Anticipation Science 3

D. John Doyle

What Does it Mean

to be Human?
Life, Death,
Personhood and
the Transhumanist
Movement
Anticipation Science

Volume 3

Editor-in-chief
Roberto Poli, University of Trento, Trento, Italy
Anticipation Science encompasses natural, formal, and social systems that
intentionally or unintentionally use ideas of a future to act in the present, with a
broad focus on humans, institutions, and human-designed systems. Our aim is to
enhance the repertoire of resources for developing ideas of the future, and for
expanding and deepening the ability to use the future. Some questions that the
Series intends to address are the following: When does anticipation occur in
behavior and life? Which types of anticipation can be distinguished? Which
properties of our environment change the pertinence of different types of
anticipation? Which structures and processes are necessary for anticipatory action?
Which is the behavioral impact of anticipation? How can anticipation be modeled?

The series is interested in receiving book proposals that:

• are aimed at an academic audience of graduate level and up
• combine applied and/or theoretical and/or philosophical studies with work
especially from disciplines within the human and social sciences broadly
conceived.

More information about this series at http://www.springer.com/series/15713

D. John Doyle

What Does it Mean to be

Human? Life, Death,
Personhood
and the Transhumanist
Movement

123
D. John Doyle
Department of General Anesthesiology
Cleveland Clinic
Cleveland, OH, USA

ISSN 2522-039X ISSN 2522-0403 (electronic)

Anticipation Science
ISBN 978-3-319-94949-9 ISBN 978-3-319-94950-5 (eBook)
https://doi.org/10.1007/978-3-319-94950-5

Library of Congress Control Number: 2018953304

© Springer Nature Switzerland AG 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein or
for any errors or omissions that may have been made. The publisher remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my wife of four decades, Jo-Anne, and our
son, Jonathan.
Foreword

It has been a pleasure and a challenge undertaking the writing of this book. My
hope that the book will provide the reader with valuable new insights into the
ethical debate on transhumanism and human enhancement.
The book is distinctive in that it breaks new ground in a number of domains
pertinent to transhumanism, especially with respect to matters of death and dying
and with respect to cryonic suspension. In addition, since the book is written by a
trained medical scientist (M.D./Ph.D.), the book naturally places a special emphasis
on scientific and clinical rigor, particularly with respect to citing the peer-reviewed
medical literature.
That being said, one special challenge faced in the writing of this book was that
it necessarily addressed two very different audiences: philosopher/ethicists on the
one hand and clinician/scientists on the other.
With respect to the first audience, I have done my best to avoid unnecessary
technical jargon, although I readily admit that this is at times simply unavoidable.
With the second audience in mind, I have included an unusually comprehensive
review of bioethics in Chap. 2.
Finally, here is my advice to those who are fascinated by the ideas presented and
wish to learn more: start by consulting some of the recent books listed in the
Appendix as well as some of the review articles listed in the references provided at
the end of each chapter. In addition, the transhumanist website humanityplus.org is
filled with wonderful resources such as their h+ magazine that will undoubtedly
interest many readers.

D. John Doyle
Department of General
Anesthesiology
Cleveland Clinic
Cleveland, OH, USA

vii
Acknowledgements

I owe a sincere debt of gratitude to a great many individuals who have helped shape
my thinking in what has been a lengthy philosophical journey that began when I
took my first philosophy course at St. Francis Xavier University (Canada) at the
tender age of 16. Fifty years have passed from that time, but my interest in phi-
losophy has only grown, thanks to the various mentors who have helped me along
the way.
I am particularly grateful for helpful discussions and advice from Prof. Benda
Hofmeyr and Prof. Alex Antonites, my doctoral dissertation advisors at the
University of Pretoria.
I am also indebted for helpful insights from Dr. Martin Harvey and Dr.
Allyson L. Robichaud of the Department of Philosophy, Cleveland State
University, Cleveland, Ohio, USA, as well as from Dr. James Hughes of Trinity
College, Hartford, Connecticut, USA.
I am especially grateful to my wife Jo-Anne and my son Jonathan, to whom this
book is dedicated, for being supportive of my life-long academic interests.
Finally, I am indebted to the numerous individuals who advised me as the book
evolved over the last decade, and particularly those who identified misstatements,
errors, and omissions. Naturally, I am responsible for any remaining errors.
There are instances where we have been unable to trace or contact the copyright
holders. If notified the publisher will be pleased to rectify any errors or omissions at
the earliest opportunity.
Some of the material in this book is drawn from a series of journal articles I
previously published in Ethics in Biology, Engineering and Medicine:
• Doyle DJ. An Introduction to Bioethics and Ethical Theory. Ethics in Biology,
Engineering and Medicine. 2010; 1:19–41.
• Doyle DJ. What Does It Mean to Be Human? Humanness, Personhood and the
Transhumanist Movement. Ethics in Biology, Engineering and Medicine. 2010;
1:107–131.

