Glannon has been a central figure in the field of neuroethics from its inception, exemplifying through his ample scholarship its interdisciplinary mission and far-ranging impact. As a practicing neuroethicist before and after its labelling, he examined and supported attributions of responsibility, authenticity, and consent for patients undergoing diagnoses and treatments for neurological disorders, while neurosurgery, neuroimaging, and deep brain stimulation became increasingly reliable. With the advent of neuropharmacological and neuromodulation interventions, his compatibilist compromise between determinism and libertarianism placed debates over free will, responsibility, personal identity, and psychological continuity on firmer grounds both empirical and ethical. Brain-computing interfaces (BCIs) and neural prosthetics then started to arrive, again provoking Glannon's measured estimations of clinical applicability and social acceptability, pleasing neither prohibitionist skeptics nor transhumanist optimists. To characterize his new book as introductory, although academically accurate, would fall short of appreciating its illumination of perplexing issues across bioethics, medicine, psychiatry, philosophy of mind, moral philosophy, and law. His expertise with philosophical, ethical, and clinical dimensions of neuroscience informs an agent-centered locus for assessing bio-psychological knowledge while steering neuroethics away from metaphysical mind-body misadventures. Ethical principles find no validation in brain activity, but that's not because neural correlates for moral sensibility or responsibility appear absent. Brains within the central nervous systems of bodies behaving in social activities utilize adaptive neurons as mediators, not makers, of our mental and moral lives. Glannon would keep neuroethics in multidisciplinary hands coordinated for both the adeptness of clinical practice on treatment subjects and the insightfulness of medical humanities into human subjectivity. The initial chapter sketches the recent origin of neuroethics and then the traditional range of ethical theories, lending the four principles of autonomy, beneficence, nonmaleficence, and justice a presumptive applicability for framing, if not quite settling, ethical issues. Less accommodating is Glannon's stance towards materialism or reductionism, citing considerations familiar from neuropragmatism and embodied cognitive science where mental causes and capacities are not metaphorical or epiphenomenal. Subsequent chapters follow a sequence of topics roughly parallel to the journey since the 1990s taken by neurotechnologies and their impacts on human self-understanding and transformation: neuroimaging, disorders of consciousness, brain damage and death, cognitive and moral enhancement, interventions with moral agency, and neural prosthetics. Each chapter opens with explanations about the pertinent neuroscientific and neurotechnological advances and observes their implications for experimental research and contributions to clinical neuroscience, while drawing attention to inherent risks and limitations. Precautionary counsels in place, each chapter proceeds into discussions of ethical, legal, and social concerns about such matters as the accessibility of neurotechnologies across society, unintended yet tempting implementations beyond original designs, and the availability of brain information outside of medical control. Purely philosophical debates hardly have a place to interrupt amidst these concrete considerations, but Glannon does not hesitate to point out persistent quandaries deserving further investigation. The chapter on brain imaging and mapping illustrates this crafted sequence of topics for discussion. Neuroimaging techniques and typical applications are described concisely. The reader is also informed that no scan depicts a particular brain process or mental event, due to statistical methods of accumulating and interpreting neural data. Structural deviations detected from comparing thousands of subjects can be clinical indications, but functional directions are a different matter. Even readings in real time of neuronal activation are dependent on global cognitive tasking so such data cannot by itself determine the contribution of a neuron or neural cluster to conscious mental states. Advances in machine learning and artificial intelligence (ML/AI) will enable refined diagnostics, prognostics, and drug treatments for brain damage and disease, especially when imaging data is combined with detected biomarkers. Beyond expected clinical outcomes, Glannon explains why better-informed patients are empowered along the way to form decisions about the timing of preventative or interventional options. Philosophical concerns ensue with individual-specific brain information, in both intentional and ethical directions. Where certain brain activities can be strongly correlated with specific behaviors, detecting a particular kind of activity can be indicative of cognitive-motor preparation for that behavior, and hence, an intent or thought seems to appear from the brain data. Glannon hastens to say that nothing so ephemeral substitutes for an actual mental intention much less an actionable deed. However, the reverse process may be practicable, where consciously chosen