Human enhancement has emerged in recent years as a blossoming topic in applied ethics. With continuing advances in science and technology, people are beginning to realize that some of the basic parameters of the human condition might be changed in the future. One important way in which the human condition could be changed is through the enhancement of basic human capacities. If this becomes feasible within the lifespan of many people alive today, then it is important now to consider the (...) normative questions raised by such prospects. The answers to these questions might not only help us be better prepared when technology catches up with imagination, but they may be relevant to many decisions we make today, such as decisions about how much funding to give to various kinds of research. Enhancement is typically contraposed to therapy. In broad terms, therapy aims to fix something that has gone wrong, by curing specific diseases or injuries, while enhancement interventions aim to improve the state of an organism beyond its normal healthy state. However, the distinction between therapy and enhancement is problematic, for several reasons. First, we may note that the therapy-enhancement dichotomy does not map onto any corresponding dichotomy between standard-contemporary-medicine and medicineas-it-could-be-practised-in-the-future. Standard contemporary medicine includes many practices that do not aim to cure diseases or injuries. It includes, for example, preventive medicine, palliative care, obstetrics, sports medicine, plastic surgery, contraceptive devices, fertility treatments, cosmetic dental procedures, and much else. At the same time, many enhancement interventions occur outside of the medical framework. Office workers enhance their performance by drinking coffee. Make-up and grooming are used to enhance appearance. Exercise, meditation, fish oil, and St John’s Wort are used to enhance mood. Second, it is unclear how to classify interventions that reduce the probability of disease and death.. (shrink)

Anthropogenic climate change is arguably one of the biggest problems that confront us today. There is ample evidence that climate change is likely to affect adversely many aspects of life for all people around the world, and that existing solutions such as geoengineering might be too risky and ordinary behavioural and market solutions might not be sufficient to mitigate climate change. In this paper, we consider a new kind of solution to climate change, what we call human engineering, which involves (...) biomedical modifications of humans so that they can mitigate and/or adapt to climate change. We argue that human engineering is potentially less risky than geoengineering and that it could help behavioural and market solutions succeed in mitigating climate change. We also consider some possible ethical concerns regarding human engineering such as its safety, the implications of human engineering for our children and society, and we argue that these concerns can be addressed. Our upshot is that human engineering deserves further consideration in the debate about climate change. (shrink)

We consider the current debate between bioconservatives and their opponents—whom we dub bioliberals—about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and action, there are circumstances in (...) which they are not reliable. Intuitions—including intuitions about enhancement—are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

Stanley Klein and Shaun Nichols describe the case of patient R.B., whose memories lacked the sense of “mineness” usually conveyed by memory. Klein and Nichols take R.B.’s case to show that the sense of mineness is merely a contingent feature of memory, which they see as raising two problems for memory-based accounts of personal identity. First, they see it as potentially undermining the appeal of memory-based accounts. Second, they take it to show that the conception of quasi-memory that underpins many (...) memory-based accounts is inadequate. I argue that Klein and Nichols’ characterization of R.B.’s experience is implausible; as a result, the problems that they describe for memory-based accounts of personal identity do not arise. (shrink)

Some writers claim that ethicists involved in assessing future technologies like nanotechnology and human enhancement devote too much time to debating issues that may or may not arise, at the expense of addressing more urgent, current issues. This practice has been claimed to squander the scarce and valuable resource of ethical concern. I assess this view, and consider some alternatives to ‘speculative ethics’ that have been put forward. I argue that attempting to restrict ethical debate so as to avoid considering (...) unacceptably speculative scenarios would not only leave scientific progress devoid of ethical guidance, but would also rule out some of our most important ethical projects. I conclude that the issue of speculation is a red herring: what is most important is not that ethicists concentrate on current issues or those that are most likely to arise; but that ethicists, scientists, and others focus on maximising what is most valuable. (shrink)

There is an apparent epidemic of mental illness. At the end of 2011, untreated mental disorders accounted for 13% of the total global burden of disease, and for 25.3% and 33.5% of all years lived with a disability in low-and middle-income countries, respectively. Depression affects 350 million people globally and is the leading cause of disability. One in five U.S. adults takes psychiatric medication. One study found that by age 32, 50% of people surveyed qualified for an anxiety disorder, more (...) than 40% for a mood disorder, and more than 30% for substance dependence. Another study reported that... (shrink)

(No abstract is available for this citation).

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.

With contributions from psychiatry, psychology, neuroscience, and philosophy, this book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions.

