Patients in a minimally conscious state (MCS) fall into a different diagnostic category than patients in the more familiar vegetative states (VS). Not only are MCS patients conscious in some sense, they have a higher chance for recovery than VS patients. Because of these differences, we ostensibly have reason to provide MCS patients with care that goes beyond what we provide to patients with some VS patients. But how to justify this differential treatment? I argue we can’t justify it solely (...) by looking to MCS patients’ actual levels of consciousness. We must look also to the ways in which these patients are potentially conscious. Specifically, I argue that certain sensible and well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness, but that they can be justified by looking to patients’ potential for consciousness. Insofar then as we have prima facie reason to follow the recommendations, we also have prima facie reason to view the potential for consciousness as morally salient. If that is true, however, several important implications follow: first, if the potential for consciousness is morally salient, this translates into actual and pressing obligations to patients with disorders of consciousness generally. Second, if the potential for consciousness is morally salient, this has implications that go beyond our obligations to patients with disorders of consciousness. Indeed, if the potential for consciousness is morally salient, this adds an important layer of complexity to the normative landscape, a layer we may not have sufficiently noticed before. (shrink)

Lockean accounts of personhood propose that an individual is a person just in case that individual is characterized by some advanced cognitive capacity. On these accounts, human beings with severe cognitive impairment are not persons. Some accept this result—I do not. In this paper, I therefore advance and defend an account of personhood that secures personhood for human beings who are cognitively impaired. On the account for which I argue, an individual is a person just in case that individual belongs (...) to a natural kind that is normally characterized by advanced cognitive capacities. Since “human being” is just such a natural kind, individual human beings can be persons even when they do not themselves have advanced cognitive capacities. I argue, furthermore, that we have good reason to accept this account of personhood over rival accounts since it is uniquely able to accommodate the intuitive concept of an impaired person. (shrink)

Goering and colleagues (2017) acknowledge closed-loop neural devices have the potential to undermine agency. Indeed, the authors observe that “the agent using the device may . . . sometimes doubt whether she is the author of her action, given that the device may operate in ways that are not transparent to her” (65). Still, the authors ultimately argue that closed-loop neural devices may be construed as supporting agency, especially when we view agency from a relational perspective. The reason? We often (...) manifest our agency in relation with others. For example, family and close friends sometimes step in to support us in setting and achieving our aims. In a similar way, then, the authors argue that “we can imagine [a closed-loop] device stepping in to support the user in achieving her aim” (67). Closed-loop neural devices, in other words, can be construed as supporting one’s agency in much the same way as other people can be seen as supporting one’s agency. The authors thus conclude that when we view agents from a relational perspective, closed-loop neural devices may be viewed as supporting rather than undermining agency. I largely agree with the authors’ conclusion. I also believe, however, that their discussion can be clarified by distinguishing three kinds of agency and viewing closed-loop neural devices from the perspective of each. By thinking carefully about agency, we can see more clearly the ways in which it is undermined by closed-loop neural devices, as well as the way in which these devices may support agency. (shrink)

Dickert et al. (2020) effectively address how factors such as time limitations, stress, and illness severity in acute conditions warrant a deeper evaluation of how current consent processes serve patients. While data suggests that patients “prefer to be asked for permission upfront rather than waiving consent” (2), consent forms themselves “are frequently long and technical, follow rigid templates, and contain language that appears to prioritize institutional protection” (1). Such findings elucidate patients’ valuation of personal agency over settling for the “benefit (...) of the doubt” that physicians and the consent forms they provide are acting in the patients’ best interests. In response, the authors recommend revisions to consent forms in terms of content, structure, and tone to better facilitate patient understanding beyond the mere conveyance of information. We aim to build Dickert et al.’s discussion of how “consent processes serve functions beyond facilitating an informed, autonomous decision” (2), but with a broader focus on an underrecognized purpose of the consent process: namely, reaffirming a patient’s status as a capable, rational agent. Specifically, we argue that patients can exercise this agency when they thoroughly understand the consent process, per Grimm’s (2012) conception of understanding. (shrink)

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized (...) protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. (shrink)

According to Macklin & Natanson (2019), one reason unusual practices can be misidentified as usual care is that “instead of using pertinent, accurate information describing usual care, investigators may rely on the opinion of ‘experts’ in the field, whose information may be out of date or otherwise inaccurate." We find Macklin & Natanson’s insights about misattributed expertise crucial, and suggest their discussion can be elucidated further by characterizing it in the context of Ballantyne (2018)’s recent exploration of what he calls (...) epistemic trespassing. What insights can be drawn from this characterization? In this commentary, we highlight two. First, the characterization elucidates the serious consequences that can result from epistemic trespassing. Second, the characterization of Macklin & Natanson’s cases as instances of epistemic trespassing offers us a potential roadmap for overcoming some of the problems the authors identify. (shrink)

Memory blunting is a pharmacological intervention that decreases the emotional salience of memories. The technique promises a brighter future for those suffering from memory-related disorders such as PTSD, but it also raises normative questions about the limits of its permissibility. So far, neuroethicists have staked out two primary camps in response to these questions. In this paper, I argue both are problematic. I then argue for an alternative approach to memory blunting, one that can accommodate the considerations that motivate rival (...) approaches even while avoiding the problems these rivals face. In addition to arguing for this primary thesis, the paper also aims to suggest something about neuroethics generally: despite what some neuroethicists claim, new discoveries in neuroscience may not typically upend traditional views of morality. Rather, discoveries in neuroscience often provide us with new occasions to reflect on enduring questions about what it means to be human. (shrink)