ix
x Acknowledgements

• Doyle DJ. Pharmacologic Emancipation from the Human Condition: Laudable

Goal or Dangerous Pipe Dream? Ethics in Biology, Engineering and Medicine.
2010; 1:199–214.
• Doyle DJ. The Thorny but Pervasive Problem of Permissible Deaths. Ethics in
Biology, Engineering and Medicine. 2010; 1:259–265.
• Doyle DJ. Should Logic Trump Intuition in Bioethical Discourse? Contrasting
Peter Singer and Leon Kass. Ethics in Biology, Engineering and Medicine.
2011; 2:1–9.
• Doyle DJ. Life, Death and Brain Death: A Critical Examination. Ethics in
Biology, Engineering and Medicine. 2011; 2:11–31.
• Doyle DJ. Cryonic Life Extension: Scientific Possibility or Stupid Pipe Dream.
Ethics in Biology, Engineering and Medicine. 2012; 3:9–28.
• Doyle DJ. Robots, Androids, and Cyborgs in Warfare: Ethical and Philosophical
Issues. Ethics in Biology, Engineering and Medicine. 2014; 4:13–23.
• Doyle DJ. Exploring the Intersection of Religion, Psychology, and Ethics.
Ethics in Biology, Engineering and Medicine. 2016; 6:91–107.
Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 What Does It Mean to Be Human? . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Insights from Science Fiction . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Transhumanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Artificial Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5 Cosmetic Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.6 Personhood Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.7 Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.8 Cryonics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.9 Critique of Transhumanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.10 Transhumanism and Religion . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2 Biomedical Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.2 Overview of Ethics and Bioethics . . . . . . . . . . . . . . . . . . . . . . . 12
2.3 Hippocratic Origins of Bioethics . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4 Lapses in Medical Ethics I: The Origins of Formal
Bioethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 16
2.5 Lapses in Medical Ethics II: The Tuskegee Syphilis Study ..... 19
2.6 Lapses in Medical Ethics III: Japanese Wartime Medical
Atrocities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.7 Ethical Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.8 Kantian Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.9 Principlism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.10 Ethical Conflicts in Principlism: Autonomy as “First
Principle Among Equals” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.11 Peter Singer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.12 A Transplantation Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.13 Critique of Utilitarianism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.14 John Rawls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

xi
xii Contents

2.15 Virtue Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

2.16 Characteristics of a Good Moral Theory . . . . . . . . . . . . . . . . . . . 31
2.17 Bernard Williams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.18 Reason Vs. Moral Intuition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.19 Sanctity of Human Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.20 Further Concerns About Singer . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.21 Logic in Philosophical Discourse . . . . . . . . . . . . . . . . . . . . . . . . 35
2.22 An Axiomatic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.23 Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
2.24 Medical Futility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.25 Doctrine of Double Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
2.26 Therapeutic Privilege . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
2.27 The Permissible Death Problem . . . . . . . . . . . . . . . . . . . . . . . . . 41
2.28 Legal Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.29 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3 Humans, Transhumans and Humanoids . . . . . . . . . . . . . . . . . . . . . . 47
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.2 Moral Standing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.3 Personhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
3.4 Nonhuman Personhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.5 Classical Eugenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.6 Liberal Eugenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.7 Introducing Transhumanism . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
3.8 Nick Bostrom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
3.9 Julian Savulescu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
3.10 John Harris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
3.11 Charles Tandy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.12 Enhancing Human Performance for Spaceflight . . . . . . . . . . . . . 61
3.13 Animal/Human Hybrids and Other Strange Creatures . . . . . . . . . 62
3.14 Putting Human Genes into Animals . . . . . . . . . . . . . . . . . . . . . . 62
3.15 Language Genes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.16 Human/Animal Chimeras . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.17 Inserting New Genes in Existing Humans . . . . . . . . . . . . . . . . . 65
3.18 Human/Computer Hybrids and Neuroprostheses . . . . . . . . . . . . . 65
3.19 Robots, Androids and Artificial Persons . . . . . . . . . . . . . . . . . . . 67
3.20 Consciousness, Artificial Beings and the Turing Test . . . . . . . . . 69
3.21 Artificial Beings and Moral Standing . . . . . . . . . . . . . . . . . . . . . 71
3.22 Moral Robots and Robot Ethics . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.23 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Contents xiii

