Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know

By Charles Foster

From the time of the decision of the House of Lords in Airedale NHS Trust v Bland (1993) until the decision of the Supreme Court in An NHS Trust v Y (2018) (which I will refer to here as ‘Y”) it had been understood that the withdrawal of life-sustaining treatment (typically clinically assisted nutrition and hydration – ‘CANH’) from patients in a vegetative state should be endorsed by the court. Over the years, this practice had been extended to cover such withdrawals in Minimally Conscious States too.

In Y, the Supreme Court held that there was no requirement for court review or endorsement. Why? Continue reading

Nonconsensual Neurointerventions and Expressed Disrespect: a Dilemma

Written by Gabriel De Marco and Tom Douglas

This essay is based on a co-authored paper recently published in Criminal Law and Philosophy

Neurointerventions—interventions that modify brain states—are sometimes imposed on criminal offenders for the purposes of diminishing the risk that they will re-offend or, more generally, of facilitating their rehabilitation. A commonly discussed example is the use of hormonal agents to reduce the sex drive of certain sexual offenders. Some suggest that in the future, we will have a wider range of such interventions at our disposal, possibly including, for instance, treatments to reduce aggression or impulsivity, or treatment to enhance capacities for empathy or sympathy.

In a recent paper, we consider an objection to the imposition of such neurointerventions without the offender’s prior agreement. Some object to these ‘nonconsensual neurointerventions’ (or ‘NNs’) by claiming that they express disrespect for the offender. This, according to the objection, gives us reason not to implement them. On a strong version of the objection, NNs are invariably wrong because they always express disrespect. Continue reading

The Neuroscience of a Life Well-lived: New St Cross Ethics Seminar

Professor Morten Kringelbach (Aarhus and Oxford) recently gave a fascinating New St Cross Ethics Seminar on ‘The Neuroscience of a Life Well-Lived’ (YouTube; mp3). Continue reading

Who You Really Are And Why It Matters

By Charles Foster

 [This is a review of The Flip: Who you really are, and why it matters, by  Jeffrey J. Kripal. Penguin, 2020]

A few years ago I dislocated my shoulder. I went off to hospital, and breathed nitrous oxide while they tried to put it back. Something very strange yet very common happened. ‘I’ rose out of ‘my’ body, and looked down at it. I could see the nurse’s centre parting and the top of my own bald head. ‘I’ was aware of the pain in the shoulder, and regretted it, but it wasn’t really my business.

My mind was hovering over the skull that encased my brain, and so it seemed ludicrous to say that mind and brain were identical. The experience ousted my residual materialism. Out went Aristotle: in came Plato. This change was a ‘flip’, as Kripal describes such events in this exhilarating, bold, timely, and profoundly important book.

Personal experience of this kind often produces tectonic philosophical conversions in professional philosophers and scientists. Mere reflection rarely does. This observation itself is likely to elicit howls of derision from the materialists. For them, to intrude oneself into an inquiry is necessarily to invalidate it. And of course the humanities are supremely to be mocked, for they are all to do with subjectivity. Continue reading

Mandatory Morality: When Should Moral Enhancement Be Mandatory?

By Julian Savulescu

Together with Tom Douglas and Ingmar Persson, I launched the field of moral bioenhancement. I have often been asked ‘When should moral bioenhancement be mandatory?’ I have often been told that it won’t be effective if it is not mandatory.

I have defended the possibility that it could be mandatory. In that paper with Ingmar Persson, I discussed the conditions under which mandatory moral bioenhancement that removed “the freedom to fall” might be justified: a grave threat to humanity (existential threat) with a very circumscribed limitation of freedom (namely the freedom to kill large numbers of innocent people), but with freedom retained in all other spheres. That is, large benefit for a small cost.

Elsewhere I have described this as an “easy rescue”, and have argued that some level of coercion can be used to enforce a duty of easy rescue in both individual and collective action problems. Continue reading

Video Interview: Jesper Ryberg on Neurointerventions, Crime and Punishment

Should neurotechnologies that affect emotional regulation, empathy and moral judgment, be used to prevent offenders from reoffending? Is it morally acceptable to offer more lenient sentences to offenders in return for participation in neuroscientific treatment programs? Or would this amount too coercion? Is it possible to administer neurointerventions as a type of punishment? Is it permissible for physicians to administer neurointerventions to offenders? Is there a risk that the dark history of compulsory brain interventions in offenders will repeat itself? In this interview Dr Katrien Devolder (Oxford), Professor Jesper Ryberg (Roskilde) argues that there are no good in-principle objections to using neurointerventions to prevent crime, BUT (!) that given the way criminal justice systems currently function, we should not currently use these interventions…

