Matteo Laspro et al. (2024) provide a thought-provoking review of the ethical issues surrounding Whole-Eye Transplantation (WET). In this commentary, we expand on three of the concerns they raise i...

As Jan Christoph Bublitz (2024) rightly notes, the first international declaration on neurotechnologies and human rights would set the tone for further international and domestic regulations. For t...

Philosophy and Literature is an internationally renowned refereed journal founded by Denis Dutton at the University of Canterbury, Christchurch. It is now published by the Johns Hopkins University Press. Since its inception in 1976, Philosophy and Literature has been concerned with the relation between literary and philosophical studies, publishing articles on the philosophical interpretation of literature as well as the literary treatment of philosophy. Philosophy and Literature has sometimes been regarded as iconoclastic, in the sense that it repudiates academic pretensions, (...) insidious jargon and institutional vogue. Dutton, who remains the editor, still writes a regular column. A distinctive feature of Philosophy and Literature was the annual Bad Writing Contest, held from 1995–98, which sought to identify (and publish) the ‘most stylistically lamentable passages’ of academic prose, often to great amusement. (shrink)

The time is near where ‘therapeutic’ bodily assistive devices, developed to mimic species-typical body structures in order to enable normative body functioning, will allow the wearer to outperform the species-typical body in various functions. Although such devices are developed for people that are seen to exhibit sub species-typical abilities, many ‘therapeutic enhancements’ might also be desired and used by people that exhibit species-typical body abilities. This paper presents the views of members of the World Federation of the Deaf on potential (...) beyond species-typical abilities enabling therapeutic assistive devices (i.e. related to hearing). Survey respondents showed support for the development and uptake of beyond normal hearing enabling devices. The views of survey respondents as clients affect hearing-enabling professions (such as audiologist and speech pathologists). The paper analyzes what guidance code of ethics of hearing enabling professions give in regards to beyond normal hearing enabling devices. This paper suggests that people labeled impaired and the professions that serve them should more involved in the enhancement discourse. (shrink)

Advances in prosthetic design should benefit people with limb difference. But empirical evidence demonstrates a lack of uptake of prosthetics among those with limb difference, including of advanced designs. Non-use is often framed as a problem of prosthetic design or a user’s response to prosthetics. Few studies investigate user experience and preferences, and those that do tend to address satisfaction or dissatisfaction with functional aspects of particular designs. This results in limited data to improve designs and, we argue, this is (...) pragmatically and ethically problematic. This paper presents results of a survey we conducted in 2017 with people with upper limb difference in Australia. The survey sought to further knowledge about preferences surrounding prosthetics and understanding of how preferences relate to user experience, perspective, and context. Survey responses demonstrated variety in the uptake, use and type of prosthetic—and that use of, preferences about, and impacts of prosthetics rely not just on design factors but on various contextual factors bearing on identity and social understandings of disability and prosthetic use. From these results, we argue that non-use of prosthetics could be usefully reframed as an issue of understanding how prosthetics can best support users’ autonomy. This supports the claim that there is a need to incorporate user engagement into design processes for prosthetic limbs, though further work is needed on methods for doing so. (shrink)

Background The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals’ lifeworlds and need to be considered in implant care and in the course of technical developments. Methods This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical (...) research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data. Results Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability. Conclusions Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in “lived experiences” may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design. (shrink)

‘Liberal eugenics’ has emerged as the most popular position amongst philosophers writing in the contemporary debate about the ethics of human enhancement. This position has been most clearly articulated by Nicholas Agar, who argues that the ‘new’ liberal eugenics can avoid the repugnant consequences associated with eugenics in the past. Agar suggests that parents should be free to make only those interventions into the genetics of their children that will benefit them no matter what way of life they grow up (...) to endorse. I argue that Agar's attempt to distinguish the new from the old eugenics fails. Once we start to consciously determine the genetics of future persons, we will not be able to avoid controversial assumptions about the relative worth of different life plans. Liberal eugenicists therefore confront the horns of a dilemma. Whichever way they try to resolve it, the consequences of widespread use of technologies of genetic selection are likely to look more like the old eugenics than defenders of the new eugenics have acknowledged. (shrink)