4 Pharmacologic Enhancement of the Human Condition:

Possibilities and Perils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
4.2 Might Pharmacological Interventions Help Humanity? . . . . . . . . 76
4.3 Some Pharmacophilosophical Questions . . . . . . . . . . . . . . . . . . . 80
4.4 Imagining a World Without Negative Emotions . . . . . . . . . . . . . 82
4.5 Brain Enhancement Via Electrical Brain Stimulation . . . . . . . . . . 84
4.6 But Should We Partake? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.7 What Does It Mean to Be an “Authentic” Human Being? . . . . . . 87
4.8 Back to Religion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
5 Life, Death, and Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
5.2 What Is Life? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
5.3 The Traditional Concept of Death . . . . . . . . . . . . . . . . . . . . . . . 95
5.4 Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
5.5 Early Brain Death Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
5.6 Ancillary Tests for Confirming Brain Death . . . . . . . . . . . . . . . . 98
5.7 Death of the Entire Brain as a Requirement for Brain Death . . . . 98
5.8 Ignoring the “Death of the Entire Brain” Rule in Declaring
Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 99
5.9 Some Brain Stem Nuclei Are not Tested When Testing
for Brain Stem Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 99
5.10 The Problem of Spontaneous Movements Despite
Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5.11 The Problem of Waxing and Waning of Neuronal Function . . . . 101
5.12 Limitations Inherent in All Medical Testing . . . . . . . . . . . . . . . . 102
5.13 Ambiguity in the Definition of Brain Death . . . . . . . . . . . . . . . . 102
5.14 Further Difficulties in the Declaration of Brain Death . . . . . . . . . 104
5.15 The Problem of Indistinct Boundaries: Death as a Process . . . . . 105
5.16 Peter Singer and Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . 106
5.17 The Diagnosis of Brain Death Compared to a Murder Trial . . . . 107
5.18 Neomorts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
5.19 Non-heart-Beating Organ Donors . . . . . . . . . . . . . . . . . . . . . . . . 109
5.20 Nanotechnology and the Death of Death . . . . . . . . . . . . . . . . . . 110
6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe
Dream? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
6.2 What Is Cryonics? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
6.3 Is Cryonics Possible in Principle? . . . . . . . . . . . . . . . . . . . . . . . 115
6.4 Vitrification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
6.5 Substrate Preservation Versus Information Preservation . . . . . . . . 117
6.6 The Two Usual Cryonics Scenarios . . . . . . . . . . . . . . . . . . . . . . 118
xiv Contents

6.7 Living as an Isolated Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

6.8 Head Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
6.9 An Interesting Hypothetical Scenario . . . . . . . . . . . . . . . . . . . . . 122
6.10 A Second Hypothetical Scenario . . . . . . . . . . . . . . . . . . . . . . . . 122
6.11 Cryonics as “Borderlands Science” . . . . . . . . . . . . . . . . . . . . . . 123
6.12 Cryonic Reincarnation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
6.13 Some Philosophical Considerations . . . . . . . . . . . . . . . . . . . . . . 124
6.14 Some Bioethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . 125
6.15 Some Negative Bioethical Considerations . . . . . . . . . . . . . . . . . . 126
6.16 Burden on Society? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
6.17 A Waste of Money? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
6.18 Some Legal Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
6.19 Religious Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
6.20 Whole Brain Emulation and Mind Uploading . . . . . . . . . . . . . . . 130
6.21 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
7 Defending Attacks Against Transhumanism . . . . . . . . . . . . . . . . . . . 133
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.2 Transhumanism as Fringe Science . . . . . . . . . . . . . . . . . . . . . . . 134
7.3 Ethical Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
7.4 Leon Kass and the Wisdom of Repugnance . . . . . . . . . . . . . . . . 135
7.5 Francis Fukuyama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
7.6 The President’s Council on Bioethics . . . . . . . . . . . . . . . . . . . . . 136
7.7 Exploring Bioconservative Arguments . . . . . . . . . . . . . . . . . . . . 137
7.8 The Fairness Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.9 The Dignity Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7.10 The “Slippery Slope” Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
7.11 The “Repugnance” Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
7.12 Playing God . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
7.13 The Safety Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
7.14 Existential Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
7.15 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
8 Transhumanism and Religion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
8.1 Introduction and Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
8.2 Religion and Modernity: Views from Marx, Freud, Weber,
Einstein, Harris and Dawkins . . . . . . . . . . . . . . . . . . . . . . . . . . 151
8.3 The Evolutionary Origins of Religious Belief . . . . . . . . . . . . . . . 154
8.4 What Is a Religious Experience? . . . . . . . . . . . . . . . . . . . . . . . . 155
8.5 William James’ the Varieties of Religious Experience . . . . . . . . . 157
8.6 What Can We Learn from the Experiences of Epileptics? . . . . . . 158
8.7 What Pharmacologic Interventions Tell Us . . . . . . . . . . . . . . . . . 160
8.8 Insights from Functional Neuroimaging Experiments . . . . . . . . . 162
8.9 Religion and Psychopathology. Hyper-religiosity
Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Contents xv

