❤❤❤ Arguments Against Organ Donation

Tuesday, June 22, 2021 4:10:06 PM

Arguments Against Organ Donation

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We have a really effective vaccine. Jason Goldman, an assistant professor in Florida who was representing the American College of Physicians as a liaison to the panel, added later. She said the risk-benefit calculus did not seem to support boosters for many young people. But the studies give limited insight into third doses, CDC officials said, with serious risks of bias and wide confidence intervals. Some members and liaisons expressed support for the recommendation, with arguments primarily centering around the perceived benefit to others that may come if people get boosters. At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. Katherine Poehling, professor of pediatrics and epidemiology prevention at the Wake Forest School of Medicine, declined to immediately comment through a spokeswoman.

The other eight panel members who voted against the fourth recommendation did not respond to requests for comment, nor did the CDC. Approximately President Joe Biden said Friday that the number of those now eligible for boosters is around 60 million. Additionally, at least 6 months need to have elapsed after the final dose. They said boosters would be recommended to all adults 16 and older, pending FDA authorization. But the FDA limited boosters to certain populations after its advisory panel rejected authorizing shots for everybody. That vote came after two top FDA scientists submitted their resignations in protest of the pre-emptive announcement by federal health officials. Copy Link. These value-laden appellations may unnecessarily polarize a debate that need not pit extreme viewpoints against each other, and that offers many nuanced intermediate positions that recognize shared values Parens, and make room for embracing the benefits of enhancement while recognizing the need for some type of regulation e.

Lin and Alhoff, The relevance of this debate itself depends to some extent upon a philosophical issue familiar to traditional bioethicists: the notorious difficulty of identifying the line between disease and normal function, and the corresponding difference between treatment and enhancement. However, despite the difficulty attending the principled drawing of this line, there are already clear instances in which a technology such as a drug is used with the aim of improving a capacity or behavior that is by no means clinically dysfunctional, or with the goal of improving a capacity beyond the range of normal functioning.

One common example is the use, now widespread on college campuses and beyond, of methylphenidate, a stimulant typically prescribed for the treatment of ADHD. Known by the brand name Ritalin, methylphenidate has been shown to improve performance on working memory, episodic memory and inhibitory control tasks. Many students use it as a study aid, and the ethical standing of such off-label use is a focus of debate among neuroethicists Sahakian, ; Greely et al.

As in the example above, the enhancements neuroethicists most often discuss are cognitive enhancements: technologies that allow normal people to function cognitively at a higher level than they might without use of the technology Knafo and Venero, One standing theoretical issue for neuroethics is a careful and precise articulation of whether, how and why cognitive enhancement has a philosophical status different than any other kind of enhancement, such as enhancement of physical capacities by the use of steroids Dresler, Often overlooked are other interesting potential neuroenhancements. These are less frequently discussed than cognitive enhancements, but just as worthy of consideration. In many ways, discussions regarding these kinds of enhancement effectively recapitulate the cognitive enhancement debate, but in some respects they raise different concerns and prompt different arguments.

Naturalness: Although the aim of cognitive enhancement may at first seem ethically questionable at best, it is plausible that humans naturally engage in many forms of enhancement, including cognitive enhancement. Indeed, we typically applaud and value these efforts. After all, the aim of education is to cognitively enhance students which, we now understand, occurs by changing their brains , and we look askance at those who devalue this particular enhancement, rather than at those who embrace it.

So some kinds of cognitive enhancement are routine and unremarkable. Proponents of neuroenhancement will argue that there is no principled difference between the enhancements we routinely engage in, and enhancement by use of drugs or other neurotechnologies. Many in fact argue that we are a species whose nature it is to develop and use technology for augmenting our capacities, and that continual pursuit of enhancement is a mark of the human.

Boire, , one can recognize the value of cognitive liberty without swallowing an entire political agenda. So, for example, even if we think that there is a prima facie right to determine our own cognitive states, there may be justifiable limits to that right. More work needs to be done to establish the boundaries of the cognitive liberty we ought to safeguard. Utilitarian arguments: Many proponents of cognitive enhancement point to the positive effects of enhancement and argue that the benefits outweigh the costs.

