I am pleased to kick off our new symposium series on articles published in the journal Neuroethics with a discussion of Farah Focquaert and Maartje Schermer’s paper “Moral Enhancement: Do Means Matter Morally?” Below you will find a video introduction of the paper by the authors, together with a written introduction that I have prepared. These are followed by commentaries by Christoph Bublitz (University of Hamburg), Elizabeth Shaw (University of Aberdeen School of Law), Justin Caouette (University of Calgary), and Simon Gaus (Humboldt-Universität zu Berlin). Farah and Maartje have also provided responses to the commentaries.
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Recent research by Nina Strohminger and Shaun Nicols found that the single strongest predictor of identity change was disruption of moral capacities. When one suffers from severe degradation of their moral faculty, others don’t continue to see them as the same person. Although Stohminger and Nicols studied the effects of apparent moral degradation, it seems possible that any large change in a person’s moral self may lead to a perceived disruption of their identity.
This is reason enough to worry about interventions aimed at make a person a better moral agent (so-called “moral enhancements”). Added to this concern, however, is the fact that it is often not in pursuit of the interests of the person “enhanced” that we aim to influence their moral agency. Instead, interventions aimed at influencing moral decisions and action are often in the name of public safety or societal interest. This means interventions meant to act as moral enhancements are especially vulnerable to abuse, as well as uniquely dangerous with regard to their impact on personal narratives.
But we are constantly evolving as moral agents, so it can’t be just any interventions that are ethically suspect. Interestingly, we often do not think of moral interventions we apply to ourselves as interventions at all: I may go to yoga twice a week knowing that it calms me and makes me a much better mother, but I’m unlikely to describe this practice as a moral intervention or enhancement. Similarly, a good night’s sleep and a good diet are likely to impact my moral decision-making, but I consider these healthy lifestyle choices (that, like so many of my choices, happen to impact others).
It may be that I don’t think of these practices as interventions because of the sort of the interventions they are: yoga and what I eat are choices I make that indirectly affect my moral faculties. Along this vein, many have argued that direct interventions, such as drug interventions like SSRIs, or techniques such as deep brain stimulation and neurosurgery, are more ethically suspect than indirect interventions like yoga. It may be that direct interventions are thought of as interventions because they are aimed more directly at my moral capacities and work directly upon the brain.
In our target article, however, Focquaert and Schermer argue that this direct/indirect distinction is only useful insofar as it tracks what really matters in moral enhancement: the extent to which the recipient is actively involved in the intervention. For example, cognitive behavioral therapy is an active intervention, because the recipient is requires to exert effort over time for the intervention to have an effect. Deep brain stimulation (DBS), on the other hand, is passive because it requires very little effort or involvement on the part of the recipient. Such passive interventions, say Focquaert and Schermer, are more ethically worrying because they are likely to create radical or concealed identity changes – aspects of one’s personality that are out of sync with ones’ overall identity.
Many of our commentators disagree. Christoph Bublitz notes that our brains are never really passive if this means something like “inactive”, and argues that one may rationally reflect upon the impacts of a drug just as much as upon cognitive behavioral therapy. Elizabeth Shaw indicates that it isn’t so much whether the recipient is active, but whether they have a chance to rationally reflect upon the intervention. Justin Caouette argues that there may be some cases – say, where the recipient is a criminal offender – where a sudden change to personal identity isn’t really ethically concerning. And Simon Gaus notes that in many cases of active interventions, such as yoga or moral education, the person intervened upon isn’t aware enough of the intervention to rationally reflect upon it, so the passive/active distinction doesn’t do the work Farah and Maartje want it to.
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Thank you to Neil Levy, editor of Neuroethics, and Springer for assisting us in this symposium. And a huge thank you to Farah and Maartje for all their hard work.
Please feel free to join in the fun and post a comment for the authors of our target article and the commentaries below.