Berger (2019) argues effectively that “representativeness is more aptly understood as a variable that is multidimensional and continuous based on relational moral authority,” and also makes some useful suggestions about how taking this observation seriously might require changes in current patterns of practice regarding surrogates. But the essay raises additional important questions about how the Best Interest Standard (BIS) should be used among unrepresented patients and other patients as well because many surrogates besides those who “have no actionable knowledge of (...) a patient’s preferences” find themselves in positions in which they need to determine, with the physician, what is in the patient’s best interests. In this commentary, we therefore provide support for the ethical superiority of BIS judgments made by a multi-stakeholder process (rather than solo decision-makers), and sketch a process by which such judgments might be made. (shrink)

Jecker & Ko (2017) argue that numerical identity is not the only aspect of identity that matters to patients faced with certain neurosurgical interventions. Put differently: surviving an intervention in the numerical sense—being numerically the same person before and after the intervention—is not enough. It also matters whether an intervention preserves a patient’s narrative identity, that is, whether an intervention allows the patient’s “inner story” to continue. I agree with the authors’ conclusion. I believe, however, that further work can be (...) done to show precisely why narrative identity matters. We can accept Jecker & Ko’s conclusion, but still wonder: why should it matter to us that our inner story continues? In this response, I suggest that the reason rests on a more basic concern we have with living authentic lives. We are concerned with preserving our narrative identities because we want to live authentic lives rather than inauthentic ones. If that’s the case, however, those considering neurosurgical interventions such as deep brain stimulation and temporal lobectomy should not only pay attention to ways the interventions may support or undermine narrative identity, but also to broader considerations about the ways these interventions may support or undermine one’s living an authentic life. (shrink)

Discussion of the ethics of memory modification technologies (MMTs) has often focused on questions about the limits of their permissibility. In the current paper, I focus primarily on a different issue: when (if ever) is it rational to prefer MMTs to alternative interventions? The question is crucial. Unless those who condone the use of MMTs offer guidance for navigating among various interventions, their account risks becoming a moral endorsement that says little about what one faced with the option of using (...) an MMT should do. In this paper, I therefore consider questions about the conditions in which MMTs are rationally preferable to alternative interventions. My conclusion is that these conditions are rare. The reason stems from considerations of autonomy. When compared with other interventions, MMTs do a particularly poor job at promoting of their users. Insofar as a decision-maker values autonomy, this therefore counts against choosing MMTs over alternative interventions. If that is true, moreover, this provides a fresh perspective on debates about the permissibility MMTs. For those who would limit the use of MMTs to a narrow range of circumstances, the conclusion that MMTs are rarely preferable gives them further reason to eye MMTs with suspicion. For those who view MMTs as permissible in a wide range of circumstances, the conclusion may deflate their endorsement. By approaching MMTs from the perspective offered by questions about preferability, I therefore ultimately aim to focus discussions about MMTs on the subjective rationality rather than the moral permissibility of their usage. (shrink)

Some psychologists and philosophers have argued that neuroscience is importantly relevant to our moral responsibility practices, especially to our practices of praise and blame. For consider: on an unprecedented scale, contemporary neuroscience presents us with a mechanistic account of human action. Furthermore, in uential studies – most notoriously, Libet et al. (1983) – seem to show that the brain decides to do things (so to speak) before we consciously make a decision. In light of these ndings, then – or so (...) some have argued – we ought to revise our practices of praise and blame. In the current paper, I argue that this conclusion is unwarranted. The reason is that the argument for it depends on controversial non-empirical premises, premises we need not accept. I suggest, however, that neuroscience does bear on our moral responsibility practices in one important, if less revisionary, way. In particular, neuroscience o ers a new kind of evidence for determining when agents should be held exempt from our normal moral responsibility practices. (shrink)

Understanding the difference between conscious and unconscious states is important for making sense of human cognition. Consider: your perception of these words is currently conscious while the feeling of the floor beneath your left foot presumably is not. But what does the difference between these states consist in? Contemporary philosophers disagree about how to answer this kind of question. Extrinsic theorists claim states are conscious because of how they are related to other states, entities, or processes. Intrinsic theorists deny this (...) by claiming that consciousness is internal to states. As it stands, debates about consciousness are thus stuck at an impasse.^ So I approach things differently. In this dissertation, I argue there is a way to overcome the gridlock that plagues contemporary debates about consciousness, and to accommodate the considerations that motivate both intrinsic and extrinsic theorists. The way forward lies in developing a robust account of causal powers. Causal powers, on my view, correspond to dispositions things have. For example, salt’s disposition to dissolve in water corresponds to a power salt has: its solubility. Causal powers, moreover, can help us account for how things behave, for how and why things interact with each other in the ways they do. For example, we can account for salt’s dissolving in water by studying when and why salt manifests its power of solubility. ^ And we can also account for our conscious experiences in reference to causal powers. Indeed, I argue that just as salt manifests one of its powers when it dissolves in water, so too humans manifest one of their powers when they have conscious experiences—our conscious experiences can be understood in reference to the causal powers we have, and in reference to how and why we manifest these powers. Just as importantly, if we use causal powers as a basis for a theory of consciousness, we can overcome the current opposition between extrinsic and intrinsic theories, and in doing so, open up avenues for theorizing about consciousness anew. (shrink)

Rainey et al. (forthcoming) discuss the complications that arise with assigning responsibility for brain computer interface (BCI)-mediated actions. Because BCI-mediated actions can differ from non-BCI-mediated actions in terms of control and foreseeability, the authors suggest that our ethical and legal evaluation of these actions may differ in important ways. While we take no issue with the authors’ discussion or conclusion, we also recognize the difficulty of grappling with the relationship between control, foreseeability, and moral responsibility practices, even without the additional (...) complications introduced by BCI-mediation. In this commentary, we therefore consider BCI-mediated action against the backdrop of a different--perhaps less murky--normative framework: blame. (shrink)