An integrated and principled neuroethics offers ethical guidelines able to transcend conventional and medical reliance on normality standards. Elsewhere we have proposed four principles for wise guidance on human transformations. Principles like these are already urgently needed, as bio- and cyberenhancements are rapidly emerging. Context matters. Neither “treatments” nor “enhancements” are objectively identifiable apart from performance expectations, social contexts, and civic orders. Lessons learned from disability studies about enablement and inclusion suggest a fresh way to categorize modifications to the body and its performance. The term “enhancement” should be broken apart to permit recognition of enablements and augmentations, and kinds of radical augmentation for specialized performance. Augmentations affecting the self, self-worth, and self-identity of persons require heightened ethical scrutiny. Reversibility becomes the core problem, not the easy answer, as augmented persons may not cooperate with either decommissioning or displacement into unaccommodating societies. We conclude by indicating how our four principles of self-creativity, nonobsolescence, empowerment, and citizenship establish a neuroethics beyond normal that is better prepared for a future in which humans and their societies are going so far beyond normal.
1. Levy, N. Neuroethics: A new way of doing ethics. AJOB Neuroscience 2012;2(2):3–9.
2. Farah, M. Neuroethics: The ethical, legal, and societal impact of neuroscience. Annual Review of Psychology 2012;63:571–91.
3. Giordano, J, Benedikter, R. An early—and necessary—flight of the Owl of Minerva: Neuroscience, neurotechnology, human socio-cultural boundaries, and the importance of neuroethics. Journal of Evolution and Technology 2012;22(1):14–25.
4. Shook, JR, Giordano, J. A principled and cosmopolitan neuroethics: Considerations for international relevance. Philosophy, Ethics, and Humanities in Medicine 2014;9(1):article 1.
5. Beauchamp, T, Childress, J. Principles of Biomedical Ethics. Oxford: Oxford University Press; 1979.
6. Lanzilao, E, Shook, JR, Benedikter, R, Giordano, J. Advancing neuroscience on the 21st century world stage: The need for—and proposed structure of—an internationally relevant neuroethics. Ethics in Biology, Engineering and Medicine 2013;4(3):211–29.
7. Spranger, T, ed. International Neurolaw: A Comparative Analysis. Berlin: Springer; 2012.
8. Savulescu, J, Bostrom, N. Human enhancement ethics: The state of the debate. In: Savulescu, J, Bostrom, N, eds. Human Enhancement. Oxford: Oxford University Press; 2008:1–22.
9. Lin, P, Allhoff, F. Untangling the debate: The ethics of human enhancement. NanoEthics 2008;2(3):251–64.
10. Chatterjee, A. The ethics of neuroenhancement. Handbook of Clinical Neurology 2013;118:323–34.
11. Gordijn, B, Chadwick, R, eds. Medical Enhancement and Posthumanity. Berlin: Springer; 2008.
12. More, M, Vita-More, N. The Transhumanist Reader. Malden, MA: Wiley-Blackwell; 2013.
13. Benedikter, R, Giordano, J, FitzGerald, K. The future of the self-image of the human being in the age of transhumanism, neurotechnology and global transition. Futures 2010;42(10):1102–9.
14 Giordano, J. A preparatory neuroethical approach to assessing developments in neurotechnology. AMA Journal of Ethics 2015;17(1):56–61.
15. Garrett, J, Jotterand, F, Ralston, DC. The Development of Bioethics in the United States. Dordrecht: Springer; 2013.
16. See note 4, Shook, Giordano 2014.
17. Parens, E. Is better always good? The enhancement project. Hastings Center Report 1998;28(1):S1–S15, at S2.
18. Daniels, N. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly of Healthcare Ethics 2000;9(3):309–22.
19. Resnik, D. The moral significance of the therapy-enhancement distinction in human genetics. Cambridge Quarterly of Healthcare Ethics 2000;9(3):365–77.
20. Kamm, F. Is there a problem with enhancement? American Journal of Bioethics 2005;5(3):5–14.
21. Chadwick, R. Therapy, enhancement and improvement. In: Gordjin, B, Chadwick, R, eds. Medical Enhancement and Posthumanity. Dordrecht: Springer; 2008:25–37.
