Fabrice Jotterand

“Virtue Engineering” and Moral Agency: Will Post-Humans Still Need the Virtues?

It is not the purpose of this article to evaluate the techno-scientific claims of the transhumanists. Instead, I question seriously the nature of the ethics and morals they claim can, or soon will, be manipulated artificially. I argue that while the possibility to manipulate human behavior via emotional processes exists, the question still remains concerning the content of morality. In other words, neural moral enhancement does not capture the fullness of human moral psychology, which includes moral capacity and moral content. In this article, I revisit the debate between Hume and Kant concerning the role of emotions and reason in moral philosophy. I do so with reference to the work of philosopher Alasdair McIntyre. His moral philosophy has long stood as an essential text in virtue ethics, which constitutes the basis for my critique of the promise to engineer virtues (what I call “neural moral enhancement”). First, I outline three specific shifts that occurred in the history of Western moral philosophy in order to contextualize current debates on the nature of morality/moral agency. Second, I summarize MacIntyres critique of contemporary moral philosophy and show its relevance to an assessment of neural moral enhancement. Finally I argue that moral neuroenhancement is a one-dimensional conceptualization of moral agency that does not reflect the fullness of human moral psychology. It envisions a world in which individual moral capacities will be enhanced and controlled but says nothing about the nature of the morality.

Can medicalization be good? Situating medicalization within bioethics

Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.

Bioethics as biopolitics

From its inception, bioethics has claimed to be a project of reflection on the moral issues raised by new technologies. Yet, in its present form there is a perception of a gradual transformation in bioethics. This transformation is characterized by an increasing politicization of bioethical issues, that is, one’s “bio-ethical views” will reflect one’s political assumptions concerning the nature, goals and values that should guide the biomedical sciences. Or, perhaps better stated, bioethics has always been a biopolitics and the politicaldimension is only now coming into relief for bioethicists.

Human dignity and transhumanism: do anthro-technological devices have moral status?

In this paper, I focus on the concept of human dignity and critically assess whether such a concept, as used in the Universal Declaration on Bioethics and Human Rights, is indeed a useful tool for bioethical debates. However, I consider this concept within the context of the development of emerging technologies, that is, with a particular focus on transhumanism. The question I address is not whether attaching artificial limbs or enhancing particular traits or capacities would dehumanize or undignify persons but whether nonbiological entities introduced into or attached to the human body contribute to the “augmentation” of human dignity. First, I outline briefly how the Universal Declaration on Bioethics and Human Rights uses the concept of dignity. Second, I look at the possibility of a universal bioethics in relation to the concept of human dignity. Third, I examine the concept of posthuman dignity and whether the concept of human dignity as construed in the declaration has any relevance to posthuman dignity.

Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice.

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients’ sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients’ personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.

The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine

In this article we critically examine the principle of equivalence of care in prison medicine. First, we provide an overview of how the principle of equivalence is utilized in various national and international guidelines on health care provision to prisoners. Second, we outline some of the problems associated with its applications, and argue that the principle of equivalence should go beyond equivalence to access and include equivalence of outcomes. However, because of the particular context of the prison environment, third, we contend that the concept of “health” in equivalence of health outcomes needs conceptual clarity; otherwise, it fails to provide a threshold for healthy states among inmates. We accomplish this by examining common understandings of the concepts of health and disease. We conclude our article by showing why the conceptualization of diseases as clinical problems provides a helpful approach in the delivery of health care in prison.

The Precautionary Principle: A Dialectical Reconsideration

This essay examines an overlooked element of the precautionary principle: a prudent assessment of the long-range or remote catastrophes possibly associated with technological development must include the catastrophes that may take place because of the absence of such technologies. In short, this brief essay attempts to turn the precautionary principle on its head by arguing that, (1) if the long-term survival of any life form is precarious, and if the survival of the current human population is particularly precarious, especially given contemporary urban population densities, and (2) if technological innovation and progress are necessary in order rapidly to adapt humans to meet environmental threats that would otherwise be catastrophic on a large scale (e.g., pandemics of highly lethal diseases), then (3) the development of biomedical technologies in many forms, but in particular including human germ-line genetic engineering, may be required by the precautionary principle, given the prospect of the obliteration of humans in the absence of such enhanced biotechnology. The precautionary principle thus properly understood requires an ethos that should generally support technological innovation, at least in particular areas of biotechnology.

Nanomedicine: how it could reshape clinical practice

Fabrice Jotterand1,2 1The University of Texas at Dallas, School of Arts and Humanities (Philosophy), Center for Values in Medicine, Science, & Technology, Richardson, TX 75080, USA Tel.: +1 972 883 6782; E-mail: jotterandf@ utdallas.edu 2The University of Texas, Southwestern Medical Center at Dallas, Department of Psychiatry, Program in Ethics in Science and Medicine Department of Clinical Sciences, Research Ethics Division, Dallas, TX 75390, USA ‘The development of procedures and devices in medicine generate great hopes for the improvement of the human condition...’

Social and Assistive Robotics in Dementia Care: Ethical Recommendations for Research and Practice

The steadily growing number of older adults with dementia worldwide poses a major challenge for global public health. The integration of robotics into both formal and informal dementia care opens up new possibilities for improving the life of patients and alleviating the burden on caregivers and the healthcare services. However, ethical, legal and social implications should be considered early in the development of assistive and social robots for dementia to prevent slow adoption, incorrect implementation and inappropriate use. This paper delineates the ethical landscape and provides recommendations for design and use aimed at protecting users and maximizing the benefit in assisting such vulnerable population.

Real-time functional magnetic resonance imaging-brain-computer interfacing in the assessment and treatment of psychopathy : potential and challenges

This chapter focuses on the engagement of real-time functional magnetic resonance imaging-brain-computer interfacing (rtfMRI-BCI) in the treatment of psychopathy and some of the more pertinent ethico-legal and social issues fostered by such use of this neurotechnological approach. To this end, we first provide an overview of the nature of psychopathy. Second, we pose the premise that given the paucity – if not frank absence – of effective psychopharmacological treatment(s) or rehabilitation strategies presently available for psychopathy, it becomes important to examine the present state of neurotechnologies that might be used to effect potential benefit in the treatment of this disorder and focus this examination upon the possible utility of rtfMRI-brain-computer interface technology. Third, we present an overview of those tools that are currently used to determine and diagnose psychopathy and discuss their limitations. Finally, we address the major ethical questions and issues arising from the use of this technology to modify behavior in individuals with psychopathic traits