Introduction
Kelly wanted to improve herself. After considering different ways of doing that, she decided to use novel neuroscientific means. Just as she desired, she became more creative, cognitively able, and cheerful than she was before. Not radically, but still significantly. However, before her enhancement process Kelly thought that, the improvements notwithstanding, she would ultimately remain the same old Kelly. She would be a more creative art director, a quicker thinking businesswoman, and have some more laughs, but basically still be the Kelly she has always been. But after her enhancement, Kelly sees the world and herself differently than she used to do and wants to behave in ways she did not expect to want. While Kelly is quite pleased with her new personality, her spouse, Larry, who was always somewhat suspicious about Kelly’s self-improvement project, thinks that Kelly approves of her new self just because her neuroenhancement changed her. In Larry’s view, the enhancement process Kelly underwent did not only alter her personality, but also made her endorse her new self. Accordingly, Larry maintains that Kelly’s enhancement process was not autonomous because it validated itself.
Autonomy plays an important role in common morality and in moral philosophy (see, e.g., Beauchamp and Childress
2013) and questions related to autonomy have already gathered a significant amount of attention in the moral philosophical literature on human enhancement (see, e.g., Heilinger and Crone
2014; Juth
2011; Pömsl and Friedrich
2017; Schaefer et al.
2014). Yet whether self-validating neuroenhancement—neuroenhancement in which an individual’s endorsement of her new self is caused by the enhancement process she underwent—can be autonomous would not appear to have received due consideration.
1 If it is incompatible with autonomy that would apparently be a good reason to avoid neuroenhancement likely to be self-validating, at least when other things are being equal.
2 This motivates the following reflections. I start by explicating the main starting points of the argument of this article. In the three subsequent sections, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with individual autonomy. On the basis of the consideration, I conclude that self-validating neuroenhancement can be autonomous.
Main starting points
Contemporary philosophical debate on human enhancement has mainly focused on improvement of mood, cognition, morality, and physical abilities and expansion of lifespan with techniques enabled by novel or anticipated results from neuroscience and genetics (see, e.g., Levy
2007; Meulen et al.
2017; Savulescu and Bostrom
2009; Schermer
2017). Instead of going into the problems related to how, precisely, human enhancement should be defined (cf., e.g., Raus et al.
2014; Savulescu et al.
2011; Wolpe
2002), I here settle for the following rough characterization of
neuroenhancement of humans: human neuroenhancement refers to improving the capacities of, or producing new capacities for, healthy individuals by means provided by neuroscience.
3 In self-validating neuroenhancement, the enhanced individual’s personality changes in significant way(s) she did not foresee and the individual endorses her new self because the neurointervention changed her. Here the individual’s acceptance of her new personality is thus caused by the neuroenhancement she underwent. By the individual’s new personality—now used interchangeably with her new self,—I thus refer to the novel personality the individual acquires within the enhancement process she undergoes. Correspondingly, by talking about an enhanced individual’s old personality and about her old self, I refer to the personality she had when she decided to undergo the neuroenhancement process she undergoes. I understand personality in the colloquial sense in which the term denotes the combination of characteristics or qualities that form an individual’s distinctive character and to endorse in the colloquial sense in which to endorse something means to accept it, to approve of it. I focus on neuroenhancement of mental capacities.
4
Consider a case that is otherwise similar to Kelly’s except that the individual improved in it, Mike, was aware of all of the ways in which his enhancement changed his personality already before the enhancement process started. His foreknowledge of the alterations notwithstanding, Mike’s current endorsement of his new self could be taken to result from his having been changed by neuroscientific means.
5 Yet that it involves unforeseen consequences is one of the central concerns neuroenhancement raises. While some initially unpredicted consequences might be immaterial, the acquisition of a new personality would most plausibly usually be important. Accordingly, accounting for such a consequence is arguably, if not evidently, relevant in assessing neuroenhancement. This motivates my understanding self-validating neuroenhancement in the above characterized way. Yet the considerations presented below pertain to assessing the autonomy of the kind of fully informed self-validating neuroenhancement just characterized as well.
That a person enhanced by neuroscientific means endorses the new personality she may acquire within her enhancement process is, of course, not the only possibility. In self-invalidating neuroenhancement, the enhanced person rejects his new self because the neurointervention changed him. In indecisive neuroenhancement, the enhanced person remains undecided whether to endorse or to reject her new personality because the neurointervention changed her. While the following considerations apply,
mutatis mutandis, to assessing the autonomy of self-invalidating and indecisive neuroenhancement as well, for the sake of simplicity I now focus on self-validating neuroenhancement.
