Skip to main content Accesibility Help

Imagining Moral Bioenhancement Practices: Drawing Inspiration from Moral Education, Public Health Ethics, and Forensic Psychiatry


In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed (in view of public safety and managing public risk). Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as “moral bioenhancement.”

Hide All


1. Douglas, T. Moral enhancement. Journal of Applied Philosophy 2008;25(3):228–45.

2. Specker, J, Focquaert, F, Raus, K, Sterckx, S, Schermer, MHN. The ethical desirability of moral bioenhancement: A review of reasons. BMC Medical Ethics 2014;15(1):67.

3. Schaefer, GO. Direct vs. indirect moral enhancement. Kennedy Institute of Ethics Journal 2015;25(3):261–89; Focquaert, F, Schermer, MHN. Moral enhancement: Do means matter morally? Neuroethics 2015;8(2):139–51.

4. Levy, N, Douglas, T, Kahane, G, Terbeck, S, Cowen, PJ, Hewstone, M, et al. Are you morally modified?: The moral effects of widely used pharmaceuticals. Philosophy, Psychiatry, & Psychology 2014;21(2):111–25; Levy, N, Douglas, T, Kahane, G, Terbeck, S, Cowen, PJ, Hewstone, M, et al. Disease, normality, and current pharmacological moral modification. Philosophy, Psychiatry, & Psychology 2014;21(2):135–7.

5. Carter, S. Putting a price on empathy: Against incentivising moral enhancement. Journal of Medical Ethics 2015;41(10):825–9; Persson, I, Savulescu, J. Should moral bioenhancement be compulsory? Reply to Vojin Rakić. Journal of Medical Ethics 2014;40(4):251–2; Rakić, V. Voluntary moral enhancement and the survival-at-any-cost bias. Journal of Medical Ethics 2014;40(4):246–50.

6. See note 2, Specker et al. 2014.

7. Crockett, MJ. Pharmaceutical effects on moral behavior: A neuroscientific perspective. Philosophy, Psychiatry, & Psychology 2014;21(2):131–4.

8. Nordmann, A. If and then: A critique of speculative nanoethics. NanoEthics 2007;1(1):31.

9. Brey, PAE. Anticipatory ethics for emerging technologies. NanoEthics 2012;6(1):2.

10. This list is not exhaustive, and closer examination of other domains might be of interest as well; for example, the domain of artificial intelligence; see, Savulescu J, Maslen H. Moral enhancement and artificial intelligence: Moral AI? In: Romportl, J., Zockova, E., Kelemen, J., eds. Beyond Artificial Intelligence: The Disappearing HumanMachine Divide. Cham: Springer International Publishing; 2015:79–95.

11. DeGrazia D. Moral enhancement, freedom, and what we (should) value in moral behaviour. Journal of Medical Ethics 2014;40(6):363.

12. Young L, Dungan J. Where in the brain is morality? Everywhere and maybe nowhere. Social Neuroscience 2012;7(1):1–10; Decety J, Wheatley T, eds. The Moral Brain. A Multidisciplinary Perspective. Cambridge, MA: MIT Press; 2015; Darragh M, Buniak L, Giordano J. A four-part working bibliography of neuroethics: Part 2-neuroscientific studies of morality and ethics. Philosophy, Ethics, and Humanities in Medicine 2015;10(2).

13. Lapsley, D, Carlo, G. Moral development at the crossroads: New trends and possible futures. Developmental Psychology 2014;50(1):17.

14. See note 13, Lapsley, Carlo 2014, at 3. The diverse social issues they mention are frequently discussed in the debate on moral bioenhancement as well: violence, genocide, and war; concerns about environmental degradation; poverty and famine; and the persistence of racism and discrimination.

15. Frimer, JA, Walker, LJ. Towards a new paradigm of moral personhood. Journal of Moral Education 2008;37(3):334.

16. Narvaez D. Integrative ethical education. In: Killen M, Smetana JG, eds. Handbook of Moral Development. Mahwah, NJ: Erlbaum; 2006, at 703.

17. See note 16, Narvaez 2006, at 708.

18. Schuitema, J, Ten Dam, G, Veugelers, W. Teaching strategies for moral education: A review. Journal of Curriculum Studies 2008;40(1):6989.

19. See note 16, Narvaez 2006, at 712.

20. Turiel E. Foreword. Journal of Moral Education 2008;37(3):279–88.

21. Reed DC, Stoermer RM. Towards an integrated model of moral functioning: an overview of the Special Issue. Journal of Moral Education 2008;37(3):418.