Target article:
- Farah Focquaert and Maartje Schermer, “Moral Enhancement: Do Means Matter Morally?”, Neuroethics 8 (2), 139-151
Commentaries and replies:
- Commentary by Christoph Bublitz, and the authors’ reply
- Commentary by Elizabeth Shaw, and the authors’ reply
- Commentary by Justin Caouette, and the authors’ reply
- Commentary by Simon Gaus, and the authors’ reply
I have a question for our audience. Ablative neurosurgery for heroine addiction is being performed in China. Recently a philosopher suggested that giving an offender a choice between incarceration and ablative surgery for (heroine) addiction can be understood as raising autonomy. Before offering the intervention the offender has no options, whereas after the offer the offender has a choice between imprisonment and ablative surgery. Hence, his or her autonomy is raised. I have previously argued that offering neuro-interventions to offenders can be ethical provided certain conditions are met. However, in my view, offering ablative surgery for addiction as an alternative to imprisonment is unethical (it is not the least invasive intervention, we do not have data on effectiveness, other effective and much less invasive interventions for addiction exist, the side effects are likely tremendous). What does our audience think? Can it be ethical to offer ablative surgery to offenders?
Great question, Farah, I’m really interested to hear what people think.
Certainly ablative surgery is an intervention where the offender is passive, which means (on your theory) there are more likely to be interruptions to identity.
In addition I would see this as a coercive offer by the state, because the intervention is not narrowly tailored to address illegal behavior (and not just any illegal behavior, but the sort of illegal behavior for which the offender is being punished). I would imagine that this sort of surgery has impacts on a wide range of thoughts and acts, not just on addictive cravings. I’ve made the same sort of argument regarding state “offers” of chemical castration: castrating drugs don’t just effect the offender’s capacity to chose illegal sex partners, but instead impact their ability to have any type of sexual partner. The drugs may also effect an offender’s abilty (now and into the future) to form a family, have children, etc. Thus a state offer of chemical castration in exchange for early release is coercive and unjust.
(Bomann-Larsen makes the argument about coercive state offers of rehabilitation in a Neuroethics article, here: https://link.springer.com/article/10.1007%2Fs12152-011-9105-9 . But not everyone agrees – a critical reply can be found here: https://link.springer.com/article/10.1007/s12152-011-9146-0.)
Thank you to the hosts and authors for the opportunity to ask questions and for giving such an interesting series of topics a forum for discussion.
The issue of coercion may be addressed elsewhere in more detail in this Symposium, but in the Farah Focquaert and Maartje Schermer’s paper “Moral Enhancement: Do Means Matter Morally?” there is mention of the risk of “coercive normalization” (as per Bradshaw, H.G., and R. Ter Meulen.2010)
Despite this Focquaert and Schermer go on to “agree with Bublitz and Merkel [30] that respect for persons entails respect for an individual’s first-person perspective and entails prohibitions on direct interventions without consent. Nevertheless – and we agree with this point as well – they claim that, within certain limits, direct interventions can be justified if informed consent is given.”
Is it possible to clarify whether Focquaert and Scherner recognise that being abnormal leaves you at risk of coercive change (where individuals deemed abnormal are most at risk when they are minors or criminals)?
Thanks to biomedical technology coercive change can now be introduced by either passive or active methods in order to alter mental states, but only methods that invite and require the active participation of an individual in the change of their abnormal behaviour, can ensure mental-integrity is not at risk while attempting to alter an individual’s propensity to immoral acts.
But this model may be broken because it is the mental-integrity of the individual that is considered part of the abnormality. That is, for the law and for an individual, thinking about harming someone unlawfully is not the same as acting on that inclination. Either there are no abnormal mental states with respect to morality, just abnormal or immoral behaviour (when illegal action is the result of these metal states), or alternatively, there are thoughts that are so abhorrent that even to think them, and to possibly feel compelled to think them, can justify the extreme biomedical, legal and moral invasiveness of direct brain manipulation with all the risks that this entails, for the individual and society, particularly the most vulnerable in our society, namely minors and criminals.
It sounds as if thanks to neuro-scientific innovation we may be at risk of returning to a medieval dystopia where sinful thoughts (that may or may not result in no illegal acts) are considered biomedically abnormal, even illegal.
So finally, in this context can you please re-address the way that morality relates to mental states, and morality relates to behavior, possibly again with respect to the distinction of active and passive.
That is, does passivity imply coercion? If not why not?
Does an individual have the right to seek to risk or invade their own mental-integrity? and by any means?
Is a minor or a criminal who thinks, but may not act on, immoral/abnormal thoughts really now at risk of direct alteration and “normalisation” of their mental states by direct/passive means?
Without a satisfactory answer to these and many other questions, it appears that the means of direct moral enhancement is essentially and fundamentally flawed because it demonstrates a failure to recognise what is required in order to behave morally, as well as what enhancement entails.
