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

Abstract: The notion of a self-pattern, as developed in the pattern theory of self, which holds that the self is best explained in terms of the kind of reality that pertains to a dynamical pattern, acknowledges the importance of neural dynamics, but also expands the account of self to extra-neural (embodied and enactive) dynamics. The pattern theory of self, however, has been criticized for failing to explicate the dynamical relations among elements of the self-pattern; as such, it seems to be (...) nothing more than a mere list of elements. We’ll argue that the dynamics of a self-pattern are reflected in three significant and interrelated ways that allow for investigation. First, a self-pattern is reflectively reiterated in its narrative component. Second, studies of psychiatric or neurological disorders can help us understand the precise nature of the dynamical relations in a self-pattern, and how they can fail. Third, referencing predictive processing accounts, neuroscience can also help to explicate the dynamical relations that constitute the self-pattern. (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)

Autonomous Agents addresses the related topics of self-control and individual autonomy. "Self-control" is defined as the opposite of akrasia-weakness of will. The study of self-control seeks to understand the concept of its own terms, followed by an examination of its bearing on one's actions, beliefs, emotions, and personal values. It goes on to consider how a proper understanding of self-control and its manifestations can shed light on personal autonomy and autonomous behaviour. Perspicuous, objective, and incisive throughout, Alfred Mele makes a (...) convincing case for the value of individual autonomy. (shrink)

Questions about the nature of self and self-consciousness are closely aligned with questions about the nature of autonomy. These concepts have deep roots in traditional philosophical discussions that concern metaphysics, epistemology and ethics. They also have direct relevance to practical considerations about informed consent in medical contexts. In this paper, with reference to understanding specific side effects of deep brain stimulation treatment in cases of, for example, Parkinson’s Disease, Obsessive Compulsive Disorder, and Major Depressive Disorder, I’ll argue that it is (...) best to frame discussions of informed consent in terms of relational autonomy and a pattern theory of self. (shrink)

Skepticism about moral responsibility, or what is more commonly referred to as moral responsibility skepticism, refers to a family of views that all take seriously the possibility that human beings are never morally responsible for their actions in a particular but pervasive sense. This sense is typically set apart by the notion of basic desert and is defined in terms of the control in action needed for an agent to be truly deserving of blame and praise. Some moral responsibility skeptics (...) wholly reject this notion of moral responsibility because they believe it to be incoherent or impossible. Others maintain that, though possible, our best philosophical and scientific theories about the world provide strong and compelling reasons for adopting skepticism about moral responsibility. What all varieties of moral responsibility skepticism share, however, is the belief that the justification needed to ground basic desert moral responsibility and the practices associated with it—such as backward-looking praise and blame, punishment and reward (including retributive punishment), and the reactive attitudes of resentment and indignation—is not met. Versions of moral responsibility skepticism have historically been defended by Spinoza, Voltaire, Diderot, d’Holbach, Priestley, Schopenhauer, Nietzsche, Clarence Darrow, B.F. Skinner, and Paul Edwards, and more recently by Galen Strawson, Derk Pereboom, Bruce Waller, Neil Levy, Tamler Sommers, and Gregg D. Caruso. -/- Critics of these views tend to focus both on the arguments for skepticism about moral responsibility and on the implications of such views. They worry that adopting such a view would have dire consequences for our interpersonal relationships, society, morality, meaning, and the law. They fear, for instance, that relinquishing belief in moral responsibility would undermine morality, leave us unable to adequately deal with criminal behavior, increase anti-social conduct, and destroy meaning in life. Optimistic skeptics, however, respond by arguing that life without free will and basic desert moral responsibility would not be as destructive as many people believe. These optimistic skeptics argue that prospects of finding meaning in life or of sustaining good interpersonal relationships, for instance, would not be threatened. They further maintain that morality and moral judgments would remain intact. And although retributivism and severe punishment, such as the death penalty, would be ruled out, they argue that the imposition of sanctions could serve purposes other than the punishment of the guilty—e.g., it can also be justified by its role in incapacitating, rehabilitating, and deterring offenders. (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)

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights (...) from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement. (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)

This chapter develops a point made in preceding chapters that autonomy, although socially grounded, has an individualizing dimension — a dimension that is defend against the worries of critics. The main thesis is that: at the same time that we embrace relational accounts of autonomy, we should also be cautious about them. Autonomy increases the risk of disruption in interpersonal relationships. While this is an empirical and not a conceptual claim about autonomy, nevertheless, the risk is significant and its bearing (...) on the value of autonomy is therefore empirically significant. It makes a difference in particular to whether the ideal of autonomy is genuinely hospitable to women. (shrink)

