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Jonathan Pugh
Oxford University
  1.  24
    Evidence-Based Neuroethics, Deep Brain Stimulation and Personality - Deflating, but Not Bursting, the Bubble.Jonathan Pugh, Laurie Pycroft, Hannah Maslen, Tipu Aziz & Julian Savulescu - forthcoming - Neuroethics.
    Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining how different trial (...)
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  2.  63
    The Ethics of Deep Brain Stimulation for the Treatment of Anorexia Nervosa.Hannah Maslen, Jonathan Pugh & Julian Savulescu - 2015 - Neuroethics 8 (3):215-230.
    There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific (...)
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  3.  80
    The Moral Imperative to Continue Gene Editing Research on Human Embryos.Julian Savulescu, Jonathan Pugh, Thomas Douglas & Chris Gyngell - 2015 - Protein Cell 6 (7):476–479.
    The publication of the first study to use gene editing techniques in human embryos (Liang et al., 2015) has drawn outrage from many in the scientific community. The prestigious scientific journals Nature and Science have published commentaries which call for this research to be strongly discouraged or halted all together (Lanphier et al., 2015; Baltimore et al., 2015). We believe this should be questioned. There is a moral imperative to continue this research.
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  4. Neuro-Interventions as Criminal Rehabilitation: An Ethical Review.Jonathan Pugh & Thomas Douglas - 2017 - In Jonathan D. Jacobs & Jonathan Jackson (eds.), The Routledge Handbook of Criminal Justice Ethics. London: Routledge.
    According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...)
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  5.  2
    Clarifying the Normative Significance of ‘Personality Changes’ Following Deep Brain Stimulation.Jonathan Pugh - forthcoming - Science and Engineering Ethics:1-26.
    There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...)
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  6. The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa.Jonathan Pugh, Jacinta Tan, Tipu Aziz & Rebecca J. Park - forthcoming - Frontiers in Psychiatry 9:523.
    Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...)
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  7. Justifications for Non-­Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation.Jonathan Pugh & Thomas Douglas - 2016 - Criminal Justice Ethics 35 (3):205-229.
    A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...)
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  8.  32
    No Going Back? Reversibility and Why It Matters for Deep Brain Stimulation.Jonathan Pugh - 2019 - Journal of Medical Ethics 45 (4):225-230.
    Deep brain stimulation (DBS) is frequently described as a ‘reversible’ medical treatment, and the reversibility of DBS is often cited as an important reason for preferring it to brain lesioning procedures as a last resort treatment modality for patients suffering from treatment-refractory conditions. Despite its widespread acceptance, the claim that DBS is reversible has recently come under attack. Critics have pointed out that data are beginning to suggest that there can be non-stimulation-dependent effects of DBS. Furthermore, we lack long-term data (...)
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  9. Risk Assessment Tools in Criminal Justice and Forensic Psychiatry: The Need for Better Data.Thomas Douglas, Jonathan Pugh, Illina Singh, Julian Savulescu & Seena Fazel - 2017 - European Psychiatry 42:134-137.
    Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.
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  10.  94
    Deep Brain Stimulation and Revising the Mental Health Act: The Case for Intervention-Specific Safeguards.Jonathan Pugh, Tipu Aziz, Jonathan Herring & Julian Savulescu - forthcoming - British Journal of Psychiatry.
    Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.
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  11.  22
    Navigating Individual and Collective Interests in Medical Ethics.Jonathan Pugh - 2018 - Journal of Medical Ethics 44 (1):1-2.
    In medical ethics, we are often concerned with questions that pertain predominantly to the treatment of a particular individual. However, in a number of cases it is crucial to broaden the scope of our moral inquiry beyond consideration of the individual alone, since the interests of the individual can come into conflict with the interests of the wider community. How should we resolve such conflicts between the interests of the individual and the collective? Most readers of this journal will likely (...)
