Walter Glannon

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.

Today, advances in medicine and biotechnology occur at a rapid pace and have a profound impact on our lives. Mechanical devices can sustain an injured person's life indefinitely. Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the body and brain can reveal disorders before symptoms appear. Genetic testing of embryos can predict whether people will have diseases earlier or later in life. It may even become possible to clone human beings. These and other developments raise difficult ethical questions. Biomedical Ethics is an engaging philosophical introduction to the most important ethical positions and arguments in six areas of biomedicine: the patient-doctor relationship, medical research on humans, reproductive rights and technologies, genetics, medical decisions at the end of life, and the allocation of scarce medical resources. Concisely capturing the historical, contemporary, and future-oriented aspects of the field, author Walter Glannon discusses both perennial issues in medicine, such as doctors' duties to patients, and recent and emerging issues in scientific innovation, including gene therapy and cloning. Ideal for undergraduate courses in contemporary moral problems, introduction to ethics, and introduction to bioethics, Biomedical Ethics is accessible to students who have little or no background in ethical theory, medicine, or biotechnology

Most religious traditions hold that what makes one a person is the possession of a soul and that this gives one moral status. This status in turn gives persons interests and rights that delimit the set of actions that are permitted to be done to them. In this paper, I identify the soul with the capacity for consciousness and mental life and examine the ethical aspects of medical decision-making at the beginning and end of life in cases of patients who either never have had or have lost this capacity. I argue that, although these patients may lack moral status, they nonetheless have moral value as human organisms and forms of Godgiven biological life. In particular, I explore what this value entails about the permissibility of withholding or withdrawing life-sustaining treatment and of harvesting viable organs from patients with no higher-brain function.

With the gap between the number of transplantable organs and the number of people needing transplants widening, many have argued for moving from an opt-in to an opt-out system of deceased organ donation. In the first system, individuals must register their willingness to become donors after they die. In the second system, it is assumed that individuals wish to become donors unless they have registered an objection to donation. Opting out has also been described as presumed consent. Spain has had the most successful presumed consent policy, resulting in a substantial increase in the donation rate. 1 Despite support for an opt-out system from the British Medical Association and other groups since 1999, the report of a task force delivered in November 2008 recommended that the current opt-in system in the UK be retained. 2 The USA has also retained an opt-in system.3 Two prominent American bioethicists, Tom Beauchamp and James Childress, claim that an opt-out policy “would not likely be adopted in the United States, and if it were adopted, it probably would not increase the number of organs for transplantation because so many citizens would opt out.”4Offering financial incentives such as paying funeral expenses for a deceased donor’s family is one way of increasing the number of organs. A regulated market in organs is another.5 In the UK at least, there is broader support for presumed consent. Among the alternatives to opting in, this system has the best prospect of eventually being adopted. Presumed consent would not obviate but retain the basic idea of consent, because individuals would still have the right to opt out and choose not to donate. 6One argument for presumed consent is that it would reduce the incidence of free riding. For a free rider, it is not rational …

In 1999, a case was described on national television in which a woman had enlisted onto an international bone marrow registry with the altruistic desire to offer her bone marrow to some unidentified individual in need of a transplant. The potential donor then was notified that she was a compatible match with someone dying from leukemia and gladly donated her marrow, which cured the recipient of the disease. Years later, though, the recipient developed end-stage renal disease, a consequence of the high-dose chemotherapy she received earlier to destroy her stem cells and prepare her for the bone marrow transplant. Finding a suitable donor for a kidney transplant proved extremely difficult. Desperate, she requested that the donor registry personnel help her locate the individual who earlier was determined to be a compatible donor and asked this now-identifiable individual to consider donating one of her two normally functioning kidneys for a kidney transplant

In a recent article in this journal, we argued that living organ donation from a parent to a child should be described as a beneficent rather than an altruistic act. Emotional relationships can generate an obligation of beneficence to help those with whom we have these relationships. This may involve an obligation for a parent to donate an organ to a child, even though it entails some risk to the parent. The parent's donation is not altruistic because altruistic acts are not obligatory but optional, and they are motivated solely or primarily by other-regarding concerns. In contrast, donor parents' other-regarding concerns are inseparable from their own self-regarding concerns. An individual who donates to a stranger is acting altruistically. She may choose to help others to whom she is not emotionally related for a variety of reasons—sympathy, compassion, generosity, or a desire to give something back to humanity. But she does not have an obligation to do so. Although she may benefit as a consequence of donating, this is not her reason for donating. Instead, her action is motivated by a concern for the recipient's own sake. This is what makes the donation altruistic, and it can be justified without any expectation of benefit to the donor. However, although the potential competent donor decides whether the donation is in her best interests, physicians have the right to refuse to perform a transplant if the risks to the donor are too great or the potential benefits to the recipient are too small

Testing embryonic cells for genetic abnormalities gives us the capacity to predict whether and to what extent people will exist with disease and disability. Moreover, the freezing of embryos for long periods of time enables us to alter the length of a normal human lifespan. After highlighting the shortcomings of somatic‐cell gene therapy and germ‐line genetic alteration, I argue that the testing and selective termination of genetically defective embryos is the only medically and morally defensible way to prevent the existence of people with severe disability, pain and suffering that make their lives not worth living for them on the whole. In addition, I consider the possible harmful effects on children born from frozen embryos after the deaths of their biological parents, or when their parents are at an advanced age. I also explore whether embryos have moral status and whether the prospects for disease‐preventing genetic alteration can justify long‐term cryopreservation of embryos.

Neuroimaging showing brain abnormalities is increasingly being introduced in criminal court proceedings to argue that a defendant could not control his behavior and should not be held responsible for it. But imaging has questionable probative value because it does not directly capture brain function or a defendant’s mental states at the time of a criminal act. Advanced techniques could transform imaging from a coarse-grained measure of correlations between brain states and behavior to a fine-grained measure of causal connections between them. Even if this occurs, bias and other attitudes may unduly influence jurors’ interpretation of the data. Moreover, judges’ decisions about whether neuroimaging data is legally relevant and admissible are normative decisions based on more than empirical evidence. Advanced neuroimaging will better inform assessments of criminal responsibility but will not supplant or explain away the psychological and normative foundation of the criminal law

Some philosophers have argued that the psychopath serves as the ultimate test of the limits of moral responsibility. They hold that the psychopath lacks a deep knowledge of right and wrong, and that Kant’s ethics arguably offers the most plausible account of this moral knowledge. On this view, the psychopath’s lack of moral understanding is due to a cognitive failure involving practical reason. I argue that the deep knowledge of right and wrong consists of emotional and volitional components in addition to a cognitive one. Hence it is mistaken to claim that the psychopath’s moral deficiency is due solely to a cognitive failure, or that his lack of the deep knowledge of right and wrong can be explained entirely in terms of a defect of practical reason. I refer to empirical research to show that the Kantian model of practical reason does not provide a satisfactory account of responsibility of the psychopath in particular or of moral agents in general. On the basis of both philosophical and empirical considerations, I argue that the psychopath is at least partly responsible for his behaviour.

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure.

In light of the magnitude of interpersonal harm and the risk of greater harm in the future, Ingmar Persson and Julian Savulescu have argued for pharmacological enhancement of moral behaviour. I discuss moral bioenhancement as a set of collective action problems. Psychotropic drugs or other forms of neuromodulation designed to enhance moral sensitivity would have to produce the same or similar effects in the brains of a majority of people. Also, a significant number of healthy subjects would have to participate in clinical trials testing the safety and efficacy of these drugs, which may expose them to unreasonable risk. Even if the drugs were safe and effective, a majority of people would have to co-operate in a moral enhancement programme for such a project to succeed. This goal would be thwarted if enough people opted out and decided not to enhance. To avoid this scenario, Persson and Savulescu argue that moral enhancement should be compulsory rather than voluntary. But the collective interest in harm reduction through compulsory enhancement would come at the cost of a loss of individual freedom. In general, there are many theoretical and practical reasons for scepticism about the concept and goal of moral enhancement.

The ethics of human enhancement has been a hotly debated topic in the last 15 years. In this debate, some advocate examining science fiction stories to elucidate the ethical issues regarding the current phenomenon of human enhancement. Stories from science fiction seem well suited to analyze biomedical advances, providing some possible case studies. Of particular interest is the work of screenwriter Andrew Niccol (Gattaca, S1m0ne, In Time, and Good Kill), which often focuses on ethical questions raised by the use of new technologies. Examining the movie In Time (2011), the aim of this paper is to show how science fiction can contribute to the ethical debate of human enhancement. In Time provides an interesting case study to explore what could be some of the consequences of radical life-extension technologies. In this paper, we will show how arguments regarding radical life-extension portrayed in this particular movie differ from what is found in the scientific literature. We will see how In Time gives flesh to arguments defending or rejecting radical life-extension. It articulates feelings of unease, alienation and boredom associated with this possibility. Finally, this article will conclude that science fiction movies in general, and In Time in particular, are a valuable resource for a broad and comprehensive debate about our coming future.

In defending what he calls ‘full-blooded Epicureanism’, James Stacey Taylor argues that the dead cannot be harmed or wronged.1 This has implications for a range of bioethical issues pertaining to death, including posthumous organ procurement. Taylor claims that respecting the autonomy of persons requires that their desires regarding the treatment of their postmortem bodies be given due consideration while these persons are alive. It is not obvious what this means in practical terms, though Taylor says that respect for autonomy requires that these wishes be recorded with the intention that they be followed. Yet if respect for autonomy only applies to the wishes of premortem persons, and if there are no posthumous harms or wrongs, then it is not clear why it would matter morally whether one's wishes about what to do with one's organs were fulfilled or thwarted after one's death.Most of us have an interest in what happens to our bodies not just during our lives but also after our deaths. Personal sovereignty and autonomy give persons a right to control what happens to their bodies, and since the body …