8.10 The Central Role of the Frontal Lobes in Religiosity . . . . . . . . . 164

8.11 The Muramoto Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
8.12 The Problem of “Pathological” Beliefs . . . . . . . . . . . . . . . . . . . . 166
8.13 What Would an Atheist Say? What Would a Believer Say? . . . . 166
8.14 Ethical Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
8.15 Dreams and Religion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8.16 Genospiritual Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
8.17 Transhumanism and Chritianity . . . . . . . . . . . . . . . . . . . . . . . . . 174
8.18 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
9 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
9.1 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
About the Author

D. John Doyle is an Anesthesiologist at Cleveland Clinic, in Cleveland, Ohio,

where he holds the rank of Professor. He is currently seconded to Cleveland Clinic
Abu Dhabi, where he is a Consultant in the Department of General Anesthesia.
He received the M.D., Ph.D., and FRCPC qualifications at the University of
Toronto in Toronto, Canada in 1982, 1986, and 1986, respectively. Although he has
numerous scholarly publications in the fields of medicine and anesthesiology, in
recent years he has developed his long-standing interest in philosophy by branching
into research and academic writing in the fields of ethics and bioethics, culminating
in being awarded the D.Phil. degree in Moral Philosophy from the University of
Pretoria in September 2017.

xvii
List of Figures

Fig. 2.1 The Original Hippocratic Oath, translated from ancient Greek.
Source MIT tech classics collection at http://classics.mit.
edu/Hippocrates/hippooath.html . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Fig. 2.2 The Nuremberg Code. Reprinted from Trials of War Criminals
before the Nuremberg Military Tribunals 208 under Control
Council Law No. 10, Vol. 2, pp. 181–182. Washington, D.C.:
U.S. 209 Government Printing Office, 1949. See also
http://ohsr.od.nih.gov/guidelines/nurem210berg.html . . . . . . . . . . 18
Fig. 9.1 A sampling of historical quotations that suggest that famous
inventors, scientists and engineers are sometimes poor
at predicting the future of technology . . . . . . . . . . . . . . . . . . . . . . 182

xix
List of Tables

Table 1.1 Some philosophical questions related to humanness and

personhood, some of which are addressed in this book . . . . . .. 6
Table 3.1 Modification (elaboration) of Hughes’s classification
of the future continuum of consciousness and rights
in organisms (Hughes 2004) . . . . . . . . . . . . . . . . . . . . . . . . . .. 53
Table 3.2 The Transhumanist Declaration, 2009 revision. World
Transhumanist Association . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58
Table 5.1 Some potential research areas involving neomorts . . . . . . . . . . . 109
Table 5.2 Some potential concerns with neomort research protocols . . . . . 109

