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Deep Brain Stimulation, Authenticity and Value

  • JONATHAN PUGH, HANNAH MASLEN and JULIAN SAVULESCU
  • Please note a correction has been issued for this article.
Abstract:

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Notes

The funding information was not included in the print or original online version of this article. It has now been added as an acknowledgment footnote on page 640. A corrigendum has been published.

1. Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C. Deep brain stimulation for treatment-resistant depression. Neuron 2003;45(5):651–60; Lipsman N, Lozano AM. Targeting emotion circuits with deep brain stimulation in refractory anorexia nervosa. Neuropsychopharmacology 2014;39(1):250–51; Bari AA, Kon Kam King N, Lipsman N, Lozano AM. Deep brain stimulation for neuropsychiatric disorders. In: Tuszynski MH, ed. Translational Neuroscience. New York: Springer US;2016:499–516.

2. Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S. Bilateral deep brain stimulation in Parkinson’s disease: A multicentre study with 4 years follow-up. Brain 2005;128(10): 2240–49; Hu W, Stead M, Deep brain stimulation for dystonia. Translational Neurodegeneration 2014;3:2.

3. Clausen J. Ethical brain stimulation – neuroethics of deep brain stimulation in research and clinical practice. European Journal of Neuroscience 2010;32(7):1152–62.

4. Baylis, F. ’I am who I am’: On the perceived threats to personal identity from deep brain stimulation. Neuroethics 2013;6(3):513–26; Kraemer F. Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 2013;6(3):483–97; Lipsman N, Glannon W. Brain, mind and machine: What are the implications of deep brain stimulation for perceptions of personal identity, agency and free will? Bioethics 2013;27(9):465–70; Klaming L, Haselager P. Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence, Neuroethics 2010;6(3):527–39.

5. See note 4, Kraemer 2013; Nyholm S, O’Neill E. Deep brain stimulation, continuity over time, and the true self. Cambridge Quarterly of Healthcare Ethics 2016;25(4):647–58; Maslen, H, Pugh, J, Savulescu, J. Authenticity and the stimulated self: Neurosurgery for anorexia nervosa. AJOB Neuroscience 2015;6(4):6971 .

6. See note 4, Baylis 2013.

7. Sharp, D, Wasserman, D. Deep brain stimulation, historicism, and moral responsibility. Neuroethics 2016;9(2):173–85; see note 4, Klaming, Haselager 2010.

8. See note 4, Kraemer 2013.

9. The issues pertaining to personal identity and moral responsibility might also be understood to be more complicated in the case of psychiatric disorders to the extent that such disorders can be understood to threaten personal identity and/or moral responsibility. However, we do not make a stand on this claim here.

10. See note 4, Kraemer 2013.

11. Maslen, H, Pugh, J, Savulescu, J. The ethics of deep brain stimulation for the treatment of anorexia nervosa. Neuroethics 2015;8(3):215230 ; see note 15, Maslen et al. 2015.

12. See note 5, Nyholm, O’Neill 2015.

13. Marya Schetmann calls this the characterization question. See Schechtman M. The Constitution of Selves. Ithaca; London: Cornell University Press; 1996, 73.

14. We note that the spatial metaphor of peripheral traits is suggestive of synchronicity: traits at different distances from the central self, instantiated at the same time. However, we do not intend to use this metaphor to illustrate anything substantive about the account of authenticity we will develop: peripheral traits might be better or alternatively understood as less frequently instantiated.

15. Newman GE, Bloom P, Knobe J. Value judgments and the true self. Personality and Social Psychology 2014;40(2):203–16.

16. See note 15, Strohminger et al.

17. See note 15, Strohminger et al.; DeGrazia D. Human Identity and Bioethics. Cambridge: Cambridge University Press; 2005, at 233–34.