Making Ourselves Better

Written by Stephen Rainey

Human beings are sometimes seen as uniquely capable of enacting life plans and controlling our environment. Take technology, for instance; with it we make the world around us yield to our desires in various ways. Communication technologies, and global transport, for example, have the effect of practically shrinking a vast world, making hitherto impossible coordination possible among a global population. This contributes to a view of human-as-maker, or ‘homo faber‘. But taking such a view can risk minimising human interests that ought not to be ignored.

Homo faber is a future-oriented, adaptable, rational animal, whose efforts are aligned with her interests when she creates technology that enables a stable counteraction of natural circumstance. Whereas animals are typically seen to have well adapted responses to their environment, honed through generations of adaptation, human beings appear to have instead a general and adaptable skill that can emancipate them from material, external circumstances. We are bad at running away from danger, for instance, but good at building barriers to obviate the need to run. The protections this general, adaptable skill offer are inherently future-facing: humans seem to seek not to react to, but to control the environment.

Continue reading

Abolish Medical Ethics

Written by Charles Foster

In a recent blog post on this site Dom Wilkinson, writing about the case of Vincent Lambert, said this:

If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.’

The post was (as everything Dom writes is), completely coherent and beautifully expressed. I say nothing here about my agreement or otherwise with his view – which is comfortably in accord with the zeitgeist, at least in the academy. My purpose is only to point out that if he is right, there is no conceivable justification for a department of medical ethics. Dom is arguing himself out of a job. Continue reading

Withdrawing Life Support: Only One Person’s View Matters

Dominic Wilkinson, University of Oxford

Shortly before Frenchman Vincent Lambert’s life support was due to be removed, doctors at Sebastopol Hospital in Reims, France, were ordered to stop. An appeal court ruled that life support must continue.

Lambert was seriously injured in a motorcycle accident in 2008 and has been diagnosed as being in a persistent vegetative state. Since 2014, his case has been heard many times in French and European courts.

His wife, who is his legal guardian, wishes artificial nutrition and hydration to be stopped and Vincent to be allowed to die. His parents are opposed to this. On Monday, May 20, the parents succeeded in a last-minute legal appeal to stop Vincent’s doctors from withdrawing feeding, pending a review by a UN Committee on the Rights of Persons with Disabilities.

Lambert’s case is the latest example of disputed treatment for adult patients with profound brain injury. The case has obvious parallels with that of Terri Schiavo, in the US who died in 2005 following seven years of legal battles. And there have been other similar high-profile cases over more than 40 years, including Elena Englaro (Italy, court cases 1999-2008), Tony Bland (UK 1993) Nancy Cruzan (US 1988-90) and Karen Ann Quinlan (US 1975-76). Continue reading

Regulating The Untapped Trove Of Brain Data

Written by Stephen Rainey and Christoph Bublitz

Increasing use of brain data, either from research contexts, medical device use, or in the growing consumer brain-tech sector raises privacy concerns. Some already call for international regulation, especially as consumer neurotech is about to enter the market more widely. In this post, we wish to look at the regulation of brain data under the GDPR and suggest a modified understanding to provide better protection of such data.

In medicine, the use of brain-reading devices is increasing, e.g. Brain-Computer-Interfaces that afford communication, control of neural or motor prostheses. But there is also a range of non-medical applications devices in development, for applications from gaming to the workplace.

Currently marketed ones, e.g. by Emotiv, Neurosky, are not yet widespread, which might be owing to a lack of apps or issues with ease of use, or perhaps just a lack of perceived need. However, various tech companies have announced their entrance to the field, and have invested significant sums. Kernel, a three year old multi-million dollar company based in Los Angeles, wants to ‘hack the human brain’. More recently, they are joined by Facebook, who want to develop a means of controlling devices directly with data derived from the brain (to be developed by their not-at-all-sinister sounding ‘Building 8’ group). Meanwhile, Elon Musk’s ‘Neuralink’ is a venture which aims to ‘merge the brain with AI’ by means of a ‘wizard hat for the brain’. Whatever that means, it’s likely to be based in recording and stimulating the brain.

Continue reading

Authors

Affiliations