Can we understand what makes someone the same person without understanding what it is to be a person? Prereflectively we might not think so, but philosophers often accord these questions separate treatments, with personal-identity theorists claiming the first question and free-will theorists the second. Yet much of what is of interest to a person—the possibility of survival over time, compensation for past hardships, concern for future projects, or moral responsibility—is not obviously intelligible from the perspective of either question alone. Marya (...) Schechtman encourages us to adopt a more unified perspective. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Marya Schechtman takes issue with analytic philosophy's emphasis on the first sort of question to the exclusion of the second.

Deep brain stimulation (DBS) has in some cases been associated with significant psychological effects and/or personality change. These effects occur sometimes as acute changes experienced intraoperatively or during the initial setting of the stimulator and sometimes as longer term progressive changes in the months following surgery. Sometimes they are the intended outcome of treatment, and in other cases they are an unintended side-effect. In all of these circumstances some patients and caregivers have described the psychological effects of DBS as frightening (...) or disconcerting. I trace the source of these negative reactions to the fear that stimulation-related psychological and personality changes represent a threat to personal identity and agency. This issue has implications both for philosophical theories of personal identity and agency and for clinical concerns. A narrative account of personal identity is developed to illuminate the nature of the threat to identity and agency DBS potentially poses, and to suggest steps that might be taken to mitigate and avoid these threats. (shrink)

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and (...) Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. (shrink)

One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a “threat” to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a “threat” to continuity over time is (...) too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g. a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self”. We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self. (shrink)

The prospect of using memory modifying technologies raises interesting and important normative concerns. We first point out that those developing desirable memory modifying technologies should keep in mind certain technical and user-limitation issues. We next discuss certain normative issues that the use of these technologies can raise such as truthfulness, appropriate moral reaction, self-knowledge, agency, and moral obligations. Finally, we propose that as long as individuals using these technologies do not harm others and themselves in certain ways, and as long (...) as there is no prima facie duty to retain particular memories, it is up to individuals to determine the permissibility of particular uses of these technologies. (shrink)

Moral bioenhancement is the attempt to improve human behavioral dispositions, especially in relation to the great ethical challenges of our age. To this end, scientists have hypothesised new molecules or even permanent changes in the genetic makeup to achieve such moral bioenhancement. The philosophical debate has focused on the permissibility and desirability of that enhancement and the possibility of making it mandatory, given the positive result that would follow. However, there might be another way to enhance the overall moral behavior (...) of us humans, namely that of targeting people with lower propensity to trust and altruism. Based on the theory of attachment, people who have a pattern of insecure attachment are less inclined to prosocial behavior. We know that these people are influenced by negative childhood memories: this negative emotional component may be erased or reduced by the administration of propranolol when the bad memory is reactivated, thereby improving prosocial skills. It could be objected that memory-editing might be a threat for the person’s identity and authenticity. However, if the notion of rigid identity is replaced by that of extended identity, this objection loses validity. If identity is understood as something that changes over time, moral bioenhancement through memory-editing seems indeed legitimate and even desirable. (shrink)

Neuroscientific research on the removal of unpleasant and traumatic memories is still at a very early stage, but is making rapid progress and has stirred a significant philosophical and neuroethical debate. Even if memory is considered to be a fundamental element of personal identity, in the context of memory-erasing the autonomy of decision-making seems prevailing. However, there seem to be situations where the overall context in which people might choose to intervene on their memories would lead to view those actions (...) as counterproductive. In this article, I outline situations where the so-called composition effects can produce negative results for everyone involved, even if the individual decisions are not as such negative. In such situations medical treatments that usually everyone should be free to take, following the principle of autonomy, can make it so that the personal autonomy of the individuals in the group considered is damaged or even destroyed. In these specific cases, in which what is called the “conformity to context” prevails, the moral admissibility of procedures of memory-erasing is called into question and the principle of personal autonomy turns out to be subordinate to social interests benefitting every member of the group. (shrink)

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

In her article, Pascale Hess raises the issue of whether her proposed model may be extrapolated and applied to clinical research fields other than stem cell-based interventions in the brain (SCBI-B) (Hess 2012). Broadly summarized, Hess’s model suggests prioritizing efficacy over safety in phase 1 trials involving irreversible interventions in the brain, when clinical criteria meet the appropriate population suffering from “degenerative brain diseases” (Hess 2012). Although there is a need to reconsider the traditional phase 1 model, especially with respect (...) to first-in-human clinical trials involving novel technologies, the question arises as to whether it is appropriate to advocate for a new model that prioritizes efficacy over safety across all phase 1 clinical research trials involving irreversible interventions in the brain. -/- . (shrink)

One objection to enhancement technologies is that they might lead us to live inauthentic lives. Memory modification technologies (MMTs) raise this worry in a particularly acute manner. In this paper I describe four scenarios where the use of MMTs might be said to lead to an inauthentic life. I then undertake to justify that judgment. I review the main existing accounts of authenticity, and present my own version of what I call a “true self” account (intended as a complement, rather (...) than a substitute, to existing accounts). I briefly describe current and prospective MMTs, distinguishing between memory enhancement and memory editing . Moving then to an assessment of the initial scenarios in the light of the accounts previously described, I argue that memory enhancement does not, by its very nature, raise serious concerns about authenticity. The main threat to authenticity posed by MMTs comes, I suggest, from memory editing. Rejecting as inadequate the worries about identity raised by the President’s Council on Bioethics in Beyond Therapy , I argue instead that memory editing can cause us to live an inauthentic life in two main ways: first, by threatening its truthfulness, and secondly, by interfering with our disposition to respond in certain ways to some past events, when we have reasons to respond in such ways. This consideration allows us to justify the charge of inauthenticity in cases where existing accounts fail. It also gives us a significant moral reason not to use MMTs in ways that would lead to such an outcome. (shrink)

