Reversibility, Colds, and Neurosurgery

By Jonny Pugh

This blog was originally published on the Journal of Medical Ethics Blog

 

Happy new year to readers of the blog!

I always approach the new year with some trepidation. This is not just due to the terrible weather, or even my resolution to take more exercise (unfortunately in the aforementioned terrible weather). Instead, I approach January with a sense of dread because it is always when I seem to come down with the common cold.

In my recent research, I have been interested in the nature and moral significance of reversibility, and the common cold is an interesting case study of this concept. In this blog, I will use this example to very briefly preview a couple of points that I make in a forthcoming open access article about reversibility in the context of psychiatric neurosurgery. You can read the open access paper here.

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Moral Responsibility and Interventions

Written by Gabriel De Marco

Consider a story about Joe, Louie, and Dr. White. Joe is a gambling man and has been for much of his life. In his late twenties, Joe began to gamble occasionally and after a while, he decided that he would embrace this practice of gambling. Although Joe gambles fairly often, he has his limits, and can often resist the desire to gamble.

Louie, on the other hand, is a frugal family man. With his wife, he has been saving money over the last year so that they can take their kids to Disneyland. Dr. White, an evil neurosurgeon who detests the thought of children enjoying themselves at Disneyland, wants to stop this trip. So, Dr. White designs and executes a plan. One night, while Louie is sleeping, Dr. White uses his fancy neuroscientific methods to make Louie more like Joe. He implants in Louie a strong desire to gamble, as well as further attitudes that will help Louie embrace this desire, such that Louie, for example, now values the thrill of gambling, and he desires that his gambling desires are the ones that lead him to action. In order to increase chances of success, Dr. White also significantly weakens some of Louie’s competing attitudes, like some of his family values, or his attitudes towards frugality. When Joe wakes up the next morning, he feels this strong desire to gamble, and although he finds it strange that it has come out of the blue, he fully embraces it (as much as Joe embraces his own gambling desires), having recognized that it lines up with some of his other attitudes about his desires (which were also implanted). Later in the day, while he is “out running errands,” Louie swings by a casino, bets the money he has been saving for the trip, and loses it. “Great success” thinks Dr. White. Since his goal of preventing some children’s joy at Disneyland has been achieved, he turns Louie back into his old self after Louie goes to sleep.

This story is similar to stories sometimes found in the debate about freedom and moral responsibility, though I will focus on moral responsibility. Intuitively, Louie is not morally responsible for gambling away these savings; or, at the very least, he is significantly less responsible for doing so than someone like Joe would be for doing something similar. If we want to make sense of these different judgments about Louie and Joe’s responsibility, we are going to need to find some difference between them that can explain why Louie is, at least, less responsible than regular Joe.

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Harnessing the Power of Moral Identity to Improve Morality

Written by Doug McConnell

Over the last 25 years there has been an explosion of psychological research investigating the influence of ‘moral identity’ on agency with a recent meta-analysis of 111 studies concluding that people’s moral identity has as much of an effect on agency is either their moral emotion or powers of moral reasoning (Hertz & Krettenauer, 2016). Although the mainstream view of moral psychology is that moral self-concept plays a significant role in moral agency, the practical ethical implications of this view remain underexplored. Here, I argue that one of those implications is that, in situations where we need to improve morality, such as decision-making in the boardroom, consumer behaviour, and reform of criminal offenders, we should do so (in part) by developing people’s moral identities. Indeed, in many cases, changes to moral identity have the potential to efficiently deliver relatively large moral improvements. Continue reading

The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests. Continue reading

Pain for Ethicists #2: Is the Cerebral Cortex Required for Pain? (Video)

Here’s my presentation from the UQAM 2018 Summer School in Animal Cognition organised by Stevan Harnad:

I also highly recommend Jonathan Birch’s talk on Animal Sentience and the Precautionary Principle and Lars Chittka’s amazing presentation about the minds of bees.

Thanks again to EA Grants for supporting this research as well as my home institutions Uehiro & WEH. And thanks to Mélissa Desrochers for the video.

You can find the first Pain for Ethicists post here.

Adam Shriver is a Research Fellow at the Oxford Uehiro Centre for Practical Ethics and the Wellcome Centre for Ethics and Humanities.

Follow him on Twitter.

Illness and Attitude – Richard Holton’s 3rd Uehiro Lecture

By Jonathan Pugh

 

In the final lecture of the 2018 Uehiro lecture series, Richard Holton concluded his reflections on the theme of ‘illness and the social self’ by turning to questions about how attitudes can play a role in the onset of medical disorders, with a particular focus on psycho-somatic disorders.

 

You can find a recording of the lecture here

 

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Coffee with Colleagues: Caffeine is a “Social” Enhancer

By Nadira Faber

The coffee you are having with your colleagues at a business meeting does more than keep you awake. Many of us know that caffeine can help with alertness and working memory – the first systematic study on caffeine and performance, sponsored by Coca-Cola, was published over 100 years ago. But did you know caffeine can also have “social” effects?

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Video Series: Tom Douglas Defends the Chemical Castration of Sex Offenders

The Minister of Justice in the UK wants to dramatically increase the use of chemical castration in sex offenders to reduce their risk of reoffending.Dr Tom Douglas (University of Oxford) argues that offering chemical castration to sex offenders might be a better option than current practices to prevent sex offenders from reoffending (e.g. incarceration), and responds to concerns about coercion and interfering in sex offenders’ mental states (e.g. by changing their desires).

Neuroblame?

Written by Stephen Rainey

Brain-machine interfaces (BMIs), or brain-computer interfaces (BCIs), are technologies controlled directly by the brain. They are increasingly well known in terms of therapeutic contexts. We have probably all seen the remarkable advances in prosthetic limbs that can be controlled directly by the brain. Brain-controlled legs, arms, and hands allow natural-like mobility to be restored where limbs had been lost. Neuroprosthetic devices connected directly to the brain allow communication to be restored in cases where linguistic ability is impaired or missing.

It is often said that such devices are controlled ‘by thoughts’. This isn’t strictly true, as it is the brain that the devices read, not the mind. In a sense, unnatural patterns of neural activity must be realised to trigger and control devices. Producing the patterns is a learned behaviour – the brain is put to use by the device owner in order to operate it. This distinction between thought-reading and brain-reading might have important consequences for some conceivable scenarios. To think these through, we’ll indulge in a little bit of ‘science fiction prototyping’.

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Video Series: Tom Douglas on Using Neurointerventions in Crime Prevention

Should neurointerventions be used to prevent crime? For example, should we use chemical castration as part of efforts to prevent re-offending in sex offenders? What about methadone treatment for heroin-dependent offenders? Would offering such interventions to incarcerated individuals involve coercion? Would it violate their right to freedom from mental interference? Is there such a right? Should psychiatrists involved in treating offenders always do what is in their patients’ best interests or should they sometimes act in the best interests of society? Tom Douglas (Oxford) briefly introduces these issues, which he investigates in depth as part of his Wellcome Trust project ‘Neurointerventions in Crime Prevention’ (http://www.neurocorrectives.com).

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