This 1988 volume is a collection of thirteen seminal essays on ethics, free will, and the philosophy of mind. The essays deal with such central topics as freedom of the will, moral responsibility, the concept of a person, the structure of the will, the nature of action, the constitution of the self, and the theory of personal ideals. By focusing on the distinctive nature of human freedom, Professor Frankfurt is able to explore fundamental problems of what it is to be (...) a person and of what one should care about in life. (shrink)

This essay challenges the widely accepted principle that a person is morally responsible for what he has done only if he could have done otherwise. The author considers situations in which there are sufficient conditions for a certain choice or action to be performed by someone, So that it is impossible for the person to choose or to do otherwise, But in which these conditions do not in any way bring it about that the person chooses or acts as he (...) does. In such situations the person may well be morally responsible for what he chooses or does despite his inability to choose or to do otherwise. Finally the author considers certain suggestions for revising the principle he rejects or for replacing it with a principle of an altogether different kind. (shrink)

In Freedom Within Reason, Susan Wolf charts a course between incompatibilism, or the notion that freedom and responsibility require causal and metaphysical independence from the impersonal forces of nature, and compatibilism, or the notion that people are free and responsible as long as their actions are governed by their desires. Wolf argues that some of the forces which are beyond our control are friends to freedom rather than enemies of it, enabling us to see the world for what it is. (...) The freedom we want is not independence from the world, but independence from the forces that prevent us from choosing how to live in the light of a sufficient appreciation of the world. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

This book argues two main things: The first is that there is no such thing as free will—at least not in the sense most ordinary folk take to be central or fundamental; the second is that the strong and pervasive belief in free will can be accounted for through a careful analysis of our phenomenology and a proper theoretical understanding of consciousness.

The concept of luck has played an important role in debates concerning free will and moral responsibility, yet participants in these debates have relied upon an intuitive notion of what luck is. Neil Levy develops an account of luck, which is then applied to the free will debate. He argues that the standard luck objection succeeds against common accounts of libertarian free will, but that it is possible to amend libertarian accounts so that they are no more vulnerable to luck (...) than is compatibilism. But compatibilist accounts of luck are themselves vulnerable to a powerful luck objection: historical compatibilisms cannot satisfactorily explain how agents can take responsibility for their constitutive luck; non-historical compatibilisms run into insurmountable difficulties with the epistemic condition on control over action. Levy argues that because epistemic conditions on control are so demanding that they are rarely satisfied, agents are not blameworthy for performing actions that they take to be best in a given situation. It follows that if there are any actions for which agents are responsible, they are akratic actions; but even these are unacceptably subject to luck. Levy goes on to discuss recent non-historical compatibilisms, and argues that they do not offer a viable alternative to control-based compatibilisms. He suggests that luck undermines our freedom and moral responsibility no matter whether determinism is true or not. (shrink)

According to Dewey, we are responsible for our conduct because it is “ourselves objectified in action”. This idea lies at the heart of an increasingly influential deep self approach to moral responsibility. Existing formulations of deep self views have two major problems: They are often underspecified, and they tend to understand the nature of the deep self in excessively rationalistic terms. Here I propose a new deep self theory of moral responsibility called the Self-Expression account that addresses these issues. The (...) account is composed of two parts. The first part answers the question, What is a deep self? Theorists have tended to favor cognitive views that understand the deep self in terms of rationally formed evaluative judgment. I propose instead a conative view that says one’s deep self consists of a distinctive kind of pro-attitude, cares, and I provide an account of cares in terms of their distinctive psychological functional role. The second part answers the question, When does an action express one’s deep self? I criticize the agentially demanding conditions set out in existing views and propose a more minimalist alternative. I show that the Self-Expression account handles issues that bedeviled traditional deep self views, including how to explain moral responsibility for spontaneous, out of character, and weak-willed actions. (shrink)

Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this challenge (...) by invoking the right to bodily integrity. I argue that it is not. (shrink)

To be autonomous is to be governed in one's actions by values, principles, or reflections that are truly one's own, to be one's own person, as opposed to being guided by external, manipulative, or alien forces. This chapter examines the concept of autonomy in western moral philosophy, beginning with a discussion of ancient philosophy to illustrate how autonomy is in many ways a modern idea. It then reviews contemporary debates about autonomy set against a backdrop of historical traditions that do (...) not always place self-government at the centre of moral value, and considers some controversies in the more recent literature on autonomy in moral philosophy. The chapter concludes with a consideration of how that notion functions in social and political thought. (shrink)

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions of autonomy such as (...) authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general. (shrink)

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)

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs (...) a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.Sabine MNeuroScienceAndNorms: Ethical and Legal Aspects of Norms in Neuroimaging at Bonn University Hospital, Germany. Her main research interests are in neuroethics. She is coauthor of three German books about neuroethics and bioethics.Henrik Walter, M.D., Ph.D., is Full Professor of Medical Psychology at the University of Bonn, Germany, and vice-director of the Department of Psychiatry and Psychotherapy at the University Clinic of Bonn. He is author of Neurophilosophy of Free Will and editor of the book From Neuroethics to Neurolaw?. His research fields are biological psychiatry, cognitive neuroscience, neuroimaging, neurophilosophy, and neuroethics. (shrink)

