. The real challenge from the particularists, we argue, lies elsewhere. It is that practical wisdom, being essentially context-sensitive, cannot be enhanced via biomedical means. On the basis of this, we further argue that BME ought to be used with great caution, for it may wrongly enhance, for instance, a terrorist financier’s generosity, a robber’s courage, or an undercover detective’s honesty. Finally, we sketch how boundaries can be set on the use of BME, and address some potential objections to our position. (shrink)

In this chapter we will review experimental evidence related to pharmacological moral enhancement. Firstly, we will present our recent study in which we found that a drug called propranolol could change moral judgements. Further research, which also investigated this, found similar results. Secondly, we will discuss the limitations of such approaches, when it comes to the idea of general “human enhancement”. Whilst promising effects on certain moral concepts might be beneficial to the development of theoretical moral psychology, enhancement of human (...) moral behaviour in general – to our current understanding – has more side-effects than intended effects, making it potentially harmful. We give an overview of misconceptions when taking experimental findings beyond the laboratory and discuss the problems and solutions associated with the psychological assessment of moral behaviour. Indeed, how is morality “measured” in psychology, and are those measures reliable? (shrink)

:In this article, we consider contexts or domains in which moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party (...) concerns in psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed. Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as “moral bioenhancement.”. (shrink)

In the context of debates on psychiatry issues pertaining to moral dimensions of psychiatric health care are frequently discussed. These debates invite reflection on the question whether forensic practitioners have a role in stimulating patients’ moral development and moral growth in the context of forensic psychiatric and psychological treatment and care. We conducted a qualitative study to examine to what extent forensic practitioners consider moral development and moral growth to be a part of their current professional practices and to what (...) extent they think that stimulating moral development is a legitimate objective in the context of forensic psychiatric treatment. In addition, we asked how forensic practitioners balance pubic safety and risk management concerns with the interests and wellbeing of the individual patient. We conclude that: elements of moral development and moral growth in forensic psychiatric care practices are to a certain extent inevitable and not necessarily questionable or undesirable; yet, as in similar debates these elements need to be made explicit in order to discuss the accompanying ethical challenges and boundaries. An open academic, professional and public debate on aspects of stimulating moral betterment within current practices is therefore desirable. (shrink)

The neuroscience of ethics is allegedly having a double impact. First, it is transforming the view of human morality through the discovery of the neurobiological underpinnings that influence moral behavior. Secondly, some neuroscientific findings are radically challenging traditional views on normative ethics. Both claims have some truth but are also overstated. In this article, the author shows that they can be understood together, although with different caveats, under the label of ‘neurofoundationalism’. Whereas the neuroscientific picture of human morality is undoubtedly (...) valuable if we avoid neuroessentialistic portraits, the empirical disruption of normative ethics seems less plausible. The neuroscience of morality, however, is providing relevant evidence that any empirically-informed ethical theory needs to critically consider. Although neuroethics is not going to bridge the is-ought divide, it may establish certain facts that require us to rethink the way we achieve our ethical aspirations. (shrink)

Some proponents of moral bioenhancement propose that people should utilize biomedical practices to enhance the faculties and traits that are associated with moral agency, such as empathy and a sense of justice. The hope is that doing so will improve our ability to meet the moral challenges that have emerged in our contemporary, globalized world. In this paper, we caution against this view by arguing that biomedically inducing more empathy may, in fact, diminish moral agency. We argue that this type (...) of increase in empathy would not be effective for addressing empathy’s vulnerability to the biases that can undermine moral judgment. Furthermore, doing so may undermine the important capacity to regulate empathy. We determine that if the moral enhancement project is to be a serious one, it must address these challenges. (shrink)

This paper considers, firstly, to what extent the administration of oxytocin can augment the capacity of empathy in human beings; and secondly, whether or not such practice ought to be allowed. In relation to the latter, the author develops an argument in favour of this intervention by virtue of its consistency with the belief that, if a therapeutic treatment is to be considered acceptable, it is essential that it maximizes the well-being of those affected and that it does not compromise (...) the autonomy of the patient. Having rejected several objections related to the nature of this intervention, the author finally questions its morality on the basis of a concern with its universalizability. (shrink)

The human faculty of moral judgment is not well suited to address problems, like climate change, that are global in scope and remote in time. Advocates of ‘moral bioenhancement’ have proposed that we should investigate the use of medical technologies to make human beings more trusting and altruistic, and hence more willing to cooperate in efforts to mitigate the impacts of climate change. We survey recent accounts of the proximate and ultimate causes of human cooperation in order to assess the (...) prospects for bioenhancement. We identify a number of issues that are likely to be significant obstacles to effective bioenhancement, as well as areas for future research. (shrink)

Our present moral traits are unable to provide the level of large-scale co-operation necessary to deal with risks such as nuclear proliferation, drastic climate change and pandemics. In order to survive in an environment with powerful and easily available technologies, some authors claim that we need to improve our moral traits with moral enhancement. But this is prone to produce paradoxical effects, be self-reinforcing and harm personal identity. The risks of moral enhancement require the use of a safety framework; such (...) a framework should guarantee practical robustness to moral uncertainty, empirical adequacy, correct balance between dispositions, preservation of identity, and be sensitive to practical considerations such as emergent social effects. A virtue theory can meet all these desiderata. Possible frameworks incorporate them to variable degrees. The social value orientations framework is one of the most promising candidates. (shrink)

I will argue that deep moral enhancement is relatively prone to unexpected consequences. I first argue that even an apparently straightforward example of moral enhancement such as increasing human co-operation could plausibly lead to unexpected harmful effects. Secondly, I generalise the example and argue that technological intervention on individual moral traits will often lead to paradoxical effects on the group level. Thirdly, I contend that insofar as deep moral enhancement targets higher-order desires, it is prone to be self-reinforcing and irreversible. (...) Fourthly, I argue that the complex causal history of moral traits, with its relatively high frequency of contingencies, indicates their fragility. Finally, I conclude that attempts at deep moral enhancement pose greater risks than other enhancement technologies. For example, one of the major problems that moral enhancement is hoped to address is lack of co-operation between groups. If humanity developed and distributed a drug that dramatically increased co-operation between individuals, we would likely see a paradoxical decrease in co-operation between groups and a self-reinforcing increase in the disposition to engage in further modifications – both of which are potential problems. (shrink)

Current suggestions for capacities that should be targeted for moral enhancement has centered on traits like empathy, fairness or aggression. The literature, however, lacks a proper model for understanding the interplay and complexity of moral capacities, which limits the practicability of proposed interventions. In this paper, I integrate some existing knowledge on the nature of human moral behavior and present a formal model of prosocial motivation. The model provides two important results regarding the most friction-free route to moral enhancement. First, (...) we should consider decreasing self-interested motivation rather than increasing prosociality directly. Second, this should be complemented with cognitive enhancement. These suggestions are tested against existing and emerging evidence on cognitive capacity, mindfulness meditation and the effects of psychedelic drugs and are found to have sufficient grounding for further theoretical and empirical exploration. Furthermore, moral effects of the latter two are hypothesized to result from a diminished sense of self with subsequent reductions in self-interest. (shrink)