xxi
Abstract

This book addresses various aspects of the question “What does it mean to be
human?”, approaching the issue from biological, philosophical, and ethical per-
spectives. The discussion focuses primarily on the philosophical and ethical
implications of the transhumanist movement, an intellectual community seeking to
favorably transform the human organism via the safe deployment of interventions
such as genetic engineering and pharmacologic enhancement.
Following a review of bioethical principles, the book begins by examining the
notion of “personhood” in philosophical, historical, and biological contexts. Next,
the possibility that developments in neuropharmacology might ultimately lead to an
artificial paradise free of the negative aspects of the human condition (but without
the often-destructive effects of today’s mood-altering drugs) is considered.
A philosophical difficulty related to the existentialist notion of “authenticity” in
such a “mood optimized” synthetic existence is identified.
This discussion is followed by a rather technical exposition on the occasional
difficulties of establishing when a person is alive or dead, particularly in the setting
of “brain death.” A number of philosophical flaws with the notion of brain death as
it is used currently are presented.
The discussion then considers some of the philosophical issues raised by the
possibility of human cryonic suspension. A distinction is made between the
information preserved in a person's brain and the substrate used to hold that
information. Implications for personhood are also discussed, as well as a number of
related ethical issues.
Next, objections raised by “bioconservative” critics of transhumanism are crit-
ically examined and found to be for the most part unconvincing, frequently relying
on emotion and intuition rather than on evidence, logic, and reason.
Finally, in the penultimate chapter, the relationship between religion and tran-
shumanism is explored.

xxiii
Chapter 1
Introduction

Homo sapiens, the first truly free species, is about to

decommission natural selection, the force that made us…. Soon
we must look deep within ourselves and decide what we wish to
become.

Edward O. Wilson, Consilience, The Unity of Knowledge.

(http://www.paklinks.com/gs/philosophy-and-spirituality/17972
3-post-brainy-quotes-4.html)

Abstract This chapter introduces the reader to the central themes introduced in
the book, beginning with some historical vignettes and insights from the world of
science fiction. These themes are introduced to help explain why it can at times be
problematic to define what it means to be human or to establish which organisms
merit full human rights or full moral standing. Also introduced are the central themes
of the transhumanist movement, the notion of artificial lifeforms and the implications
for the notion of personhood. Finally, the chapter introduces the concept that some
forms of death are potentially reversible as well as introduces the cryonics movement
that depends on this particular premise.

1.1 What Does It Mean to Be Human?

“What does it mean to be human?” This question has been a matter of consid-
erable philosophical debate for centuries. The answer will depend in part on the
“lens” through which the question is examined. For instance, a geneticist might
define humanness in terms of an organism’s genetic composition, looking for DNA
sequences unique to humans, while a zoologist might use an organism’s behavior
(such as looking at the use of language or tools) as a guide to humanness. Yet another
scientist (a physical anthropologist, say) might focus on bone structure. Other peo-
ple, including many scientists and philosophers, might argue that, in real life, formal
definitions may be less useful than the “I know it when I see it” approach common
to everyday life.
© Springer Nature Switzerland AG 2018 1
D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_1
2 1 Introduction

After the “discovery” of America in 1492, considerable speculation arose as to

whether the natives of these lands were indeed human, and many Conquistadors and
colonists justified the cruel mistreatment of American natives on the basis of the
argument that they were subhuman (de las Casas 1992). To set the issue straight
from a theological point of view, in 1537 Pope Paul III issued a Papal bull entitled
Sublimis Deus which declared American Indians to be rational human beings with a
soul, and thus being appropriate for conversion to the Christian faith. Thus perhaps
began the debate within the intelligentsia as to when a particular living creature is
entitled to be considered to be human.
Many years later a similar issue arose in the US Supreme Court in the context
of the “Dred Scott Case” (Fehrenbacher 1981; Graber 2006; Maltz 2007). At issue
was whether Dred Scott, a slave who had lived in states and territories where slavery
was illegal, should be considered to be a free man or should instead be forcefully
returned to his owner. In 1857 the Supreme Court ruled 7 to 2 against Scott. Chief
Justice Roger B. Taney delivered the majority opinion, arguing that that any person
descended from black Africans, whether slave or free, could not be a US citizen and
was thus not entitled to the human rights ordinarily assigned to American citizens,
stating that blacks were: “beings of an inferior order, and altogether unfit to associate
with the white race, either in social or political relations, and so far inferior that they
had no rights which the white man was bound to respect”.1
This gravely flawed legal decision took over a century to be fully remedied, and
will always exist as a regrettable stain in American legal history. In its day this case
also served to stir the debate as to when a particular human individual is entitled to
be considered to merit “personhood” in the eyes of the law.
In more recent decades, the treatment of the Jews in Germany and elsewhere
during World War II serves to remind us that despite the enlightenment that was
hoped to come with the 20th century, moral corruption and intellectual laziness can
lead entire nations to hold a particular ethnic group to be subhuman and unworthy of
life, even though these individuals were not always easily distinguished from the rest
of the population. Consider, for instance, the following provocative and inflammatory
quotations from Hitler’s Mein Kampf 2 :
• “The personification of the devil as the symbol of all evil assumes the living shape
of the Jew.”
• “Was there any form of filth or profligacy, particularly in cultural life, without at
least one Jew involved in it? If you cut even cautiously into such an abscess, you
found, like a maggot in a rotting body, often dazzled by the sudden light—a kike!”
• “The great masses of the people will more easily fall victim to a big lie than to a
small one.”
Issues such as the Dred Scott case, the Papal bull Sublimis Deus and the treatment
of German Jews in World War II raise ethical and philosophical issues about person-
hood and moral status that are introduced in Chap. 2 and are discussed throughout
this work.

