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Neuroethics beyond Normal

Performance Enablement and Self-Transformative Technologies

Published online by Cambridge University Press:  20 January 2016

Abstract:

An integrated and principled neuroethics offers ethical guidelines able to transcend conventional and medical reliance on normality standards. Elsewhere we have proposed four principles for wise guidance on human transformations. Principles like these are already urgently needed, as bio- and cyberenhancements are rapidly emerging. Context matters. Neither “treatments” nor “enhancements” are objectively identifiable apart from performance expectations, social contexts, and civic orders. Lessons learned from disability studies about enablement and inclusion suggest a fresh way to categorize modifications to the body and its performance. The term “enhancement” should be broken apart to permit recognition of enablements and augmentations, and kinds of radical augmentation for specialized performance. Augmentations affecting the self, self-worth, and self-identity of persons require heightened ethical scrutiny. Reversibility becomes the core problem, not the easy answer, as augmented persons may not cooperate with either decommissioning or displacement into unaccommodating societies. We conclude by indicating how our four principles of self-creativity, nonobsolescence, empowerment, and citizenship establish a neuroethics beyond normal that is better prepared for a future in which humans and their societies are going so far beyond normal.

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Copyright © Cambridge University Press 2016 

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References

Notes

1. Levy, N. Neuroethics: A new way of doing ethics. AJOB Neuroscience 2012;2(2):39.CrossRefGoogle Scholar

2. Farah, M. Neuroethics: The ethical, legal, and societal impact of neuroscience. Annual Review of Psychology 2012;63:571–91.CrossRefGoogle ScholarPubMed

3. Giordano, J, Benedikter, R. An early—and necessary—flight of the Owl of Minerva: Neuroscience, neurotechnology, human socio-cultural boundaries, and the importance of neuroethics. Journal of Evolution and Technology 2012;22(1):1425.Google Scholar

4. Shook, JR, Giordano, J. A principled and cosmopolitan neuroethics: Considerations for international relevance. Philosophy, Ethics, and Humanities in Medicine 2014;9(1):article 1.Google ScholarPubMed

5. Beauchamp, T, Childress, J. Principles of Biomedical Ethics. Oxford: Oxford University Press; 1979.Google Scholar

6. Lanzilao, E, Shook, JR, Benedikter, R, Giordano, J. Advancing neuroscience on the 21st century world stage: The need for—and proposed structure of—an internationally relevant neuroethics. Ethics in Biology, Engineering and Medicine 2013;4(3):211–29.CrossRefGoogle Scholar

7. Spranger, T, ed. International Neurolaw: A Comparative Analysis. Berlin: Springer; 2012.CrossRefGoogle Scholar

8. Savulescu, J, Bostrom, N. Human enhancement ethics: The state of the debate. In: Savulescu, J, Bostrom, N, eds. Human Enhancement. Oxford: Oxford University Press; 2008:122.Google Scholar

9. Lin, P, Allhoff, F. Untangling the debate: The ethics of human enhancement. NanoEthics 2008;2(3):251–64.CrossRefGoogle Scholar

10. Chatterjee, A. The ethics of neuroenhancement. Handbook of Clinical Neurology 2013;118:323–34.CrossRefGoogle ScholarPubMed

11. Gordijn, B, Chadwick, R, eds. Medical Enhancement and Posthumanity. Berlin: Springer; 2008.Google Scholar

12. More, M, Vita-More, N. The Transhumanist Reader. Malden, MA: Wiley-Blackwell; 2013.CrossRefGoogle Scholar

13. Benedikter, R, Giordano, J, FitzGerald, K. The future of the self-image of the human being in the age of transhumanism, neurotechnology and global transition. Futures 2010;42(10):1102–9.CrossRefGoogle Scholar

14 Giordano, J. A preparatory neuroethical approach to assessing developments in neurotechnology. AMA Journal of Ethics 2015;17(1):5661.Google ScholarPubMed

15. Garrett, J, Jotterand, F, Ralston, DC. The Development of Bioethics in the United States. Dordrecht: Springer; 2013.CrossRefGoogle Scholar

16. See note 4, Shook, Giordano 2014.

17. Parens, E. Is better always good? The enhancement project. Hastings Center Report 1998;28(1):S1S15, at S2.CrossRefGoogle ScholarPubMed

18. Daniels, N. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly of Healthcare Ethics 2000;9(3):309–22.CrossRefGoogle ScholarPubMed

19. Resnik, D. The moral significance of the therapy-enhancement distinction in human genetics. Cambridge Quarterly of Healthcare Ethics 2000;9(3):365–77.CrossRefGoogle ScholarPubMed

20. Kamm, F. Is there a problem with enhancement? American Journal of Bioethics 2005;5(3):514.CrossRefGoogle Scholar

21. Chadwick, R. Therapy, enhancement and improvement. In: Gordjin, B, Chadwick, R, eds. Medical Enhancement and Posthumanity. Dordrecht: Springer; 2008:2537.Google Scholar

22. Savulescu, J, Sandberg, A, Kahan, G. Well-being and enhancement. In: Savulescu, J, ter Meulen, R, Kahane, G, eds. Enhancing Human Capacities. Malden, MA: Wiley-Blackwell; 2011:318.CrossRefGoogle Scholar

23. Shook, JR, Giordano, J, Galvagni, L. Cognitive enhancement kept within contexts: Neuroethics and informed public policy. Frontiers in Systems Neuroscience 2014;8:article 228.CrossRefGoogle ScholarPubMed

24. Camporesi, S. Oscar Pistorius, enhancement and post-humans. Journal of Medical Ethics 2008;34(9):639.CrossRefGoogle ScholarPubMed

25. Van Hilvoorde, I, Landeweerd, L. Enhancing disabilities: Transhumanism under the veil of inclusion? Disability and Rehabilitation 2010;32(26):2222–7.CrossRefGoogle ScholarPubMed

26. Hoberman, J. Sports physicians, human nature, and the limits of medical enhancement. In: Tolleneer, J, Sterckx, S, Bonte, P, eds. Athletic Enhancement, Human Nature and Ethics. Berlin: Springer; 2013:255–70.CrossRefGoogle Scholar

27. Ahmad, C, Grantham, W, Greiwe, R. Public perceptions of Tommy John surgery. The Physician and Sportsmedicine 2012;40(2):6472.CrossRefGoogle ScholarPubMed

28. Gini, A, Giordano, J. The human condition and strivings to flourish. In: Giordano, J, Gordijn, B, eds. Scientific and Philosophical Perspectives in Neuroethics. Cambridge: Cambridge University Press; 2010:343–54.CrossRefGoogle Scholar

29. Branson, J, Miller, D. Damned for Their Difference: The Cultural Construction of Deaf People as “Disabled.” Washington, DC: Gallaudet University; 2002.Google Scholar

30. Wolbring, G. Hearing beyond the normal enabled by therapeutic devices: The role of the recipient and the hearing profession. Neuroethics 2013;6(3):607–16.CrossRefGoogle ScholarPubMed

31. Shickle, D. Are “genetic enhancements” really enhancements? Cambridge Quarterly of Healthcare Ethics 2000;9:342–52.CrossRefGoogle ScholarPubMed

32. Jotterand, F. Beyond therapy and enhancement: The alteration of human nature. NanoEthics 2008;2(1):1523.CrossRefGoogle Scholar

33. De Melo-Martín, I. Defending human enhancement technologies: Unveiling normativity. Journal of Medical Ethics 2010;36(8):483–87.CrossRefGoogle ScholarPubMed

34. Buchanan, A. Beyond Humanity? The Ethics of Biomedical Enhancement. Oxford: Oxford University Press; 2011.CrossRefGoogle Scholar

35. Agar, N. Radical human enhancement, and what’s wrong with it. In: Basl, J, Sandler, R, eds. Designer Biology. Lanham, MD: Lexington Books; 2013:87104.Google Scholar