In these utilitarian arguments it is important to consider the positive and negative effects not only for individuals, but also for society more broadly see, e. Selgelid, Deontological arguments: Sometimes enhancements are argued to be an avenue for leveling the playing field, in pursuit of fairness and equity. Practical arguments: These often point to the difficulty in enforcing regulations of extant technology, or the detrimental effects of trying to do so. They tend to be not really arguments in favor of enhancement, but rather reasons not to oppose its use. Harms: The simplest and most powerful argument against enhancement is the claim that brain interventions carry with them the risk of harm, risks that make the use of these interventions unacceptable.

The low bar for acceptable risk is an effect of the context of enhancement: risks deemed reasonable to incur when treating a deficiency or disease with the potential benefit of restoring normal function may be deemed unreasonable when the payoff is simply augmenting performance above a normal baseline. Some suggest that no risk is justified for enhancement purposes. In evaluating the strength of a harm-based argument against enhancement, several points should be considered: 1 What are the actual and potential harms and benefits medical and social of a given enhancement?

Unnaturalness: A number of thinkers argue, in one form or another, that use of drugs or technologies to enhance our capacities is unnatural, and the implication is that unnatural implies immoral. Of course, to be a good argument, more reason has to be given both for why it is unnatural see an argument for naturalness, above , and for why naturalness and morality align. Despite its appeal to religious conservatives, a neuroethicist may want to offer a more ecumenical or naturalistic argument to support the link between unnatural and immoral , and will have to counter the claim, above, that it is natural for humans to enhance themselves.

Diminishing human agency: Another argument suggests that the effect of enhancement will be to diminish human agency by undermining the need for real effort, and allowing for success with morally meaningless shortcuts. Human life will lose the value achieved by the process of striving for a goal and will be belittled as a result see, e. Schermer, ; Kass, Although this is a promising form of argument, more needs to be done to undergird the claims that effort is intrinsically valuable. Recent work suggests no general argument to this effect is forthcoming Douglas, After all, few find compelling the argument that we ought to abandon transportation by car for horses, walking, or bicycling, because these require more effort and thus have more moral value.

The hubris objection: This interesting argument holds that the type of attitude that seems to underlie pursuit of such interventions is morally defective in some way, or is indicative of a morally defective character trait. Others have pushed back against this tack, arguing that the hubris objection against enhancement is at base a religious one, or that it fundamentally misunderstands the concepts it relies upon Kahane, However, worries about access are compounded in the case of neuroenhancements as they may also be with other learning technologies.

As enhancements increase capacities of those who use them, they are likely to further widen the already unconscionable gap between the haves and have-nots: We can foresee that those already well-off enough to afford enhancements will use them to increase their competitive advantage against others, leaving further behind those who cannot afford them. Not all arguments in this vein militate against enhancement. As public consciousness about racial and economic disparities increases, we should expect more neuroethical work on this topic. Although one can imagine policy solutions to distributive justice concerns, such as having enhancements covered by health insurance, having the state distribute them to those who cannot afford them, etc.

Coercion: The prospect of coercion is raised in several ways. Obviously, if the state decides to mandate an enhancement, treating its beneficial effects as a public health issue, this is effectively coercion. We see this currently in the backlash against vaccinations: they are mandated with the aim of promoting public health, but in some minds the mandate raises concerns about individual liberty. I would submit that the vaccination case demonstrates that at least on some occasions coercion is justified. The question is whether coercion could be justifiable for enhancement, rather than for harm prevention.

Although some coercive ideas, such as the suggestion that we put Prozac or other enhancers in the water supply, are unlikely to be taken seriously as a policy issue however, see Appel [] , less blatant forms of coercion are more realistic. The danger is that respecting the autonomy of some may put pressure on the autonomy of others. There is unlikely to be any categorical resolution of the ethics of enhancement debate. The details of a technology will be relevant to determining whether a technology ought to be made available for enhancement purposes: we ought to treat a highly enhancing technology that causes no harm differently from one that provides some benefit at noticeable cost. Moreover, the magnitude of some of the equality-related issues will depend upon empirical facts about the technologies.