22. See note 21, Reed, Stoermer 2008, at 419; Kim M, Sankey D. Towards a Dynamic Systems Approach to moral development and moral education: a response to the JME Special Issue, September 2008. Journal of Moral Education 2009;38(3):283–98.

23. See note 16, Narvaez 2006, at 703. See note 21 Reed, Stoermer 2008, at 419. Wren T. Philosophical moorings. In: Nucci L, Narvaez D, Krettenauer T, eds. Handbook of Moral and Character Education. 2nd ed. New York: Taylor & Francis; 2014:11–29.

24. See note 11, DeGrazia 2014. Shook JR. Neuroethics and the possible types of moral enhancement. AJOB Neuroscience 2012;3(4):3–14; Schaefer GO. What Is the goal of moral engineering? AJOB Neuroscience 2011;2(4):10–1; Persson I, Savulescu J. The art of misunderstanding moral bioenhancement. Cambridge Quarterly of Healthcare Ethics 2015;24(1):48–57; Hauskeller M. Better Humans? Understanding the Enhancement Project. Durham, NC: Acumen; 2013; Sparrow R. Better living through chemistry? A reply to Savulescu and Persson on ‘moral enhancement.’ Journal of Applied Philosophy 2014;31(1):23–32.

25. Mills, C. The child’s right to an open future? Journal of Social Philosophy 2003;34(4):499.

26. Feinberg J. The child’s right to an open future. In: Hirst PH, White P, eds. Philosophy of Education: Society and education. London and New York: Taylor & Francis; 1998:251.

27. Feinberg, Lotz M., Mills, and the child’s right to an open future. Journal of Social Philosophy 2006;37(4):537.

28. Millum, J. The foundation of the child’s right to an open future. Journal of Social Philosophy 2014;45(4):522.

29. See note 27, Lotz 2006.

30. Christen M, Narvaez D. Moral development in early childhood is key for moral enhancement. AJOB Neuroscience 2012;3(4):26.

31. Singh I, Rose N. Biomarkers in psychiatry. Nature 2009;460(7252):202–7; van Goozen SHM, Fairchild G. How can the study of biological processes help design new interventions for children with severe antisocial behavior? Development and Psychopathology 2008;20(3):941–73; Ferguson CJ. Genetic contributions to antisocial personality and behavior: A meta-analytic review from an evolutionary perspective. The Journal of Social Psychology 2010;150(2):160–80; Liu J. Early health risk factors for violence: Conceptualization, evidence, and implications. Aggression and Violent Behavior 2011;16(1):63–73.

32. Glenn AL, Focquaert F, Raine A. Prediction of antisocial behavior. In: Clausen J, Levy N, eds. Handbook of Neuroethics. New York: Springer; 2014:1689–701; Glenn AL, Raine A. Neurocriminology: Implications for the punishment, prediction and prevention of criminal behaviour. Nature Reviews Neuroscience 2014;15(1):54–63; Rocque M, Welsh BC, Raine A. Biosocial criminology and modern crime prevention. Journal of Criminal Justice 2012;40(4):306–12; Cornet LJM, de Kogel CH, Nijman HLI, Raine A, van der Laan PH. Neurobiological factors as predictors of cognitive–behavioral therapy outcome in individuals with antisocial behavior: A review of the literature. International Journal of Offender Therapy and Comparative Criminology 2013;58(11):1279–96.

33. See note 32, Glenn et al. 2014, at 1690.

34. See: Rose N. ‘Screen and intervene’: Governing risky brains. History of the Human Sciences 2010;23(1):79–105. As Rose rightly observes about the aims of such programs: “The first, is the desire to identify risky individuals—that is to say, those who will present a future risk to others—before the actual harm is committed. The second is the hope that one might be able to identify individuals at risk—those whose particular combination of biology and life history makes them themselves susceptible to some future condition” (Rose 2010, at 80). Hence two notions of risk—risk to self and risk to others—tend to become conflated.

35. Raus K, Focquaert F, Schermer MHN, Specker J, Sterckx S. On defining moral enhancement: A clarificatory taxonomy. Neuroethics 2014;7(3):263–73.

36. See note 32, Glenn et al. 2014. Horstkötter D, Berghmans R, de Wert G. Early prevention of antisocial behavior (ASB): A comparative ethical analysis of psychosocial and biomedical approaches. BioSocieties 2014;9(1):60–83; Munthe C, Radovic S. The return of Lombroso? Ethical aspects of (visions of) preventive forensic screening. Public Health Ethics 2015;8(3):270–83; Schermer M. [Predictive and preventive criminology. Parallels with medicine]. Justitiële Verkenningen 2006;32(8):103–16. Dutch; Pieri E, Levitt M. Risky individuals and the politics of genetic research into aggressiveness and violence. Bioethics 2008;22(9):509–18; Horstkötter D, de Wert G. The prevention of psychopathy: What we owe to young people. AJOB Neuroscience 2013;4(2):19–20.

