Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is (...) meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal. (shrink)

Williams (1970) argues that our intuitions about personal identity vary depending on how a given thought experiment is framed. Some frames lead us to think that persistence of self requires persistence of one's psychological characteristics; other frames lead us to think that the self persists even after the loss of one's distinctive psychological characteristics. The current paper takes an empirical approach to these issues. We find that framing does affect whether or not people judge that persistence of psychological characteristics is (...) required for persistence of self. Open-ended, abstract questions about what is required for survival tend to elicit responses that appeal to the importance of psychological characteristics. This emphasis on psychological characteristics is largely preserved even when participants are exposed to a concrete case that yields conflicting intuitions over whether memory must be preserved in order for a person to persist. Insofar as our philosophical theory of personal identity should be based on our intuitions, the results provide some support for the view that psychological characteristics really are critical for persistence of self. (shrink)

People maintain a positive identity in at least two ways: They evaluate themselves more favorably than other people, and they judge themselves to be better now than they were in the past. Both strategies rely on autobiographical memories. The authors investigate the role of autobiographical memories of lying and emotional harm in maintaining a positive identity. For memories of lying to or emotionally harming others, participants judge their own actions as less morally wrong and less negative than those in which (...) other people lied to or emotionally harmed them. Furthermore, people judge those actions that happened further in the past to be more morally wrong than those that happened more recently. Finally, for periods of the past when they believed that they were very different people than they are now, participants judge their actions to be more morally wrong and more negative than those actions from periods of their pasts when they believed that they were very similar to who they are now. The authors discuss these findings in relation to theories about the function of autobiographical memory and moral cognition in constructing and perceiving the self over time. (shrink)

This paper explores the impacts of neurological intervention on selfhood with reference to recipients’ claims about changes to their self-understanding following Deep Brain Stimulation for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken and (...) occludes what is ethically salient in changes from DBS. Rather, by adopting a relational narrative approach to identity and autonomy, I show that the ethically salient issue from DBS is impacts on autonomous agency—whether one’s actions and beliefs are one’s own, and how DBS may hinder, or foster, embodied, relational autonomy competences. This approach recognizes that if sufficiently significant, impacts on autonomy competences may pose a threat to one’s ability to contribute to the process of authoring one’s own life and so pose a threat to identity formation. I argue this approach resolves the confusion in the literature about whether and how DBS threatens identity and provides a complex picture of how DBS may affect selfhood by disrupting narrative identity formation and revision, distorting agency and/or undermining autonomy. (shrink)

Nichols and Bruno claim that the folk judge that psychological continuity is necessary for personal identity. In this article, we evaluate this claim. First, we argue that it is likely that in thinking about hypothetical cases of transformations, the folk do not use a unitary concept of personal identity, but instead rely on different concepts of ‘person’, ‘identity’, and ‘individual’. Identity can be ascribed even when post-transformation individuals are no longer categorized as persons. Second, we provide new empirical evidence suggesting (...) that the folk do not consider psychological continuity to be necessary for an individual to be categorized as a person or for ascribing identity over time and through transformations. In this, we assume, along with Nichols and Bruno, that folk judgments about identity can be read off the use of proper names. Furthermore, we raise some doubts about the ability of current experimental designs to adequately distinguish between qualitative and numerical identity jud.. (shrink)

Do neurosurgical procedures ever result in the patient prior to the procedure not being identical with the individual who wakes up postsurgery in the hospital bed? We address this question by offering an analysis of the persistence of persons that emphasizes narrative, rather than numerical, identity. We argue that a narrative analysis carries the advantage of highlighting what matters to patients in their ordinary lives, explaining the varying degrees of persistence of personal identity, and enhancing our understanding of patients' experiences. (...) We illustrate these points in cases involving temporal lobectomy for treatment of refractory epilepsy and deep brain stimulation for refractory Parkinson's disease. (shrink)

Brain implants, such as Deep Brain Stimulation (DBS), which are designed to improve motor, mood and behavioural pathology, present unique challenges to our understanding of identity, agency and free will. This is because these devices can have visible effects on persons' physical and psychological properties yet are essentially undetectable when operating correctly. They can supplement and compensate for one's inherent abilities and faculties when they are compromised by neuropsychiatric disorders. Further, unlike talk therapy or pharmacological treatments, patients need not ‘do’ (...) anything for the treatment to take effect. If one accepts, as we argue here, that brain implants are unique among implantable types of devices, then this can have significant implications for what it means to persist as the same person and be the source of one's thoughts and actions. By examining two of the most common indications for DBS in current use, namely in the motor (Parkinson's Disease) and psychiatric (Major Depression) domains, we further argue that although DBS, as it is currently applied, does not necessarily represent a unique threat to personal identity and agency per se, it introduces an unprecedented ‘third party’ into the debate on these concepts. In this way, DBS can be used as a tool to begin probing, both conceptually and empirically, some of philosophy's most perennial metaphysical questions. (shrink)