Are neurotechnologies equally effective for everyone? As mentioned, there is evidence that some known enhancers such as the psychostimulants are more effective for those with deficiencies than for the unimpaired: studies suggest the beneficial effects of these drugs are proportional to the degree to which a capacity is impaired Hussain et al. If this is a widespread pattern, it may alleviate some worries about distributive justice and contributions to social and economic stratification, since people with a deficit will benefit proportionately more than those using the drug for enhancement purposes. Bear in mind, however, that biology is rarely that equitable, and it would be surprising if this pattern turned out to be the norm.

Since the technologies that could provide enhancements are extremely diverse, ranging from drugs to implants to genetic manipulations, assessment of the risks and benefits and the way in which these technologies bear upon our conception of humanity will have to be empirically grounded. Freedom is a cornerstone value in liberal democracies like our own, and one of the most cherished kinds of freedom is freedom of thought. Both of these can be challenged by the new developments in neuroscience. The value of, potential threat to, and ways to protect these aspects of freedom are a concern for neuroethics. Several recent papers have posited novel rights in this realm, such as rights to cognitive liberty, to mental privacy, to mental integrity, and to psychological continuity Ienca and Andorno, , or to psychological integrity and mental self-determination Bublitz, Over the last half century, technological advances have eroded or impinged upon many traditional realms of worldly privacy.

Most of the avenues for expression can be and increasingly are monitored by third parties. It is tempting to think that the inner sanctum of the mind remains the last bastion of real privacy. This may still be largely true, but even the privacy of the mind can no longer to be taken for granted. Our neuroscientific achievements have already made significant headway in allowing others to discern some aspects of our mental content through neurotechnologies. Noninvasive methods of brain imaging have revolutionized the study of human cognition and have dramatically altered the kinds of knowledge we can acquire about people and their minds.

A focus of neuroethics is to determine the real nature of the threat to mental privacy, and to evaluate its ethical implications, many of which are relevant to legal, medical, and other social issues Shen, For example, in a world in which the bastion of the mind may be lowering its drawbridges, do we need extra protections? Doing so effectively will require both a solid understanding of the neuroscientific technologies and the neural bases of thought, as well as a sensitivity to the ethical problems raised by our growing knowledge and ever-more-powerful neurotechnologies. These dual necessities illustrate why neuroethicists must be trained both in neuroscience and in ethics. In what follows I briefly discuss the most relevant neurotechnology and its limitations and then canvas a few ways in which privacy may be infringed by it.

In general, MRI is a tool that allows researchers noninvasively to examine or monitor brain structure and activity, and to correlate that structure or function with behavior. Structural or anatomical MRI provides high-resolution structural images of the brain. While structural imaging in the biosciences is not new, MRI provides much higher resolution and better ability to differentiate tissues than prior techniques such as x-rays or CT scans. Decoding involves probabilistic matching, using machine learning, of an observed pattern of brain activation with experimentally established correlations between activity patterns and some kind of functional variable, such as task, behavior, or content.

The kind of information provided by functional imaging promises to provide important evidence useful for three goals: Decoding mental content, diagnosis, and prediction. Neuroethical questions arise in all these areas. Before discussing these issues, it is important to remember that neuroimaging is a technology that is subject to a number of significant limitations, and these technical issues limit how precise the inferences can be. For example:. Without appreciating these technical issues and the resulting limits to what can legitimately be inferred from fMRI, one is likely to overestimate or mischaracterize the potential threat that it poses.

In fact, much of the fear of mindreading expressed in non-scientific publications stems from a lack of understanding of the science Racine, For example, there is no scientific basis to the worry that imaging would enable the reading of mental content without our knowing it. Thus, fears that the government is able to remotely or covertly monitor the thoughts of citizens are unfounded. Noninvasive ways of inferring neural activity have led many to worry that mindreading is possible, not just in theory, but even now. Using decoding techniques fMRI can be used, for example, to reconstruct a visual stimulus from activity of the visual cortex while a subject is looking at a scene or to determine whether a subject is looking at a familiar face, or hearing a particular sound.

