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عدد الرسائل : 1500
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تاريخ التسجيل : 26/10/2009
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 | |  Autonomy | |
A second way in which cognitive liberty could be impacted is by limiting a person’s autonomy. Autonomy is the freedom to be the person one wants to be, to pursue one’s own goals without unjustifiable hindrances or interference, to be self-governing. Although definitions of autonomy differ (see, e.g., entries on personal autonomy and autonomy in moral and political philosophy) , it is widely appreciated as a valuable aspect of personhood. Autonomy of the mental can be impacted in a number of ways. Here are several:Direct interventions: The ability to directly manipulate our brains to control our thoughts or behavior is an obvious threat to our autonomy. Some of our neurotechnologies offer that potential, although these sorts of neurotechnologies are invasive and used only in cases where they are medically justified. Other types of interventions, such as the administration of drugs to calm a psychotic person, may also impact autonomy.We know that stimulating certain brain areas in animals will lead to repetitive and often stereotyped behaviors. Scientists have implanted rats with electrodes and have been able to control their foraging behaviors by stimulating their cortex. In theory we could control a person’s behavior by implanting electrodes in the relevant regions of cortex. In practice, we have a few methods that can do this, but only in a limited way. For example, Transcranial Magnetic Stimulation (TMS) applied to motor cortex can elicit involuntary movements in the part of the body controlled by the cortical area affected, or when repetitively administered it can inhibit activity for a period of time, acting as a temporary lesion. Effects will vary depending on what area of the brain is stimulated; higher cognitive functions can be impacted as well. tDCS, or transcranial Direct Current Stimulation, uses direct current to stimulate cortex, and there are conflicting reports about whether it can reliably enhance cognitive function (Horvath, Forte, and Carter 2015; Bennabi et al. 2014). More invasive methods, such as Deep Brain Stimulation (DBS, discussed below) and electrocorticography (ECOG), both invasive techniques requiring brain surgery, demonstrate that direct interventions can affect cognition, action, and emotion, often in very particular and predictable ways.However much of a threat to autonomy these methods pose in theory, they are rarely used with the aim of compromising autonomy. On the contrary, direct brain interventions, when used, are largely aimed at augmenting or restoring rather than bypassing or diminishing autonomy. For example, one rapidly advancing field in neuroscience is the area of neural prostheses and brain computer interfaces. Neural prostheses are artificial systems that replace defective neural ones, usually sensory systems. Some of the more advanced and widely-known are artificial cochleas. Other systems have been developed that allow vision-like information to feed touch-specific receptors, enabling blind people to navigate the visual world (Bach-y-Rita and Kercel 2003). Brain computer interfaces (BCIs), on the other hand, are systems that read brain activity and use it to guide robotic prostheses for limbs, or to move a cursor on a video screen (Lebedev and Nicolelis 2006; Wolpaw et al. 2000). Prosthetic limbs that are guided by neural signals have restored motor agency to paraplegics and quadriplegics, and other BCIs have been used to communicate with people who are “locked in”, that is, they are fully conscious but cannot move their bodies (Birbaumer, Murguialday, and Cohen 2008; Naseer and Hong 2015). Thus, although in principle brain interventions could be used to control people and diminish their autonomy, in general, direct interventions are being developed to restore and enhance it.Neuroeconomics and neuromarketing: There are more subtle ways to impact autonomy than direct brain manipulations, and these are well within our grasp: Our thoughts can be manipulated indirectly: old worries prompted by propaganda and subliminal advertising have taken on a renewed currency with the advent of neuroeconomics and neuromarketing. By better understanding how we process reward, how we make decisions more generally, and how we can bias or influence that process, we open the door to more effective external indirect manipulations. Indeed, social psychology has been showing how subtle alterations to our external environment can affect beliefs, moods, and behaviors. The precise threats posed by understanding the neural mechanisms of decision making have yet to be fully articulated. Is neuromarketing being used merely to design products that satisfy our desires more fully or is it being used to manipulate us? Depending on how you see it, it could be construed as a good or an evil. Does understanding the neural substrates of choice and reward provide advertisers more effective tools than they had merely by using behavioral data, or just more costly ones? Do consumers consequently have less autonomy? How can we compensate for or counteract these measures? These questions are only beginning to be adequately addressed (Stanton et al. 2014).Regulation: Yet another way that autonomy can be impacted is by restricting the things that a person can do with and to her own mind. For instance, banning mind-altering drugs is an externally imposed restraint on people’s ability to choose their states of consciousness. The degree to which a person should be prevented from doing what he wishes to his or her self, body or mind, is an ethical issue on which people have differing opinions. Some claim this kind of regulation is a problematic infringement of autonomy (Juth 2011; Bostrom and Sandberg 2009), but certain regulations of this type are already largely accepted in our society. For instance, regulation of drugs of abuse does impact individual autonomy, but it arguably averts potentially great harms, both self-inflicted harms to the individual users and associated harms to society. Allowing cognitive enhancing technologies only for treatment uses but not for enhancement purposes is another restriction of mental autonomy. Whether it is one we want to sanction is still up for debate. For