36. Gordijn, B.Enhancement. In: ten Have, H, Gordijn, B, eds. Handbook of Global Bioethics. Berlin: Springer; 2014:649–70.Google Scholar

37. Hickman, L. Philosophical Tools for Technological Culture: Putting Pragmatism to Work. Bloomington: Indiana University Press; 2001.Google Scholar

38. Racine, E. Pragmatic Neuroethics: Improving Treatment and Understanding of the Mind-Brain. Cambridge, MA: MIT Press; 2010.Google Scholar

39. Solymosi, T, Shook, JR. Neuropragmatism: A neurophilosophical manifesto. European Journal of Pragmatism and American Philosophy 2013;5(1):212–33.Google Scholar

40. Solymosi, T, Shook, JR, eds. Neuroscience, Neurophilosophy and Pragmatism: Brains at Work with the World. Basingstoke, UK: Palgrave Macmillan; 2014.CrossRefGoogle Scholar

41. Oishi, M, Mitchell, I, Van der Loos, H, eds. Design and Use of Assistive Technology: Social, Technical, Ethical, and Economic Challenges. Dordrecht: Springer; 2010.CrossRefGoogle Scholar

42. Academy of Medical Sciences. Human Enhancement and the Future of Work. London: Academy of Medical Sciences; 2012.Google Scholar

43. Rowland, N, Breshears, J, Chang, E. Neurosurgery and the dawning age of brain-machine interfaces. Surgical Neurology International 2013;4(1 Suppl):S1114.Google ScholarPubMed

44. Vehmas, S, Mäkelä, P. A realist account of the ontology of impairment. Journal of Medical Ethics 2008;34(2):93–5.CrossRefGoogle Scholar

45. Bradshow, H, ter Meulen, R. A transhumanist fault line around disability: Morphological freedom and the obligation to enhance. Journal of Medicine and Philosophy 2010;35(6):670–84.CrossRefGoogle Scholar

46. Wasserman, D, Asch, A. A duty to discriminate? American Journal of Bioethics 2012;12(4):22–4.CrossRefGoogle Scholar

47. Wolbring, G. Ethical theories and discourses through an ability expectations and ableism lens: The case of enhancement and global regulation. Asian Bioethics Review 2012;4(4):293309.Google Scholar

48. Turnbull, HR Jr, Stowe, MJ. Five models for thinking about disability: Implications for policy responses. Journal of Disability Policy Studies 2001;12(3):198208.CrossRefGoogle Scholar

49. Thomas, C. How is disability understood? An examination of sociological approaches. Disability & Society 2004;19(6):569–83.CrossRefGoogle Scholar

50. Mitra, S. The capability approach and disability. Journal of Disability Policy Studies 2006;16(4):236–47.CrossRefGoogle Scholar

51. Masala, C, Petretto, D. From disablement to enablement: Conceptual models of disability in the 20th century. Disability & Rehabilitation 2008;30(17):1233–44.CrossRefGoogle ScholarPubMed

52. Barnes, C. Understanding the social model of disability: Past, present and future. In: Watson, N, Roulstone, A, Thomas, C, eds. Routledge Handbook of Disability Studies. London and New York: Routledge; 2012:1229.Google Scholar

53. World Health Organization. CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities. Geneva: World Health Organization; 2004.Google Scholar

54. Nussbaum, M. Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: Harvard University Press; 2006.Google Scholar

55. World Health Organization and World Bank. World Report on Disability. Geneva: World Health Organization; 2011.Google Scholar

56. Bickenbach, J, Felder, F, Schmitz, B, eds. Disability and the Good Human Life. Cambridge: Cambridge University Press; 2013.CrossRefGoogle Scholar

57. Vehmas, S, Shakespeare, T. Disability, harm, and the origins of limited opportunities. Cambridge Quarterly of Healthcare Ethics 2014;23(1):41–7.CrossRefGoogle ScholarPubMed