My strategy is to examine a recent trend in philosophical discussions of responsibility, a trend that tries, but I think ultimately fails, to give an acceptable analysis of the conditions of responsibility. It fails due to what at first appear to be deep and irresolvable metaphysical problems. It is here that I suggest that the condition of sanity comes to the rescue. What at first appears to be an impossible requirement for responsibility---the requirement that the responsible agent have created her- (...) or himself---turns out to be the vastly more mundane and non controversial requirement that the responsible agent must, in a fairly standard sense, be sane. (shrink)

Harry G. Frankfurt begins his inquiry by asking, “What is it about human beings that makes it possible for us to take ourselves seriously?” Based on The Tanner Lectures in Moral Philosophy, Taking Ourselves Seriously and Getting It Right delves into this provocative and original question. The author maintains that taking ourselves seriously presupposes an inward-directed, reflexive oversight that enables us to focus our attention directly upon ourselves, and “[it] means that we are not prepared to accept ourselves just as (...) we come. We want our thoughts, our feelings, our choices, and our behavior to make sense. We are not satisfied to think that our ideas are formed haphazardly, or that our actions are driven by transient and opaque impulses or by mindless decisions. We need to direct ourselves—or at any rate to believe that we are directing ourselves—in thoughtful conformity to stable and appropriate norms. We want to get things right.” The essays delineate two features that have a critical role to play in this: our rationality, and our ability to love. Frankfurt incisively explores the roles of reason and of love in our active lives, and considers the relation between these two motivating forces of our actions. The argument is that the authority of practical reason is less fundamental than the authority of love. Love, as the author defines it, is a volitional matter, that is, it consists in what we are actually committed to caring about. Frankfurt adds that “The object of love can be almost anything—a life, a quality of experience, a person, a group, a moral ideal, a nonmoral ideal, a tradition, whatever.” However, these objects and ideals are difficult to comprehend and often in conflict with each other. Moral principles play an important supporting role in this process as they help us develop and elucidate a vision that inspires our love. The first section of the book consists of the two lectures, which are entitled “Taking Ourselves Seriously” and “Getting It Right.” The second section consists of comments in response by Christine M. Korsgaard, Michael E. Bratman, and Meir Dan-Cohen. The book includes a preface by Debra Satz. (shrink)

Daniel C. Dennett is a brilliant polemicist, famous for challenging unexamined orthodoxies. Over the last thirty years, he has played a major role in expanding our understanding of consciousness, developmental psychology, and evolutionary theory. And with such groundbreaking, critically acclaimed books as Consciousness Explained and Darwin's Dangerous Idea (a National Book Award and Pulitzer Prize finalist), he has reached a huge general and professional audience. In this new book, Dennett shows that evolution is the key to resolving the ancient problems (...) of moral and political freedom. Like the planet's atmosphere on which life depends, the conditions on which our freedom depends had to evolve, and like the atmosphere, they continue to evolve-and could be extinguished. According to Dennett, biology provides the perspective from which we can distinguish the varieties of freedom that matter. Throughout the history of life on this planet, an interacting web and internal and external conditions have provided the frameworks for the design of agents that are more free than their parts-from the unwitting gropings of the simplest life forms to the more informed activities of animals to the moral dilemmas that confront human beings living in societies. As in his previous books, Dennett weaves a richly detailed narrative enlivened by analogies as entertaining as they are challenging. Here is the story of how we came to be different from all other creatures, how our early ancestors mindlessly created human culture, and then, how culture gave us our minds, our visions, our moral problems-in a nutshell, our freedom. (shrink)

In the subsequent pages, I want to develop a distinction between wanting and valuing which will enable the familiar view of freedom to make sense of the notion of an unfree action. The contention will be that, in the case of actions that are unfree, the agent is unable to get what he most wants, or values, and this inability is due to his own "motivational system." In this case the obstruction to the action that he most wants to do (...) is his own will. It is in this respect that the action is unfree: the agent is obstructed in and by the very performance of the action. (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)

Mele's ultimate purpose in this book is to help readers think more clearly about free will. He identifies and makes vivid the most important conceptual obstacles to justified belief in the existence of free will and meets them head on. Mele clarifies the central issues in the philosophical debate about free will and moral responsibility, criticizes various influential contemporary theories about free will, and develops two overlapping conceptions of free will--one for readers who are convinced that free will is incompatible (...) with determinism (incompatibilists), and the other for readers who are convinced of the opposite (compatibilists). Luck poses problems for all believers in free will, and Mele offers novel solutions to those problems--one for incompatibilist believers in free will and the other for compatibilists. An early chapter of this empirically well-informed book clearly explains influential neuroscientific studies of free will and debunks some extravagant interpretations of the data. Other featured topics include abilities and alternative possibilities, control and decision-making, the bearing of manipulation on free will, and the development of human infants into free agents. Mele's theory offers an original perspective on an important problem and will garner the attention of anyone interested in the debate on free will. (shrink)

It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

Personal identity deals with questions about ourselves qua people (or persons). Many of these questions are familiar ones that occur to everyone at some time: What am I? When did I begin? What will happen to me when I die? Discussions of personal identity go right back to the origins of Western philosophy, and most major figures have had something to say about it. (There is also a rich literature on personal identity in Eastern philosophy, which I am not competent (...) to discuss. Collins 1982 is a good source.). (shrink)

Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or (...) it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example. (shrink)

In the recent neuroethics literature, there has been vigorous debate concerning the ethical implications of the use of neurotechnologies that may alter a person’s identity. Much of this debate has been framed around the concept of authenticity. The argument of this chapter is that the ethics of authenticity, as applied to neurotechnological treatment or enhancement, is conceptually misleading. The notion of authenticity is ambiguous between two distinct and conflicting conceptions: self-discovery and self-creation. The self-discovery conception of authenticity is based on (...) a problematic conception of a static, real inner self. The notion of self-creation, although more plausible, blurs the distinction between identity and autonomy. Moreover, both conceptions are overly individualistic and fail sufficiently to account for the relational constitution of personal identity. The authors propose that a relational, narrative understanding of identity and autonomy can incorporate the more plausible aspects of both interpretations of authenticity, while providing a normatively more illuminating theoretical framework for approaching the question of whether and how neurotechnologies threaten identity. (shrink)

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)

Deep brain stimulation is an invasive technique designed to stimulate certain deep brain regions for therapeutic purposes and is currently used mainly in patients with neurodegenerative disorders, such as Parkinson’s disease. However, DBS is also used increasingly for other experimental applications, such as the treatment of psychiatric disorders, weight reduction. Apart from its therapeutic potential, DBS can cause severe adverse effects, some that might also have a significant impact on the patient’s personality and autonomy by the external stimulation of DBS (...) which effects lie beyond the individual’s control and free will. The article’s purpose is to outline the procedures of DBS currently used in therapeutic and experimental applications and to discuss the ethical concerns regarding this procedure. It will address the clinical benefit-risk-ratio, the particular ethics of research in this field, and the ethical issues raised by affecting a patient’s or an individual’s personality and autonomous behaviour. Moreover, a potential ethical guideline, the Ulysses contract is discussed for the field of clinical application as well as the question of responsibility. (shrink)

Although philosophers have explored several connections between neuroscience and moral responsibility, the issue of how real-world neurological modifications, such as Deep Brain Stimulation, impact moral responsibility has received little attention. In this article, we draw on debates about the relevance of history and manipulation to moral responsibility to argue that certain kinds of neurological modification can diminish the responsibility of the agents so modified. We argue for a historicist position - a version of the history-sensitive reflection view - and defend (...) that account against a rival, relational view of responsibility. We conclude that DBS can, under certain conditions, diminish responsibility, and explore the circumstances under which this might be so. We conclude by suggesting that philosophical debates about moral responsibility, manipulation, and history have greater practical relevance than is sometimes thought, and that attention to practical cases can help inform and deepen this body of scholarship. (shrink)

It is both an ideal and an assumption of traditional conceptions of justice for liberal democracies that citizens are autonomous, self-governing persons. Yet standard accounts of the self and of self-government at work in such theories are hotly disputed and often roundly criticized in most of their guises. John Christman offers a sustained critical analysis of both the idea of the 'self' and of autonomy as these ideas function in political theory, offering interpretations of these ideas which avoid such disputes (...) and withstand such criticisms. Christman's model of individual autonomy takes into account the socially constructed nature of persons and their complex cultural and social identities, and he shows how this model can provide a foundation for principles of justice for complex democracies marked by radical difference among citizens. His book will interest a wide range of readers in philosophy, politics, and the social sciences. (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)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

This article’s guiding question is about bullet biting: When should compatibilists about moral responsibility bite the bullet in responding to stories used in arguments for incompatibilism about moral responsibility? Featured stories are vignettes in which agents’ systems of values are radically reversed by means of brainwashing and the story behind the zygote argument. The malady known as “intuition deficit disorder” is also discussed.

This article distinguishes among and examines three different kinds of argument for the thesis that moral responsibility and free action are each incompatible with the truth of determinism: straight manipulation arguments; manipulation arguments to the best explanation; and original-design arguments. Structural and methodological matters are the primary focus.