If mental content supervenes on the physical structure and function of our brains, as most philosophers and neuroscientists think it does, then in principle it should be possible to read minds by reading brains. Because of the potential to identify mental content, decoding raises issues about mental privacy. Although some aspects of content can be decoded from neural data, these tend to be quite general and nonpropositional in character. The ability to infer semantic meaning from ideation or visual stimulation tends to work best when the realm of possible contents are quite constrained.

Our current abilities allow us to infer some semantic atoms, such as representations denoting one of a prespecified set of concrete objects, but not unconstrained content, or entire propositions. Of course, future advances might make worries about mindreading more pressing. For example, if we develop robust means for decoding compositional meaning, we may one day come to be able to decode propositional thought.

Still, some worries are warranted. Even if neuroimaging is not at the stage where mindreading is possible, it can nonetheless threaten aspects of privacy in ways that should give us pause. It is possible to identify individuals on the basis of their brain scans Valizadeh et al. In addition, neuroimaging can provide some insights into attributes of people that they may not want known or disclosed. In some cases, subjects may not even know that these attributes are being probed, thinking they are being scanned for other purposes.

A willing subject may not want certain things to be monitored. In what follows, I consider a few of these more realistic worries. Implicit bias: Although explicitly acknowledged racial biases are declining, this may be due to a reporting bias attributable to the increased negative social valuation of racial prejudice. Much contemporary research now focuses on examining implicit racial biases, which are automatic or unconscious reflections of racial bias.

While there is disagreement about how best to interpret implicit bias results e. When ought this information be collected? What procedures must be followed for subjects legitimately to consent to implicit measures? What significance should be attributed to evidence of biases? What kind of responsibility should be attributed to people who hold them? What predictive power might they hold? Should they be used for practical purposes? One can imagine obvious but controversial potential uses for implicit bias measures in legal situations, in employment contexts, in education, and in policing, all areas in which concerns of social justice are significant.

Lie detection: Several neurotechnologies are being used to detect deception or neural correlates of lying or concealing information in experimental situations. For example, both fMRI measures and EEG analysis techniques relying on the P signal have been used in the laboratory to detect deception with varying levels of success. These methods are subject to a variety of criticisms Farah et al. For example, almost all experimental studies fail to study real lying or deception, but instead investigate some version of instructed misdirection. The context, tasks, and motivations differ greatly between actual instances of lying and these experimental analogs, calling into question the ecological validity of these experimental techniques.

Moreover, accuracy, though significantly higher than chance, is far from perfect, and because of the inability to determine base rates of lying, error rates cannot be effectively assessed. Thus, we cannot establish their reliability for real-world uses. Finally, both physical and mental countermeasures decrease the accuracy of these methods Hsu et al. Despite these limitations, several companies have marketed neurotechnologies for this purpose. Character traits: Neurotechnologies have shown some promise in identifying or predicting aspects of personality or character. In an interesting study aimed at determining how well neuroimaging could detect lies, Greene and colleagues gave subjects in the fMRI scanner a prediction task in a game of chance that they could easily cheat on.

By using statistical analysis the researchers could identify a group of subjects who clearly cheated and others who did not Greene and Paxton, Although they could not determine with neuroimaging on which trials subjects cheated, there were overall differences in brain activation patterns between cheaters and those who played fair and were at chance in their predictions. Moreover, Greene and colleagues repeated this study at several months remove, and found that the character trait of honesty or dishonesty was stable over time: cheaters the first time were likely to cheat indeed, cheated even more the second time , and honest players remained honest the second time around.

Also interesting was the fact that the brain patterns suggested that cheaters had to activate their executive control systems more than noncheaters, not only when they cheated, but also when deciding not to cheat. While the differential activations cannot be linked specifically to the propensity to cheat rather than to the act of cheating, the work suggests that these task-related activation patterns may reflect correlates of trustworthiness. The prospect of using methods for detecting these sorts of traits or behaviors in real-world situations raises a host of thorny issues.

What level of reliability should be required for their employment? In what circumstances should they be admissible as evidence in the courtroom? For other purposes? Using lie detection or decoding techniques from neuroscience in legal contexts may raise constitutional concerns: Is brain imaging a search or seizure as protected by the 4 th Amendment? Would its forcible use be precluded by 5 th Amendment rights? These questions, though troubling, might not be immediately pressing: in a landmark case US v. Semrau, the court ruled that fMRI lie detection is inadmissible, given its current state of development. However, the opinion left open the possibility that it may be admissible in the future, if methods improve. Finally, to the extent that relevant activation patterns may be found to correlate significantly with activation patterns on other tasks, or with a task-free measure such as default-network activity, it raises the possibility that information about character could be inferred merely by scanning them doing something innocuous, without their knowledge of the kind of information being sought.

Thus, there are multiple dimensions to the threat to privacy posed by imaging techniques. Increasingly, neuroimaging information can bear upon diagnoses for diseases, and in some instances may provide predictive information prior to the onset of symptoms. Work on the default network is promising for improving diagnosis in certain diseases without requiring that subjects perform specific tasks in the scanner Buckner et al. Neuroethical issues also arise regarding ways to handle incidental findings, that is, evidence of unsymptomatic tumors or potentially benign abnormalities that appear in the course of scanning research subjects for non-medical purposes Illes et al.

The ability to predict future functional deficits raises a host of issues, many of which have been previously addressed by genethics the ethics of genetics , since both provide information about future disease risk. What may be different is that the diseases for which neurotechnologies are diagnostically useful are those that affect the brain, and thus potentially mental competence, mood, personality, or sense of self.

As such they may raise peculiarly neuroethical questions see below. In addition, such methods can also be used to predict future behaviors, insofar as these are correlated with observations of brain activity patterns. Some studies have already reported predictive power over upcoming decisions Soon et al. Increasingly, we will see neuroscience or neuroimaging data that will give us some predictive power over longer-range future behaviors. For example, brain imaging may allow us to predict the onset of psychiatric symptoms such as psychotic or depressive episodes.

In cases in which this behavior is indicative of mental dysfunction it raises questions about stigma, but also may allow more effective interventions. Although scientists occasionally make this mistake when discussing their results, the fact that brain function or structure may give us some information about future behaviors should not be interpreted as a strong challenge to free will. The prevalence of this mistake among both philosophers and scientists again illustrates the importance for neuroethicists of sophistication in both neuroscience and philosophy. Perhaps the most consequential and most ethically difficult potential use of predictive information is in the criminal justice system.

For example, there is evidence that structural brain differences are predictive of scores on the PCL-R, a tool developed to diagnose psychopathy. It is also well-established that psychopaths have high rates of recidivism for violent offenses. Indeed, brain information appears to offer some predictive value when combined with other factors Poldrack et al. One cautionary tale comes from a recent exchange in the literature: A report suggested that brain activity on a cognitive task predicts recidivism Aharoni et al. Neuroethical analysis here is essential. Should neural data be admissible for determining sentences or parole decisions? Would that be equivalent to punishing someone for crimes they have not committed?

Or is it just a neutral extension of current uses of actuarial information, such as age, gender, and income level? At an extreme, one could imagine using predictive information to detain people who have not yet committed a crime, arresting them before they do. This dystopian scenario, portrayed in the film Minority Report Speilberg, , also illustrates how our abilities to predict can raise difficult ethical and policy questions when they collide with intuitions about and the value of free will and autonomy. In sum, neuroimaging techniques raise a number of neuroethical issues. The ones discussed above pertain to the use of fMRI, currently an expensive and cumbersome technique.

But other imaging methods exist that could be far more widespread. Even though the kind of information these methods provide is very crude and generally unsuitable for decoding mental content, there are conceivable everyday situations on the horizon in which issues of mental privacy and neurotechnology might arise. Although definitions of autonomy differ, it is widely appreciated as a valuable aspect of personhood. Autonomy of the mental can be impacted in a number of ways.