Is it conceptually possible for one person to ‘remember’ the experiences of another person? Many philosophical discussions of personal identity suppose that this is possible. For example, some philosophers believe that our personal identity through time consists in the continuation of our mental lives, including the holding of memories over time. However, since a person’s memories are necessarily memories of her own experiences, a definition of personal identity in terms of memory risks circularity. To avoid this, we must invoke the (...) concept of ‘quasi-memory’. From my quasi-memory of doing x, I cannot infer that I did x; but I can infer that somebody did x. It is then a further question as to whether the person who did x is me, the answer to which will depend upon what we believe personal identity to consist in. Quasi-memory, then, allows us to separate the concept of memory from the concept of personal identity. (shrink)

Is it conceptually possible for an event, L, to be the cause of an earlier event, E? Some writers have employed the so-called bilking argument to attempt to show that the idea of such backwards causation is incoherent . According to this argument, if we are presented with what someone claims to be a case of backwards causation, it would be possible in principle to wait for E to occur, and then intervene to prevent the occurrence of L, thus demonstrating (...) that E could not have been caused by L after all. Moreover, if our attempts to bilk L-type events having observed E-type events always fail, we have grounds to argue that any causal relationship between the two is not one of backwards causation, but of ordinary, forwards, earlier-to-later causation.Does the bilking argument succeed in showing backwards causation to be incoherent? Before answering this question, let us deal with a far simpler reason for deeming backwards causation incoherent, whose elucidation now will be useful later. To those attracted to the view that temporal order is determined by causal order, 1 backwards causation may seem incoherent because on this view a cause is by definition earlier than its effect. I do not take issue with this view, and wish my conception of backwards causation to be compatible with it. 2 By ‘backwards causation’, I mean causation that runs in the opposite direction to some other causal processes, such that the temporal order entailed by such backwards causation is the reverse of that entailed by those other causal processes. In most philosophical discussions of backwards causation, we are at least implicitly given reasons to believe that these other causal processes dictate the …. (shrink)

I discuss theories about the way in which we determine the precedence ofperceived events. I examine Mellor’s account, which claims that it is thetiming of our perceptions of events that enables us to determine their order,and Dennett’s criticism of this. Dennett cites psychological experimentswhich suggest that it is the content of our perceptions, rather than theirtiming, which allows us to determine the order of the events perceived. Iargue that by distinguishing between two different ways of construing‘perception’ we can see not (...) only that the two accounts are compatible, but that Dennett’s account presupposes Mellor’s. (shrink)

The conviction that high self-esteem is beneficial both to the individual and to society in general has been pervasive both in academia and in popular culture. If it is indeed beneficial, it is a prime candidate for pharmacological enhancement. There is evidence to suggest, however, that the benefits of high self-esteem to the individual have been exaggerated; and that there are few - if any - social benefits. With this evidence in mind, I consider in what ways high self-esteem is (...) valuable, and suggest how enhancement could play a role in maximising its valuable aspects. (shrink)

Decision-making is a prominent theme in this edition of the Journal of Medical Ethics. Our feature article examines the relationship between trust and informed consent. Informed consent is, of course, central to the decision-making process in medicine. In addition, several articles consider decision-making in medicine from a variety of angles.Informed consent and trust: Eyal's argumentIn our feature article, Nir Eyal attacks attempts by bioethicists including Onora O'Neill, Torbjörn Tännsjö, and Jennifer Jackson to ground the importance of informed consent in its (...) role in safeguarding trust in medical practice . The trust-promotion argument for informed consent, as Eyal terms it, states that trust in medical practice is necessary to ensure that people seek and comply with medical advice and participate in medical research, that as a result it is ‘usually wrong to jeopardise that trust’, that violations of informed consent jeopardise that trust, and that standard informed consent requirements are therefore justified.Eyal makes explicit that this argument is consequentialist: it takes the value of informed consent to lie in its role in ensuring trust in medical practice; in turn, trust is instrumentally valuable because it promotes health through use of the medical system, compliance with treatment, and participation in research . The consequentialist trust-promotion argument, Eyal observes, differs from deontological trust-based arguments, which defend respecting informed consent requirements with reference to factors such as its being an appropriate way of honouring the trust that patients place in doctors.Eyal attacks the trust-promotion argument on the ground that it does not account for some commonsense intuitions about informed consent. He argues, to cite one of the many problems he raises, that secret breaches of informed consent—for example, treating patients while they sleep—would …. (shrink)

Transformative technologies can radically alter human lives making us stronger, faster, more resistant to disease and so on. These include enhancement technologies as well as cloning and stem cell research. Such technologies are often approved of by many liberals who see them as offering us opportunities to lead better lives, but are often disapproved of by conservatives who worry about the many consequences of allowing these to be used. In this paper, we consider how a democratic government with mainly liberal (...) values that is governing a population divided between liberals and conservatives can introduce new transformative technologies and try to achieve consensus about the introduction of such technologies. To do so, we draw on recent work in moral psychology which enables us to better understand the intuitive and emotional responses that underpin conservative objections to such new technologies. We then show how a government may introduce incremental changes in our social practices that have the long-term effect of weakening conservative objections to transformative technologies and better enabling governments to achieve consensus about these. (shrink)

Michael Dummett argued that, whilst we can imagine circumstances under which agents may rationally believe themselves capable of affecting the past, the attitude of such agents is bound to seem ‘paradoxical and unnatural to us’. Therefore, only agents very unlike us could intentionally affect the past. I argue that this is not the case. I outline circumstances in which the attitude of such agents is prudent, even by our own standards. Worlds in which backwards causation occurs could, then, contain agents (...) very much like us. (shrink)

Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms. But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between the two approaches, psychiatry is (...) divided... (shrink)

Designer Biology: The Ethics of Intensively Engineering Biological and Ecological Systems consists of thirteen chapters that address the ethical issues raised by technological intervention and design across a broad range of biological and ecological systems. Among the technologies addressed are geoengineering, human enhancement, sex selection, genetic modification, and synthetic biology.

Leonard Berlin reports that neuroscientific data have been presented in court by lawyers wishing to argue that their clients have reduced or absent moral responsibility for their behaviour because their brain function is impaired. Berlin cites evidence showing that such neuroscientific data can influence judges to pass more lenient sentences, and he anticipates that advances in “the neurology of criminal behavior” may lead courts to view certain criminals as having reduced accountability for their actions. Similarly, an advisor to President Obama (...) recently predicted a surge in the number of U.S. defendants appealing to neuroscientific data in criminal court cases in an attempt to reduce sentences and strike out confessions, and commented that this strategy has already been successful in some cases. Berlin, and those whose comments he quotes, note that the neuroscience behind criminal behavior is in its infancy. Many of the neuroimaging techniques he considers are experimental or otherwise unproven, and their results are subject to interpretation. I wish to raise the additional point that the ability to prove criminals unaccountable on the basis of neuroimaging does not depend merely on our understanding of the brain and the availability of reliable imaging techniques, but also—crucially—on answers to philosophical questions about the relationship between brain activity and free will. I give two reasons for believing that brain scans cannot show criminals to be unaccountable, or less accountable. First, even where their brains look and function differently to the brains of normal people—in this context, healthy noncriminals—this does not itself entail that criminals are less morally responsible for their behavior than normal people. Second, since there is substantial disagreement about what neuroscience can in general tell us about free will, we should not expect it to tell us anything useful about criminals’ free will. (shrink)

Michael Nair-Collins and Franklin G. Miller argue in an extended essay that the dominant view in medical ethics of patients who are brain dead but sustained on mechanical ventilation is false. According to this view, these unfortunate patients are biologically dead, yet appear to be alive as a result of the fact that mechanical ventilation ensures that their heart continues to beat, that their skin remains warm, that their wounds continue to heal, that their body does not decay, and that (...) they continue to breathe. This view was defended by the U.S. President’s Commission in 1981, and again by the President’s Council in 2008. That brain-dead, mechanically ventilated patients are biologically dead—rather than dead merely in a social or legal sense—is seen by defenders of this view as important. The President’s Council explicitly rejected the idea that death is anything other than a fact of biology. The significance of this move is explained by Nair-Collins and Miller as follows: > Getting this biological conception right is critically important: responsible moral and policy deliberation begins with an unbiased assessment of relevant factual questions. One cannot address the difficult normative questions surrounding organ retrieval, just use of resources, withdrawal of mechanical support and so on, without first addressing the biological question: what is the vital status of this organism? Essentially, working with a biological conception of death makes certain decisions much less ethically murky than they would be in the absence of such a conception. The ‘dead donor rule’, for example, prohibits causing death to a patient by removing their organs. If it is a fact of biology that brain-dead, mechanically ventilated patients are dead, then removing their organs for donation clearly does not fall foul of the dead donor rule. If, on the other hand, the …. (shrink)

Despite some important progress over the past decade, academic philosophy remains a male-dominated discipline. This raises questions about how established philosophers can best support and advise female students and junior academics in philosophy. We need to avoid encouraging them to adopt a fatalistic attitude to their success, while also avoiding encouraging them to believe that their success lies in their own hands and that therefore it must be their own fault if they don't succeed. I argue that we can do (...) this by reflecting on what success in a misogynistic culture looks like, and by guiding young female philosophers to distinguish between the changes that it is possible for them, as individuals, to make, and those that require action by many individuals. (shrink)