Timothy Brown invites us to think about the ways in which people who are being treated with deep brain stimulation might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators". We agree that it is important to develop conceptual frameworks that (...) both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three... (shrink)

Deep Brain Stimulation is an FDA-approved treatment for the symptoms of Parkinson's disease, essential tremor, dystonia, and epilepsy—with experimental use for mood disorders. DBS systems consist of a signal generator, typically implanted in the user's chest, that sends impulses to electrodes implanted in select areas of the user's brain. These signals change the activity of areas of the brain associated with unwanted symptoms. Several research groups have begun trials to use DBS as a treatment for psychiatric disorders. DBS, however, comes (...) with a... (shrink)

In The Assisted Reproduction of Race, Camisha Russell states: "My central aim here is to explore how notions of race and racial identity function within assisted reproductive technologies ". The way she does this may surprise some bioethicists. Moving beyond principles and traditional ethical theories, Russell instead draws on the work of critical race theory and the philosophy of technology. By showing the usefulness of these theories, she encourages bioethicists to expand our theoretical toolbox.After giving an overview of the main (...) responses critical race theorists give to what race is, Russell ultimately wants to focus more on what race does. For example, one of the points Russell makes over and over... (shrink)

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...) interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

The healthcare system—the assemblage of hospitals, insurers, professional associations, policymakers, patients, caregivers, and other entities oriented toward health in the United States—does more than cure illness. It is, and in some cases ought to be but falls short, attentive to endpoints other than cure, such as comfort, participation in desired activities, and the creation of families—things that may broadly be understood as promoting well-being. In the United States, health care utilization is prohibitively expensive. As a result, most people can only (...) access care through insurance. While the care available within the broad U.S. healthcare system may be oriented toward a wide variety of endpoints, insurance... (shrink)

Timothy Brown's piece "Building Intricate Partnerships with Neurotechnology" makes a valuable contribution to ethical discussion of questions about human identity and agency raised by Deep Brain Stimulation. The paper brings together a number of relational approaches to narrative identity and autonomy, drawing on first-personal empirical accounts, to extend a relational account of agency to include neurostimulators. In doing so, it builds on the contributions relational approaches have made to making sense of changes to aspects of selfhood following neurological intervention while (...) also helpfully reframing concerns away from the threat that DBS may pose to aspects of self-hood. This approach directs... (shrink)

Bioethics has already had a rich interaction with the relatively new field of neurotechnology. Scholars have wondered whether neurotechnological interventions, such as deep brain stimulation, are threats to personal identity, lead to alienation or create dilemmas between authenticity and autonomy, impact autonomy, detract from agency, or lead to self-estrangement. Many of these ethical investigations are concerned not with the targeted health benefits of neurotechnology but with whether and how they fit into users' lives in more personal and profound ways.In some (...) ways, this focus on general bioethical issues... (shrink)

In "Neurotechnologies, Relational Autonomy, and Authenticity," Mary Walker and Catriona Mackenzie engage with discourses surrounding the morality of neurotechnologies, arguing that these debates have been largely mistaken in their focus on worries about the effects of emerging technologies on human authenticity. They offer an alternative, autonomy-centered approach that problematizes concerns about authenticity as necessarily "essentialist or existentialist views of the self" that "transcends socialization". Instead, they suggest that, although authenticity is a condition for self-governance, autonomy itself is the more helpful (...) way to frame current debates about neurotechnologies.The goals of their... (shrink)

Modern medical technology has made it possible for babies to survive with conditions that would have ended their lives only half a century ago. But complex health care interventions and regimens are not enough. These children require support, caregiving, and constant vigilance from their families, especially their parents. Sometimes referred to as children with "special needs," their dependency and vulnerability may stem from genetic disorders, premature births, serious accidents, or illness. This includes conditions such as severe autism spectrum disorder, Down (...) syndrome, hypoxic ischemic encephalopathy, Trisomy 13, Trisomy 18, Fragile X Syndrome, spina bifida, and brain damage... (shrink)

The number of cesarean sections performed globally has been consistently rising since the 1980s.1 The number of cesareans performed now greatly exceeds the number that experts predict are necessary.2 In Brazil, the world's "cesarean capital," over half of births are surgical. In the United States, approximately one third of babies are delivered by cesarean, and in the United Kingdom around 26 percent of births are by cesarean.3 Cesarean section can be a life-saving intervention when vaginal birth poses a risk to (...) woman or fetus.4 However, some doctors believe that cesareans performed in the absence of an emergency carry substantial risks for limited or no benefit (Wagner 2000... (shrink)

Mary Walker and Catriona Mackenzie's "Neurotechnologies, Relational Autonomy, and Authenticity" provides much needed reflection on the lens through which ethical concerns about the use of neurotechnologies are usually viewed. There is a general worry about the sometimes rapid and radical effects that such technologies can have on personalities and values. These concerns are often described as worries about how such technologies might alter our identities or compromise our authenticity. Clear theorizing of the notoriously slippery notions of "identity" and "authenticity" is, (...) however, surprisingly rare in these discussions. Walker and Mackenzie's paper undertakes that theoretical work, arguing that the major... (shrink)

Shelley Tremain's book, Foucault and Feminist Philosophy of Disability, considers how disability has been incorrectly contained by medical ethics or ignored entirely by mainstream philosophy. She argues for an antifoundational approach to disability that accounts for the historical and material conditions of people while also attending to the conditions of disabled philosophers themselves. This important contribution to the fields of philosophy, gender studies, and disability studies explicitly addresses how ableism has impacted academic discourses in philosophy, harming disabled philosophers, disabled people, (...) and the production of knowledge in these areas. This interrogation of ableism in academia comes as a... (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Feminists have worked extensively to explore how our contemporary capitalist and neoliberal world creates docile subjects. One feature of this docility is the focus on fostering subjects that not only are good consumers and workers but also subjects that make good choices—that is, choices that do not disrupt capitalist postcolonial distributions of wealth, power, and control. One example of this trend is the focus in public health discourses in the last several decades of seeing unhealthy bodies as objects that need (...) better behavior management—such as the wars against smoking, obesity, and drug/alcohol abuse. At the same time, feminists are often concerned with how to foster greater well-being, including the health... (shrink)

Exploitation is a concept that escapes easy definition. As Ruth Sample writes in her contribution to Exploitation: From Practice to Theory, "There seems to be no clear, publicly recognized principle, that allows us to determine which interactions are exploitative and which are not". As someone who researches in the field of human trafficking, this is a problem I recognize. Exploitation is at the nub of the international definition of human trafficking. The United Nation's anti-trafficking Palermo Protocol outlines trafficking as the (...) deceptive or coercive movement of people for "the purpose of exploitation" in realms including "the prostitution of others, servitude, labour or... (shrink)