22. Savulescu, J, Sandberg, A, Kahan, G. Well-being and enhancement. In: Savulescu, J, ter Meulen, R, Kahane, G, eds. Enhancing Human Capacities. Malden, MA: Wiley-Blackwell; 2011:3–18.
23. Shook, JR, Giordano, J, Galvagni, L. Cognitive enhancement kept within contexts: Neuroethics and informed public policy. Frontiers in Systems Neuroscience 2014;8:article 228.
24. Camporesi, S. Oscar Pistorius, enhancement and post-humans. Journal of Medical Ethics 2008;34(9):639.
25. Van Hilvoorde, I, Landeweerd, L. Enhancing disabilities: Transhumanism under the veil of inclusion? Disability and Rehabilitation 2010;32(26):2222–7.
26. Hoberman, J. Sports physicians, human nature, and the limits of medical enhancement. In: Tolleneer, J, Sterckx, S, Bonte, P, eds. Athletic Enhancement, Human Nature and Ethics. Berlin: Springer; 2013:255–70.
27. Ahmad, C, Grantham, W, Greiwe, R. Public perceptions of Tommy John surgery. The Physician and Sportsmedicine 2012;40(2):64–72.
28. Gini, A, Giordano, J. The human condition and strivings to flourish. In: Giordano, J, Gordijn, B, eds. Scientific and Philosophical Perspectives in Neuroethics. Cambridge: Cambridge University Press; 2010:343–54.
29. Branson, J, Miller, D. Damned for Their Difference: The Cultural Construction of Deaf People as “Disabled.” Washington, DC: Gallaudet University; 2002.
30. Wolbring, G. Hearing beyond the normal enabled by therapeutic devices: The role of the recipient and the hearing profession. Neuroethics 2013;6(3):607–16.
31. Shickle, D. Are “genetic enhancements” really enhancements? Cambridge Quarterly of Healthcare Ethics 2000;9:342–52.
32. Jotterand, F. Beyond therapy and enhancement: The alteration of human nature. NanoEthics 2008;2(1):15–23.
33. De Melo-Martín, I. Defending human enhancement technologies: Unveiling normativity. Journal of Medical Ethics 2010;36(8):483–87.
34. Buchanan, A. Beyond Humanity? The Ethics of Biomedical Enhancement. Oxford: Oxford University Press; 2011.
35. Agar, N. Radical human enhancement, and what’s wrong with it. In: Basl, J, Sandler, R, eds. Designer Biology. Lanham, MD: Lexington Books; 2013:87–104.
36. Gordijn, B.Enhancement. In: ten Have, H, Gordijn, B, eds. Handbook of Global Bioethics. Berlin: Springer; 2014:649–70.
37. Hickman, L. Philosophical Tools for Technological Culture: Putting Pragmatism to Work. Bloomington: Indiana University Press; 2001.
38. Racine, E. Pragmatic Neuroethics: Improving Treatment and Understanding of the Mind-Brain. Cambridge, MA: MIT Press; 2010.
39. Solymosi, T, Shook, JR. Neuropragmatism: A neurophilosophical manifesto. European Journal of Pragmatism and American Philosophy 2013;5(1):212–33.
40. Solymosi, T, Shook, JR, eds. Neuroscience, Neurophilosophy and Pragmatism: Brains at Work with the World. Basingstoke, UK: Palgrave Macmillan; 2014.
41. Oishi, M, Mitchell, I, Van der Loos, H, eds. Design and Use of Assistive Technology: Social, Technical, Ethical, and Economic Challenges. Dordrecht: Springer; 2010.
42. Academy of Medical Sciences. Human Enhancement and the Future of Work. London: Academy of Medical Sciences; 2012.
43. Rowland, N, Breshears, J, Chang, E. Neurosurgery and the dawning age of brain-machine interfaces. Surgical Neurology International 2013;4(1 Suppl):S11–14.
