Walter Glannon

Psychopathy involves impaired capacity for prudential and moral reasoning due to impaired capacity for empathy, remorse, and sensitivity to fear-inducing stimuli. Brain abnormalities and genetic polymorphisms associated with these traits appear to justify the claim that psychopaths cannot be morally responsible for their behavior. Yet psychopaths are capable of instrumental reasoning in achieving their goals, which suggests that they have some capacity to respond to moral reasons against performing harmful acts and refrain from performing them. The cognitive and affective impairment of the psychopath justifies mitigated responsibility, but not excuse

Major depression is a disorder of the mind caused by dysfunction of both the body and the brain. Because it is a psychiatric illness and psychiatry is a branch of medicine, the question of how mind and body interact in depression should be treated as a medical rather than metaphysical mind-body problem. The relation between mind and body as it pertains to this illness should be construed in teleological rather than causal terms. Mental states like beliefs and emotions serve an adaptive purpose by constraining the physiologic systems involved in the body's stress response, thus preserving homeostasis and protecting us from various disorders. Depression results when the mind fails it its constraining role.

Endophenotypes are an exciting and important area of research in genetically complex psychiatric diseases. They are biological markers between genotype and external phenotype that may indicate susceptibility to or manifest as early signs of a wide range of mental disorders. Identifying endophenotypes can enable researchers to tease apart the biological components of psychiatric diseases and thereby gain a better understanding of them. They may lead to more accurate prediction and to more effective prevention and treatment. Endophenotypes also have implications for the philosophy of mind and the ethics of informed consent.

Many drugs have therapeutic off-label uses for which they were not originally designed. Some drugs designed to treat neuropsychiatric and other disorders may enhance certain normal cognitive and affective functions. Because the long-term effects of cognitive and affective enhancement are not known and may be harmful, a precautionary principle limiting its use seems warranted. As an expression of autonomy, though, competent individuals should be permitted to take cognition- and mood-enhancing agents. But they need to be aware of the risks in chronic use of these agents and to take responsibility for their effects. A reasonable middle ground between these positions is to warn those who choose to enhance that doing so entails risks.

Advances in genetic technology in general and medical genetics in particular will enable us to intervene in the process of human biological development which extends from zygotes and embryos to people. This will allow us to control to a great extent the identities and the length and quality of the lives of people who already exist, as well as those we bring into existence in the near and distant future. Genes and Future People explores two general philosophical questions, one metaphysical, the other moral: (1) How do genes, and different forms of genetic intervention (gene therapy, genetic enhancement, presymptomatic genetic testing of adults, genetic testing of preimplantation embryos), affect the identities of the people who already exist and those we bring into existence? and (2) How do these interventions benefit or harm the people we cause to exist in the near future and those who will exist in the distant future by satisfying or defeating their interest in having reasonably long and disease-free lives? Genes and Future People begins by explaining the connection between genes and disease, placing genetic within a framework of evolutionary biology. It then discusses such topics as how genes and genetic intervention influence personal identity, what genetic testing of individuals and the knowledge resulting from it entails about responsibility to others who may be at risk, as well as how gene therapy and genetic enhancement can affect the identities of people and benefit or harm them. Furthermore, it discusses various moral aspects of cloning human beings and body parts. Finally, it explores the metaphysical and moral implications of genetic manipulation of the mechanisms of aging to extend the human life span.The aim Genes and Future People is to move philosophers, bioethicists, and readers in general to reflect on the extent to which genes determine whether we are healthy or diseased, our identities as persons, the quality of our lives, and our moral obligations to future generations of people.

Brain implants, such as Deep Brain Stimulation (DBS), which are designed to improve motor, mood and behavioural pathology, present unique challenges to our understanding of identity, agency and free will. This is because these devices can have visible effects on persons' physical and psychological properties yet are essentially undetectable when operating correctly. They can supplement and compensate for one's inherent abilities and faculties when they are compromised by neuropsychiatric disorders. Further, unlike talk therapy or pharmacological treatments, patients need not ‘do’ anything for the treatment to take effect. If one accepts, as we argue here, that brain implants are unique among implantable types of devices, then this can have significant implications for what it means to persist as the same person and be the source of one's thoughts and actions. By examining two of the most common indications for DBS in current use, namely in the motor (Parkinson's Disease) and psychiatric (Major Depression) domains, we further argue that although DBS, as it is currently applied, does not necessarily represent a unique threat to personal identity and agency per se, it introduces an unprecedented ‘third party’ into the debate on these concepts. In this way, DBS can be used as a tool to begin probing, both conceptually and empirically, some of philosophy's most perennial metaphysical questions

