Review and first analysis of an article on the subject published in Revista Iberoamericana de Bioética
Revista Iberoamericana de Bioética (Ibero-American Journal of Bioethics) recently published an interesting article on neuroenhancement, in which its difficulties and limits are addressed from the perspective of philosophy of mind and bioethics (Biscaia Fernandez, 2021). This is obviously a very topical issue in the field of biomedical applications, which this Observatory has been following closely, and that the article discusses from an informational perspective aimed at a broad audience not necessarily specialized in these issues.
In general, there are three distinctions provided by the article referred to herein:
- First, the distinction between neuroscientific applications that employ purely evaluative techniques and those that use interventional methods, which due to their biopsychosocial scope, call for a necessary philosophical and bioethical debate. These types of interventions include the use of neuropharmaceuticals, use of stem cells and nervous tissue implants, and use of modulatory neurodevices (such as transcranial magnetic stimulation [TMS], transcranial electrical stimulation [TES], electroconvulsive therapy [ECT] and deep brain stimulation [DBS]); they also include the use of brain-computer interfaces (BCI) by use of artificial intelligence (AI), although the latter are not yet applicable to clinical practice as they are currently in the developmental phase.
- Second, the distinction between the two major foci of reflection of the philosophy of mind, namely: the conceptual problems of mind reading, control and transfer, and the ontological difficulties related to the identity of a possible “Homo cyborg”.
- Finally, the distinction, based on bioethical grounds, between what is feasible and what is ethically feasible; or what is the same: between neurotechnology at the service of treatment and neural enhancement, and neuroethics as an application of classic bioethical principles to neuroenhancement. The perspective of the study is, therefore, markedly principlist. And this alerts us a little about the paper, because the repercussions on personal identity, and even the future of human nature of the issues that it addresses, would strongly suggest taking personalist bioethics into consideration.
Neuroethics and moderate transhumanism. Two controversial definitions
The article presents neuroethics as the “bioethical sentinel” of nervous system research and the treatment of neuropsychiatric disorders, while describing transhumanism as a discipline “that emerged with the commitment to reflect on the use of technology in human enhancement”. We do not fully agree with these definitions. In our opinion, transhumanism does not reflect on the use of technology for human enhancement, but considers it an ethical imperative, a moral duty (Bostrom, 2003). It is not, therefore, as “neutral” a discipline as the author presents it. And neuroethics, however much one wants it to have a privileged position in relation to bioethics (the author is talking in particular about “medical bioethics”), in our opinion, is nothing more than one of its branches.
Biscaia, in fact, cites Kathinka Evers (Evers, 2011), to argue that neuroethics transcends mere bioethical specialization by moving towards the revision of classical philosophy in the light of the brain sciences. Evers seems to forget that Bioethics is an applied ethics. Therefore, it is the implementation of Practical philosophy in a very defined context. And if philosophy consists of anything, it is the continuity of a historical nexus of dialogues about the latest issues (Spaemann, 2004, p. 91). As F. Copleston notes, what stands out in Philosophy is continuity and connections, action and reaction, thesis and antithesis. This is because Philosophy is not immanence, but grows and develops by changing or refreshing its views and expanding thanks to new approaches or the posing of new problems and situations (Copleston, 2004, p. 18). Indeed, despite the fact that Fritz Jahr and Potter initially conceived Bioethics as a “science of survival”, making it take the form of an apocalyptic warning about the risks of a global ecosystem seriously harmed by the action of man, before long, under the guidance of André Hellegers and the developers of the Kennedy Center, Bioethics evolved towards the humanistic revitalization of Medicine and the biological sciences related to human well-being.
In these areas, there is no doubt that our era poses new challenges that question the traditional limits of human capabilities and, therefore, it is no exaggeration to say that, in what we have been through this century, what was once morally obvious seems to have lost its unquestioned character. Nor is it to say that General ethics seems to be split into an array of sector-specific applied ethics, repositories each of their own script (Pardo, 2006, p. 146). Now, if Moral Philosophy did not provide answers at the time to the dilemmas that beset us today, it was simply because these problems had not yet arisen. Nevertheless, this does not mean that it cannot respond to the new challenges facing it and that, consequently, the development of “new ethics” is necessary. Nor does it imply, of course, that neuroethics is a discipline different from bioethics and that it is nothing, ultimately, but an applied ethics.
For this reason, we feel that calling neuroethics a branch of bioethics, which in turn is a branch of ethics, which in turn is a branch of philosophy, etc. (it is exhausting just thinking about this course) responds more to the need of some authors driven by the urgency of finding their cell in the hive of the academic community, than a true epistemological need.
Even so, we shall accept the distinction to which the author appeals (and the scientific community endorses) between applied neuroethics, a branch that identifies and analyzes the different bioethical problems generated by neuroscientific activity and the use of neurotechnological applications; and fundamental neuroethics, which from a neurobiological, cognitive and scientific perspective, studies aspects traditionally reserved for the humanities and the social sciences, such as consciousness, identity, free will, intentionality, thought, judgment or moral responsibility. Moreover, we shall do so without pointing out that, deep down, it is a question of returning to the institutions of foundation and application of bioethics, namely: philosophy and the medical and experimental sciences. In our opinion, nothing new under the sun of philosophy; simply, if anything, greater specificity.
In any case, the article to which we refer focuses specifically on applied neuroethics, whose objective, we agree with the author, is “to create a deontological framework for the ‘neuro’ professions; also, to encourage in-depth reflection on technical and bioethical issues such as the determination of clinical states of non-consciousness and brain death (Bonete, 2010), mind manipulation and control, or diagnosis, treatment and sensory, motor, emotional and cognitive enhancement through the use of neurotechnology” (Levy, 2014).