6
Insofar as neuroscientific means by which to effectively enhance human capacities do not exist (see, e.g., Meulen et al.
2017, see Sect. “
Main starting points”; Schleim and Quednow
2018), the idea of self-validating neuroenhancement is merely theoretical. However, given the interest in the development of neuroscientific technology (see, e.g., Marsh
2018) and the apparently widespread appeal of self-improvement, I assume that the prospect that such means become available is worth preparing for already. Especially to the extent that neuroscientific means of enhancement are hypothetical, determining the precise mechanisms by which they would improve human capacities is difficult. Yet it appears justifiable to assume that in practice neuroenhancement of mental capacities would work by affecting brain and other relevant bodily mechanisms by such means as drugs and electric devices (see also Sect. “
Is the main reason for considering self-validating neuroenhancement heteronomous plausible?”).
In their influential bioethical work, Beauchamp and Childress (
2013, pp. 101–102) characterize individual autonomy as follows:
At a minimum, personal autonomy encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding. The autonomous individual acts freely in accordance with a self-chosen plan, analogous to the way an independent government manages its territories and sets its policies. In contrast, a person of diminished autonomy is in some material respect controlled by others or incapable of deliberating or acting on the basis of his or her desires and plans. For example, cognitively challenged individuals and prisoners often have diminished autonomy. Mental incapacitation limits the autonomy of a person with severe mental handicap, whereas coercive institutionalization constrains a prisoner’s autonomy.
While the understanding of autonomy has not gone without criticism (see, e.g., Dive and Newson
2018; Manson and O’Neill
2007),
7 it nevertheless continues to play a central role in contemporary bioethics.
8 Whether Kelly’s self-validating neuroenhancement meets its criteria of free, intentional, and knowing choice can also be of interest even to those who understand autonomy in different terms.
9 Accordingly, I here employ the just described conception of individual autonomy.
It might be taken that an individual’s endorsement of the new personality she acquires within self-validating neuroenhancement is not problematic in terms of autonomy insofar as the acceptance does not employ mental capacities affected by the neuroenhancement process she underwent. Yet in connection with enhancement that affects a person as extensively as self-validating neuroenhancement does an agent’s endorsement of her new personality may not employ capacities unaffected by the neurointervention at all. It would also appear to be difficult to determine to what extent, if any, an agent’s approval of her new personality would employ capacities unaffected by the neuroenhancement process she underwent. The question whether self-validating neuroenhancement can be autonomous is evidently not the only problem relating to (self-validating) neuroenhancement. Yet, for reasons of space, I here abstract from the other difficulties (self-validating) neuroenhancement faces.
10
Why would self-validating neuroenhancement be incompatible with autonomy?
It has been proposed that the availability of the kind of techniques focused on in philosophical literature on neuroenhancement would eradicate all grounds for choosing in one way rather than another. In this view, if our mental life became as radically modifiable as the techniques are seen to make it, also the grounds of one’s choices could always be altered with the technology. Given that all choices would ultimately become arbitrary in that sense, autonomy would be lost (cf., e.g., Owens
2007). However, as a matter of psychological fact, the claim that the novel human enhancement techniques would destroy all grounds for choosing in one way rather than another appears simply false. At least when other things are being equal, that a person could always modify herself to want something different than what she in fact wants does not entail that she wants to modify herself in that way or that she has reason to do so. Many ways of altering oneself can be quite irrelevant to one, some people would assumedly reject them all (see also, e.g., Danaher
2014). Accordingly, the mere fact that Kelly would have the possibility to change herself in some further way(s) than she did plausibly does not mean that her endorsement of her new self cannot be autonomous.
But, as proposed, at the stage of deciding to enhance herself by neuroscientific means, Kelly did not foresee that after the process she will not be the same old Kelly anymore. Given that autonomy presupposes that a person is adequately informed, it would therefore seem that Kelly’s initial decision to engage in the neuroenhancement process she underwent was not autonomous. And it might now be taken that the lack of autonomy related to her initial decision to enhance herself with neuroscientific means entails that Kelly’s current approval of her new personality cannot be autonomous either. Now, making a self-governing choice whether or not to undergo the kind of enhancement process Kelly underwent would indeed seem to presuppose that a person is at least aware of the possibility that the process may change her in some unexpected way(s). However, after her enhancement process Kelly is well aware both of the possibility that the process can alter her in some initially unforeseen way(s) and of the precise ways in which it actually did change her. Accordingly, Kelly’s current endorsement of her new personality does not suffer from the kind of lack of information that compromised the autonomy of her initial decision to enhance herself by neuroscientific means.