58. Mahoney, J, Palyo, N, Napier, G, Giordano, J. The therapeutic milieu reconceptualized for the 21st century. Archives of Psychiatric Nursing 2009;23(6):423–9.CrossRefGoogle ScholarPubMed

59. Ip, K-T, ed. The Bioethics of Regenerative Medicine. Dordrecht: Springer; 2009.CrossRefGoogle Scholar

60. Whyte, J. A grand unified theory of rehabilitation (we wish!). Archives of Physical Medicine and Rehabilitation 2008;89(2):203–9.CrossRefGoogle Scholar

61. Hart, T, Tsaousides, T, Zanca, J, Whyte, J, Packel, A, Ferraro, M, et al. Toward a theory-driven classification of rehabilitation treatments. Archives of Physical and Medical Rehabilitation 2014;95(1 Suppl):3344.CrossRefGoogle Scholar

62. MacLachlan, M, Gallagher, P. Enabling Technologies: Body Image and Body Function. Edinburgh: Churchill Livingstone; 2004.Google Scholar

63. Hansson, S. The ethics of enabling technology. Cambridge Quarterly of Healthcare Ethics 2007;16(3):257–67.CrossRefGoogle ScholarPubMed

64. VanHiel, L. Treatment and enablement in rehabilitation research. Archives of Physical Medicine and Rehabilitation 2014;95(1 Suppl):8890.CrossRefGoogle ScholarPubMed

65. The U.S. Equal Employment Opportunity Commission. EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the Americans with Disabilities Act. Washington, DC: EEOC; 2002; available at http://www.eeoc.gov/policy/docs/accommodation.html (last accessed 4 July 2015).Google Scholar

66. Ikäheimo, H. Personhood and the social inclusion of people with disabilities: A recognition-theoretical approach. In: Kristiansen, K, Vehmas, S, Shakespeare, T, eds. Arguing about Disability: Philosophical Perspectives. London and New York: Routledge; 2008:7792.Google Scholar

67. Rimmerman, A. Social Inclusion of People with Disabilities: National and International Perspectives. Cambridge: Cambridge University Press; 2013.Google Scholar

68. Chatterjee, A. Cosmetic neurology and cosmetic surgery: Parallels, predictions, and challenges. Cambridge Quarterly of Healthcare Ethics 2007;16(2):129–37.CrossRefGoogle ScholarPubMed

69. Earp, B, Sandberg, A, Savulescu, J. Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. AJOB Neuroscience 2014;5(1):412.CrossRefGoogle ScholarPubMed

70. See note 28, Gini, Giordano 2010.

71. Williams, S, Higgs, P, Katz, S. Neuroculture, active ageing and the “older brain”: Problems, promises and prospects. Sociology of Health and Illness 2012;34(1):6478.CrossRefGoogle Scholar

72. Erler, A. Does memory modification threaten our authenticity? Neuroethics 2011;4:235–49.CrossRefGoogle ScholarPubMed

73. Glannon, W. Neuropsychological aspects of enhancing the will. The Monist 2012;95(3):378–98.CrossRefGoogle Scholar

74. Kraemer, F. Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 2013;6:483–97.CrossRefGoogle ScholarPubMed

75. Parvizi, J, Rangarajan, V, Shirer, W, Desai, N, Greicius, M. The will to persevere induced by electrical stimulation of the human cingulate gyrus. Neuron 2013;80(6):1359–67.CrossRefGoogle Scholar

76. Mecacci, G, Haselager, W. Stimulating the self: The influence of conceptual frameworks on reactions to deep brain stimulation. AJOB Neuroscience 2014;5(4):30–9.CrossRefGoogle Scholar

77. Hamilton, R, Messing, S, Chatterjee, A. Rethinking the thinking cap: Ethics of neural enhancement using noninvasive brain stimulation. Neurology 2011;76(2):187–93.CrossRefGoogle ScholarPubMed

78. Giordano, J. Neurogenetic and neural tissue implantation technology: Neuroethical, legal and social issues. In: Giordano, J, ed. Neurotechnology: Premises, Potential and Problems. Boca Raton, FL: CRC Press; 2012:5968.CrossRefGoogle Scholar

