(Author Posting. (c) Taylor & Francis, 2007. This is the author's version of the work. It is posted here by permission of Taylor & Francis for personal use, not for redistribution. The definitive version was published in The American Journal of Bioethics, Volume 7 Issue 5, May 2007. doi:10.1080/15265160701372609)

If the burden of applied ethics is to decide how we should treat one another in various contexts, then neuroethics raises a particularly interesting set of questions. Neuroscience finds no evidence for a soul or mental essence, so the person – the object of moral concern and source of action – must be a construction in some sense. The self becomes the target of analysis (Farah and Heberlein 2007) and thus deconstructable, mutable, perhaps even improvable according to some standard. If so, how do we defend its inviolability and authenticity? If persons can be understood as the emergent result of neurally instantiated sub-personal processes, are we permitted more latitude in fixing moral defects by medical means?

In Bioethics and the Brain (link is external), Walter Glannon takes up these challenges and many others, considered in the context of emerging technologies such as neuroimaging, drug therapy, psychosurgery and brain stimulation. Neuromedicine is improving, but as Glannon reminds us, we’re far from a complete understanding the mechanisms underlying personhood and behavior. We must proceed conservatively, therefore, in prescribing treatments that rely on a still nascent brain science. His paramount concern is the rights and welfare of those undergoing interventions that might affect the substrate of self, whether they be patients or inmates. We should keep the Brave New World at arm’s length.

Glannon provides an overview of brain physiology and function, moves quickly to philosophical considerations of mind, consciousness, self and personhood, and thence to well documented discussions of a host of cutting-edge neuroethical issues. These include (just to mention a few) the therapeutic manipulation of memory, the paradoxes of placebo use, the behavioral control of criminals, the possibly spiritual benefits of transcranial magnetic stimulation, and the biological criteria of death. In each case Glannon brings his philosophical framework to bear, weighs the risks and benefits of interventions, and makes concrete recommendations, most of which seem well-reasoned and defensible. All this makes the book a valuable resource for those wanting a survey of current (and future) neuroethical concerns, and a clear viewpoint against which to test their own intuitions and reasoning.

Glannon’s perspective is broadly physicalist and emergentist: although mental capacities aren’t straightforwardly reducible to neural operations, mind and personhood nevertheless depend on what the brain, modulated by the body and environment, does. Such dependence inevitably raises issues of free will and moral responsibility. Glannon aligns himself with philosophical compatibilists, who accept some type of physicalism yet find sufficient basis for responsibility in our capacities for self-control (Fischer and Ravizza 1998). Such responsibility is compatible with the fact that the operations of the brain, although dauntingly complex, are most likely deterministic. We remain moral agents with robust rights and responsibilities even though we’re completely caused creatures. Compatibilism thus secures the physically instantiated person as a source of responsible action and a legitimate object of moral concern against the threat of “creeping mechanism” (Dennett 1988). This conclusion is of the first importance, given that neuroscience will likely make the cause and effect relations between brain, mind and behavior ever more transparent.

But if the self survives scientific analysis, the immaterial soul doesn’t, which means that the integrity of persons – now understood as neural constructions, not essences – is obviously at risk from interventions that target the brain. Glannon is concerned to protect the self and its identity as we seek to cure diseases, treat behavioral disorders and perhaps even rehabilitate inmates using the latest neurotechnology. But the question then becomes how and where to draw the line between interventions that restore the peripheral characteristics and capacities of persons, and those that alter persons themselves. That there might not be a bright line doesn’t obviate the question.

Interventions targeting the brain, it is hoped, support the integrity of persons by restoring normal function, whether it’s been compromised by a psychiatric-behavioral disorder (anxiety, depression, OCD, PTSD, addiction) or a neurological condition (epilepsy, dementia, Parkinson’s). There are, consequently, a wide range of treatments discussed by Glannon, some accepted, some experimental, some more invasive than others, that have uncontroversially therapeutic objectives. If the (mentally competent) patient voluntarily consents and the possible benefits clearly outweigh the risks, there’s no reason to withhold treatment. Glannon is particularly helpful in sorting out hypothetical risk-benefit scenarios, giving us a wealth of neurological, medical and psychiatric detail.

But more controversial are cases in which a person’s core identity – personality, autobiographical memories, behavioral dispositions – might be affected or even become the target of interventions. For instance, should the beta-blocker propranolol be used to erase traumatic memories diagnostic of PTSD if it also affects a patient’s baseline emotional responsiveness?  As Glannon reports, the President’s Council on Bioethics “expressed concern that therapeutic forgetting could subtly reshape who we are.” [p 87] But, more concerned with alleviating suffering than maintaining a patient’s perfect self-fidelity, Glannon recommends in favor of therapy, at least in severe cases.

Even more contentious is how to treat patients and (all too often) incarcerated offenders who, although basically rational, have significant personality and impulse control disorders that put them on the cusp of the medical-moral divide. In such cases the core capacities and characteristics of the self seem pathological, in dire need of treatment, but our legal and moral tradition mandates punishment for even marginally sane offenders. As meted out in our criminal justice system, punishment all too often undermines any possibility for self-transformation, except for the worse. Glannon suggests that, as an alternative to prison, we could in some cases offer voluntary treatment with psychotropic drugs to increase the capacity for self-control, even if this might affect personality [p 102]. Indeed, fundamentally changing the person might be the very objective, in which case the medical and moral domains are fully intertwined.

Many might find this prospect disturbing, since it seems to threaten the inviolability and moral status of self. But if we are essentially neural constructions, then our moral failings – our normatively condemnable behavioral propensities – are instantiated by the brain, and thus might someday be “cured” with the right sort of interventions. Why not do so, with informed consent? And if persons can be fixed, do they still deontologically deserve punishment for their misdeeds (Greene and Cohen 2004)?  

This raises the issue of whether there’s an autonomous moral domain that validates the intuition that basically sane individuals shouldn’t be fixed (they aren’t really broken, are they?), but only praised or blamed (Sher 2006). Glannon says that once conjured into existence by neurons, persons come to have their own irreducibly reasons-based, socially responsive and thus perhaps specifically moral capacities. But his physicalist compatibilism means that such capacities, for instance to resist a depraved impulse, can’t transcend the (likely) deterministic workings of our brains and bodies. The moral dimension of behavior is thus a person-level descriptive and explanatory framework operating over what neuroscience reveals as a mechanistic causal system. However, having rid the machine of its ghost, we might wonder in what sense complex biological processes such as ourselves deserve to be punished instead of (voluntarily) improved, should this become possible. Since we can’t live without making person-level normative judgments about behavior, we remain moral agents, even if we are mechanisms (Clark 2006). But a mature neuroethics, which Glannon does much to advance, might nevertheless challenge some of our deepest moral intuitions.

References

Clark, T. 2006. Holding mechanisms responsible. Medical Ethics 13(3): 10-11.

Dennett, D. 1988. Quining qualia. In Consciousness in Contemporary Science, ed. A. Marcel and E. Bisiach. Oxford: Oxford University Press.

Farah, J., and A. Heberlein. 2007. Personhood and neuroscience: naturalizing or nihilating?  American Journal of Bioethics 7(1): 37-48.

Fischer, J., and M. Ravizza. 1998. Responsibility and Control: A Theory of Moral Responsibility. New York: Cambridge University Press.

Greene, J., and J. Cohen. 2004. For the law, neuroscience changes nothing, and everything (link is external). Philosophical transactions of the Royal Society of London. Series B, Biological sciences 359: 1775-1785.

Sher, G. 2006. In Praise of Blame. Oxford: Oxford University Press.