Here are several:. Direct interventions: The ability to directly manipulate our brains to control our thoughts or behavior is an obvious threat to our autonomy Gilbert, ; Walker and Mackenzie, Some of our neurotechnologies offer that potential, although these sorts of neurotechnologies are invasive and used only in cases where they are medically justified. Other types of interventions, such as the administration of drugs to calm a psychotic person, may also impact autonomy.

We know that stimulating certain brain areas in animals will lead to repetitive and often stereotyped behaviors. Scientists have implanted rats with electrodes and have been able to control their foraging behaviors by stimulating their cortex. In practice, we have a few methods that can do this, but only in a limited way. For example, Transcranial Magnetic Stimulation TMS applied to motor cortex can elicit involuntary movements in the part of the body controlled by the cortical area affected, or when repetitively administered it can inhibit activity for a period of time, acting as a temporary lesion.

Effects will vary depending on what area of the brain is stimulated; higher cognitive functions can be impacted as well. Relatively invasive methods, such as Deep Brain Stimulation DBS, discussed below and electrocorticography ECOG , both techniques requiring brain surgery, demonstrate that direct interventions can affect cognition, action, and emotion, often in very particular and predictable ways. However much of a threat to autonomy these methods pose in theory, they are rarely used with the aim of compromising autonomy.

On the contrary, direct brain interventions, when used, are largely aimed at augmenting or restoring rather than bypassing or diminishing autonomy Roskies, ; Brown, For example, one rapidly advancing field in neuroscience is the area of neural prostheses and brain computer interfaces Jebari, ; Klein et al. Neural prostheses are artificial systems that replace defective neural ones, usually of sensory systems. Some of the more advanced and widely-known are artificial cochleas. Other systems have been developed that allow vision-like information to feed to touch-specific receptors, enabling blind people to navigate the visual world.

Brain computer interfaces, on the other hand, are systems that read brain activity and use it to guide robotic prostheses for limbs, or to move a cursor on a video screen. Advisory and predictive implants use neural information to warn patients about the risk of, for example, an upcoming seizure, allowing them to prophylactically self-medicate Brown, ; Lazaro-Munoz et al. Thus, although in principle brain interventions could be used to control people and diminish their autonomy, in general, direct interventions are being developed to restore and enhance it Lavazza, Neuroeconomics and neuromarketing: There are more subtle ways to impact autonomy than direct brain manipulations, and these are well within our grasp: Our thoughts can be manipulated indirectly: old worries prompted by propaganda and subliminal advertising have taken on a renewed currency with the advent of neuroeconomics and neuromarketing Spence, By better understanding how we process reward, how we make decisions more generally, and how we can bias or influence that process, we open the door to more effective external indirect manipulations.

Indeed, social psychology has been showing how subtle alterations to our external environment can affect beliefs, moods, and behaviors. The precise threats posed by understanding the neural mechanisms of decision making have yet to be fully articulated Stanton et al. Is neuromarketing being used merely to design products that satisfy our desires more fully or is it being used to manipulate us? Depending on how you see it, it could be construed as a good or an evil. Does understanding the neural substrates of choice and reward provide advertisers more effective tools than they had merely by using behavioral data, or just more costly ones?

Do consumers consequently have less autonomy? How can we compensate for or counteract these measures? These questions have yet to be adequately addressed. Regulation: Yet another way that autonomy can be impacted is by restricting the things that a person can do with and to her own mind. The degree to which a person should be prevented from doing what he wishes to his or her self, body or mind, is an ethical issue on which people have differing opinions. Some claim this kind of regulation is a problematic infringement of autonomy, but certain regulations of this type are already largely accepted in our society. Regulation of drugs does impact our autonomy, but it arguably averts potentially great harms.

Allowing cognitive enhancing technologies only for treatment uses but not for enhancement purposes is another restriction of mental autonomy. Whether it is one we want to sanction is still up for debate. Belief in free will: Advances in neuroscience have been frequently claimed to have bearing upon the question of whether we have free will and on whether we can be truly morally responsible for our actions.