The paper focuses on processes of normalization through which dis/ability is simultaneously produced in specific collectives, networks, and socio-technological systems that enable the construction of such demarcations. Our point of departure is the cochlear implant, a neuroprosthetic device intended to replace and/or augment the function of the damaged inner ear. Unlike hearing aids, which amplify sounds, the CI does the work of damaged hair cells in the inner ear by providing sound signals to the brain. We examine the processes of (...) the CI’s genesis as well as its specific uses by and interrelations to the different and divergent actors that the CI assembles. We argue that the technological device and the implicated normalization process mobilize complex effects in varying socio-technical arrangements. The CI is conceived as a “boundary object” [89] or a “quasi-object” [49, 83], i.e., a metastabilized medium of translation that coordinates social, cultural, and technological action. Although intended to transform non-hearing or hard of hearing people into competent and “normal” hearing subjects, the CI system reproduces the asymmetrical structures of the disability discourse [14] through its function of “developing and maintaining coherence between intersecting social worlds” [89, 393]. Additionally, it initiates controversial discourses that have resulted in new forms of biosocial collectivities ranging from cochlear implantees with normal human hearing to human configurations who have passed through human enhancement. Our approach is thus situated at the intersection of disability and media studies and tackles the particular conditions technological media configurations impose upon the production of dis/ability. (shrink)

This article provides an ethnographic account of pediatric cochlear implantation, revealing an important shift in the definition of deafness from a sensory loss to a neurological processing problem. In clinical and long-term therapeutic practices involved in pediatric implantation, the cochlear implant is recast as a device that merely provides access to the brain. The “real” treatment emerges as long-term therapeutic endeavors focused on neurological training. This redefinition then ushers in an ensuing responsibility to “train the brain,” subsequently displacing failure from (...) the device onto the individual’s ability to train his or her brain. New caregiving techniques that accompany implantation are understood through neuropolitics, showing how parents are encouraged to engage in neuro-self-governance, and how the concept of neuroplasticity is used to cultural ends. (shrink)

Previous discussions of addiction have often focused on the question of whether addiction is a disease. This discussion distinguishes that question – the disease question – from the question of whether addiction is a disability. I argue that, however one answers the disease question, and indeed on almost any credible account of addiction, addiction is a disability. I then consider the implications of this view, or why it matters that addiction is a disability. The disease model of addiction has led (...) many to see addiction as primarily a medical problem, and to make medical treatment of the addicted person the first priority in addressing addiction. Once addiction is viewed as a disability, different concerns are foregrounded. The problem of addiction resides not only in the addicted person, but also in the social environment in which the addicted person finds herself. The fundamental ethical question about addiction is not how addicted persons can be treated or otherwise changed, but how a just society can make reasonable accommodations for addicted persons. (shrink)

Biomedical engineering technologies such as brain–machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: (...) will everyone be enhanced? Will we be “human” if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism’s reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation’s unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation—and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis. (shrink)

Sex selection, which refers to the attempt to choose or control the sex of a child prior to its birth, has become the subject of increasing ethical scrutiny and many jurisdictions have criminalized it except for serious sex-linked diseases or conditions that cannot easily be ameliorated or remedied. This paper argues that such a blanket prohibition is ethically unwarranted because it is based on a flawed understanding of the difference between sexist values and mere sex-oriented preferences. It distinguishes between ethics (...) and public policy, and suggests a way of allowing preference-based sex selection as a matter of public policy without permitting value-based sex selection. It further argues that medically-based sex selection should be publicly funded but that preference-base sex selection should not be paid for by society, and that the prohibition against value-based sex selection should be enforced through legislation that controls the licensing of health care facilities and through disciplinary procedures against health care professionals. (shrink)

In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry (...) within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments. (shrink)

Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make (...) recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices. (shrink)

In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry (...) within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments. (shrink)

