Neuroethics

Neuroethics: Agency in the Age of Brain Science

by Joshua May

(Oxford University Press, under contract)

Neuroscience is booming, fueled by sensational discoveries, unparalleled grant support, and promises to reveal deep insights into the human condition. What ethical questions does it raise and help to answer? 

  • Does neuroscience show that free will is an illusion?
  • Do brain stimulation treatments impair a patient’s autonomy or sense of self? 
  • Does having a mental disorder excuse bad behavior? 
  • Is addiction a chronic brain disease?
  • Does neuroscience show we shouldn’t trust our gut feelings in ethics and politics? 
  • Are pills and brain stimulation appropriate methods of moral improvement?
  • Is self-deception rampant in everyday life, even in neuroscience itself?
  • Should we trust brain science to read the minds of criminals and consumers?

The book provides an opinionated tour of neuroethics through gripping case studies and serious attention paid to both the philosophical issues and scientific evidence. The result is a nuanced neuroethics that reconceives human agency as less conscious and reliable, but more diverse and flexible, than we ordinarily think. A central lesson for medicine, law, ethics, and cognitive science is that disordered and neurotypical minds are more alike than they are different.

The text has a writing style that’s accessible to students and scholars in both the sciences and humanities. A companion webpage includes a glossary, a teaching guide, and discussion questions for each chapter. 

Table of Contents

Introduction
1. Ethics Meets Neuroscience
Appendix: Philosophy and Brain Primers
Autonomy
2. Free Will
3. Manipulating Brains
Care
4. Mental Disorders
5. Addiction
Character
6. Moral Judgment
7. Moral Enhancement
Justice
8. Motivated Reasoning
9. Brain Reading
Conclusion
10. Nuanced Neuroethics

Chapter Abstracts

Ch. 1: Ethics Meets Neuroscience
Neuroethics covers a wide range of ethical issues in neuroscience. In this chapter, we gain a sense of what those heady issues are, along with a preview of the chapters to come. This book’s main aim is to provide an picture of this burgeoning field, with serious attention paid to both the philosophical issues and scientific evidence. To soberly scrutinize the empirical literature and avoid basing philosophical conclusions on alarmist reactions, we need tools from multiple disciplines. So the chapter ends with an appendix describing some basic philosophical and neurobiological concepts necessary for navigating neuroethics. But first we begin with a case study of someone who developed deviant sexual appetites following brain surgery, which illustrates some questions that fall squarely within neuroethics.

Ch. 2: Free Will
Does neuroscience show that free will is an illusion? A number of scientists believe so, because it shows that unconscious brain mechanisms control our actions, which leaves us with no real choice. But such skeptical conclusions are not necessarily foisted on us by the science. Free will can exist even if it turns out to be a bit different from what you might expect. Our decisions are driven largely by unconscious forces, but these facilitate human agency. To kick off the discussion, we begin with another legal case, one of the first in which brain imaging evidence has successfully reduced the sentence of a defendant in a homicide trial.

Ch. 3: Manipulating Brains
Do brain stimulation treatments impair a patient’s autonomy or sense of self? Brain interventions do have risks, including changing one’s identity. The self is quite dynamic and flexible, given the ubiquity of transformative experiences throughout life. Nevertheless, risks of adverse events from neuromodulation are concerning given the history of unethical medical procedures in neuroscience, the specter of eugenics, and the overuse of many medical treatments. Threats to the self might be exaggerated, but greater medical humility is warranted all around, especially in brain interventions. A fascinating case of deep brain stimulation sparks these interrelated issues of adverse side effects, patient autonomy, and personal identity. 

Ch. 4: Mental Disorders
Does having a mental disorder excuse bad behavior? On a standard naïve view, the mentally ill are often regarded as clear examples of individuals lacking full-fledged freedom and responsibility. However, our evolving understanding of the brain and human agency reveals that there is more agency in mental disorders than it might seem at first blush. Psychopathology affects agency in such a variety of ways that it’s difficult to draw an inference about one’s moral responsibility merely from the fact that one has a mental disorder. Symptoms only sometimes reduce one’s agency and sometimes enhance it. This nuanced view paves the way for a cognitive continuum on which all people lie, which can help to reduce the stigma we commonly attach to mental disorders. 