A great series of questions, Tommy. I can’t speak for Farah and Maartje, but I have a few thoughts.
First, I don’t think a passive intervention necessarily implies that the recipient was coerced. Farah and Maartje think that taking SSRI drugs may be a passive intervention, and certainly many who take SSRI drugs don’t feel coerced into doing so. Instead, many may feel they have made an informed, deliberate, rational choice to intervene in their mental processes using such drugs.
I’m not entirely clear on what you mean by mental-integrity, but I think that persons certainly have a right to risk or invade their mental processes – people do this routinely when they drink too much, or get too little sleep. They may also do this if they watch too many violent video games (and are at a certain point in development), or hang out with the “wrong crowd” (a criminal gang, for example). All of these choices are probably within a person’s rights of autonomy until the choice creates some sort of danger to society.
I think it is interesting that in the US we’re finally having the beginnings of a discussion of a person’s right to take recreational drugs with a greater impact (in certain ways) on thought processes than alcohol (e.g. drugs like marijuana, and hallucinogenics). If society isn’t willing to step in when someone starves themselves in the name of some social cause or gets plastic surgery to look like Justin Bieber, then why should we step in when they do these sort of drugs?
Your last question really is a great one, and one that I have been thinking about quite a bit in my work on chemical castration. It seems to me that we ought not intervene in the case of a pedophile who never acts upon his sexual desires. That is, if he has the rational capacity to inhibit his sexual desires from becoming action every time, then we ought not care what he desires. To “normalize” such a person (especially involuntarily!) would be wrong.
All of your questions seem to be centered upon the point at which society is justified in promoting moral enhancements and interventions, passive or active. My answer is simple: only once they commit a crime related to some serious abnormality in their moral processes, and sometimes not even then.
Thank you, Tommy, for your interesting reflections and questions!
I do agree with most of the remarks already made by Katrina, and would like to add that in our paper, we have explicitly stated that informed consent would be a requirement for any direct intervention aimed at changing a person or improving her moral functions in any way.
Since informed consent implies a voluntary decision, based on adequate and fair information, I believe this requirement rules out coercion. Indeed, the fact that it is easier to force passive interventions upon a person – easier, we have claimed, than in case of active interventions- is one of the main reasons to be cautious about such interventions. They bear more risk of being abused in coercive ways.
The final question you pose is indeed intriguing. It asks whether new biotechnologies lead us towards a kind of ‘thought police’, and to interventions aimed at ‘immoral’ thoughts or attitudes, and not merely at immoral behavior. (The movie ‘Minority report’ gives a nice science fiction view of what that might look like, by the way!)
First, I think that biotechnology is not equipped (and probably never will be, but that is a matter for another symposium) to read our minds or our thoughts, so in that sense, it does not pose a direct risk. However, if a person would share their ‘immoral’ thoughts, or attitudes, or perhaps even plans for ‘immoral’ actions, they might become the object of attempts to change them. They might become the object of ‘moral enhancement’.
(I am putting ‘immoral’ in quotation marks, in order to stress that this is a highly contested category, of course; that one person’s morals may be very different from another’s; and hence in itself a category that may be prone to abuse)
Second, I do not think that we should necessarily always wait until someone has committed some grossly immoral act, before offering some kind of intervention. In some cases, a person himself may suffer from his own thoughts or inclinations, or may be afraid that he will not be able to control himself rationally. He may then seek help and voluntarily choose some kind of intervention, e.g. behavioral or cognitive psychotherapy, but perhaps also some kind of medication, to try to change. Already, psychotherapies (active interventions) are used to try to changes attitudes, ways of thinking, and self-control, in pedophiles, for example. But voluntariness and the request and desire to change coming from the person himself, is essential here.
Finally, a very important issue that we have not discussed in our present paper, is that of risk profiling, especially in children. Increasingly, biomedical research is aimed at screening and early diagnosis for psychopathic traits or antisocial behavior in children, thus opening up a space for preventive interventions. This certainly is an area that merits ethical attention and one that Farah and I have been discussing in our project group, and hope to work on in the future.
So, I agree with you, Tommy, that direct and passive interventions do pose a risk of being used – or perhaps better: abused – for coercive normalization. And that probably prisoners, children and perhaps certain marginalized groups are most vulnerable. That is precisely why it is important to discuss these topics!