44. Vehmas, S, Mäkelä, P. A realist account of the ontology of impairment. Journal of Medical Ethics 2008;34(2):93–5.
45. Bradshow, H, ter Meulen, R. A transhumanist fault line around disability: Morphological freedom and the obligation to enhance. Journal of Medicine and Philosophy 2010;35(6):670–84.
46. Wasserman, D, Asch, A. A duty to discriminate? American Journal of Bioethics 2012;12(4):22–4.
47. Wolbring, G. Ethical theories and discourses through an ability expectations and ableism lens: The case of enhancement and global regulation. Asian Bioethics Review 2012;4(4):293–309.
48. Turnbull, HR Jr, Stowe, MJ. Five models for thinking about disability: Implications for policy responses. Journal of Disability Policy Studies 2001;12(3):198–208.
49. Thomas, C. How is disability understood? An examination of sociological approaches. Disability & Society 2004;19(6):569–83.
50. Mitra, S. The capability approach and disability. Journal of Disability Policy Studies 2006;16(4):236–47.
51. Masala, C, Petretto, D. From disablement to enablement: Conceptual models of disability in the 20th century. Disability & Rehabilitation 2008;30(17):1233–44.
52. Barnes, C. Understanding the social model of disability: Past, present and future. In: Watson, N, Roulstone, A, Thomas, C, eds. Routledge Handbook of Disability Studies. London and New York: Routledge; 2012:12–29.
53. World Health Organization. CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities. Geneva: World Health Organization; 2004.
54. Nussbaum, M. Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: Harvard University Press; 2006.
55. World Health Organization and World Bank. World Report on Disability. Geneva: World Health Organization; 2011.
56. Bickenbach, J, Felder, F, Schmitz, B, eds. Disability and the Good Human Life. Cambridge: Cambridge University Press; 2013.
57. Vehmas, S, Shakespeare, T. Disability, harm, and the origins of limited opportunities. Cambridge Quarterly of Healthcare Ethics 2014;23(1):41–7.
58. Mahoney, J, Palyo, N, Napier, G, Giordano, J. The therapeutic milieu reconceptualized for the 21st century. Archives of Psychiatric Nursing 2009;23(6):423–9.
59. Ip, K-T, ed. The Bioethics of Regenerative Medicine. Dordrecht: Springer; 2009.
60. Whyte, J. A grand unified theory of rehabilitation (we wish!). Archives of Physical Medicine and Rehabilitation 2008;89(2):203–9.
61. Hart, T, Tsaousides, T, Zanca, J, Whyte, J, Packel, A, Ferraro, M, et al. Toward a theory-driven classification of rehabilitation treatments. Archives of Physical and Medical Rehabilitation 2014;95(1 Suppl):33–44.
62. MacLachlan, M, Gallagher, P. Enabling Technologies: Body Image and Body Function. Edinburgh: Churchill Livingstone; 2004.
63. Hansson, S. The ethics of enabling technology. Cambridge Quarterly of Healthcare Ethics 2007;16(3):257–67.
64. VanHiel, L. Treatment and enablement in rehabilitation research. Archives of Physical Medicine and Rehabilitation 2014;95(1 Suppl):88–90.
65. The U.S. Equal Employment Opportunity Commission. EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the Americans with Disabilities Act. Washington, DC: EEOC; 2002; available at http://www.eeoc.gov/policy/docs/accommodation.html (last accessed 4 July 2015).
66. Ikäheimo, H. Personhood and the social inclusion of people with disabilities: A recognition-theoretical approach. In: Kristiansen, K, Vehmas, S, Shakespeare, T, eds. Arguing about Disability: Philosophical Perspectives. London and New York: Routledge; 2008:77–92.
67. Rimmerman, A. Social Inclusion of People with Disabilities: National and International Perspectives. Cambridge: Cambridge University Press; 2013.
68. Chatterjee, A. Cosmetic neurology and cosmetic surgery: Parallels, predictions, and challenges. Cambridge Quarterly of Healthcare Ethics 2007;16(2):129–37.
69. Earp, B, Sandberg, A, Savulescu, J. Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. AJOB Neuroscience 2014;5(1):4–12.