Although the philosophical problem of free will is generally considered to be a metaphysical problem, demonstrable lack of freedom would have significant ethical consequences. A number of neuroscientists and psychologists have intimated or asserted that neuroscience can show or has shown that free will is an illusion Brembs, ; Libet, ; Soon, ; Harris, Others have countered with arguments to the effect that such a demonstration is in principle impossible Roskies Regardless of what science actually shows about the nature of free will, the fact that people believe neuroscience evidence supports or undermines free will has been shown to have practical consequences.

For example, evidence merely supporting the premise that our minds are a function of our brains, as most of neuroscience does, is perceived by some people to be a challenge to free will. And in several studies, manipulating belief in free will affects the likelihood of cheating e. Vohs and Schooler The debate within neuroscience about the nature and existence of free will will remain relevant to neuroethics in part because of its impact on our moral, legal and interpersonal practices of blaming and punishing people for their harmful actions. One of the aspects of neuroethics that makes it distinctive and importantly different from traditional bioethics is that we recognize that, in some yet-to-be-articulated sense, the brain is the seat of who we are.

For example, we now have techniques that alter memories by blunting them, strengthening them, or selectively editing them. We have drugs that affect sexuality, and others that affect mood. Here, neuroethics rubs up against some of the most challenging and contentious questions in philosophy: What is the self? What sorts of changes can we undergo and still remain ourselves? What is it that makes us the same person over time? Of what value is this temporal persistence? What costs would changing personhood incur?

Because neuroscience intervention techniques can affect memory, desires, personality, mood, impulsivity and other things we might think of as constitutive of the person or the self, the changes they can cause and combat have a unique potential to affect both the meaning and quality of the most intimate aspects of our lives. Although neuroethics is quite different from traditional bioethics in this regard, it is not so different from genethics.

But as we have discovered, we are not just our genes. Our ability to sequence the human genome has not laid bare the causes of cancer, the genetic basis for intelligence, or of psychiatric illness, as many had anticipated. One reason is that our genome is a distal cause of the people we come to be: many complex and intervening factors matter along the way. Our brains, on the other hand, are a far more proximal cause of who we are and what we do. Our moment-to-moment behavior and our long-range plans are directly controlled by our brains, in a way they are not directly controlled by our genomes.

Despite its plausibility, it is notoriously difficult to articulate the way in which we are our brains: What aspects of our brains makes us the people that we are? What aspects of brain function shape our memories, our personality, our dispositions? What aspects are irrelevant or inessential to who we are? What makes possible a coherent sense of self? The lack of answers we have to these deep neurophilosophical questions does little to alleviate the pragmatic worries raised by neuroscience, since our ability to intervene in brains outstrips our understanding of what we are doing, and can affect all these aspects of our being. In philosophy, work focusing on persons may address a variety of distinct issues using different constructs.

Philosophers might be interested in the nature of personhood, in the nature of the self, in the kinds of traits and psychological states or processes that give an experienced life coherence or authenticity, or in the ingredients for a flourishing life. Each calls for its own analysis. Outside of philosophy, many of these issues are run together, and confusion often results.

Neuroethics, while in a unique position to leverage these issues and apply them in a fruitful way, often fails to make the most of the conceptual work philosophers have done in this area. This conflation further muddies already difficult waters, and diminishes the potential value of neuroethical work. Below I try to give a brief roadmap of the separate strands that neuroethicists have been concerned with. This metaphysical question has been addressed by a variety of philosophical theories. For example, some theorists argue that what it is to be the numerically identical over time is to be the same human organism Olson, , and that being the same organism is determined by sameness of life.

If having the same life is the relevant criterion, one could argue that life-sustaining areas of the brainstem are essential to personal identity Olson, For those who believe instead that bodily integrity is what is essential, the ability of neuroscience to alter the brain will arguably have little effect on personal identity. Many other philosophers have identified the same person as being grounded in psychological continuity of some sort e.

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