The ideas of technological determinism and the autonomy of technology are long-standing and widespread. This article explores why the use of certain technologies is perceived to be obligatory, thus fueling the fatalism of technological determinism and undermining our sense of freedom vis-à-vis the use of technologies. Three main mechanisms that might explain “obligatory technologies” (technologies that must be adopted) are explored. First, competition between individuals or groups drives the adoption of technologies that enhance or extend human capacities. Second, individuals and (...) groups may become dependent on technologies. Third, technologies induce changes in social norms and values that may come to be enforced through various social mechanisms, including the law. The widespread ideology of the beneficence and inevitability of technological progress in our culture helps this process along. (shrink)

Judith Butler's (2006) account of vulnerability, resonant with other accounts offered by feminist theorists of embodiment (such as Margrit Shildrick [2000] and Rosalyn Diprose [2002]), underscores a "conception of the human . . . in which we are, from the start, given over to the other, one in which we are, from the start, even prior to individuation itself and, by virtue of bodily requirements, given over to some set of primary others" (31). She is concerned with how this state (...) of being—"not only constituted by our relations but also dispossessed by them as well" (24)—becomes recognized, or not, in the political production and recognition of vulnerability, and the suffering that occurs in the violent .. (shrink)

It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I (...) conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam’s concept of the zone of parental discretion. (shrink)

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have (...) the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population. (shrink)

Riassunto: L’impianto cocleare è una neuroprotesi che consente un recupero parziale dell’udito nella persona sorda. Nonostante la sua generale efficacia nel contrastare alcuni dei problemi legati alla sordità, il suo utilizzo è stato fortemente osteggiato da quella parte della comunità sorda che vede nella sordità una forma di identità culturale e non una patologia. Questo articolo inquadra in una prospettiva neuroetica le preoccupazioni della comunità sorda – difficilmente comprensibili agli udenti – esaminando le analogie fra il rifiuto dell’IC e il (...) disagio che si osserva nella popolazione generale relativamente al Potenziamento Cognitivo. Nel PCog, individui sani insoddisfatti delle proprie prestazioni, o comunque desiderosi di migliorarle, ricorrono ad interventi artificiali per potenziare le proprie funzioni cognitive. L’analisi evidenzia come, nel rifiutare l’IC, la comunità sorda possa voler tutelare un insieme di valori non così diverso da quello che la comunità generale richiama spesso nelle sue preoccupazioni rispetto alla diffusione dei PCog. Parole chiave : Impianto cocleare; Potenziamento cognitivo; Sordità; Cultura sorda The cochlear implant as cognitive enhancement? A neuroethical perspective on some issues raised by the deaf community: The cochlear implant is a neuroprosthesis that allows for partial recovery of auditory function in individuals who are deaf. Despite its general efficacy, its use has been strongly opposed by a part of the deaf community that perceives deafness as a form of cultural identity, rather than a pathology. This article considers the concerns of the deaf community – which are often difficult for hearing people to understand – from a neuroethics perspective, proposing that such opposition to CI is analogous to the general population’s unease with regard to Cognitive Enhancement. CE allows healthy individuals who are unsatisfied with – or would like to improve – their performance to use artificial interventions that enhance cognitive functions. The analysis reveals that, when opposing CIs, the deaf community may be protecting a set of values similar to those that the general community often evokes when voicing concerns about CE diffusion. Keywords: Cochlear Implant; Cognitive Enhancement; Deafness; Deaf Culture. (shrink)

Some philosophers and disability advocates argue that disability is not bad for you. Rather than treated as a harm, it should be considered and even celebrated as just another manifestation of human diversity. Disability is mere difference. To most of us, these are extraordinary claims. Can they be defended?

The suggestion that individuals should be considered disadvantaged, and consequently entitled to compensation, only if they consider themselves disadvantaged (Dworkin’s ‘continuity test’) is initially appealing. However, it also faces problems. First, if individuals are routinely mistaken, then we routinely fail to assist the deserving. Second, if individuals assess their circumstances differently then the state will provide different levels of assistance to people in identical situations. Thus, should we instead ignore individuals’ convictions and provide assistance that some, at least, do not (...) feel they need? One set of cases where this dilemma is salient are those in which disabled individuals disagree over whether they are disadvantaged. Focussing on these, I argue that despite objections, individuals should have a voice in determining whether they are disadvantaged. However, I contend that our goal should not be ensuring continuity with individuals’ ethical convictions (concerning the pursuits they deem worthwhile or valuable), but their convictions regarding whether they are relevantly disadvantaged (whether they have what they are entitled to). (shrink)

