Discussion of the ethics of memory modification technologies has often focused on questions about the limits of their permissibility. In the current paper, I focus primarily on a different issue: when is it rational to prefer MMTs 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 the autonomy of their users. If this conclusion is true, moreover, it provides (...) a fresh perspective on debates about the permissibility of MMTs. On the one hand, 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. On the other hand, for those who view MMTs as permissible in a wide range of circumstances, the conclusion may deflate their endorsement. (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)

Jorge Luis Borges introduces the mythical ouroboros as follows: “A third-century Greek amulet, to be found today in the British Museum, gives us an image that can better illustrate that infinitude:...

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)

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)