79. Heinrichs, J-H. The promises and perils of non-invasive brain stimulation. International Journal of Law and Psychiatry 2012;35(2):121–9.CrossRefGoogle ScholarPubMed

80. Kadosh, RC, Levy, N, O’Shea, J, Shea, N, Savulescu, J. The neuroethics of non-invasive brain stimulation. Current Biology 2012;22(4): R108–11.CrossRefGoogle Scholar

81. Jebari, K. Brain machine interface and human enhancement: An ethical review. Neuroethics 2013;6(3):617–25.CrossRefGoogle Scholar

82. Cabrera, L, Evans, E, Hamilton, R. Ethics of the electrified mind: Defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care. Brain Topography 2014;27(1):3345.CrossRefGoogle ScholarPubMed

83. McCullagh, P, Lightbody, G, Jygierewicz, J, Kernohan, WG. Ethical challenges associated with the development and deployment of brain computer interface technology. Neuroethics 2014;7(2):109–22.CrossRefGoogle Scholar

84. DeGrazia, D. Enhancement technologies and human identity. Journal of Medicine and Philosophy 2005;30(3):261–83.CrossRefGoogle ScholarPubMed

85. Brey, P. Human enhancement and personal identity. In: Olsen, B, ed. New Waves in the Philosophy of Technology. Basingstoke, UK: Palgrave Macmillan; 2009:169–85.CrossRefGoogle Scholar

86. Costa, P. Personal identity and the nature of the self. In: Giordano, J, Gordijn, B, eds. Scientific and Philosophical Perspectives in Neuroethics. Cambridge: Cambridge University Press; 2010:117–33.CrossRefGoogle Scholar

87. Baylis, F. Neuroethics and identity. In: Clausen, J, Levy, N, eds. Handbook of Neuroethics. Berlin: Springer; 2014:367–72.Google Scholar

88. Elliot, C. Enhancement technologies and the modern self. Journal of Medicine and Philosophy 2011;36(4):364–74.CrossRefGoogle Scholar

89. Kraemer, F. Authenticity or autonomy? When deep brain stimulation causes a dilemma. Journal of Medical Ethics 2013;39(2):757–60.CrossRefGoogle ScholarPubMed

90. Agar, N. The threat to human identities from too much enhancement. In: Agar, N. Truly Human Enhancement: A Philosophical Defense of Limits. Cambridge, MA: MIT Press; 2014:5579.CrossRefGoogle Scholar

91. Glannon, W. Neuromodulation, agency and autonomy. Brain Topography 2014;27(1):4654.CrossRefGoogle ScholarPubMed

92. Savulescu, J, Douglas, T, Persson, I. Autonomy and the ethics of biological behaviour modification. In: Akabayashi, A, ed. The Future of Bioethics: International Dialogues. Oxford: Oxford University Press; 2014:91112.CrossRefGoogle Scholar

93. Merkel, R, Boer, G, Fegert, J, Galert, T, Hartmann, D, Nuttin, B, et al. Intervening in the Brain: Changing Psyche and Society. Dordrecht: Springer; 2007.Google Scholar

94. Klaming, L, Haselager, P. Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics 2013;6:527–39.CrossRefGoogle ScholarPubMed

95. Vincent, N, ed. Neuroscience and Legal Responsibility. Oxford: Oxford University Press; 2013.CrossRefGoogle Scholar

96. Wurzman, R, Giordano, J. NEURINT and neuroweapons: Neurotechnologies in national intelligence and defense. In: Giordano, J, ed. Neurotechnology in National Security and Defense: Practical Considerations, Neuroethical Concerns. Boca Raton, FL: CRC Press; 2014:79114.CrossRefGoogle Scholar

97. Savulescu, J, Persson, I. Getting moral enhancement right. Bioethics 2011;27(3):124–31.Google Scholar

98. Tennison, M. Moral transhumanism: The next step. Journal of Medicine and Philosophy 2012;37(4):405–16.CrossRefGoogle ScholarPubMed