The strategy of developing an ontology or models of disability as a prior step to settling ethical issues regarding disabilities is highly problematic for two reasons. First, key definitional aspects of disability are normative and cannot helpfully be made value-neutral. Second, if we accept that the contested concept of disability is value-laden, it is far from obvious that there are definitive reasons for choosing one interpretation of the concept over another. I conclude that the concept of disability is better left (...) ethically open-ended or broad enough to encompass the examination of various ethical issues. Alternatively, the concept of disability could be altogether abandoned in order to focus on specific issues without being hindered by debates about the nature of disability. Only political costs, rather than conceptual considerations internal to the models, could be weighed against such a conclusion. (shrink)

In this paper, I analyze the ethical implications of genetic enhancement within the specific framework of the “child’s right to an open future” argument (CROF). Whilst there is a broad ethical consensus that genetic modifications for eradicating diseases or disabilities are in line with – or do not violate – CROF, there is huge disagreement about how to ethically understand genetic enhancement. Here, I analyze this disagreement and I provide a revised formulation of the argument in the specific field of (...) genetic enhancement. First, I argue that CROF is not in contrast with every kind of enhancement. I subsequently discuss whether CROF requires some moral obligations to enhance progeny. My argument is that parents do not have the moral obligation to open as many options as possible for their children. Rather, they should provide them with a reasonable range of opportunities. Finally, I contend that the moral obligations required by CROF are directly dependent on what Allen Buchanan calls the ‘dominant cooperative framework’ in a given society. I conclude by claiming that, at present, parents are not morally obliged to genetically enhance their children since a non-enhanced person already might have access to a reasonable range of opportunities. However, the moral obligation to enhance progeny might arise if a structural modification of the dominant cooperative framework occurs. (shrink)

This paper proposes a novel method for identifying the public evaluative standards that contribute to the classification of certain conditions as mental disabilities. Public evaluative standards could contribute to ascertaining disabilities by outlining characteristics whose presence beyond a threshold is fundamentally important for the life of a person and whose absence or reduced occurrence constitutes a disability. Additionally, they can participate in determining disabilities by delineating particularly grave difficulties, impairments, or incapacities. Our method relies on a model of public justification (...) of evaluative standards that is inspired by Gerald Gaus’s theory of public reason. Thus, our approach recommends the justification of evaluative standards through sound deliberative routes from reasons accessible to all persons who participate in the process of justification and the convergence of what is justified in this way to each of them. We deem that disabilities could be caused both by problems in the internal characteristics of a person as well as by unfairness or a lack of hospitality in external circumstances. This is why the method of justification is applied to the assessment of those circumstances as well. If social or environmental circumstances cannot be justified through the convergence of reasons accessible to all persons involved in the process of justification, we have reasons to exclude the presence of a disability and ascertain the presence of inadequate external conditions. (shrink)

This paper uses the fictional case of the ‘Babel fish’ to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf culture. I argue that the relationships between Deaf and hearing cultures that are revealed and constructed in debates about genetic testing are themselves deserving of ethical evaluation. Making (...) good policy about genetic testing for deafness will require addressing questions in political philosophy and anthropology about the value of culture and also thinking hard about what sorts of experiences and achievements make a human life worthwhile. (shrink)

This paper explores early Australasian philosophy in some detail. Two approaches have dominated Western philosophy in Australia: idealism and materialism. Idealism was prevalent between the 1880s and the 1930s, but dissipated thereafter. Idealism in Australia often reflected Kantian themes, but it also reflected the revival of interest in Hegel through the work of ‘absolute idealists’ such as T. H. Green, F. H. Bradley, and Henry Jones. A number of the early New Zealand philosophers were also educated in the idealist tradition (...) and were influential in their communities, but produced relatively little. In Australia, materialism gained prominence through the work of John Anderson, who arrived in Australia in 1927, and continues to be influential. John Anderson had been a student of Henry Jones, who might therefore be said to have influenced both main strands of Australian philosophical thought. (shrink)

An e-mail interview made by Francisco Guzmán. April 2010.