instance, the potential harms to individuals and to society are much less obvious and foreseeable. Regardless of where this debate goes, it should be clear that complete autonomy is not practically possible in a world in which one person’s actions affect the well-being of others.Belief in free will: Advances in neuroscience have been frequently claimed to have bearing upon the question of whether we have free will and on whether we can be truly morally responsible for our actions. Although the philosophical problem of free will is generally considered to be a metaphysical problem, demonstrable lack of freedom would have significant ethical consequences. A number of neuroscientists and psychologists have intimated or asserted that neuroscience can show or has shown that free will is or is not an illusion (Brembs 2011; Libet et al. 1983; Soon et al. 2008; Wegner 2003). Others have countered with arguments to the effect that such a demonstration is in principle impossible (Roskies 2006). Regardless of what science actually shows about the nature of free will, the fact that people believe neuroscience evidence supports or undermines free will has been shown to have practical consequences. For example, evidence merely supporting the premise that our minds are a function of our brains, as most of neuroscience does, is perceived by some people to be a challenge to free will (Nahmias, Coates, and Kvaran 2007). And in several studies, manipulating belief in free will affects the likelihood of cheating (e.g., Vohs and Schooler 2008). The debate within neuroscience about the nature and existence of free will will remain relevant to neuroethics in part because of its impact on our moral, legal and interpersonal practices of blaming and punishing people for their harmful actions (see also entries on free will and moral responsibility).4. Identity and consciousness 4.1 Personal IdentityOne of the aspects of neuroethics that makes it distinctive and importantly different from traditional bioethics is that we recognize that, in some yet-to-be-articulated sense, the brain is the seat of who we are (see, e.g., personal identity). For example, we now have techniques that alter memories by blunting them, strengthening them, or selectively editing them. We have drugs that affect sexuality, and others that affect mood. Here, neuroethics rubs up against some of the most challenging and contentious questions in philosophy: What is the self? Does neuroscience show that the concept does not refer? If there is a self, what sorts of changes can we undergo and still remain ourselves? What is it that makes us the same person over time? Of what value is this temporal persistence? What costs would changing personhood incur?Because neuroscience intervention techniques can affect memory, desires, personality, mood, impulsivity and other things we might think of as constitutive of the person or the self, the changes they can cause (and combat) have a unique potential to affect both the meaning and quality of the most intimate aspects of our lives. Although neuroethics is quite different from traditional bioethics in this regard, it is not so different from genethics. For a long time, it was argued that “you are your genes”, and so the ability to interrogate our genomes, to change them, or to select among them was seen as both a promising and potentially problematic one, enabling us to understand and manipulate human nature to an extent far beyond any we had previously enjoyed. But as we have discovered, we are not (just) our genes. Our ability to sequence the human genome has not laid bare the causes of cancer, the genetic basis for intelligence, or of psychiatric illness, as many had anticipated. One reason is that our genome is a distal cause of the people we come to be: many complex and intervening factors matter along the way. Our brains, on the other hand, are a far more proximal cause of who we are and what we do. Our moment-to-moment behavior and our long-range plans are directly controlled by our brains, in a way they are not directly controlled by our genomes. If “You are your genes” seemed a plausible maxim, “You are your brain” is far more so.Despite its plausibility, it is notoriously difficult to articulate the way in which we are our brains: What aspects of our brains makes us the people that we are? What aspects of brain function shape our memories, our personality, our dispositions? What aspects are irrelevant or inessential to who we are? What makes possible a coherent sense of self? The lack of answers we have to these deep questions does little to alleviate the pragmatic worries raised by neuroscience, since our ability to intervene in brains outstrips our understanding of what we are doing, and can affect all these aspects of our being.In philosophy, work focusing on persons may address a variety of distinct issues using different constructs. Philosophers might be interested in the nature of personhood, in the nature of the self, in the kinds of traits and psychological states or processes that give an experienced life coherence, or in the ingredients for a flourishing life. Each calls for its own analysis. Outside of philosophy, many of these issues are run together, and confusion often results. Neuroethics, while in a unique position to leverage these issues and apply them in a fruitful way, often fails to make the most of the conceptual work philosophers have done in this area. For example, papers in neuroethics often conflate a number of these distinct concepts, referring them under the rubric of “personal identity”. This conflation further muddies already difficult waters, and diminishes the potential value of neuroethical work. Below I try to give a brief roadmap of the separate strands that neuroethicists have been concerned with.The philosopher’s conception of personal identity refers to the issue of what makes a person at one time numerically identical to a person at another time (see entry on personal identity). This metaphysical question has been addressed by a variety of philosophical theories. For example, some theorists argue that what it is to be the numerically identical over time is to be the same human organism (Olson 1999) and that being the same organism is determined by sameness of life. If having the same life is the relevant criterion, one could argue that although life-sustaining areas of the brainstem are essential