11
Several authors have, however, been concerned about the way neuroscientific modification of mental capacities is seen to work. Instead of employing the rational abilities of the individuals whose capacities are modified with neuroscientific techniques, neurointerventions are perceived to function by directly affecting the neural underpinnings of the capacities altered with the techniques (cf., e.g., Levy
2007, Chap. 3). Witt expresses the worry related to this feature of neurointerventions—henceforth referred to as the directness of neuroscientific techniques—in connection with a patient whose treatment caused a personality change the patient endorsed because the therapy changed him. Witt (
2017, p. 388, emphasis in original) writes as follows:
The stimulation [the treatment in question] not only altered his [the patient’s] personality and his central projects, but also made him approve of those changes. If this is what happens, there is a relevant sense in which the approval is not his
own: like the change itself, it is not under his control. Instead of being the result of rational, independent deliberation on his side, it has been brought about by the intervention. Therefore, it counts as heteronomous and to that extent unsuitable for informed consent.
12
If the directness of neurointerventions compromised autonomy, the problem would apparently concern the use of neurointerventions in general, not only self-validating neuroenhancement.
13 Yet modifying some more peripheral feature(s) of a person could leave (the central aspects of) her personality unaffected. Therefore, the directness can still be seen to make self-validating neuroenhancement—in which central aspects of a person’s self change—especially problematic. Accordingly, I henceforth treat the directness of neuroscientific techniques as the main reason for considering self-validating neuroenhancement incompatible with autonomy. In terms of the criteria of autonomy characterized above, the problem the directness is perceived to cause here relates to the requirements of understanding and intentionality: the mental changes brought about by neuroenhancement are not seen to result,
in an appropriate way, from the knowing and intentional activity of the person undergoing them.
Is the main reason for considering self-validating neuroenhancement heteronomous plausible?
Some neurointerventions work through thought processes and, hence, employ the rational capacities of the persons modified with the techniques, at least to an extent. A central example is neurofeedback, in which a person regulates her brain function on the basis of real-time neuroscientific displays of her brain activity. Transcranial current stimulation of medial prefrontal cortex, for another instance, is reported to enable the replacement of impulsive unconscious attitudes with rationally controlled reactions in a way that employs the rational faculties of the individuals undergoing the intervention (see, e.g., Diéguez and Véliz
2017; Sellaro et al.
2015). Assuming that these kind of techniques could be employed in connection with self-validating neuroenhancement, the view that such enhancement conflicts with autonomy because of the directness of the techniques it employs might not apply to all self-validating neuroenhancement. But, for the sake of argument, let us now focus on neurointerventions that are entirely direct. Would its employing such techniques be a sufficient reason to consider self-validating neuroenhancement incompatible with autonomy?
The answer to this question would appear to be no. To see why, consider Larry’s case. A few years ago, Larry too wanted to become more creative, cognitively able, and cheerful. He had learned that particular kind of nutrition—foods including omega-3 fatty acids, folic acid, choline, and iron, for instance,—physical exercise, and sufficient sleep can improve one in those respects (see, e.g., Dresler et al.
2013; Misuraca et al.
2017; Pilcher and Huffcutt
1996; Ratcliff and van Dongen
2009; Strasser and Fuchs
2015). Accordingly, Larry decided to dump his couch potato ways. He replaced his diet of junk food with healthy nourishment, started jogging, doing yoga, and going to the gym, and became careful to sleep at least 8 h each night. After that had went on for several months, Larry had become more creative, cognitively able, and cheerful than he was before. While he initially thought that he would ultimately remain the same old Larry his self-improvement notwithstanding, he also realized that his personality had changed in unexpected ways. He saw the world and himself differently than he used to do and wanted to behave in ways he did not expect to want before his life-style reform. Yet, because his enhancement process changed him, Larry accepted his new self without reservations.
Instead of having come into being through rational reflection on his part, Larry’s new personality came about as a result of the neurobiological changes that his adoption of the new lifestyle caused in him. Therefore, also Larry’s endorsement of his new personality is based on mechanisms that circumvented his rational capacities. Yet I take it that Larry’s approval of his new personality would commonly be deemed autonomous (see also, e.g., Bublitz and Merkel
2009, p. 367; Levy
2007, pp. 106–107). The intuition is buttressed by the following considerations. To begin with, Larry is acquainted with both his old and new self and understands that his personality change was grounded on the neurobiological alterations his new lifestyle caused. Indeed, before he realized that his self had changed in unexpected ways, Larry was not much interested in understanding how one becomes the kind of person one is. Accordingly, he may be even better aware of the origins of his new self than he is about the origins of his old self. Moreover, Larry’s personality change and his endorsement of his new self does not result from control by others. Hence, his acceptance of his new personality apparently meets the criteria of autonomy understood as “self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding” (Beauchamp and Childress
2013, p. 101). Insisting that Larry’s endorsement of his new self cannot be autonomous because his personality change did not came about through rational reflection would just beg the question why autonomy as it is now understood would presuppose rational reflection in that sense. Is Kelly’s case then different from Larry’s in terms of the directness of the personality changes the individuals underwent?