intentions can be translated through BCI for machine-aided communication or mobility. So much generated and processed brain data raises proportionate concerns for privacy and security, and the chapter endorses neurorights and legislation to prevent harmful and discriminatory consequences. Subsequent chapters similarly cover the history and current state of neuroscience enabling neurotechnologies promising clinical, psychological, and social improvements, with an aim to address ethical, legal, and policy implications. Vital and sometimes surprising questions, with equally thought-provoking answers, enliven the thoroughly reliable discussions. Chapter three, about neuroscientific progress dealing with disorders of consciousness, asks whether a minimally conscious state or a “locked-in” state of awareness would be preferable to the permanent vegetative state. Glannon next questions how to assess a patient's quality of life and best interests in regard to sustaining treatment or pursuing therapies, and ponders communications through BCI with patients to obtain medical decisions. Chapter four treats the long-standing medical and legal debate between whole-brain and higher-brain definitions of death as missing the ethical point: since conscious personal interests are not reducible to any measure of brain functioning, only a biopsychological view of death and the moral and cultural status of personhood should prevail. As persons are not mere human organisms, the person may die with permanent loss of awareness, or die when the entire body dies in accord with cultural or religious convictions. If one standard must legally prevail, what may be a dubious premise in itself, respect for the patient's own perspective should not get overridden. In addition, premature organ procurement must avoid an apparent overlap with involuntary euthanasia. More speculatively, Glannon wonders if the infusion of brain organoid tissue for restoring brain function could regenerate enough conscious awareness, or possibly alter consciousness, to degrees unacceptably harmful for a patient. The fifth chapter on enhancement warns against crude ideas for targeting specific cognitive functions, noting how optimization should improve overall adaptability to challenging environments and not just particular skill performance or pursuing “cosmetic neurology.” Difficult trade-offs confront both cognitive and moral enhancement, in Glannon's view. Those flush with enhancers may find other capacities diminished, fail to gain merited success, worsen social disparities, and get caught up in coerced usage. Moral enhancement through neurology cannot be any more creditable. So-called “moral” capacities are aspects of emotional, psycho-social, and cultural mentality too complex to adjust in one place without cognition going askew elsewhere. Besides, the immoral among respectable society are the least likely to volunteer, and moral bioenhancement could get weaponized by illiberal “guardians” of virtue. This reviewer also hears in such warnings that proponents envisioning posthumanity seem similarly naive about blithely inviting post-morality. Firmer neuroethical ground is found with implementable neuroimaging and neuromodulation for detecting and correcting abnormal and criminal psychological conditions. Neurolaw, as a subfield of forensic psychiatry, takes an interest in revising legal practices, assessing criminal responsibility, and treating criminals therapeutically. Stimulating interrogations of forensic and legal proposals abound. Although mental decisions and (un)civil conduct are not reducible to or predictable from brain data, neurological screenings combined with biomarkers (here, psychopathy in illustration) may identify early treatment candidates. Forced neuro-rehabilitation for criminals must confront rights to bodily integrity and mental integrity. Glannon's expertise in clinical neuropsychiatry also illuminates his final chapter on neuroprosthetics and their promising therapeutic and restorative applications. Serious concerns about identifying intentionality, upholding responsibility, maintaining autonomous control, and preserving authentic agency have to receive experimental as well as ethical scrutiny. Readers familiar with speculations about brain technologies won't be faced with promotional endorsements or stern rejections, but this book's detailed accounts of their neuroscientific and neurocognitive foundations will be more rewarding. Each chapter is replete with citations to neuroscientists, neuroethicists, academics, and clinicians contributing valuable insights every step of the way. Any introductory text would have to choose among numerous medical and consumer drugs, devices, and interventions. Absent are direct-to-consumer devices marketed for meditation, learning, or athletics, the do-it-yourself world of brain hacking and gaming neurofeedback, and neurowearables for mental health monitoring. Also less prominent are some destinations for neurotechnological applications, such as the workplace, the school, and the military. Students and researchers alike are nevertheless going to be well-prepared for lively ethical, legal, and policy debates about emerging neurotechnologies.
John R. Shook (Tue,) studied this question.
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