In the case of the minimally conscious patient M, the English Court of Protection ruled that it would be unlawful to withdraw artificial nutrition and hydration (ANH) from her. The Court reasoned that the sanctity of life was the determining factor and that it would not be in M's best interests for ANH to be withdrawn. This paper argues that the Court's reasoning is flawed and that continued ANH was not in this patient's best interests and thus should have been (...) withdrawn. (shrink)
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 .. (shrink)
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. (shrink)
In “Minds, Brains, and Norms,” Michael Pardo and Dennis Patterson claim that the idea that ‘you are your brain’ does not contribute to a plausible account of human behavior. I argue that they leave too little of the brain in their account of different types of behavior.
Deep-brain stimulation has been used to treat advanced Parkinson disease and other neurological and psychiatric disorders that have not responded to other treatments. While deep-brain stimulation can modulate overactive or underactive regions of the brain and thereby improve motor function, it can also cause changes in a patient’s thought and personality. This paper discusses the trade-offs between the physiological benefit of this technique and the potential psychological harm.
Many neuroscientists have claimed that our minds are just a function of and thus reducible to our brains. I challenge neuroreductionism by arguing that the mind emerges from and is shaped by interaction among the brain, body, and environment. The mind is not located in the brain but is distributed among these three entities. I then explore the implications of the distributed mind for neuroethics.
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. (shrink)
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. (shrink)
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. (shrink)
Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 regarding books they would like to see reviewed or books they are interested in reviewing.
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. (shrink)
Narrative fiction can engage readers in generating imaginative recreations of the inner worlds of doctors and patients, which are largely inaccessible through typical clinical case analysis. Fiction about medicine can yield insight into patients’ subjective experience of illness and can highlight the need for an empathetic response from doctors to patients affected by illness. Mark Salzman’s novel, Lying Awake, invites us to reflect on social, psychological, and spiritual dimensions of neurological illness in particular and of the doctor/patient relationship in general.
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. (shrink)
Healing aims to restore the wholeness of persons by restoring the unity of mind and body disrupted by disease. Transcendence promotes healing by altering or cultivating beliefs that can modulate the body’s response to pain or make sense of pain. This in turn can produce an emotional response that enables people to cope with chronic or terminal illness. I explain transcendence in terms of a monistic rather than dualistic conception of mind and body, which supports the idea of medicine as (...) a healing art as well as a curative science. (shrink)
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. (shrink)
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. (shrink)
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. (shrink)