18. In their discussion, Erler and Hope draw a tripartite distinction between what they term “authenticity as wholeheartedness,” “authenticity as autonomous and honest endorsement,” and “true-self-accounts.” The first two can be understood to be examples of what we call existentialist accounts, whereas the latter maps onto what we are terming essentialist accounts. Erler A, Hope T. Mental disorder and the concept of authenticity. Philosophy, Psychiatry, & Psychology 2015;21(3):219–32.

19. Bublitz, JC, Merkel, R. Autonomy and authenticity of enhanced personality traits. Bioethics 2009;23(6):370.

20. See note 18, Erler, Hope 2015.

21. Parens E, Authenticity and ambivalence: Toward understanding the enhancement debate. The Hastings Center Report 2005;35(3):34–41.

22. Levy N. Enhancing authenticity. Journal of Applied Philosophy 2011;28(3):312.

23. See note 5, Nyholm, O’Neill, 2016.

24. Elliott C. Better than Well : American Medicine Meets the American Dream. New York ,London: W.W. Norton; 2003.

25. Levy N. Enhancing authenticity. Journal of Applied Philosophy 2011;28(3):316.

26. Schechtman M. The Constitution of Selves. Ithaca; London: Cornell University Press; 1996.

27. See note 17, DeGrazia 2005, at 102.

28. See note 18, Erler, Hope 2015.

29. For a detailed account of this rationalist approach see See Parfit D. On What Matters. Oxford: Oxford University Press; 2011. Part One.

30. Ekstrom, LW. A coherence theory of autonomy. Philosophy and Phenomenological Research 1993;53(3):599616.

31. See note 30, Ekstrom 1993, at 607.

32. See note 30, Ekstrom 1993, at 608–9.

33. According to social psychology research, we may also observe that people would likely attribute authenticity to Scrooge by virtue of the fact that they regard his change in character as having positive valence. See note 15, Strohminger et al.

34. Robert Noggle also appeals to the idea of “Neurathian Autonomy” in Noggle R. The public conception of autonomy and critical self-reflection. Southern Journal of Philosophy 1997;35(4):510. However, he appeals to this sort of idea with regards to what he terms the core attitudes that undergird agential autonomy. See Noggle R. Autonomy and the paradox of self-creation. In: Taylor JS, ed. Personal Autonomy New Essays on Personal Autonomy and Its Role in Contemporary Moral Philosophy, Cambridge: Cambridge University Press; 2005.

35. See note 30, Ekstrom 1993, at 600.

36. Doshi, P, Bhargava, P. Hypersexuality following subthalamic nucleus stimulation for Parkinson’s disease. Neurology India 2008;56(4):474–76.

37. Voon V, Kubu C, Krack P, Houeto JL, Tröster AI. Deep brain stimulation: Neuropsychological and neuropsychiatric issues. Movement Disorders 2006;21(Suppl 14):S305–327.

38. Tan J, Hope T, Stewart A, Fitzpatrick R. Competence to make treatment decisions in anorexia nervosa: Thinking processes and values. Philosophy, Psychiatry, & Psychology 2007;13(4):267–82.

39. See note 11, Maslen et al. 2015.

40. Focquaert, F, Schermer, M. Moral enhancement: Do means matter morally? Neuroethics 2015;8(2): 139–51.

41. See note 11, Maslen et al. 2015.

42. See note 18, Erler, Hope 2015.

43. See note 4, Kraemer 2013.

44. Mill JS. On Liberty. New Haven: Yale University Press; 2003, at 125.

45. See note 15, Strohminger et al.

46. See note 41, Mill 2003, at 131.

47. Hughes J. Beyond “Real Boys” and Back to Parental Obligations. The American Journal of Bioethics 2005;5(3):61.

48. See note 5, Nyholm, O’Neill 2015.

49. See note 41, Mill 2003, at 124.

This work was supported by the Wellcome Trust [WT203195/Z/16/Z]; [WT104848/Z/14/Z].

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Cambridge Quarterly of Healthcare Ethics
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  • EISSN: 1469-2147
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