Tom Buller

What can neuroscience contribute to ethics

Neuroscience cannot and should not be allowed to replace normative questions with scientific ones

Advance consent, critical interests and dementia research

Although advance directives have become a familiar instrument within the context of treatment, there has been minimal support for their expansion into the context of research. In this paper I argue that the principle of precedent autonomy that grants a competent person the right to refuse life-sustaining treatment when later incompetent, also grants a competent person the right to consent to research that is greater than minimal risk. An examination of the principle of precedent autonomy reveals that a future-binding research decision is within the scope of a competent persons critical interests, if the decision is consistent with what the person believes gives her life intrinsic value.

Balancing procreative autonomy and parental responsibility.

In Rationality and the Genetic Challenge: Making People Better? Matti Hayry provides a clear and informed discussion and analysis of a number of competing answers to the above questions. Hayry describes three main perspectives on the morality of prenatal genetic diagnosis (PGD), the “restrictive,” “moderate,” and “permissive” views, and his analysis illuminates that these views can be distinguished in terms of their different “rationalities”—their respective understanding of what counts as a reasonable choice for parents to make in light of PGD.

Morality in a Blur

in what can be called pseudoteams i.e., people who work in groups but do not affiliate to any degree. Of particular interest for us in the present context is the fact that integration into a clearly identifiable group structure is one of the recommended routes to alleviate the aftermath of a toxic manager (Frost 2007). Working with a toxic manager thus leads to stress and a breakdown in the work ethic, and, by identifying with group members in a team, such toxicity is alleviated. In light of this finding, the parallels with the target article model (Pfaff et al. 2008) are obvious, and further parallels can be highlighted by identifying the overlap with the areas of the brain that may mediate such change. Pfaff and colleagues (2008) argue that distinct behavioral components occur in the initiation of moral behavior; the observer needs to be able to recognize and affiliate with individuals that are causing fear. It may seem likely, therefore, that two cortical systems in the brain exist to subserve such processing. Neuropsychological studies of patients who have incurred damage to the medial prefrontal cortex do indeed confirm this area as playing an important role in moral behavior (Greene and Haidt, 2002). However, recent functional neuroimaging work has shown that this region can be fractionated into two aspects, each playing a distinct role in mentalizing about yourself and other people. Here the ventral sector of the medial prefrontal cortex is activated when the observer mentalizes about oneself; however, the dorsal sector is activated when the observer starts to consider a second person dissimilar from themselves within the immediate social group (Mitchell et al. 2006). Within the context of the target article model (Pfaff et al. 2008) the presence of this dorsal–ventral medial prefrontal dichotomy allows us to generate hypotheses regarding bullying at work, and the cortical response that may mediate changes in the work ethic. Thus, the utility of this model to examine the “complex social processes that operate in real life” (Pfaff et al. 2008, 10) could be tested by examining differences in medial prefrontal activity in bullied workers who have been recently been integrated into a productive work team.

Response to commentaries by Karin Rolanda Jongsma and Suzanne van de Vathorst, and Oliver Hallich

The authors of the two commentaries raise some interesting and important objections to my paper, ‘Advance Consent, Critical Interests, and Dementia Research’. In my response I try to show that the objections raised can be understood as general objections against advance directives, rather than against research directives in particular. Since my main argument in the paper is that if we accept advance directives for treatment then we should accept them for research, arguments showing that we should not accept advance directives at all are consistent with my point of view.

Review of Ethan Watters, Crazy Like Us: The Globalization of the American Psyche 1

The recent outbreak of swine flu bears evidence of our concerns about globalization of disease via air travel. This facility of transmission and the patient’s role as a “vector” raises significant global public health concerns as well as questions regarding how best to balance public health and individual freedom. What does not come to mind is global occurrences of mental illness, and presumably this is because we do not ordinarily think of mental illness as a condition that can be transmitted from person to person. If we do see a link between globalization and mental illness we would likely see the connection as indirect: globalization and the increasing demands of a global society can lead to alienation, anxiety, and stress which, in turn could lead to mental illness. One of the central themes in Ethan Watters book is that we should see a link between globalization and mental health in more direct terms. More specifically we should see how the West, and particularly the US, has been responsible for transmitting mental illness across the globe through the export of our own understanding of its diagnosis, symptoms and meaning. In this regard we have served as intellectual vectors of disease, “infecting” other cultures with our own peculiar notions of what it means to be mentally ill or mentally healthy, and we have thereby helped to undermine other cultures’ ideas about these notions. Furthermore, in so doing we have not only failed to see that our own notions and remedies may not be superior, in fact could well be inferior, to those of the cultures around us, but we have also sometimes unintentionally and sometimes deliberately increased the incidence of mental illness in these countries. Crazy Like Us is a thought-provoking, well-written and challenging book that I hope will help draw more attention towards global mental health concerns, and the impact that our particular understanding of the mind and mental illness is having across the world. I hope also that the book provokes interest in these issues within neuroethics. The book is divided into four main chapters: “The Rise of Anorexia in

Reproduction, Responsibility and Rationality

In general terms, competent adults are deemed to have the right to reproduce. This right is generally understood as a negative right – a right of non-interference – derived from broader notions of autonomy and liberty. To say that someone has a right to reproduce is to say that, other things being equal, the person has the freedom to decide whether to reproduce or not, and other persons have correlative duties not to interfere. In this regard, the right to reproduce is akin to other negative rights, for example, the right to choose one’s own religion, partner, or the method by which to educate one’s children. Framed as a negative right, the right to reproduce serves to recognize and protect individual values and personal liberty against the interests of others or social utility. As we are familiar, this negative right is not universally respected, and some countries have enacted policies that permit such restrictions. Furthermore, we may believe, or come to believe in the future, that such restrictions are morally defensible. The right to reproduce, however, is not a unitary notion, and neither is the right isolated nor absolute. As has been argued elsewhere, the notion of reproductive freedom should not be understood simply to be limited to the decision whether to reproduce or not; rather this freedom encompasses a number of decisions, such as choices regarding reproductive method and what kind of children to have [1]. Furthermore, as Tom Murray has argued, the right to reproduction conceived as “procreative liberty” may be too narrow a framework for thinking about parents and children [2]. Decisions to have children are rarely, if ever, made or defended purely in terms of negative rights; rather, they are made in the context of other interests, values, and obligations. Additionally, the right to reproduce is not unrestricted. As John Robertson has argued the right to reproduce entails that the person violates no prima facie moral duty in deciding whether to reproduce or not; in other words, if S has a right to X then, other things being equal, S does not have a moral duty to refrain from