It has been maintained that it is implausible to argue for A by maintaining that it is relevantly similar to some allegedly commonly accepted B when the acceptability of B is merely assumed (see, e.g., Mizrahi
2014). The position is plausible when intuitions about the acceptability of B in fact are rather unclear or vary significantly. Consider, for instance, intuitions related to the case in which you wake up in the morning to find yourself attached to a world-famous violinist whose circulatory system has been plugged into yours so that his life now depends on you (Thomson
1971, pp. 48–49). Yet the view that Larry’s endorsement of his new personality is autonomous is plausibly not overly unclear or controversial. The other main objection to arguments of the just described kind is that there after all is some important difference(s) between the A and B compared with each other. Accordingly, below I do my best to account for all of the features in which the cases of Kelly and Larry could now be deemed relevantly different from each other.
To begin with, Larry is male whereas Kelly is female, Larry is two years younger than Kelly, and Larry’s personality change took place earlier and in the town in which the couple resided previously whereas Kelly was enhanced more recently and in the city they live in now. Yet, other things being equal, such facts do not entail that Kelly’s change of self was more direct than Larry’s.
Besides in the terms just mentioned—and in the respect that Larry changed his lifestyle whereas Kelly was improved by neuroscientific means,—the personality changes of Kelly and Larry differ in that his was slower and more gradual than hers. It might be taken that slower and more gradual changes are more amenable to control by the person undergoing them. Yet slow and gradual changes can also be more difficult for the person to notice than fast and abrupt ones. And, as it happened, Larry focused on the anticipated alterations in creativity, cognitive ability, and mood and the actual realization that he is not the same old Larry anymore came only after that change had already occurred. Accordingly, that Larry’s change of self was slower and more gradual than Kelly’s does not make Larry’s change of self less direct than Kelly’s.
As Larry needed to alter his diet, exercise regularly, and sleep more than he did previously whereas Kelly just underwent a relatively undemanding neuroscientific procedure, Larry’s change of self presupposed more activity on his part than Kelly’s personality change required from her. Yet, again, that does not mean that the changes in Larry’s personality came about in a less direct manner than did the alterations in Kelly’s personality. Perhaps Larry could return to his old self by, say, adopting his old habits? Yet, even if Kelly’s enhancement were irreversible—which it need not be—that would not mean that the changes in her personality occurred more directly than did the alterations in Larry’s self. As the cases of Kelly and Larry would not appear to differ from each other in terms of the directness of the personality changes the individuals underwent, it would seem that Kelly’s endorsement of her new personality should be considered autonomous too.
Conclusion
In what I called self-validating neuroenhancement, the enhanced individual’s personality changes in significant way(s) she did not foresee and the individual endorses her new self because the neurointervention changed her. Above I considered whether self-validating neuroenhancement can be autonomous. I focused on what has been deemed a/the central understanding of individual autonomy in contemporary bioethics (and in applied ethics more generally). I assessed several possible grounds for considering self-validating neuroenhancement incompatible with autonomy and maintained that they do not entail that self-validating neuroenhancement cannot be autonomous. The above considerations do not show that self-validating neuroenhancement is morally unproblematic nor that it cannot undermine autonomy (see, e.g., Sect. “
Misuses, abuses, and disordered mental conditions”). Yet, insofar as the considerations are adequate, self-validating neuroenhancement can be autonomous.
Given that her decision to improve herself was not unduly affected by others and that her enhancement process did not result in mental disorder, the conclusion suggests that Kelly’s endorsement of her new personality is autonomous. The conclusion also implies that neuroenhancement likely to be self-validating need not be avoided out of the fear that such enhancement necessarily results in heteronomy. In light of the above considerations, the fear is misguided. As proposed, the conclusion that self-validating neuroenhancement can be autonomous applies,
mutatis mutandis, to the cases of self-invalidating and indecisive neuroenhancement as well.
17 Besides self-validating, self-invalidating, and indecisive neuroenhancement, the conclusion pertains to corresponding forms of neuroscientific treatment too (see note 12) and can also be of relevance in assessing at least some forms of, say, genetic treatment and enhancement.
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