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  12.  91
    Coercion and the Neurocorrective Offer.Jonathan Pugh - forthcoming - In David Rhys Birks & Thomas Douglas (eds.), reatment for Crime: Philosophical Essays on Neurointerventions in Criminal Justice. Oxford, UK:
    According to what Douglas calls ‘the consent requirement’, neuro-correctives can only permissibly be provided with the valid consent of the offender who will undergo the intervention. Some of those who endorse the consent requirement have claimed that even though the requirement prohibits the imposition of mandatory neurocorrectives on criminal offenders, it may yet be permissible to offer offenders the opportunity to consent to undergoing such an intervention, in return for a reduction to their penal sentence. I call this the neurocorrective (...)
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  13.  75
    Moral Bio-Enhancement, Freedom, Value and the Parity Principle.Jonathan Pugh - 2019 - Topoi 38 (1):73-86.
    A prominent objection to non-cognitive moral bio-enhancements is that they would compromise the recipient’s ‘freedom to fall’. I begin by discussing some ambiguities in this objection, before outlining an Aristotelian reading of it. I suggest that this reading may help to forestall Persson and Savulescu’s ‘God-Machine’ criticism; however, I suggest that the objection still faces the problem of explaining why the value of moral conformity is insufficient to outweigh the value of the freedom to fall itself. I also question whether (...)
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  14. Driven to Extinction? The Ethics of Eradicating Mosquitoes with Gene-Drive Technologies.Jonathan Pugh - 2016 - Journal of Medical Ethics 42 (9):578-581.
    Mosquito-borne diseases represent a significant global disease burden, and recent outbreaks of such diseases have led to calls to reduce mosquito populations. Furthermore, advances in ‘gene-drive’ technology have raised the prospect of eradicating certain species of mosquito via genetic modification. This technology has attracted a great deal of media attention, and the idea of using gene-drive technology to eradicate mosquitoes has been met with criticism in the public domain. In this paper, I shall dispel two moral objections that have been (...)
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  15.  44
    Unexpected Complications of Novel Deep Brain Stimulation Treatments: Ethical Issues and Clinical Recommendations.Hannah Maslen, Binith Cheeran, Jonathan Pugh, Laurie Pycroft, Sandra Boccard, Simon Prangnell, Alexander Green, James FitzGerald, Julian Savulescu & Tipu Aziz - forthcoming - Neuromodulation.
    Background -/- Innovative neurosurgical treatments present a number of known risks, the natures and probabilities of which can be adequately communicated to patients via the standard procedures governing obtaining informed consent. However, due to their novelty, these treatments also come with unknown risks, which require an augmented approach to obtaining informed consent. -/- Objective -/- This paper aims to discuss and provide concrete procedural guidance on the ethical issues raised by serious unexpected complications of novel deep brain stimulation treatments. -/- (...)
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  16. Cohen’s Conservatism and Human Enhancement.Jonathan Pugh, Guy Kahane & Julian Savulescu - 2013 - The Journal of Ethics 17 (4):331-354.
    In an intriguing essay, G. A. Cohen has defended a conservative bias in favour of existing value. In this paper, we consider whether Cohen’s conservatism raises a new challenge to the use of human enhancement technologies. We develop some of Cohen’s suggestive remarks into a new line of argument against human enhancement that, we believe, is in several ways superior to existing objections. However, we shall argue that on closer inspection, Cohen’s conservatism fails to offer grounds for a strong sweeping (...)
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  17.  63
    Ravines and Sugar Pills: Defending Deceptive Placebo Use.Jonathan Pugh - 2015 - Journal of Medicine and Philosophy 40 (1):83-101.
    In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will to (...)
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  18.  32
    Enhancing Autonomy by Reducing Impulsivity: The Case of ADHD.Jonathan Pugh - 2014 - Neuroethics 7 (3):373-375.
    In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that (...)
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  19.  24
    Authenticity and the Stimulated Self: Neurosurgery for Anorexia Nervosa.Hannah Maslen, Jonathan Pugh & Julian Savulescu - 2015 - American Journal of Bioethics Neuroscience 6 (4):69-71.
