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Policy Priorities and the Role of Neuroethics

Frustration over excessive contextualization is a perennial complaint. Simplifying matters can seem attractive when modest advances require prompt address and short-term priorities are within reach. Simplification would be possible if “enhancement” just satisfied pragmatically defined scientific and ethical criteria. That way, any continued debate would be centered on those improvements that were already deemed to be fairly good for people in general, so far as could be scientifically and ethically determined. But matters shouldn’t be too simplified, of course. Warnings are certainly in order that current enhancement interventions rarely prove to be wholly effective or without deleterious effects. Unsurprisingly, there is wide agreement among the scientific, ethics, and policy communities that enhancing interventions shouldn’t be counterproductive or harmful to overall health. Couldn’t the practical route, bypassing those contextual complexities raised in previous sections, maintain scientific focus on whatever looks to be safe and effective for individuals?

We claim that practical risk-benefit analyses are insufficient. Detailed ethical scrutiny is required before any such practical improvements can be classified as good enhancers. It is wise to demand that putatively enhancing interventions do not diminish self-control or autonomy, degrade personal growth or self-worth, or diminish life-management and social skills.52,53 These demands of ethics can be reasonably placed on envisioned enhancements, even if they aren’t so stringently applied to proven medical therapies. Improvements toward health are usually consistent with personal empowerment, and the consequences of restoring expected functioning are largely understood. By contrast, the longer term effects of experimental enhancements, especially cognitive enhancements, on the psychological self and internal self-conceptions and motivations are among the least predictable and least understood aspects of this issue. Ethics is rightly concerned about the vital capacities for autonomy, dignity, and morality. All the same, as we have noted, setting high standards for enhancing interventions need not cast dark suspicions on the persistent search for enhancements. A number of scholars have advocated practical and ethical standards while endorsing the pursuit of enhancement.38,53-58 In short, the goal is to develop helpful interventions that are able to meet these high standards.

If such normative thresholds are maintained, public and regulatory approval could be a helpfully expedited matter. But approval may not be automatic. Labeling an intervention as an “enhancement” once it makes some individual lives demonstrably better can’t be the final hurdle before regulatory approval. An additional major factor that cannot be omitted is the wider public context. We believe that this is where the broadest and deepest deliberations over the wisdom of enhancement should occur. We are forced to ponder what shall be done when sound public priorities cannot automatically approve genuinely ethical enhancements. Policy principles should be well-informed, ethical, and just. When some reliable enhancements are deemed safe and effective, and seem capable of promoting the good life, then why wouldn’t they be approved through policy and law? Here, it is important to appreciate that sincere advocacy of genuine individual enhancers could still be underinformed, potentially unethical, and possibly unjust. In those cases, public judgment should lean against approval.

From this position, due regard for the broader contexts of enhancement cannot be avoided. Ascertaining when some improved capacity is actually an enhancement must undergo closer examination. The determination that something is an enhancement involves knowing what a “good life” generally looks like. Perhaps, as musician Louis Armstrong said of jazz, it’s intuitive: one just knows it when one sees it. All the same, not everything “jazzy” is jazz,59 and even intuitions have origins and contexts. Let’s say that an author is writing about the use of neurological enhancement to achieve the “good life.” What would a claim about enhancement for the “good life” specifically mean? Four primary meanings might be intended:

  • 1. When individual P receives an enhancement for the good life, that “good life” is P’s own conception of the good life. This is an appeal to what can be labeled as personally subjective enhancement.
  • 2. When individual P receives an enhancement for the good life, that “good life” is what P’s society generally regards as the good life. This appeals to what can be labeled as locally relativist enhancement.
  • 3. When individual P receives an enhancement for the good life, that “good life” is what the author and that author’s readers typically regard as the good life. This makes an appeal to what could be called socially conventional enhancement.
  • 4. When individual P receives an enhancement for the good life, that “good life” is what the objectively correct ethical theory sets as the good life. This is an appeal to what can be called objectively ethical enhancement.

Someone writing about the “good life” might intend a subjective conception of the good life, but an author offering broadly applicable ethical or policy principles would avoid subjectivism, as well as local relativism. Unless an author explicitly takes one ethical standpoint to be most valid, the default position thus falls to the “socially conventional” level. Norms about the good life can indeed seem so conventional within one’s own society that they needn’t even be mentioned, much less explicitly defended or philosophically grounded.

Defining enhancers as improvements toward “the good life” may essentially amount to this:

Some capacity is enhanced if it is improved relative to its prior level of functioning such that it increases the individual’s chances of leading what Our Society rightly regards as a good life.

We already see how an enhancement could be underinformed, potentially unethical, and possibly unjust. Putting these two matters together, we get:

An enhancement according to Our Social Standards may be something that well-informed, ethical, and just policy couldn’t approve.

This viewpoint encapsulates our point that a modification deemed to be an improvement according to local expectations could prove to be unacceptable by higher level principles of crucial importance to any public.