70. See note 28, Gini, Giordano 2010.
71. Williams, S, Higgs, P, Katz, S. Neuroculture, active ageing and the “older brain”: Problems, promises and prospects. Sociology of Health and Illness 2012;34(1):64–78.
72. Erler, A. Does memory modification threaten our authenticity? Neuroethics 2011;4:235–49.
73. Glannon, W. Neuropsychological aspects of enhancing the will. The Monist 2012;95(3):378–98.
74. Kraemer, F. Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 2013;6:483–97.
75. Parvizi, J, Rangarajan, V, Shirer, W, Desai, N, Greicius, M. The will to persevere induced by electrical stimulation of the human cingulate gyrus. Neuron 2013;80(6):1359–67.
76. Mecacci, G, Haselager, W. Stimulating the self: The influence of conceptual frameworks on reactions to deep brain stimulation. AJOB Neuroscience 2014;5(4):30–9.
77. Hamilton, R, Messing, S, Chatterjee, A. Rethinking the thinking cap: Ethics of neural enhancement using noninvasive brain stimulation. Neurology 2011;76(2):187–93.
78. Giordano, J. Neurogenetic and neural tissue implantation technology: Neuroethical, legal and social issues. In: Giordano, J, ed. Neurotechnology: Premises, Potential and Problems. Boca Raton, FL: CRC Press; 2012:59–68.
79. Heinrichs, J-H. The promises and perils of non-invasive brain stimulation. International Journal of Law and Psychiatry 2012;35(2):121–9.
80. Kadosh, RC, Levy, N, O’Shea, J, Shea, N, Savulescu, J. The neuroethics of non-invasive brain stimulation. Current Biology 2012;22(4): R108–11.
81. Jebari, K. Brain machine interface and human enhancement: An ethical review. Neuroethics 2013;6(3):617–25.
82. Cabrera, L, Evans, E, Hamilton, R. Ethics of the electrified mind: Defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care. Brain Topography 2014;27(1):33–45.
83. McCullagh, P, Lightbody, G, Jygierewicz, J, Kernohan, WG. Ethical challenges associated with the development and deployment of brain computer interface technology. Neuroethics 2014;7(2):109–22.
84. DeGrazia, D. Enhancement technologies and human identity. Journal of Medicine and Philosophy 2005;30(3):261–83.
85. Brey, P. Human enhancement and personal identity. In: Olsen, B, ed. New Waves in the Philosophy of Technology. Basingstoke, UK: Palgrave Macmillan; 2009:169–85.
86. Costa, P. Personal identity and the nature of the self. In: Giordano, J, Gordijn, B, eds. Scientific and Philosophical Perspectives in Neuroethics. Cambridge: Cambridge University Press; 2010:117–33.
87. Baylis, F. Neuroethics and identity. In: Clausen, J, Levy, N, eds. Handbook of Neuroethics. Berlin: Springer; 2014:367–72.
88. Elliot, C. Enhancement technologies and the modern self. Journal of Medicine and Philosophy 2011;36(4):364–74.
89. Kraemer, F. Authenticity or autonomy? When deep brain stimulation causes a dilemma. Journal of Medical Ethics 2013;39(2):757–60.
90. Agar, N. The threat to human identities from too much enhancement. In: Agar, N. Truly Human Enhancement: A Philosophical Defense of Limits. Cambridge, MA: MIT Press; 2014:55–79.
91. Glannon, W. Neuromodulation, agency and autonomy. Brain Topography 2014;27(1):46–54.
92. Savulescu, J, Douglas, T, Persson, I. Autonomy and the ethics of biological behaviour modification. In: Akabayashi, A, ed. The Future of Bioethics: International Dialogues. Oxford: Oxford University Press; 2014:91–112.
93. Merkel, R, Boer, G, Fegert, J, Galert, T, Hartmann, D, Nuttin, B, et al. Intervening in the Brain: Changing Psyche and Society. Dordrecht: Springer; 2007.
94. 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 2013;6:527–39.
