David Wasserman

A Framework for Unrestricted Prenatal Whole-Genome Sequencing: Respecting and Enhancing the Autonomy of Prospective Parents

Noninvasive, prenatal whole genome sequencing (NIPW) may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation by prospective parents before deciding whether or how to use NIPW.

Brain–computer interfaces and disability: extending embodiment, reducing stigma?

Brain-Computer Interfaces (BCIs) now enable an individual without limb function to “move” a detached mechanical arm to perform simple actions, such as feeding herself. This technology may eventually offer almost everyone a way to move objects at a distance, by exercising cognitive control of a mechanical device. At that point, BCIs may be seen less as an assistive technology for disabled people, and more as a tool, like the internet, which can benefit all users. We will argue that BCIs will have a significant but uncertain impact on attitudes toward disabilities and on norms of bodily form and function. It may be liberating, oppressive, or both. Its impact, we argue, will depend – though not in any simple way – on whether BCIs come to be seen as parts of the body itself or as external tools.

BCIs and disability: enhancement, environmental modification, and embodiment

Abstract:This paper explores the ways that BCIs can modify the environment as well as the individual, blur the boundaries between them, and thereby affect the physical functioning and social inclusion of people with disabilities. We begin by outlining the traditional distinction between two kinds of technology that serve people with disabilities: assistive devices and universal design. We then examine a spectrum of BCI applications, from prosthetic attachments to public infrastructure, with the potential to vastly improve the functioning of both disabled and nondisabled people, and to diminish the importance and salience of physical impairments. We suggest that these applications will erode the distinction between assistive devices and universal design as they blur the lines between individual and environmental modifications. Our optimism is tempered by concern for the impact that BCI technology may have on our embodied connection to the physical world and on people with intellectual disabilities. We find...

A More “Inclusive” Approach to Enhancement and Disability

David Wasserman and Stephen Campbell call for a reconsideration of our understanding of ability and enhancement in light of the increasingly blurry line between bodies and environments. They advocate for a way of seeing human enhancement in light of technologies that do not modify a person’s body. Specifically, they favor a broader conception of enhancement that acknowledges that a person’s abilities cannot be evaluated in isolation from a person’s environment. This approach challenges the social model of disability by demonstrating that the distinction between a bodily modification and an environmental modification isn’t always justified. Wasserman and Campbell’s broader focus also demonstrates why it is a mistake for bioethicists and commentators to evaluate individual bodily changes in ability without considering how those changes would also change human environments.

A Case for Greater Risk Tolerance in Internet Use by Adults with Intellectual Disabilities: A Comment on Chalghoumi et al.

This comment argues for increased tolerance of privacy risks in the Internet activity of adults with intellectual disabilities. Excessive caution about such risks denies those individuals not only the great benefits of Internet use but also the difficult but valuable experiences of loss, disappointment, and hurt associated with those risks. A level of risk-aversion appropriate for small children will be disrespectful for adults with intellectual disabilities. To the extent that additional safeguards are justified, they are better achieved through individualized security and privacy settings than through caregiver oversight.

Deception, Harm, and Expectations of Pain

In response to the national opioid epidemic—42,000 Americans died from opioid overdoses in 2016 alone (Centers for Disease Control and Prevention 2017)—clinicians have been urged to reduce unnecessary prescribing of opioids and other potentially addictive medications. One way to reduce such prescribing is to prime the patient to expect less pain, taking advantage of the cognitive modulation of pain to reduce its intensity. But while such priming may alleviate pain without pharmacological risks, it may also have significant moral and practical costs. Gligorov (2018) suggests, without explicitly endorsing, the intriguing claim that it is not deceptive to tell a patient that a procedure “won’t be too painful” if that assurance is reasonably expected to make it less painful. She observes that such an assurance recruits the same or similar biological mechanisms as actual analgesics. We argue that (1) such an assurance would indeed be deceptive and (2) claims of minimal pain that are justified primarily by their impact on the patient are also potentially harmful, as they may discourage prudent preparation and erode trust.

Driving a Wedge Between Self-Control and Self-Ownership

Frederick Gilbert’s (2015) account of predictive brain implants (PBIs) suggests the intriguing possibility that greater control over our impulses can be acquired by treating them like external forces. In the third section of the article, Gilbert discusses the possibility that individuals could use predictive brain implants (PBIs) to “control their undesirable urges.” He suggests that individuals able to do so “might be provided with better chances for achieving a sense of autonomy” (9). In acquiring such control, the individual may be alienating herself from those “undesirable urges,” rather than acknowledging them as her own. Although Gilbert is concerned in that section with the use of PBIs in the criminal justice system, I am more interested in their use for self-control than for social control. I also focus on a narrower kind of alienation than Gilbert has elsewhere addressed (Gilbert 2014): not a sense of global detachment from one’s feelings, thoughts, and actions, but a sense that specific types of impulses or urges are external, rather than products of one’s own perception or judgment. We are often unselfconscious about the impulses from which our actions spring, whether the innocuous impulse to flex a finger tracked by Benjamin Libet (1985) or the angry, violent impulses that sometimes come upon us unbidden. An “early warning” system of the sort Gilbert suggests might enable agents to check those impulses quickly and effectively, enhancing self-control. But the warning would externalize the impulse, presenting it as an intrusion that the agent can resist or yield to. It may not be problematic for her to externalize the initial impulse to a trivial action like finger-flexing; distancing herself from the initial impulse might give her greater control over the action than Libet thought she had. It would be more problematic to externalize angry, violent impulses. Such emotional impulses are associated with judgments, for example, that the agent has been wronged or threatened (Greenspan 2014). Authenticity may requires us to “own” those impulses—to acknowledge and critically assess them—rather than suppress them as external influences. On a practical level, PBIs may thus present difficult tradeoffs between authenticity and self-control; on a theoretical level, they may further complicate the notion of “autonomy.” To illustrate my concern with a mundane example, imagine that Pete frequently becomes angry or exasperated, leading to harsh, often vicious outbursts that threaten his