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Neuroethics
Neuroethics
Agency in the Age of Brain Science
J O SH UA M AY
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2023
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
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by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: May, Joshua, author.
Title: Neuroethics : agency in the age of brain science / Joshua May.
Description: New York, NY : Oxford University Press, [2023] |
Includes bibliographical references and index.
Identifiers: LCCN 2023006178 (print) | LCCN 2023006179 (ebook) |
ISBN 9780197648094 (paperback) | ISBN 9780197648087 (hardback) |
ISBN 9780197648124 (ebook) | ISBN 9780197648117 (epub)
Subjects: LCSH: Neurosciences—Moral and ethical aspects. |
Agent (Philosophy)
Classification: LCC RC343 .M395 2023 (print) | LCC RC343 (ebook) |
DDC 612.8—dc23/eng/20230315
LC record available at https://lccn.loc.gov/2023006178
LC ebook record available at https://lccn.loc.gov/2023006179
DOI: 10.1093/oso/9780197648087.001.0001
Paperback printed by Marquis Book Printing, Canada
Hardback printed by Bridgeport National Bindery, Inc., United States of America
To my parents and my students,
who have shaped my brain for the better.
I note the obvious differences
between each sort and type,
but we are more alike, my friends,
than we are unalike.
–Maya Angelou
from the poem “The Human Family”
Contents
List of Figures xi
List of Tables xiii
Preface xv
Acknowledgments xix
PA RT I . I N T R O D U C T IO N
PA RT I I . AU T O N OM Y
2. Free Will 35
2.1 Weinstein’s Window 35
2.2 What in the World Is Free Will? 38
2.3 Determinism: No Choice? 40
2.4 Physicalism: No Control? 43
2.5 Epiphenomenalism: No Coherence? 46
2.6 Conclusion 61
3. Manipulating Brains 63
3.1 A Parkinson’s Patient 64
3.2 What’s the Problem? 65
3.3 Patient Autonomy 68
3.4 Personal Identity 70
3.5 Unreliable Risk-Benefit Ratios 80
3.6 Conclusion 88
viii Contents
PA RT I I I . C A R E
4. Mental Disorder 93
4.1 Two Homicides in Texas 93
4.2 Two Theories 95
4.3 The Need for Nuance 99
4.4 Ethical Implications 109
4.5 Conclusion 116
5. Addiction 119
5.1 Reprimand for Relapse 119
5.2 What Is Addiction? 120
5.3 Loss of Control in Addiction? 128
5.4 Is Addiction a Brain Disease? 132
5.5 Addiction as a Disorder 138
5.6 Conclusion 144
PA RT I V. C HA R AC T E R
PA RT V. J U S T IC E
PA RT V I . C O N C LU SIO N
Bibliography 275
Index 307
Figures
Immanuel Kant famously proclaimed: “Two things fill the mind with
ever-increasing wonder and awe . . . the starry heavens above me and
the moral law within me.” I would add the three-pound organ be-
tween my ears. It’s no understatement to say we’re in the age of brain
science. We’ve come so far since the days of lobotomies and phre-
nology, and yet we remain largely ignorant of how these billions of
neurons generate the mind. Since the brain is the seat of the self, this
new frontier brings forth new ethical conundrums and forces us to
reconsider the conception of ourselves as rational, virtuous creatures
with free will.
As with all frontiers, there is the risk of excessive zeal and over-
reach. Unlocking the mysteries of the brain and deploying novel
neurotechnologies is both alluring and scary. Many scientists and
ethicists are led to speculate about and oversell the prospects or
perils of the science. We’re sometimes told that advances in neurobi-
ology reveal that free will is a farce but that these same advances also
have the power to make us superhuman. Ethical alarm bells ring with
urgency.
My aim in this book is to take the brain science seriously
while carefully and soberly scrutinizing its ethical concerns and
implications. The “nuanced neuroethics” that emerges is modest, not
alarmist, yet we’ll see that our present understanding of the human
brain does force us to see our minds as less conscious and reliable—
though more diverse and flexible—than we might otherwise think.
This balanced conception of human agency has direct implications
for how we address the ethical concerns raised by this new frontier.
Ultimately, I hope a more nuanced approach to the entire field helps
us appreciate the abundant forms of agency made possible by the
human brain.
xvi Preface
Ambitions
occasional sip of word play as a digestif). The book also employs some
handy expository tactics from the sciences, such as figures and tables.
