Neuroethics: Agency in the Age of Brain Science

NEUROETHICS: Agency in the Age of Brain Science by Joshua May. New York: Oxford University Press, 2023. 340 pages. Hardcover; 110. 00. ISBN: 9780197648087. Paperback; 29. 95. ISBN: 9780197648094. *Neuroethics, "the study of moral issues that are either raised or answered by neuroscience" (p. 4), is a relatively young field, whose origins are generally traced to the early 2000s. Despite its rapid growth since then, it remains unfamiliar to many, and over the years, numerous introductions and overviews have been written to make it more familiar. Joshua May's new book, the latest in this line, is described as an "opinionated introduction" (p. 9). It has grown out of the author's undergraduate course in neuroethics and is written partly with students in mind. However, he aims to "challenge the distinction between a research monograph and a textbook" (p. xvi), not only introducing a representative range of neuroethical topics, but also contributing to the debates. *May follows Adina Roskies, one of the field's founders, in distinguishing two main branches of neuroethics: the more practically focused "ethics of neuroscience" and the more theoretical "neuroscience of ethics. " He emphasizes, though, how "intertwined" (p. 6) these branches are. The design of the book reflects this: each of the four main parts consists of a pair of chapters on related topics, one more theoretical and one more practical in focus. *Before we reach these, a single introductory chapter is designated as Part I. This does a good job of defining and introducing the field, as well as summarizing the book and announcing May's overall approach and conclusions. In addition, the chapter offers appendices with overviews of philosophy and neuroscience for readers unfamiliar with these disciplines. To put it mildly, this is an ambitious thing to attempt in a few pages of an opening chapter, but May succeeds in offering lucid and accessible accounts. *In the first main part, "Autonomy" (Part II), the more theoretically focused chapter (chap. 2) is on free will, while the more practically focused (chap. 3) is entitled "Manipulating Brains. " The former examines three threats that neuroscience might pose to the idea that humans have free will: determinism, physicalism, and epiphenomenalism (the last implying that our experience of conscious will is illusory). May argues that none of these rules out free will, but they do suggest that we are less free than we often think. Chapter 3 then explores ethical concerns about manipulating brain activity for therapeutic purposes, concluding that such interventions are legitimate, but a cautious approach to balancing risks and benefits is needed. *Part III is entitled "Care" (perhaps an odd title for a pair of chapters largely concerned with agency and responsibility). Chapter 4 focuses on mental disorders, asking "whether having a mental illness. . . categorically exculpates one for inappropriate behavior" (p. 116). May's answer is that a "nuanced" view is required, in which we cannot generalize about the effects of mental disorder on agency and responsibility but must judge on a case-by-case basis. To my mind, while I generally agree with the conclusion, this chapter is less satisfying than much of the book. It is built on a contrast between "naïve" and "nuanced" views of the implications of psychopathology for responsibility, but the former seems something of a straw man, as May himself comes close to acknowledging in the conclusion. One section of the argument, claiming that some psychopathologies enhance agency, I find rather unconvincing. And there are a few instances of careless expression, as when physical injury is categorized as a non-pathological effect on agency (p. 115, table 4. 2). Chapter 5 continues in similar vein with a discussion of addiction, critically examining the "brain disease model" and arguing that conceptualizing addiction as a disorder (as distinct from a disease) does not imply complete loss of agency, responsibility, or accountability. *Part IV turns to the neuroscience of morality, with one chapter examining the neuroscience of moral judgment and another assessing the legitimacy of moral enhancement. The first is focused on the relationship and balance between reason and emotion in the making of moral judgments. It includes a well-judged critical account of Joshua Greene's high-profile but controversial brain-imaging studies of moral cognition. This is followed in chapter 7 by an ethical evaluation of moral bioenhancement: the project to improve ourselves morally by the use of neurotechnologies such as psychoactive drugs or electrical brain stimulation. May develops a "presumptive case" (p. 175) in favor of this project and rejects a series of objections to it. *The final main part is entitled "Justice. " Chapter 8, "Motivated Reasoning, " begins with neuroscientific perspectives on self-deception, cognitive bias, and the like, then moves into a discussion of bias, questionable practice, and misconduct in science. While acknowledging the challenges--including those facing neuroscience, in particular--May takes an optimistic view of the capacity of scientific communities to produce genuine knowledge. This optimism feeds into the next chapter on brain reading, the use of functional neuroimaging to gain information about subjects' mental activity, in which it takes two almost opposite forms. In criminal justice, May concludes that for all its limitations, brain reading can be useful in the courts. By contrast, he believes that it is unlikely to be effective enough in neuromarketing to seriously threaten consumers' privacy or autonomy; other technologies such as big data pose greater threats. While May takes concerns about brain reading seriously, I can't help wondering if his general aversion to alarmism tends in this chapter toward over-optimism. But it would take a longer discussion to settle that question. *May's overall argument, spelled out in the concluding chapter, is for a "nuanced neuroethics" that avoids alarmism, takes evidence and complexity seriously, recognizes the alikeness of neurotypical and neurodiverse people, and engages both neuroscience and philosophy carefully. The book is beautifully written, communicating complex content and ideas with admirable clarity. In general, I find it persuasively argued, with a few caveats of the sort indicated earlier. The structure of the book is effective in integrating the "neuroscience of ethics" with the "ethics of neuroscience. " Another valuable design feature is that each chapter begins and ends with a real-life case study, effectively keeping the book's complex discussions grounded in concrete realities. However, most of the case studies are drawn from the world of criminal justice, which could give a rather skewed impression of the areas of human life on which neuroethics has a bearing. *I would certainly recommend May's book to readers of this journal. While some of the content is complex and challenging, the clarity of presentation should make it accessible to advanced students. It would be a valuable text for an upper-level undergraduate or graduate class in neuroethics, as well as an excellent introduction for anyone prepared to work through some complex ideas and arguments. If I use it for my own classes, though, I shall need to supplement it, because one thing it does not address at all is religious and theological perspectives. This is not to fault May for not having written a different book: as a philosopher also trained in neuroscience, he brings these two disciplines together very adeptly. In this respect, the book also faithfully reflects neuroethics as a field, often a highly secular one in which religious and theological voices are not much in evidence. To my mind, there is work to be done to challenge that secularity and explore what difference a theological engagement with this field might make. But that is my agenda, not May's. *Reviewed by Neil Messer, Professor of Theological Bioethics, Baylor University, Waco, TX 76798.