Neuroimaging, psychosurgery, deep-brain stimulation, and psychopharmacology hold considerable promise for more accurate prediction and diagnosis and more effective treatment of neurological and psychiatric disorders. Some forms of psychopharmacology may even be able to enhance normal cognitive and affective capacities. But the brain remains the most complex and least understood of all the organs in the human body. Mapping the neural correlates of the mind through brain scans, and altering these correlates through surgery, stimulation, or pharmacological interventions can affect us in both positive and negative ways. We need to carefully weigh the potential benefit against the potential harm of such techniques. This paper examines some of these techniques and explores the emerging ethical issues in clinical neuroscience.

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 a provocative 1991 paper, Alvin Moss and Mark Siegler argued that it may be fair to give individuals with alcohol-related end-stage liver disease lower priority for a liver transplant than those who develop end-stage liver disease from other factors. Like other organs, there is a substantial gap between the available livers for transplantation and the number of people who need liver transplants. Yet, unlike those with end-stage renal disease, who can survive for some time on dialysis before receiving a kidney transplant, those with liver failure will die without a liver transplant

Obsessive-compulsive disorder (OCD) and other psychiatric disorders can interfere with a person’s capacity to control the nature of his mental states and how they issue in his decisions and actions. Insofar as this sort of control is identified with free will, and psychiatric disorders can impair this control, these disorders can impair free will. The will can be compromised by dysregulated neural networks that disable the mental mechanisms necessary to regulate thought, motivation, and action. Neural and mental dys-function result in the maladaptive and pathological behaviors associated with these disorders. In “Obsessive-Compulsive Disorder, Free Will, and Control,” Gerben Meynen (2012) rightly ..

Many believe that it is morally wrong to give lower priority for a liver transplant to alcoholics with end-stage liver disease than to patients whose disease is not alcohol-related. Presumably, alcoholism is a disease that results from factors beyond one's control and therefore one cannot be causally or morally responsible for alcoholism or the liver failure that results from it. Moreover, giving lower priority to alcoholics unfairly singles them out for the moral vice of heavy drinking. I argue that the etiology of alcoholism may involve enough control for the alcoholic to be responsible for his condition and accordingly have a weaker claim to receive a new liver than someone who acquires the disease through no fault of his own. In addition, I show why it is more plausible to reframe the question of priority in terms of control and responsibility rather than virtue and vice. Given that medical resources like livers are scarce, some people may justifiably be given lower priority than others in receiving these resources.

Neurostimulation to restore cognitive and physical functions is an innovative and promising technique for treating patients with severe brain injury that has resulted in a minimally conscious state (MCS). The technique may involve electrical stimulation of the central thalamus, which has extensive projections to the cerebral cortex. Yet it is unclear whether an improvement in neurological functions would result in a net benefit for these patients. Quality-of-life measurements would be necessary to determine whether any benefit of neurostimulation outweighed any harm in their response to different degrees of cognitive and physical disability. These measures could also indicate whether the technique could be ethically justified and whether surrogates could give proxy consent to its use on brain-injured patients.

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...

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices.

Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. More generally, the paper addresses the question of how to weigh the psychopath’s presumptive right to non-interference in his brain and mind against the public interest in avoiding harm.

Recent advances in human genetics suggest that it may become possible to genetically manipulate telomerase and embryonic stem cells to alter the mechanisms of aging and extend the human life span. But a life span significantly longer than the present norm would be undesirable because it would severely weaken the connections between past‐ and future‐oriented mental states and in turn the psychological grounds for personal identity and prudential concern for our future selves. In addition, the collective effects of longer lives might lower the quality of life for all people. These two problems provide reasons against genetic manipulation of cells to alter the length of the human life span.

Research into the mechanisms of aging has suggested the possibility of extending the human life span. But there may be evolutionary biological reasons for senescence and the limits of the cell cycle that explain the infirmities of aging and the eventual demise of all human organisms. Genetic manipulation of the mechanisms of aging could over many generations alter the course of natural selection and shift the majority of deleterious mutations in humans from later to earlier stages of life. This could harm people in the distant future by making them more susceptible to premature disease and mortality. Thus there are biological and moral reasons to carefully consider the implications of exploiting this technology on a broad scale to extend the lives of people in the present and near future.