Many believe that the treatment-enhancement distinction marks an important ethical boundary that we should use to shape public policy on biomedical interventions. A common justification for this purported normative force appeals to the idea that, whereas treatments respond to genuine medical needs, enhancements can only satisfy mere preferences or “expensive tastes”. This article offers a critique of that justification, while still accepting the TED as a conceptual tool, as well as some of the key ethical axioms endorsed by its proponents. (...) I begin by laying out the TED, the practical implications that tend to be drawn from it, and the justification just sketched for these implications. Using examples drawn from preventive medicine, biomedical technology, and other categories of biomedical interventions, I then go on to challenge both the presupposition of a fundamental dichotomy between treatments and enhancements, and the assumption that enhancements – barring rare exceptions – cannot serve legitimate medical needs. Finally, I consider some ways in which supporters of the TED might try re-formulating the distinction to blunt the force of my critique. I conclude that such a move cannot fully succeed, and that while the TED does have some degree of normative force, it nevertheless cannot play the role that its advocates expect from it. Seeking to justify a general presumption against enhancements based on the rationale I critique here would mean ignoring their various potential benefits, including medical or therapeutic, and would reflect a prejudice – which I refer to as “treatment fetishism”. (shrink)

According to a standard view, the physical boundary of the person—the skin-and-skull boundary—matters morally because this boundary delineates between where the person begins and the world ends. On the basis of this view we make a distinction between invasive interventions that penetrate this boundary and non-invasive interventions that do not. The development of neuroprosthetics, however, raises questions about the significance of this boundary and the relationship between person and body. In particular it has been argued by appeal to the Extended (...) Mind thesis that mind and person can extend beyond the body, and hence the skin-and-skull boundary is of questionable significance. In this paper I argue that the Extended Mind thesis is consistent with the ethical relevance of the skin-and-skull barrier. Although it can be argued that cognitive processes and aspect of mind can extend beyond the skin-and-skull boundary as EM claims, it does not follow that the person is also extended beyond this boundary. The moral sense of person is closely related to the notion of person as a subject of experiences and this, in turn, is related to the sensory and somatosensory aspects of the body. The development of neuroprosthetics provides us with reason to see that persons can be variously embodied, but this is consistent with the functional and ethical significance of the skin-and-skull boundary. (shrink)

In the movie, Memento, the hero, Leonard, suffers from a form of anterograde amnesia that results in an inability to lay down new memories. Nonetheless, he sets out on a quest to find his wife’s killer, aided by the use of notes, annotated polaroids, and (for the most important pieces of information obtained) body tattoos. Using these resources he attempts to build up a stock of new beliefs and to thus piece together the puzzle of his wife’s death. At one (...) point in the movie, a character exasperated by Leonard’s lack of biological recall, shouts. (shrink)

Human enhancement has emerged in recent years as a blossoming topic in applied ethics. With continuing advances in science and technology, people are beginning to realize that some of the basic parameters of the human condition might be changed in the future. One important way in which the human condition could be changed is through the enhancement of basic human capacities. If this becomes feasible within the lifespan of many people alive today, then it is important now to consider the (...) normative questions raised by such prospects. The answers to these questions might not only help us be better prepared when technology catches up with imagination, but they may be relevant to many decisions we make today, such as decisions about how much funding to give to various kinds of research. Enhancement is typically contraposed to therapy. In broad terms, therapy aims to fix something that has gone wrong, by curing specific diseases or injuries, while enhancement interventions aim to improve the state of an organism beyond its normal healthy state. However, the distinction between therapy and enhancement is problematic, for several reasons. First, we may note that the therapy-enhancement dichotomy does not map onto any corresponding dichotomy between standard-contemporary-medicine and medicineas-it-could-be-practised-in-the-future. Standard contemporary medicine includes many practices that do not aim to cure diseases or injuries. It includes, for example, preventive medicine, palliative care, obstetrics, sports medicine, plastic surgery, contraceptive devices, fertility treatments, cosmetic dental procedures, and much else. At the same time, many enhancement interventions occur outside of the medical framework. Office workers enhance their performance by drinking coffee. Make-up and grooming are used to enhance appearance. Exercise, meditation, fish oil, and St John’s Wort are used to enhance mood. Second, it is unclear how to classify interventions that reduce the probability of disease and death.. (shrink)

Where does the mind stop and the rest of the world begin? The question invites two standard replies. Some accept the demarcations of skin and skull, and say that what is outside the body is outside the mind. Others are impressed by arguments suggesting that the meaning of our words "just ain't in the head", and hold that this externalism about meaning carries over into an externalism about mind. We propose to pursue a third position. We advocate a very different (...) sort of externalism: an _active externalism_, based on the active role of the environment in driving cognitive processes. (shrink)

As artificial intelligence technologies become increasingly prominent in our daily lives, media coverage of the ethical considerations of these technologies has followed suit. Since previous research has shown that media coverage can drive public discourse about novel technologies, studying how the ethical issues of AI are portrayed in the media may lead to greater insight into the potential ramifications of this public discourse, particularly with regard to development and regulation of AI. This paper expands upon previous research by systematically analyzing (...) and categorizing the media portrayal of the ethical issues of AI to better understand how media coverage of these issues may shape public debate about AI. Our results suggest that the media has a fairly realistic and practical focus in its coverage of the ethics of AI, but that the coverage is still shallow. A multifaceted approach to handling the social, ethical and policy issues of AI technology is needed, including increasing the accessibility of correct information to the public in the form of fact sheets and ethical value statements on trusted webpages, collaboration and inclusion of ethics and AI experts in both research and public debate, and consistent government policies or regulatory frameworks for AI technology. (shrink)

Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.

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)

What is the ethical impact of artificial intelligence assistants on human lives, and specifically how much do they threaten our individual autonomy? Recently, as part of forming an ethical framework for thinking about the impact of AI assistants on our lives, John Danaher claims that if the external automaticity generated by the use of AI assistants threatens our autonomy and is therefore ethically problematic, then the internal automaticity we already live with should be viewed in the same way. He takes (...) advantage of this paradox of internal automaticity to downplay the threats of external automaticity to our autonomy. We respond in this paper by challenging the legitimacy of the paradox. While Danaher assumes that internal and external automaticity are roughly equivalent, we argue that there are reasons why we should accept a large degree of internal automaticity, that it is actually essential to our sense of autonomy, and as such it is ethically good; however, the same does not go for external automaticity. Therefore, the similarity between the two is not as powerful as the paradox presumes. In conclusion, we make practical recommendations for how to better manage the integration of AI assistants into society. (shrink)

There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...) these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment. (shrink)