    Müller and colleagues (2015) address a range of ethical considerations associated with neurosurgical interventions for the treatment of anorexia nervosa (AN), arguing for several protective measures to safeguard clinical research and practice. This is an important article, which provides a thorough review of current neurosurgical research and presents key insights into challenges associated with compromised decision-making capacities in the context of AN and the early average age of onset. However, it is somewhat striking that they neither use nor examine the (...)
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  20.  20
    Brainjacking in Deep Brain Stimulation and Autonomy.Jonathan Pugh, Laurie Pycroft, Anders Sandberg, Tipu Aziz & Julian Savulescu - 2018 - Ethics and Information Technology 20 (3):219-232.
    'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators that play a central role in Deep Brain Stimulation systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim that the possibility (...)
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  21.  85
    Exercise Prescription and The Doctor's Duty of Non-Maleficence.Jonathan Pugh, Christopher Pugh & Julian Savulesu - 2017 - British Journal of Sports Medicine 51 (21):1555-1556.
    An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...)
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  22.  99
    ‘Drugs That Make You Feel Bad’? Remorse-Based Mitigation and Neurointerventions.Jonathan Pugh & Hannah Maslen - 2017 - Criminal Law and Philosophy 11 (3):499-522.
    In many jurisdictions, an offender’s remorse is considered to be a relevant factor to take into account in mitigation at sentencing. The growing philosophical interest in the use of neurointerventions in criminal justice raises an important question about such remorse-based mitigation: to what extent should technologically facilitated remorse be honoured such that it is permitted the same penal significance as standard instances of remorse? To motivate this question, we begin by sketching a tripartite account of remorse that distinguishes cognitive, affective (...)
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  23. Autonomy, Natality and Freedom: A Liberal Re-Examination of Habermas in the Enhancement Debate.Jonathan Pugh - 2015 - Bioethics 29 (3):142-152.
    Jurgen Habermas has argued that carrying out pre-natal germline enhancements would be inimical to the future child's autonomy. In this article, I suggest that many of the objections that have been made against Habermas' arguments by liberals in the enhancement debate misconstrue his claims. To explain why, I begin by explaining how Habermas' view of personal autonomy confers particular importance to the agent's embodiment and social environment. In view of this, I explain that it is possible to draw two arguments (...)
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  24.  35
    Coercive Paternalism and Back-Door Perfectionism.Jonathan Pugh - 2014 - Journal of Medical Ethics 40 (5):350-351.
    In this response piece, I argue that the ‘coercive paternalism’ that Sarah Conly endorses in her book Against Autonomy veers towards a back-door perfectionism. Although Conly points out that coercive paternalism does not mandate the imposition of alien values upon us in the same way that perfectionism does, I argue that coercive paternalism might yet impose an alien weighting of our own values; this, I suggest, means that coercive paternalism remains perfectionist in spirit, if not in letter. I go on (...)
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  25.  49
    How Should We Deal with Misattributed Paternity? A Survey of Lay Public Attitudes.Georgia Lowe, Jonathan Pugh, Guy Kahane, Louise Corben, Sharon Lewis, Martin Delatycki & Julian Savulescu - 2017 - Ajob Empirical Bioethics 8 (4):234-242.
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  26.  25
    Concerns About Eroding the Ethical Barrier to in Vitro Eugenics: Lessons From the hESC Debate.Jonathan Pugh - 2014 - Journal of Medical Ethics 40 (11):737-738.
    In his discussion of in vitrogametogenesis, Rob Sparrow claims that an ethical barrier to development of this technology is that many jurisdictions currently prohibit the practice of creating embryos solely for the purpose of research. However, he suggests that this ethical barrier will soon be eroded, in view of the fact that in vitro gametogenesis could serve as a powerful new technology to overcome infertility. In this commentary, I argue that Sparrow is being overly optimistic in his analysis here. I (...)