to personal identity (Olson 1999), arguably brain changes that did not interrupt life would not be. For those who believe instead that bodily integrity is what is essential, arguably the ability of neuroscience to alter brain activity will have little effect on personal identity. Many other philosophers have identified the sameness of a person as being grounded in psychological continuity of some sort (e.g., Locke 1689). If this criterion is the correct one, then the stringency of that criterion may be crucial: radical brain manipulation may cause an abrupt enough shift in memories and other psychological states that a person after brain intervention is no longer the same person he or she was prior (Jotterand and Giordano 2011; Glannon 2009; Schermer 2011; see also papers in Neuroethics, 6(3), 2013). The more stringent the criterion, the greater is the potential threat of neurotherapies to personal identity. On the other hand, if the standards for psychological continuity or connectedness are high enough, changes in personal identity may in fact be commonplace even without neurotherapies (Baylis 2011). Recognizing this may prompt us to question the criterion and/or the importance or value of personal identity. Parfit, for example, argues that what makes us one and the same person over time, and what we value (psychological continuity and connectedness) can come apart (Parfit 1984).For some, the question of personhood comes apart from the question of identity. Even if personal (i.e., numerical) identity is unchallenged by neurotechnologies and by brain dysfunction, important neuroethical questions may still be raised. Philosophers less concerned with metaphysical questions about numerical identity have focused more on the self, and on notions of authenticity and self-identification, emphasizing the importance of the psychological perspective of the person in question in creating a coherent self (e.g., Witt et al. 2013). In this vein, Schectman has suggested that what is important is the ability to create a coherent narrative, or “narrative self” (Schechtman 2014). There is evidence that the ability to create and sustain a coherent narrative in which we are the protagonist and with which we identify is a measure of psychological health (Waters and Fivush 2015). On the other hand, some philosophers deny that they have a narrative self and locate selfhood in a synchronic property (Strawson 2004). Concerns about the nature and coherence of the narrative self, and about authenticity and autonomy, tend to be the ones most relevant to neuroethics, since these constructs clearly can be affected by even modest brain changes. For example, how do we evaluate the costs and ethical issues attending a dramatic change in personality? If neurointerventions promise to result in dramatic shifts in a person’s values and commitments, whose interests should take priority if one person must be favored—the original or the resulting person? The relevance of personhood, self, agency, identity and identification needs further elaboration for neuroethics. In what follows we discuss how one neurotechnology can bear upon some of these questions.4.1.1 Example: Deep Brain StimulationDeep Brain Stimulation (DBS) involves the stimulation of chronically implanted electrodes deep in the brain, and it is FDA approved for treating Parkinson’s Disease, a neurodegenerative disease affecting the dopamine neurons in the striatum. Neuromodulation with DBS often restores motor function in these patients, permitting many to live much improved lives. It is also being explored as treatments for treatment-resistant depression, OCD, addiction, and other neurological and psychiatric issues. Although DBS is clearly a boon to many people suffering from neurological diseases, there are a number of puzzling issues that arise from its adoption. First, it is a highly invasive treatment, requiring brain surgery and permanent implantation of a stimulator, thus posing a real possibility of harm and raising questions of cost/benefit tradeoffs. This is coupled with the fact that scientists have little mechanistic understanding of how the treatment works when it does, and treatment regimes and electrode placement tend to be determined more by art than by science. Occasionally DBS causes unusual side effects, such as mood changes, hypomania or mania, addictive behaviors, or hypersexual behavior. In one case a patient with wide-ranging musical tastes developed a fixation for Johnny Cash’s music, which persisted until stimulation was ceased (Mantione, Figee, and Denys 2014). Other reported cases involve changes in personality. The ethical questions in this area revolve around the ethics of intervening in ways that alter mood and/or personality, which is often discussed in terms of personal identity or “changing who the person is”, and around questions of autonomy and alienation (Klaming and Haselager 2013; Kraemer 2013).One poignant example from the literature tells of a patient who, without intervention, was bedridden and had to be hospitalized due to severe motor dysfunction caused by Parkinson’s Disease (Leentjens et al. 2004). DBS resulted in a marked improvement in his motor symptoms but also caused him to be untreatably manic, which required institutionalization. Thus, this unfortunate man had to choose between being bedridden and catatonic, or manic and institutionalized. He made the choice (in his unstimulated state) to remain on stimulation (the literature does not mention whether his stimulated self concurred). While it did not happen in this case, one could imagine a situation in which the patient will choose, while unstimulated, to undergo chronic stimulation, but, while under stimulation, would choose otherwise (or vice versa). The possibility for dilemmas or paradoxes will arise when, for example, we try to determine the value of two potential outcomes that are differently valued by the people who might exist. To which person (or to the person in which state) should we give priority? Or, even more perplexing: if the “identity” (narrative or numerical) of the person is indeed shifted by the treatment, should we give one person the authority to consent to a procedure or choose an outcome that in practice affects a different person? DBS cases like this will provide fodder for neuroethicists for years to come. | |
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