Ch. 5: Addiction
Is addiction a chronic brain disease? Most health professionals now believe that substance use disorder is a brain disease that greatly inhibits self-control with respect to using drugs (including alcohol). Continuing with our nuanced approach, we see in this chapter that matters are not so simple. Although addiction is certainly a disorder of some sort, it’s not clearly a brain disease that erodes control. The brain mechanisms involved in addiction look to be the same as those involved in more ordinary failures of self-control. The difference is one of degree rather than kind. Our discussion begins with the case of an opioid addict who is punished for relapsing. 

Ch. 6: Moral Judgment
Does neuroscience show we shouldn’t trust our gut feelings in ethics and politics? Psychopathy serves as a useful springboard for exploring what normal versus abnormal moral judgment looks like in the brain. First, we examine both typical and atypical brains and compare the role of reason versus emotion in moral judgment. The neurobiological evidence suggests that the distinction is fraught. One upshot is that psychopaths don’t necessarily lack moral knowledge, except perhaps in extreme cases (again mental capacities come in degrees that do not switch off or on with a diagnosis). Second, we consider whether gut feelings in ethics are untrustworthy, particularly those that lead us to make moral judgments that conflict with utilitarianism by privileging the needs of the few over the needs of the many. Such an ambitious conclusion isn’t clearly forced upon us by the evidence.

Ch. 7: Moral Enhancement
Are pills and brain stimulation appropriate methods of moral improvement? This chapter evaluates five key ethical concerns with going beyond treatment to enhancing ourselves. For example, such endeavors could bypass one’s agency, promote a problematic desire to master oneself, or lead to the rich getting morally richer. Although such concerns are to be taken seriously, they are typically overblown. Brain interventions will work best and most ethically when they merely aid more traditional forms of character building, such as moral education and talk therapy. These work through our rational learning mechanisms rather than bypassing them in some posthuman fashion. The result is a realistic conception of moral enhancements that are no more problematic than traditional modes of moral improvement. To make our discussion concrete, we begin by considering the neurobiological manipulation of intelligence and love. 

Ch. 8: Motivated Reasoning
Is self-deception rampant in everyday life, even in neuroscience itself? Unfortunately, yes. Much of our reasoning is motivated by our values. Even scientific investigations, whether in neuroscience or physics, are subject to bias, which has led to nothing short of a crisis in many areas of science, including biomedical research. Chapter 3 touched on this crisis of confidence in the context of medical hubris and gentle medicine. Now we dig more deeply into these issues and the psychological mechanisms underlying them. Neuroscience ably reveals motivated reasoning in split-brain patients but also neurotypical individuals, including scientists themselves. Nonetheless, we’ll see that there is reason to be cautiously optimistic about human reasoning and its ability to produce scientific knowledge through a marketplace of competing ideas and evidence. 

Ch. 9: Brain Reading
Should we trust brain science to read the minds of criminals and consumers? Concerns about justice, privacy, and the health of society might make one deeply suspicious of even using neuroscience in such contexts, but such alarmism is unwarranted. Concerns about neuromarketing are often based on over-inflated claims about the power of brain imaging to uncover our deepest desires. Yet some neuroscientific technologies do provide useful evidence in the law, at least as useful as sources of evidence we already permit (an argument from parity). The benefits are modest, but this also limits the damage brain reading can do. Moreover, the meager benefits can be amplified when combined with other tools we already possess in our legal toolbelts. 

Ch. 10: Nuanced Neuroethics
In this brief conclusion, we return to the grim case of Kevin’s brain surgery and draw out some general lessons. Each chapter might seem to tackle rather distinct topics, but together they suggest connections and a rather unified approach to the field. A nuanced approach to neuroethics emerges that reconceives human agency as less conscious and reliable, but more diverse and flexible, than we ordinarily think. An overarching lesson for medicine, law, cognitive science, and public policy is one of cognitive continuity: disordered and neurotypical minds are more alike than they are different. By avoiding alarmism and embracing nuance, neuroscience and philosophy can work together to improve the human condition through a better understanding of it.