95. Vincent, N, ed. Neuroscience and Legal Responsibility. Oxford: Oxford University Press; 2013.
96. Wurzman, R, Giordano, J. NEURINT and neuroweapons: Neurotechnologies in national intelligence and defense. In: Giordano, J, ed. Neurotechnology in National Security and Defense: Practical Considerations, Neuroethical Concerns. Boca Raton, FL: CRC Press; 2014:79–114.
97. Savulescu, J, Persson, I. Getting moral enhancement right. Bioethics 2011;27(3):124–31.
98. Tennison, M. Moral transhumanism: The next step. Journal of Medicine and Philosophy 2012;37(4):405–16.
99. Kabasenche, W. Engineering for virtue? Toward holistic moral enhancement. In: Basl, J, Sandler, R, eds. Designer Biology. Lanham, MD: Lexington Books; 2013:69–81.
100. Shook, JR. Neuroethics and the possible types of moral enhancement. AJOB Neuroscience 2012;3(4):3–14.
101. Kamieński, Ł. Helping the postmodern Ajax: Is managing combat trauma through pharmacology a Faustian bargain? Armed Forces and Society 2013;39(3):395–414.
102. Olsthoorn, P.Military Ethics and Virtues: An Interdisciplinary Approach for the 21st Century. London and New York: Routledge; 2011.
103. Mehlman, M, Lin, P, Abney, K. Enhanced warfighters: A policy framework. In: Gross, M, Carrick, D, eds. Military Medical Ethics for the 21st Century. Aldershot, UK: Ashgate; 2013:130–43.
104. Ford, K, Glymour, C. The enhanced warfighter. Bulletin of the Atomic Scientists 2014;70(1):43–53.
105. Bomann-Larsen, L. Voluntary rehabilitation? On neurotechnological behavioural treatment, valid consent and (in)appropriate offers. Neuroethics 2013;6(1):65–77.
106. Chandler, J. Autonomy and the unintended legal consequences of emerging neurotherapies. Neuroethics 2013;6(2):249–63.
107. Robbins, L. Refusing to be all that you can be: Regulating against forced cognitive enhancement in the military. In: Gross, D, Carrick, D, eds. Military Medical Ethics for the 21st Century. Aldershot, UK: Ashgate; 2013:144–55.
108. National Research Council. Opportunities in Neuroscience for Future Army Applications. Washington, DC: National Academies Press; 2009.
109. Moreno, J. Mind Wars: Brain Science and the Military in the 21st Century. New York: Bellevue Literary Press; 2012.
110. Kotchetkov, I, Hwang, B, Appelboom, G, Kellner, C, Connolly, E. Brain-computer interfaces: Military, neurosurgical, and ethical perspective. Neurosurgical Focus 2010;28(5):1–6.
111. Russo, M, Stetz, M, Stetz, T. Ethical considerations: Cogniceuticals in the military. In: Chatterjee, A, Farah, M, eds. Neuroethics in Practice. Oxford: Oxford University Press; 2013:35–45.
112. Parasidis, E. Human enhancement and experimental research in the military. Connecticut Law Review 2012;44(4):1117–32.
113. Sehm, B, Ragert, P. Why non-invasive brain stimulation should not be used in military and security services. Frontiers in Human Neuroscience 2013;7:article 553.
114. LaCroix, A, Burnam-Fink, M, Galliott, J, Vallor, S, French, S, Abney, K, et al. Super soldiers: The ethical, legal and operational implications (part 2). In: Thompson, S, ed. Global Issues and Ethical Considerations in Human Enhancement Technologies. Hershey, PA: IGI Global; 2014:139–60.
115. Mehlman, M.Captain America and Iron Man: Biological, genetic, and psychological enhancement and the warrior ethos. In: Lucas, G, ed. Routledge Handbook of Military Ethics. London and New York: Routledge; 2015:406–20.
116. Bublitz, J, Merkel, R. Crimes against minds: On mental manipulations, harms and a human right to mental self-determination. Criminal Law and Philosophy 2014;8(1):51–77.
117. See note 4, Shook, Giordano 2014.
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