Deep brain stimulation is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory (...) conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research. (shrink)

As things currently stand, our deaths are unavoidable and our lifespans short. It might be thought that these qualities leave room for improvement. According to a prominent line of argument in philosophy, however, this thought is mistaken. Against the idea that a longer life would be better, it is claimed that negative psychological states, such as boredom, would be unavoidable if our lives were significantly longer. Against the idea that a deathless life would be better, it is claimed that such (...) a life would be lacking in important sources of value, because death is a precondition for many of our valuing attitudes. I argue that these problems are avoided by very long lives that incorporate fading memory, limited ignorance of future events, and temporal scarcity. I conclude that very long lives are, in principle, desirable, and that death does not play an essential role in our valuing attitudes. (shrink)