Home Health Cognitive enhancement : ethical and policy implications in international perspectives
Neuroessentialist Premises in the Moral Enhancement Discourse
Before we turn to a critique of neuroessentialism within the context of moral bioenhancement, key conceptual issues need definitional clarity. First, we need to distinguish between psychopharmacology and neurotechnologies as means to cognitive enhancements.1 Psychopharmaceutical enhancers are drugs initially designed to treat a variety of neuropsychiatric disorders (Alzheimer’s disease, Parkinson’s disease, cerebral palsy, traumatic brain injury, etc.) but that can have enhancing cognitive effects in healthy subjects.9-11 The effects of these drugs on cognition are complex and encompass the altering of mental capacities such as executive functions (inhibition, problem-solving, planning, etc.), memory, spatial and verbal learning, attention, and mood enhance- ment.11-12 The drugs that may affect cognition include modafinil (Provigil), dextroamphetamine, methylphenidate (Ritalin), fluoxetine (Prozac), donepezil (Aricept), and propranolol (Inderal).13-17
On the other hand, the use of brain stimulation techniques for a number of neurological and psychiatric disorders is currently being investigated. These techniques include deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS), and they provide complementary or alternative treatment options for movement disorders and investigational interventions for psychiatric conditions and disorders including Tourette syndrome, severe depression, Alzheimer’s disease, obsessive-compulsive disorder (OCD), and dystonia.18-20 Studies indicate that the same neurostimulation techniques used for therapeutic purposes may have enhancing properties with regards to mood, cognition, working memory, attention, procedural learning tasks, motor learning, and visuomotor coordination tasks.12-17
The second concept to be defined is what we mean by moral enhancement. In the bioethics literature, enhancement usually “characterize[s] interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health.”21: 29 Enhancement, then, refers to the “augmentation of biological capacities beyond what is species-typical” in healthy individuals.5,22 For some moral enhancement aims at the improvement of moral capacities such as empathy, solidarity, justice, shame, and forgiveness,2,3,23 whereas, for some others, moral realistic options include the treatment of moral pathologies such as psychopathy.24,25 Moral enhancement would focus on various dimensions of moral capacities: affective enhancement, motivational enhancement, and cognitive enhancement.
Third, a crucial distinction between moral capacity and moral content is warranted. In moral psychology, human behavior is explained as the interplay among affective, motivational, and cognitive processes. The various techniques allegedly enhancing morality focus on the alteration of affective/motivational processes (moral capacity), but they do not consider the question of the source of moral content outside one’s psychological profile or genetic makeup. More precisely, two issues are at stake: (1) what is the role of reasoning in moral deliberation? And (2) how does one define conceptions of the good, the right, and the just? In short, one’s genetic makeup or psychological profile certainly influences one moral identity, but it does not determine it. As I have stated elsewhere, “moral emotions can be modified and most likely affect moral judgments, but moral judgments require an epistemic framework [moral content] that guides moral behavior. This framework allows for a continuous shaping and assessment of one’s moral beliefs and values, and provides a point of reference to moral emotions.”25 Hence moral capacity refers to one’s ability or disposition to respond morally and involves the motivational, cognitive, and affective mental processes determining how one behaves when confronted with moral dilemmas. On the other hand, moral content constitutes the set of particular beliefs, values, and ideas shaped by environmental, cultural, and historical factors in addition to rational and moral deliberation and moral theorizing. Moral content is determined by the process of reasoning about moral conundrums, and it influences the emotional and psychological states by ascribing specific beliefs and values during moral judgments.26-27
Neuroessentialism is the fourth and final concept to examine. Peter Reiner states that “neuroessentialism is the position that, for all intents and purposes, we are our brains.”28 Neuroessentialism holds the position that mental states, behavior, notions of self, and personal identity can be reduced to neurobiology. In the same way that genetics has been used to support that “we are our genes,” neuroessentialism contends that “we are our brains.” There is evidence that various psychiatric disorders are caused by chemical imbalance (e.g., Parkinson’s disease is the result of low levels of the neurotransmitter dopamine, which influences motor and thinking areas of the brain) or that abnormalities in brain structure may increase the risk of deviant behaviors (e.g., psychopathy; neuroimaging shows abnormalities in brain areas of psychopaths associated with behavior [anterior cingulate], cognition [orbitofrontal cortex], and affect [amygdala]; see Kiehl29). In addition, changes in the brain caused by traumatic insults to brain structure (e.g., the case of Phineas Gage30), the purposive manipulation of brain structure (e.g., lobotomies31), the use of psychotropic drugs,32-33 or the use of neurostimulation technologies34,35 directly affect the behavior, personal identity, and mood of individuals.5
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