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DBS and Autonomy: Clarifying the Role of Theoretical Neuroethics

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Abstract

In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS (personality, identity, agency, authenticity, autonomy, and self) and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

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Notes

  1. In Agid et al. [8], however, the quote is apparently mistranslated as “I am an electric doll” ([1], 4).

  2. On Korsgaard’s view, autonomy is one of two “essential characteristics of an agent,” with the other being efficacy (the degree to which one is successful in realizing the effects one intended to cause in action) ([24], 82). We thank an anonymous reviewer for raising this issue.

  3. de Haan et al.’s emphasis on the significance affordances in this context is in line with recent experimental work in other neuropsychiatric contexts. See, for example, Thill et al. [29] and McBride et al. [30].

  4. They cite Goering [32], Gilbert and Cook [33], and Glannon and Ineichen [34] as supportive of this rationale.

  5. Of particular significance is the distinction between substantive and procedural relational views of autonomy ([39], §3). Substantive views place normative constraints on an agent’s point of view, requiring that she have (or not have) certain attitudes in order to count as autonomous. Procedural views, by contrast, require only that an agent’s attitudes were (or could have been) arrived at through an adequate process of reflection. We do not attempt to decided between these types of views, as our aim is not to adjudicate between different specifications of the conceptions that we have identified. We thank an anonymous reviewer for raising this point.

  6. …Or at least, of her exercising it beyond the confines of her own mind. Some views of the mind conceptualize states of consciousness as mental acts ([45]).

  7. Self-determination pertains to “external, structural conditions” involving freedom and opportunity ([50], 17), and so captures important aspects of the relational conception of autonomy. Self-governance pertains to the ability decide and act in accordance with a Korsgaardian practical identity or self-conception (17-18), and so encompasses important aspects of both the traditional and experiential conceptions of autonomy. Self-authorization pertains to taking oneself to possess the “normative authority to be self-determining and self-governing” (18) in a way related to, among other things, practices of accountability and answerability (19), and so also involves aspects of the experiential and relational conceptions of autonomy.

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Acknowledgements

Research for this article was funded by a BRAIN Initiative grant from the U.S. National Institute of Mental Health of the National Institutes of Health, Award Number R01MH114854 (to G.L.M.). The views expressed are those of the authors alone and do not necessarily reflect views of the NIH, Baylor College of Medicine, or Rice University.

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  1. Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Peter Zuk & Gabriel Lázaro-Muñoz

  2. Department of Philosophy, Rice University, 6100 Main St, Houston, TX, 77005, USA

    Peter Zuk

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Zuk, P., Lázaro-Muñoz, G. DBS and Autonomy: Clarifying the Role of Theoretical Neuroethics. Neuroethics 14 (Suppl 1), 83–93 (2021). https://doi.org/10.1007/s12152-019-09417-4

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