Misremembering is a systematic and ordinary occurrence in our daily lives. Since it is commonly assumed that the function of memory is to remember the past, misremembering is typically thought to happen because our memory system malfunctions. In this paper I argue that not all cases of misremembering are due to failures in our memory system. In particular, I argue that many ordinary cases of misremembering should not be seen as instances of memory’s malfunction, but rather as the normal result (...) of a larger cognitive system that performs a different function, and for which remembering is just one operation. Building upon extant psychological and neuroscientific evidence, I offer a picture of memory as an integral part of a larger system that supports not only thinking of what was the case and what potentially could be the case, but also what could have been the case. More precisely, I claim that remembering is a particular operation of a cognitive system that permits the flexible recombination of different components of encoded traces into representations of possible past events that might or might not have occurred, in the service of constructing mental simulations of possible future events. So that imagination and memory are but one thing, which for diverse considerations hath diverse names.Thomas Hobbes, Leviathan 1.2. (shrink)

In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical (...) purposes, but that in the future could be used in the forensic setting to modify criminal offenders’ memories. In this section we contrast the cases of dampening and enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders’ memories. (shrink)

This article explores the notion of the dislocated self following deep brain stimulation (DBS) and concludes that when personal identity is understood in dynamic, narrative, and relational terms, the claim that DBS is a threat to personal identity is deeply problematic. While DBS may result in profound changes in behaviour, mood and cognition (characteristics closely linked to personality), it is not helpful to characterize DBS as threatening to personal identity insofar as this claim is either false, misdirected or trivially true. (...) The claim is false insofar as it misunderstands the dynamic nature of identity formation. The claim is misdirected at DBS insofar as the real threat to personal identity is the discriminatory attitudes of others towards persons with motor and other disabilities. The claim is trivially true insofar as any dramatic event or experience integrated into one’s identity-constituting narrative could then potentially be described as threatening. From the perspective of relational personal identity, when DBS dramatically disrupts the narrative flow, this disruption is best examined through the lens of agency. For illustrative purposes, the focus is on DBS for the treatment of Parkinson’s disease. (shrink)

Neuroscience has dramatically increased understanding of how mental states and processes are realized by the brain, thus opening doors for treating the multitude of ways in which minds become dysfunctional. This book explores questions such as when is it permissible to alter a person's memories, influence personality traits or read minds? What can neuroscience tell us about free will, self-control, self-deception and the foundations of morality? The view of neuroethics offered here argues that many of our new powers to read (...) ,alter and control minds are not entirely unparalleled with older ones. They have, however, expanded to include almost all our social, political and ethical decisions. Written primarily for graduate students, this book will appeal to anyone with an interest in the more philosophical and ethical aspects of the neurosciences. (shrink)

This book is a discussion of the most timely and contentious issues in the two branches of neuroethics: the neuroscience of ethics; and the ethics of neuroscience. Drawing upon recent work in psychiatry, neurology, and neurosurgery, it develops a phenomenologically inspired theory of neuroscience to explain the brain-mind relation. The idea that the mind is shaped not just by the brain but also by the body and how the human subject interacts with the environment has significant implications for free will, (...) moral responsibility, and moral justification of actions. It also provides a better understanding of how different interventions in the brain can benefit or harm us. In addition, the book discusses brain imaging techniques to diagnose altered states of consciousness, deep-brain stimulation to treat neuropsychiatric disorders, and restorative neurosurgery for neurodegenerative diseases. It examines the medical and ethical trade-offs of these interventions in the brain when they produce both positive and negative physical and psychological effects, and how these trade-offs shape decisions by physicians and patients about whether to provide and undergo them. (shrink)

The doyen of living English philosophers, by these reflections, took hold of and changed the outlook of a good many other philosophers, if not quite enough. He did so, essentially, by assuming that talk of freedom and responsibility is talk not of facts or truths, in a certain sense, but of our attitudes. His more explicit concern was to look again at the question of whether determinism and freedom are consistent with one another -- by shifting attention to certain personal (...) rather than moral attitudes, first of all gratitude and resentment. In the end, he arrived at a kind of Compatibilist or, as he says, Optimist conclusion. That is no doubt a recommendation but not the largest recommendation of this splendidly rich piece of philosophy. (shrink)

Neuroscientists have made significant advances in identifying drugs to dampen the intensity of traumatic memories. Such drugs hold promise for victims of terrorism, military conflict, assault, car accidents, and natural disasters who might otherwise suffer for many years from intense, painful memories. In 2003, the President's Council on Bioethics released a report entitled Beyond Therapy: Biotechnology and the Pursuit of Happiness, which analyzed memory dampening in some detail. While the Council acknowledged the potential benefits of memory dampening, some Council members (...) were concerned that it may: (1) discourage us from authentically coping with trauma, (2) tamper with personal identity, (3) demean the genuineness of human life and experience, (4) encourage us to forget memories that we are obligated to keep, and (5) inure us to the pain of others. In this Article, I describe possible legal and ethical implications of memory dampening. For example, I note that traumatic events frequently lead to legal proceedings that rely on memories of those events. Drugs that dampen traumatic memories may someday test the boundaries between an individual's right to medically modify his memories and society's right to stop him from altering valuable evidence. More broadly, I respond to the Council by arguing that many of its concerns are founded on controversial premises that unjustifiably privilege our natural cognitive abilities. While memory dampening may eventually require thoughtful regulation, broad-brushed restrictions are unjustified: We have a deeply personal interest in controlling our own minds that entitles us to a certain freedom of memory. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)