37. Wikström P-OH. Explaining crime as moral actions. In: Hitlin S, Vaisey S, eds. Handbook of the Sociology of Morality. New York: Springer; 2010:211–39.

38. See note 36, Horstkötter, de Wert 2013.

39. See note 36, Munthe, Radovic 2015.

40. Giordano J, Kulkarni A, Farwell J. Deliver us from evil? The temptation, realities, and neuroethico-legal issues of employing assessment neurotechnologies in public safety initiatives. Theoretical Medicine and Bioethics 2014;35(1):81–2.

41. See note 5, Persson, Savulescu 2014. Persson I, Savulescu J. The perils of cognitive enhancement and the urgent imperative to enhance the moral character of humanity. Journal of Applied Philosophy 2008;25(3):174.

42. See note 5, Carter 2015. See note 5, Rakić 2014. Rakić V. Voluntary moral bioenhancement is a solution to Sparrow’s concerns. American Journal of Bioethics 2014;14(4):37–8; Rakić V, Hughes J. Reflections on moral enhancement: Can we? Should we? Cambridge Quarterly of Healthcare Ethics 2015;24(01):3–6; Curtis BL. Moral enhancement as rehabilitation? AJOB Neuroscience 2012;3(4):23–4.

43. Ward, T. Addressing the dual relationship problem in forensic and correctional practice. Aggression and Violent Behavior 2013;18(1):95.

44. Robertson MD, Walter G. Many faces of the dual-role dilemma in psychiatric ethics. Australian and New Zealand Journal of Psychiatry 2008;42(3):233.

45. Contexts that involve court-mandated forensic psychiatric evaluation and assessment, risk management, and forensic treatment. There is great variation in what the profession of forensic psychiatrist entails. There are large differences in the range of forensic psychiatric services available, there are no unified standards, and forensic psychiatry is not recognized as distinct subspecialty everywhere. See: Velinov VT, Marinov PM. Forensic psychiatric practice: Worldwide similarities and differences. World Psychiatry 2006;5(2):98–9.

46. Sharma S, Sharma G. Exploring evolving concepts and challenges in forensic psychiatry. World Psychiatry 2006;5(2):98.

47. See note 43, Ward 2013, at 95.

48. See note 44, Robertson, Walter 2008.

49. Ward T, Gannon TA, Fortune C-A. Restorative justice–Informed moral acquaintance: resolving the dual role problem in correctional and forensic practice. Criminal Justice and Behavior 2015;42(1):45–57.

50. See note 43, Ward 2013, at 92.

51. Stone AA. The ethical boundaries of forensic psychiatry: A view from the ivory tower. Journal of the American Academy of Psychiatry and the Law 1984;12(3):209–19.

52. See note 51, Stone 1984, at 171.

53. Appelbaum PS. The parable of the forensic psychiatrist: Ethics and the problem of doing harm. International Journal of Law and Psychiatry 1990;13(4):249–59; Appelbaum PS. A theory of ethics for forensic psychiatry. Journal of the American Academy of Psychiatry and the Law 1997;25(3):233–47.

54. Roychowdhury A, Adshead G. Violence risk assessment as a medical intervention: Ethical tensions. The Psychiatrist 2014;38(2):75–82.

55. See note 43, Ward 2013, at 97.

56. van Marle HJ. The Dutch Entrustment Act (TBS): Its principles and innovations. International Journal of Forensic Mental Health 2002;1(1):83–92.

57. Petrila J, de Ruiter C. The competing faces of mental health law: Recovery and access versus the expanding use of preventive confinement. Amsterdam Law Forum 2011;3(1):59–67.

58. See note 43, Ward 2013, at 98.

59. See note 43, Ward 2013, at 98.

60. Shaw E. The use of brain interventions in offender rehabilitation programs: Should it be mandatory, voluntary, or prohibited? In: Clausen J, Levy N, eds. Handbook of Neuroethics. Dordrecht: Springer Netherlands; 2014:1381–98.

61. Parens E, ed. Enhancing Human Traits: Ethical And Social Implications. Washington, DC: Georgetown University Press; 1998, at 11.

An earlier version of this article was presented at the conference “Enhancing Understanding of Enhancement” in Belgrade, Serbia, on October 27–28, 2015. We thank audience members for their feedback. The research for this article was funded by the Netherlands Organization for Scientific Research (NWO) as part of the project Our Brain as Capital.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed