Autonomy and authenticity of enhanced personality traits

Bioethics

Volumn 23, Issue 6, 2009, Pages 360-374

  Bublitz, Jan Christoph ^a   Merkel, Reinhard ^a  

^a UNIVERSITY OF HAMBURG   (Germany)

Author keywords

Authenticity; Autonomy; Direct brain intervention; Manipulation; Neuroenhancement; Neuroethics; Prozac Defence

Indexed keywords

PSYCHOTROPIC AGENT;

ARTICLE; DRUG THERAPY; ETHICS; HUMAN; INFORMED CONSENT; MEDICAL TECHNOLOGY; NEUROSURGERY; PERSONAL AUTONOMY; PERSONALITY;

BIOMEDICAL ENHANCEMENT; DRUG THERAPY; HUMANS; INFORMED CONSENT; NEUROSURGICAL PROCEDURES; PERSONAL AUTONOMY; PERSONALITY; PSYCHOTROPIC DRUGS;

EID: 67149130239     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2009.01725.x     Document Type: Article

References (55)

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2. E. Parens. Authenticity and Ambivalence: Toward Understanding the Enhancement Debate. Hastings Cent Rep 2005 35 : 34 41 (Pubitemid 41523644)
3. L. Bolt. True to Oneself? Broad and Narrow Ideas on Authenticity in the Enhancement Debate. Theor Med Bioeth 2007 28 : 285 300
4. President's Council on Bioethics. 2003. Beyond Therapy. Washington, DC: U.S. Government Printing Office: 253.
5. C. Taylor. 1991. The Ethics of Authenticity. Cambridge, MA: Harvard University Press.
6. M. Sandel. 2003. What's Wrong with Enhancement? Background paper for the President's Council on Bioethics, op. cit. note 3. http://www.bioethics.gov/ background [Accessed 15 Jan 2009].
7. We only consider pharmaceutical enhancements, but our arguments can be generalized so as to apply to other means of brain intervention. For a comprehensive review of state-of-the-art techniques, see: R. Merkel et al. 2007. Intervening in the Brain: Changing Psyche and Society. Berlin: Springer
8. D. Repantis & I. Heuser. 2008. Antidepressants for Neuroenhancement in Healthy Individuals: A Systematic Review. Poiesis & Praxis [DOI: 10.1007/s10202-008-0060-4].
9. There are a great many theories of autonomy that sometimes share the same name but not the same subject matter. It is impossible to find an all-encompassing notion of autonomy. Often it is understood as an ideal with rather strong conditions, while our narrow and technical understanding relates only to the functional sense of moral accountability, which is much less demanding. Cf. N. Aparly. 2004. Which Autonomy? Freedom and Determinism. J. Campbell et al., eds. Cambridge, MA: MIT Press: 173-187.
10. Notwithstanding certain exceptions such as the legal prohibition of 'killing on demand.'
11. Note that our argument does not presuppose the metaphysical possibility of acting otherwise - as contended and contested in the free will debate.
12. H. Frankfurt. Freedom of the Will and the Concept of a Person. J Philos 1971 67 : 5 20
13. G. Dworkin. 1988. The Theory and Practice of Autonomy. Cambridge: Cambridge University Press: 25.
14. H. Frankfurt. 2002. Reply to Gary Watson. Contours of Agency: Essays on Themes from Harry Frankfurt. S. Buss & L. Overton, eds. Cambridge, MA: MIT Press: 161.
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16. H. Frankfurt. 1999. The Faintest Passion. Necessity, Volition, Love. Cambridge: Cambridge University Press: 105.
17. Note that it is a different question whether M bears responsibility for his hedonistic lifestyle if it were a foreseeable consequence of the autonomous decision d1. If a reprehensible act can be traced back to an autonomous decision and was foreseeable at that time, there is room for a charge of negligently causing the second nonautonomous act d2. However, charges of negligence are weaker than those of intent, and events occurring after a long stretch of time may not have been foreseeable at d1.
18. Analogously, feminists challenge the individualistic conceptions of autonomy that disregard personal interdependence and cultural and societal influences. An interesting collection of such views is C. Mackenzie & N. Stoljar, eds. 2000. Relational Autonomy: Feminist Perspectives on Autonomy, Agency and the Social Self. Oxford: Oxford University Press.
19. This is a modified version of a case developed by A. Mele. 1995. Autonomous Agents: From Self-Control to Autonomy. Oxford: Oxford University Press.
20. H. Frankfurt. 2002. Reply to J. M. Fischer. In op. cit. note 12, p. 27.
21. J. Fischer & M. Ravizza. 1998. Responsibility and Control. Cambridge: Cambridge University Press: 182. Of course, in their view autonomy is also a historical concept.
22. J. Fischer. Responsibility and Manipulation. J of Ethics 2004 145-177 : 146
23. Fischer & Ravizza, op. cit. note 19, p. 35.
24. J. Fischer. Responsibility, History and Manipulation. J of Ethics 2000 385-391 : 391
25. st Century. Cambridge: Cambridge University Press: 71.
26. Ibid: 70.
27. Ibid: 75.
28. We hasten to note that Levy does not endorse the claims he depicts. In fact, he refutes several presumptions against direct interventions. Ibid.
29. J. Fischer, op. cit. note 20, p. 145.
30. A. Damasio. 1995. Descartes' Error. Emotion, Reason, and the Human Brain. New York: Avon Books.
31. Although more powerful, changes by direct interventions are not necessarily irreversible. Especially if pharmaceuticals require repeated intake, the agent has opting-out opportunities to correct changes against his better judgment. Still, as a caveat, the rational decision to employ highly effective neuroenhancements with hard-to-reverse effects must be well considered. A way to ensure this would be to restrict access to such neuroenhancements to qualified consumers.
32. B. Baars. 1997. In the Theater of Consciousness: The Workspace of the Mind. Oxford: Oxford University Press.
33. Further refinements need to incorporate empirical findings on the effectiveness of the influence and to define a normative threshold for the transfer of responsibility.
34. The insanity defences date back to the famous M'Naghten case in 1843. M'Naghten had the delusional belief that there was a conspiratorial Tory plot to kill him, so he concocted a preemptive plan to kill the Tory Prime Minister, Robert Peel, but only ended up shooting Peel's secretary. For a comprehensive and critical discussion of insanity tests and recent developments in United States law, see: S. Morse & B. Hoffman. 2007. The Uneasy Entente Between Insanity and Mens Rea: Beyond Clark v. Arizona. U Penn Public Law and Legal Theory Research Paper Series. http://papers.ssrn.com/abstract=962945 [Accessed 15 Jan 2009].
35. Scientifically, the relation between SSRIs and suicide or violent behaviour is a highly contested issue on which we cannot comment here. In 2007 the FDA directed the use of black-boxed warning labels stating an increased risk of suicide.
36. Here our theoretical case possibly differs from real cases: defendants report that they had no self-control during the incidents, as they felt like spectators to everything their body did.
37. Of course we oversimplify the way courts deal with Prozac cases. In the US, insanity defences vary from state to state. Globally the picture is even more diverse, as concepts of criminal responsibility in common law and in continental systems differ fundamentally. Moreover, insanity defences and their continental equivalents are subject to a lively debate growing proportionally to increasing understanding of the neuronal underpinnings of criminal behaviour. Nevertheless, our portrait of legal reasoning can be deemed the classic way in which courts deal with such cases. Cf. a special issue on: Responsibility and Mental Impairment. Int J Law Psychiatry. 2004: 395-503.
38. For some of such stories, see D. Healy. 2004. Let Them Eat Prozac. New York: New York University Press.
39. Especially M. Sandel draws on the notion of giftedness in his case against enhancements. 2007. The Case Against Perfection. Cambridge, MA: Harvard University Press.
40. The inconsistencies of an in-between-position that denies a pre-given self and understands authenticity as being true to the self as it is are pointed out by Levy in op. cit. note 23.
41. B. Berofsky. 1995. Liberation from Self: A Theory of Personal Autonomy. Cambridge: Cambridge University Press.
42. Mele, op. cit. note 17, pp. 166 f.
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44. Mele's reply, Manipulation, Compatibilism and Moral Responsibility. J Ethics 2008 263-286 : 272
45. An interesting discussion of autonomy, authenticity and social identity can be found in D. Meyers. Intersectional Identity and the Authentic Self: Opposites Attract! In Mackenzie & Stoljar op. cit. note 16, pp. 151-180.
46. See G. Watson's description of the life-story of a prime example of an 'authentic murderer.' Responsibility and the Limits of Evil: Variations on a Strawsonian Theme. Repr. in Free Will: Critical Concepts in Philosophy. Vol. 1. J. Fischer, ed. 2005. London: Routledge: 106-135.
47. I Haji S. Cuypers. Libertarian Free Will and CNC Manipulation. Dialectica 2001 221 238
48. Hence, Hans Kelsen's notorious statement: 'A person is subject to legal imputation not because he is free; rather, he is free because he is subject to imputation.' Kelsen. 1967. Pure Theory of Law. Second Edition. Translated by M. Knight. Berkeley: University of California Press: 98.
49. G. Jakobs. Imputation in Criminal Law and the Conditions for Norm Validity. Buffalo Crim Law Rev 2004 491 511
50. For stories of antidepressants making consumers 'feel like themselves' see P. Kramer. 1993. Listening to Prozac. New York: Penguin.
51. I. Hyun. Authentic Values and Individual Autonomy. J Value Inq 2001 35 : 195 208 (Pubitemid 33397750)
52. Merkel op. cit. note 3.
53. J. Feinberg. 1987. The Moral Limits of the Criminal Law 3: Harm to Self. Oxford: Oxford University Press: 196.
54. It has also been criticized by A. Fenton in his review of Merkel et al. Neuroethics 2008; 215. However, Fenton seems to misunderstand (or, at any rate, erroneously not accept) that legitimate pressures originating from the compulsive force of legal norms (of a largely legitimate order) are akin to natural forces but not to blackmailing forces exerted by other agents. Furthermore, the nature/person distinction does not entail that agents are unentitled to a defence of necessity when threatened by a natural calamity. This is a matter of weighing the harm inflicted against the harm avoided, and it pertains to the justification of an autonomous act; Prozac cases question the agent's autonomy in unjust acts.
55. T. Douglas. Moral Enhancement. J Appl Philos 2008 228 245