99. Kabasenche, W. Engineering for virtue? Toward holistic moral enhancement. In: Basl, J, Sandler, R, eds. Designer Biology. Lanham, MD: Lexington Books; 2013:6981.Google Scholar

100. Shook, JR. Neuroethics and the possible types of moral enhancement. AJOB Neuroscience 2012;3(4):314.CrossRefGoogle Scholar

101. Kamieński, Ł. Helping the postmodern Ajax: Is managing combat trauma through pharmacology a Faustian bargain? Armed Forces and Society 2013;39(3):395414.CrossRefGoogle Scholar

102. Olsthoorn, P.Military Ethics and Virtues: An Interdisciplinary Approach for the 21st Century. London and New York: Routledge; 2011.Google Scholar

103. Mehlman, M, Lin, P, Abney, K. Enhanced warfighters: A policy framework. In: Gross, M, Carrick, D, eds. Military Medical Ethics for the 21st Century. Aldershot, UK: Ashgate; 2013:130–43.Google Scholar

104. Ford, K, Glymour, C. The enhanced warfighter. Bulletin of the Atomic Scientists 2014;70(1):4353.CrossRefGoogle Scholar

105. Bomann-Larsen, L. Voluntary rehabilitation? On neurotechnological behavioural treatment, valid consent and (in)appropriate offers. Neuroethics 2013;6(1):6577.CrossRefGoogle Scholar

106. Chandler, J. Autonomy and the unintended legal consequences of emerging neurotherapies. Neuroethics 2013;6(2):249–63.CrossRefGoogle Scholar

107. Robbins, L. Refusing to be all that you can be: Regulating against forced cognitive enhancement in the military. In: Gross, D, Carrick, D, eds. Military Medical Ethics for the 21st Century. Aldershot, UK: Ashgate; 2013:144–55.Google Scholar

108. National Research Council. Opportunities in Neuroscience for Future Army Applications. Washington, DC: National Academies Press; 2009.Google Scholar

109. Moreno, J. Mind Wars: Brain Science and the Military in the 21st Century. New York: Bellevue Literary Press; 2012.Google Scholar

110. Kotchetkov, I, Hwang, B, Appelboom, G, Kellner, C, Connolly, E. Brain-computer interfaces: Military, neurosurgical, and ethical perspective. Neurosurgical Focus 2010;28(5):16.CrossRefGoogle ScholarPubMed

111. Russo, M, Stetz, M, Stetz, T. Ethical considerations: Cogniceuticals in the military. In: Chatterjee, A, Farah, M, eds. Neuroethics in Practice. Oxford: Oxford University Press; 2013:3545.CrossRefGoogle Scholar

112. Parasidis, E. Human enhancement and experimental research in the military. Connecticut Law Review 2012;44(4):1117–32.Google Scholar

113. Sehm, B, Ragert, P. Why non-invasive brain stimulation should not be used in military and security services. Frontiers in Human Neuroscience 2013;7:article 553.CrossRefGoogle Scholar

114. LaCroix, A, Burnam-Fink, M, Galliott, J, Vallor, S, French, S, Abney, K, et al. Super soldiers: The ethical, legal and operational implications (part 2). In: Thompson, S, ed. Global Issues and Ethical Considerations in Human Enhancement Technologies. Hershey, PA: IGI Global; 2014:139–60.Google Scholar

115. Mehlman, M.Captain America and Iron Man: Biological, genetic, and psychological enhancement and the warrior ethos. In: Lucas, G, ed. Routledge Handbook of Military Ethics. London and New York: Routledge; 2015:406–20.Google Scholar

116. Bublitz, J, Merkel, R. Crimes against minds: On mental manipulations, harms and a human right to mental self-determination. Criminal Law and Philosophy 2014;8(1):5177.CrossRefGoogle Scholar

117. See note 4, Shook, Giordano 2014.