With regard to transhumanism, the author is in line with Antonio Diéquez, who since the initial criticism seems to have turned to a sort of moderate transhumanism that the article identifies as “technoscientific”, setting it against the cultural, critical or “posthuman”. “Technoscientific” transhumanism would seem to advocate the “rational” and “ethical” use of available technology to enhance the human being. Now, a “rational” and “ethical” perspective must be in keeping with human nature, for it should be remembered that ethics is a reflection that arises from the human mind and not from a cybernetic algorithm. Rational and ethical is, therefore, the use of technology at the service of therapy. But is it rational and ethical to use technology for enhancement, to take the human being beyond his natural capabilities? What do advocates of enhancement mean by rational use? To prevent social differences in access to enhancements, to prevent unwanted side effects?
The controversial nature of neurocognitive enhancement. The issue of neurorights
This is not the place to expound the difficulties of picking apart the possible consequences of neurocognitive enhancement that make it difficult to think of a “rational” and “ethical” reading of it. As far as we are concerned, the author also distinguishes, within technoscientific transhumanism, between applications for human enhancement that are compatible with fusion (or at least interaction) with artificial and inorganic devices, machines or elements (e.g. brain-computer interfaces), and those that can be encompassed under the umbrella of bioenhancement, i.e. the entire set of advances and improvements in the human condition resulting from the use of substances that modify our biology or through the direct manipulation of our genes or our cell biology (Diéguez, 2017).
Biscaia’s article moves within the framework of applied neuroethics and technological transhumanism, reflecting on the technology responsible for the diagnosis and treatment of neuropsychiatric diseases and brain enhancement, as well as the limits and problems that these applications generate. More specifically, he sets out his specific objectives in reviewing the latest advances in the neuroscientific and neurotechnological vanguard, in reflecting on the conceptual difficulties posed by the philosophy of mind, and in defining the bioethical limits and any social risks that could arise from the use of these technologies.
The reason for his interest lies in the fact that, beyond genomic studies and biomarker analysis that have proven useful in the diagnosis and characterization of neurodegenerative and psychiatric diseases such as Parkinson’s, Alzheimer’s or Huntington’s disease, and in multiple sclerosis, drug addiction or schizophrenia; or beyond the applications of electrophysiology and above all the revolution of neuroimaging for the diagnosis of serious neurological conditions such as strokes and glioblastomas; beyond all that, the article supports — and we fully agree with — neuroscientific research with nerve tissue implants and the use of modulatory neurodevices. For example, it envisages the future use of stem cells to treat spinal cord injuries (Jin, 2019) or neurodegenerative diseases such as Alzheimer’s, neurological diseases such as Parkinson’s or psychiatric disorders such as depression.
Above all, however, the main controversies that will result from interventional applications of the neurosciences will be the possibility of mind reading, manipulation and transfer (by scanning and by expansion of the mind), as well as the eventual emergence of the “Homo cyborg” and its disputed identity. It is with regard to these issues that the article reaches its peak of interest and the reason that motivates us to recommend its reading, as well as to discuss the “neurorights” that the author suggests should be established based on (Ienca & Andorno, 2017), which are the following:
- The right to cognitive freedom, which would guarantee the possibility of altering one’s own mental states through the use of neurotechnology (and also refusing to do so). Sovereign control over one’s own consciousness, the author adds, should also protect free will, which is susceptible to manipulation through the use of neurotechnology.
- The right to mental privacy, avoiding the illegitimate use of brain information (so-called “neurodata” and “internet of the body”).
- The right to mental integrity, which implies protection of the neural status in its sensory, motor and cognitive-emotional dimension, taking into account that many of the interventionist applications described above could alter it.
- The right to psychological continuity, which should protect against a possible alteration of individual identity and the concept of oneself. An example of violation of this right could be found in any interventions that modify memories, since manipulation of the past would alter personal identity and the projection of future actions, as personal identity is linked to the experience of time.
The article, which is extremely interesting in many aspects, requires a deeper bioethical reflection that will be the subject of future analysis.
Enrique Burguete
Bioethics Observatory – Institute of Life Sciences
Catholic University of Valencia
References
Biscaia Fernández, J. (2021). Neuromejora: de la vanguardia científica y tecnológica a las dificultades y límites planteadospor la filosofía de la mente y la bioética. Revista Iberoamericana de Bioética (16), 01-17. doi:10.14422/rib.i16.y2021.003
Bonete, E. (2010). Neuroética práctica. Bilbao: Desclée.
Bostrom, N. (26 de junio de 2003). Intensive Seminar on Transhumanism. Yale University.
Copleston, F. (2004). Historia de la Filosofía (Vol. 1). (J. Mora, Trad.) Barcelona: Ariel.
Diéguez, A. (2017). Transhumanismo. La búsqueda tecnológica del mejoramiento humano. Barcelona: Herder.
Evers, K. (2011). Neuroética. Cuando la materia se despierta. Madrid: Katz Editores.
Ienca, M., & Andorno, R. (2017). Towards new human rights in the age of neuroscience and neurotechnology. Life Sciences, Society and Policy, 13(5).
Jin, M. C. (2019). Stem cell therapies for acute spinal cord injury in humans: a review. Neurosurg Focus, 46(3).
Levy, N. (2014). Neuroética. Retos para el siglo XXI. Barcelona: Avarigani Editores.
Pardo, J. (2006). El cuerpo sin órganos. Sobre Deleuze y sus consecuencias. Valencia: Pretextos.
Spaemann, R. (2004). Ensayos Filosóficos. Madrid: Cristiandad.
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