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  27.  52
    The Case Against Forced Methadone Detox in the US Prisons.Daniel D’Hotman, Jonathan Pugh & Thomas Douglas - 2019 - Public Health Ethics 12 (1):89-93.
    Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification for current policies of (...)
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  28.  27
    When is Coercive Methadone Therapy Justified?Daniel D'Hotman, Jonathan Pugh & Thomas Douglas - 2018 - Bioethics 32 (7):405-413.
    Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build (...)
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  29.  27
    Wittgenstein, Shakespeare, and Metaphysical Wit.Jonathan Pugh - 2012 - Philosophy and Literature 36 (1):238-248.
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  30.  1
    Neurostimulation, doping, and the spirit of sport.Jonathan Pugh & Christopher Pugh - forthcoming - Neuroethics:1-18.
    There is increasing interest in using neuro-stimulation devices to achieve an ergogenic effect in elite athletes. Although the World Anti-Doping Authority does not currently prohibit neuro-stimulation techniques, a number of researchers have called on WADA to consider its position on this issue. Focusing on trans-cranial direct current stimulation as a case study of an imminent so-called ‘neuro-doping’ intervention, we argue that the emerging evidence suggests that tDCS may meet WADA’s own criteria for a method’s inclusion on its list of prohibited (...)
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  31.  66
    Embryos, The Principle of Proportionality, and the Shaky Ground of Moral Respect.Jonathan Pugh - 2014 - Bioethics 28 (8):420-426.
    The debate concerning the moral permissibility of using human embryos in human embryonic stem cell (hESC) research has long centred on the question of the embryo's supposed right to life. However, in focussing only on this question, many opponents to hESC research have escaped rigorous scrutiny by making vague and unfounded appeals to the concept of moral respect in order to justify their opposition to certain hESC practices. In this paper, I offer a critical analysis of the concept of moral (...)
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  32.  47
    Lay Attitudes Toward Deception in Medicine: Theoretical Considerations and Empirical Evidence.Jonathan Pugh, Guy Kahane, Hannah Maslen & Julian Savulescu - 2016 - Ajob Empirical Bioethics 7 (1):31-38.
    Background: There is a lack of empirical data on lay attitudes toward different sorts of deception in medicine. However, lay attitudes toward deception should be taken into account when we consider whether deception is ever permissible in a medical context. The objective of this study was to examine lay attitudes of U.S. citizens toward different sorts of deception across different medical contexts. Methods: A one-time online survey was administered to U.S. users of the Amazon “Mechanical Turk” website. Participants were asked (...)
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  33.  14
    The Need for Further Fine-Grained Distinctions in Discussions of Authenticity and Deep Brain Stimulation.Jonathan Pugh, Hannah Maslen & Julian Savulescu - 2017 - American Journal of Bioethics Neuroscience 8 (3):W1-W3.
  34.  15
    Withholding Treatment: What, Whom and Why?Jonathan Pugh - 2017 - Journal of Medical Ethics 43 (5):279-279.
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  35.  8
    Is The 'Compromise Position' Concerning The Moral Permissibility Of Different Forms Of Human Embryonic Stem Cell Research A Tenable Position?Jonathan Pugh - unknown
    The compromise position concerning the moral permissibility of different forms of human embryonic stem cell research has two commitments. The first commitment of this position is that it is morally permissible to derive hESCs from unwanted IVF embryos, despite the fact that this process involves the destruction of these embryos. The second commitment of this position is that it is morally impermissible to create human embryos for the sole purpose of destroying them in order to harvest their hESCs. I argue (...)
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  36.  3
    Deep Brain Stimulation, Authenticity and Value—CORRIGENDUM.Jonathan Pugh, Hannah Maslen & Julian Savulescu - 2018 - Cambridge Quarterly of Healthcare Ethics 27 (1):179-179.
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  37.  10
    Autonomy, Rationality, and Contemporary Bioethics.Jonathan Pugh - 2020 - Oxford, UK: Oxford University Press.
    Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...)
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