Walter Glannon

This chapter discusses metaphysical and ethical issues regarding the neurological and psychological effects of injuries to the brain. It examines the issue of personal identity by examining how these injuries can cause amnesia, disrupting the psychological continuity necessary for one to survive as the same person, and how they can harm individuals by defeating their interest in surviving. It also discusses disorders of consciousness resulting from these injuries, whether an individual with such a disorder continues to exist as a person, and how he can be harmed by it. It considers whether consciousness has value or disvalue. It also explores the respects in which interventions designed to restore physical and cognitive functions for these individuals can benefit or harm them.

Neuroscience challenges our beliefs about agency and autonomy because it seems to imply that we have no control of our behavior: most brain processes are not transparent to us, we have no direct access to the efferent system, and we only experience the sensorimotor consequences of our unconscious motor plans. In this chapter, Walter Glannon argues that although unconscious processes drive many of our actions, this does not imply that conscious mental states have no causal role in our behavior and that we have no control over it. He argues that some degree of unconscious neural constraint on conscious mental states is necessary to modulate thought and action and promote flexible behavior and adaptability to environmental demands. He maintains that a nonreductive materialist account of the mind–brain relation makes it plausible to claim that mental states can cause changes in physical states of the brain.

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.

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.

Deep Brain Stimulation (DBS) represents a key area of neuromodulation that has gained wide adoption for the treatment of neurological and experimental testing for psychiatric disorders. It is associated with specific therapeutic effects based on the precision of an evolving mechanistic neuroscientific understanding. At the same time, there are obstacles to achieving symptom relief because of the incompleteness of such an understanding. These obstacles are at least in part based on the complexity of neuropsychiatric disorders and the incompleteness of DBS devices to represent prosthetics that modulate the breadth of pathological processes implicated in these disorders. Neuroprostheses, such as an implanted DBS system, can have vast effects on subjects in addition to the specific neuropsychiatric changes they are intended to produce. These effects largely represent blind spots in the current debate on neuromodulation. Anthropological accounts can illustrate the broad existential dimensions of patients’ illness and responses to neural implants. In combination with current neuroscientific understanding, neuropsychiatric anthropology may illuminate the possibilities and limits of neurodevices as technical “world enablers”.

This book is an analysis and discussion of the soul as a psychophysical process and its role in mental representation, meaning, understanding and agency. Grant Gillett and Walter Glannon combine contemporary neuroscience and philosophy to address fundamental issues about human existence and living and acting in the world. Based in part on Aristotle's hylomorphism and model of the psyche, their approach is informed by a neuroscientific model of the brain as a dynamic organ in which patterns of neural oscillation and synchronization are shaped by biological, social and cultural factors inside and outside of it. The authors provide a richer and more robust account of the soul, or mind, than other accounts by framing it in neuroscientific and philosophical terms that do not explain it away but explain it as something that is shaped by how it responds to the natural and social environment in enabling flexible and adaptive behavior.

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.

We have only a limited understanding of how the brain enables thought and behavior and how it becomes dysfunctional in neuropsychiatric disorders. Research in cognitive psychology, psychiatry, neurology, neurosurgery and nuclear medicine has been critical to our current understanding of the brain. Continued research is necessary to gain more knowledge of the etiology and pathophysiology of brain disorders and develop therapies to safely and effectively control and possibly prevent them. Yet mapping the brain through neuroimaging and intervening in the brain with psychotropic drugs, growth factors or implantable neuromodulating devices entail certain risks for research subjects participating in clinical trials. These risks need to be weighed against the potential benefit of knowledge gained from the outcomes of these trials to millions of people suffering from psychiatric and neurological diseases. The risks in neuroscience research are greater than in any other area of medicine and biotechnology because the brain is the source of the mind and the psychological properties that define persons. Can patients with neuropsychiatric disorders give informed consent to participate in neuroscience research? If they cannot consent, then can others give proxy consent on their behalf? What are the obligations of investigators recruiting and monitoring research subjects? In discussing the ethical issues in this research, this chapter focuses on neuroimaging to assess patients with severe brain injuries, neuromodulating techniques such as deep brain stimulation in neurology and psychiatry and brain-computer interfaces to bypass brain and spinal cord injury in restoring movement and communication.

Central and peripheral biomarkers can be used to diagnose, treat, and potentially prevent major psychiatric disorders. But there is uncertainty about the role of these biological signatures in neural pathophysiology, and their clinical significance has yet to be firmly established. Psychomotor, cognitive, affective, and volitional impairment in these disorders results from the interaction between neural, immune, endocrine, and enteric systems, which in turn are influenced by a person’s interaction with the environment. Biomarkers may be a critical component of this process. The identification and interpretation of biomarkers also raise ethical and social questions. This article analyzes and discusses these aspects of biomarkers and how advances in biomarker research could contribute to personalized psychiatry that could prevent or mitigate the effects of these disorders.

This title was first published in 2002: This book is an analysis of the ways in which mental states ground attributions of responsibility to persons. Particular features of the book include: attention to the agent's epistemic capacity for beliefs about the foreseeable consequences of actions and omissions; attention to the essential role of emotions in prudential and moral reasoning; a conception of personal identity that can justify holding persons responsible at later times for actions performed at earlier times; an emphasis on neurobiology as the science that should inform our thinking about free will and responsibility; and the melding of literature on free will and responsibility in contemporary analytic philosophy with legal cases, abnormal psychology, neurology and psychiatry, which offers a richer texture to the general debate on the relevant issues.

Testa and colleagues argue that evaluation for suitability for living donor surgery is rooted in paternalism in contrast with the evaluation for most operative interventions which is rooted in the autonomy of patients. We examine two key ethical concepts that Testa and colleagues use: paternalism and autonomy, and two related ethical concepts, moral agency and shared decision making. We show that moving the conversation from paternalism, negative autonomy and informed consent to moral agency, relational autonomy and shared decision making, one better understands why the arguments give by Testa and colleagues fail.

The Neuroethics of Memory is a thematically integrated analysis and discussion of neuroethical questions about memory capacity and content, as well as interventions to alter it. These include: how does memory function enable agency, and how does memory dysfunction disable it? To what extent is identity based on our capacity to accurately recall the past? Could a person who becomes aware during surgery be harmed if they have no memory of the experience? How do we weigh the benefits and risks of brain implants designed to enhance, weaken or erase memory? Can a person be responsible for an action if they do not recall it? Would a victim of an assault have an obligation to retain a memory of this act, or the right to erase it? This book uses a framework informed by neuroscience, psychology, and philosophy combined with actual and hypothetical cases to examine these and related questions.

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.