Understanding this viewpoint requires appreciating how two issues must remain distinct. First, it must be determined whether and in what ways a modification is a genuine enhancer. Second, it must be questioned whether a genuine enhancer will be something that sound policy can approve. The criteria by which an enhancement is deemed conducive for the “good life” cannot be the same criteria that are applied for deciding whether it should be approved. It must be possible, in the open space of public deliberation, that wise policy can proscribe or prevent something that the public presently understands to be reliably conducive to the “good life.”

Herein we avoid assumptions that knowing what is conducive to the good life for each person constitutes knowing what is ethical and wise. We also avoid the position that knowledge about what is conducive to the “good life” for everyone constitutes knowing what is ethical and wise. Rather, we posit an alternative stance. We argue that (1) well-informed policy would use more information than just the scientific facts about a performance enhancer promoting the “good life,” (2) ethical policy would use other ethical criteria beside simple promotion of the “good life” (individually or collectively), and (3) just policy may prefer a stable and well-ordered society that isn’t advancing the individual or collective “good life” quite as quickly as could be technologically possible (or imagined by technophiles).

Gazing down the tougher route we propose, eager advocates of enhancement might ask why objective scientific facts couldn’t lead the way, especially when cognitive enhancement seems so modest, practical, and generically useful? At face value, this supports two possible roles for science:

  • 1. Weak role: Ethical questions can be better pondered with relevant scientific information kept in mind during deliberations.
  • 2. Strong role: Knowing just the right scientific facts can often be sufficient for deciding many tough ethical questions.

If an enhancement advocate prefers the stronger option, that strong role for science can alleviate frustrations over excessive contextualization, and it meshes well with the simplified meta-ethical positions mentioned already and listed again for convenience:

  • 1. Only a normative standard set by an ethical theory about the good life will serve to determine “enhancement.”
  • 2. When individual receives an enhancement for the “good life,” that “good life” is what the advocates and their audience generally regard as the good life.
  • 3. Only when something typically is promoting the “good life” can policy be truly informed and ethical.
  • 4. Knowing just the right scientific facts can often be sufficient for deciding many tough ethical questions.

Converging these positions yields:

A sound policy decision will always approve what, in light of ascertainable scientific facts, can be expected to be an enhancement to an individual that is conducive to what “our society” regards as the “good life.”

Whether this viewpoint, so contrary to ours, is the actual view of any bio- ethicist or neuroethicist or just a caricature for academic target practice, we cannot really say because few scholars have explicated their meta-ethical presumptions. We do say, however, that this stance does not seem adequate to meet the urgent complexities and contextualities inherent to authentic human life as we all must actually live it. However scientifically objective it may appear, in fact, there is little that is genuinely neuroethical embedded in it.

Our call for an embellished neuroethics needs to be put into some context. Sarewitz and Karas60 outline several different approaches that can be adopted in order to make choices and decisions about cognitive enhancement technologies. Among those approaches, ours aligns with the “optimistic” approach via engagement of a managed technological optimism that best represents our position as relevant to ethical decision-making processes and public policies in this field. We endorse continued research into cognitive performance enhancements. We also call for the need to optimize definitions of any and all concepts and terms and to equally define the contexts in which any cognitive task optimization can or would occur. Only from that point can one be optimistic that progressive, nonstatic concepts of the human and human function will be realistically entertained and enhanced, both practically and ethically. This position takes a pluralistic, democratic approach toward options of emergent (rather than merely proscriptive) governance, and this final section points to ways that neuroethics can play a supportive role.

A contextualized neuroethical outlook allows for better informed approaches utilizing all relevant interdisciplinary input in considering what therapies and enhancements could be. It permits neuroethical deliberation to rise above local conventionality and a single social ethos, to instead survey the rich cultural diversity of human self-understandings and dynamic cognitive capacities.7,34,35,61,62 Neither ethics nor politics is debilitated from acknowledging that diversity. And, it encourages neuroethics to caution against destabilizing and unjust procedures in policy debates that rashly extend medical models beyond the sphere of their proper functioning.

Plurality doesn’t leave us abandoned with relativity or subjectivity; the normative default cannot be laissez-faire individuality. Sound policy decisions for pluralistic societies won’t rashly approve whatever appears to be scientifically ascertained enhancements without extensive public deliberations about human welfare and social justice. Neuroethics should play a truly informative role in that pubic arena.

In its naturalistic basis, this contextually enhanced neuroethics establishes grounds to view the human as engaging biology (through intellectual and physical tools) to optimize survival and flourishing in changing ecologies. And in its appreciation for the human as a bio-psychosocial organism, it engenders an interdisciplinary approach (conjoining anthropology, sociology, economics, and political science) to depict and address ethical issues within the contexts in which human activities are conducted. Thus, in the spirit of cognitive enhancement itself, neuroethics as a discipline—and in its methods, approaches, and practices—should embody and enable greater human self-understanding and improve our public deliberations over the many dimensions of life that we all treasure.

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