I hope readers will see the value in clearly representing, breaking
down, and analyzing both scientific evidence and arguments with
premises.
The style of the book assumes readers are comfortable with philo-
sophical writing and argumentation. Moreover, since I aim to point
readers to the relevant literatures, and situate my own views well within
them, citations are not kept to a minimum. I’ve tried to write the book
so that it’s suitable for adoption in classes that, like my own neuroethics
course, are comprised of students who already have some philosophy
under their belts. Nevertheless, the topics may be enticing and palat-
able enough for a wide range of students and scholars to digest.
Readers should take home the message that philosophy and neu-
roscience help one another. I hope neuroscientists will see that phil-
osophical analysis helps us to clarify murky debates, draw important
distinctions, and clearly construct and evaluate arguments. However,
as the neuroscientists might be quick to point out, philosophical anal-
ysis must be properly informed by the science.
Philosophers are often dubious of the relevance of neuroscience to
philosophical questions. Sure, philosophers from antiquity have cared
about how the human mind works, but shouldn’t we just look directly
to the brain’s software (the field of psychology) rather than its hard-
ware (neuroscience)? Throughout this book we’ll see that neurobi-
ology reveals psychological functions and limits, especially in cases of
brain damage. Direct interventions on the brain’s hardware also yield
novel treatments that raise important ethical questions. And studying
the brain directly can sometimes provide a more direct line to the mind
that bypasses the mouth, which is prone to rationalizations or outright
lies. Another balm to the philosopher’s skepticism about brain science
is the recognition that it’s not all about brain imaging. Neuroscience
includes psychopathology, brain damage, neurochemistry, and brain
stimulation technologies. When the evidence about the brain’s hard-
ware converges with psychological science, philosophical analysis, and
other fields of inquiry, we start to gain a handle on the mysteries of the
mind and the ethical issues they raise.
xviii Preface
Format
The main chapters share some recurring features. Each kicks off with
a case study to help ground abstract issues in the lives of real people.
Neuroethics often inspires speculations about moral problems of a
distant future when humans can skillfully manipulate their brains
with great precision, like cyborgs in a sci-fi thriller. Against this trend,
I stick to case studies from the present or recent past in order to avoid
alarmism and undue attention to problems the human species may
never live to face.
I have also compiled a companion website (visit joshdmay.com).
There readers will find discussion questions for each chapter, which
can help spark dialogue in a class or reading group.
The grouping of chapters is a bit unorthodox. Discussions of
neuroethics often divide its topics into the more theoretical and the
more practical issues (the “neuroscience of ethics” and the “ethics
of neuroscience”). I have opted instead to switch back and forth be-
tween the two sorts of questions in neuroethics, for several reasons.
First, the divide between the theoretical and practical is often blurry
and boundaries are arbitrary. Second, the answers to some questions
in one domain rely on answers from another. The practical question
of whether it’s ethical to alter our brains to become better people, for
instance, depends on a more theoretical understanding of how moral
cognition works in the brain. Finally, interweaving the topics helps
shake things up and minimize the fatigue that comes from repetition.
Throughout the book, I discuss other theorists’ answers to these
questions, but I also develop my own take. I will serve as both a tour
guide and interlocutor, for this is no ordinary trip through the an-
nals of history but an active debate rife with arguments and eth-
ical implications. If you’re more of a student than a scholar and find
yourself adamantly disagreeing with my view, congratulate yourself
on having a philosophically active mind! Indeed, if you find yourself
readily agreeing with me on the controversial issues of neuroethics,
perhaps you should take pause and reevaluate your tendencies toward
credulity. (For those active in these scholarly debates, on the other
hand, capitulations are most welcome.)
Acknowledgments
Hankalaa oli taasen taipaleen alku. Siellä näet aina väliin tuli eteen
kummallisia lampia, niin monimutkaisia ja pitkäperukkaisia, ettei
niistä joen suuta tahtonut mitenkään löytää; kartalle ei niitä
ensinkään oltu merkitty. Monesti siellä saatiin käydä umpiperässä,
soudella kahden puolen niemiä, ennenkuin lopussakin oikeaan
osauttiin. Pitkälti ei tuota kuitenkaan piisannut ennenkuin jo
saavuimme koskille. Ja sitten niitä riittikin: kokonaista kuusi kovaa
koskea, — Pikkukäylä, Vääräkoski, Peurakoski, Saarikoski,
Harjakoski ja Kelhänkoski — kaikki penikulman taipaleella.