Walter Glannon

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.

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.

This work is an analysis of the metaphysical, psychological, and normative conditions that are necessary and sufficient for individual persons to be morally responsible. It takes the content of responsibility, that is, what persons are responsible for, to include mental states as well as actions, omissions, and the consequences of actions and omissions. I hold that moral responsibility entails causal responsibility. A person is causally responsible for mental states, actions, and states of affairs just in case he has the capacity to respond to practical reasoning, to translate reasons into action, and to respond to theoretical reasoning concerning the likely consequences of what he does or fails to do. He is morally responsible if, in addition to these capacities, he has the normative capacity to respond to moral reasons for the right sorts of action. ;In Chapters One and Two, I examine the three psychological capacities necessary for moral responsibility. In Chapter Three, I challenge three principles that have figured prominently in the debate on moral responsibility. I argue that persons may be responsible for actions they are forced to perform, for failing to perform actions they are unable to perform, and for consequences that are not directly sensitive to their actions. In Chapter Four, I show how causal determinism is compatible with the notion that persons can act freely and responsibly. Three main theses distinguish this work from other work on the subject. First, the mental basis on which we act is at least as important as our actions themselves in explaining why we are responsible. Second, normative competence involves the capacity to have certain emotions, together with the capacity for practical and theoretical reasoning. Third, it is not the ability to do otherwise but rather the autonomy and causal efficacy of our motivational states and actions which can make us responsible even in a deterministic world.

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.

In a recent set of papers, Aaron Spital has proposed conscription or routine recovery of cadaveric organs without consent as a way of ameliorating the severe shortage of organs for transplantation. Under the existing consent requirement, organs can be taken from the bodies of the deceased if they expressed a wish and intention to donate while alive. Organs may also be taken when families or other substitute decisionmakers decide on behalf of the deceased to allow organ procurement for the purpose of transplantation. When patients or families do not consent to organ procurement, many transplantable organs are lost. This is a tragic yet avoidable situation. The dead are beyond any benefit or harm, and their organs could be used to prevent harm by saving and improving the lives of many people suffering and dying from end-stage organ failure

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 265-269 [Access article in PDF] The Psychology and Physiology of Depression Walter Glannon Trauma and stressful events can disrupt the physiologic homeostasis of our bodies and brains. The physiologic stress response consists of neural and endocrine mechanisms whose function is to reestablish homeostasis. These mechanisms include the secretion of glucocorticoids (cortisol) and catecholemines (epinephrine and norepinephrine). Once an external event has ceased to be a stressor or threat to a human organism, an integrated system of negative feedback loops inhibits the continued production of these hormones and effectively shuts down the stress response. These mechanisms are adaptive in the sense that they ensure the survival of the organism by reestablishing homeostasis. But prolonged exposure to real or perceived stressors can trigger prolonged secretion of stress hormones, thereby disrupting the feedback systems and causing a cascade of pathogenic events. The stress response is a double-edged sword. An acute stress response can protect an organism from external threats and reestablish homeostasis. But a chronic stress response can cause the body's defenses to become damaging rather than protective and to result in various disorders. Acute stress responses are adaptive. Chronic stress responses are often maladaptive and pathogenic.In "Depression as a Mind-Body Problem," I characterized major clinical depression as a disorder resulting from a maladaptive chronic stress response (Glannon 2003). Specifically, I argued that depression often results when our beliefs and emotions are out of proportion to the true nature of external events. The mind prolongs rather than constrains the physiologic stress response. Depression is not a disorder of the brain alone or the mind alone, however. Endocrine and immune dysfunction can contribute to the dysfunction in the brain and central nervous system that are involved in depression. Moreover, the contents of the mental states that initiate the sequence of events leading to depression are reflections of the person's natural and social environment. Thus, a satisfactory account of depression requires an analysis of the interconnections among the central nervous, endocrine, and immune systems, as well as the mind and the environment. All of these factors support the description of depression as a psychoneuroimmunologic disorder.Mike Martin (Martin 2003) and Thomas Fuchs (Fuchs 2003) discuss important aspects of depression that I did not elaborate in my paper. Martin argues that I fail to distinguish between depression as a mood and depression as a disorder. This is pertinent to the distinction evolutionary psychiatrists draw between moods that are adaptive and moods that are maladaptive. In contrast to my negative characterization of depression, Martin also makes a case for the positive [End Page 265] contributions of depression to meaningful life. Fuchs explores the notion of the brain as an organ of translation enabling patients to have meaningful subjective experience. The emphasis on subjectivity has important implications for potential preventive and therapeutic interventions for depression. For whether a person perceives an external event as a stressor may play a crucial role in the physiologic stress response. I will address the main points of these two authors in turn.Contrary to what Martin claims, I explicitly defined chronic depression as an affective (mood) disorder. My focus was on the clinical definition of major depression as a moderately severe to severe chronic disorder. It consists of affective, cognitive, and even physical dysfunction that interferes with a person's ability to carry out the normal tasks of daily life. This characterization of major chronic depression distinguishes it from milder forms of depression, such as dysthymia. Because these milder forms do not involve the same type or degree of dysfunction as more severe forms, they are not appropriately characterized as pathologies. For this reason, I focused on Nesse's (2000) discussion of depression rather than on his discussion of low mood. In fairness to Nesse and Stevens and Price (2000), not all forms of depression are pathologic according to the evolutionary view they defend. Some passive aspects of mild depression may be useful in alerting us to dangerous or wasteful behavior. It does seem plausible to describe depressed moods as falling along a continuum from those that...

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