1 http://www.digitalhistory.uh.edu/documents/documents_p2.cfm?doc=23.
2 http://www.allgreatquotes.com/mein_kampf_quotes.shtml.
1.2 Insights from Science Fiction 3

1.2 Insights from Science Fiction

For many decades, science fiction writers have written stories about sentient com-
puters, about intelligent robots serving humans as companions, about cyborgs made
from a blend of human and machine parts, and about fully organic humanoids who
were not at all human in any traditional sense. For instance, Isaac Asimov’s famous
book of essays I Robot (Asimov 1991) (and many of his other writings as well)
dealt with stories of “positronic” robotic brains and artificial intelligence, usually in
a setting of space exploration. Asimov even proposed an interesting form of robot
ethics (Sawyer 2007):
1. A robot may not injure a human being or, through
inaction, allow a human being to come to harm.
2. A robot must obey orders given to it by human beings,
except where such orders would conflict with the
First Law.
3. A robot must protect its own existence as long as
such protection does not conflict with the First or
Second Law.
A more recent cultural reference might include the fictional android character
Lieutenant Commander Data, of Star Trek: The Next Generation fame. In this
movie series, Data is a sentient artificial life form with extraordinary cognitive abili-
ties, although he is still unable to feel emotions or understand many human idiosyn-
crasies. (This was, apparently, a direct consequence of his specialized programming).
Under what circumstances would entities such as Lieutenant Commander Data merit
the rights and protections of ordinary human beings? Who would be offered citizen-
ship?

1.3 Transhumanism

Transhumanism is a relatively recent intellectual and cultural movement that pro-

motes an interdisciplinary approach to understanding and evaluating potential means
for enhancing the human organism, the human race and the human condition
(Bostrom 2003; Fukuyama 2002; Zehr 2015). Expressed in broad strokes, transhu-
manism seeks to produce “posthumans” who will variously live longer, be smarter, be
stronger, be more peace-loving, or otherwise constitute an improvement over regular
humanity in some nontrivial manner. It aims to achieve its goals primarily through
technological innovation in fields such as genetic engineering, neuropharmacology,
computer technology, artificial intelligence, and molecular nanotechnology. Some
of the less mainstream transhumanist themes include efforts to develop conscious,
self-aware computers, efforts to reanimate individuals deemed to be dead by ordi-
nary clinical criteria, and even altering humans with a view to facilitating space
colonization. Transhumanism is the subject of Chap. 3 in this book.
4 1 Introduction

1.4 Artificial Life

Another issue discussed in this book is the quest for “artificial life”. In May 2010
scientists at the J. Craig Venter Institute announced that they successfully produced
a synthetic cell controlled by human-made DNA (Gibson et al. 2010; Wu and Tan
2014). Although the practical aims of this work are ostensibly to develop better ways
to clean polluted water, speed up vaccine production and so on, one can imagine how
the techniques involved, might, in principle, eventually allow scientists to produce
humans free of undesirable genes, produce humans with multiple copies of certain
desirable genes, or even produce humans with entirely new genes aimed at extending
the natural life span of humankind. Conceivably, it could even lead to the development
of new animal/human hybrid life-forms.
While unquestionably an important scientific breakthrough, this development
raises a rich variety of bioethical issues. While this breakthrough technology might
soon yield bacteria capable of cleaning toxic waste dumps, and numerous other
things beneficial to humankind, the dangers should also be appreciated. No doubt, it
could also be used in the future to help make the most powerful bioweapons imagin-
able, even (plausibly) weapons targeted at specific ethnic groups carrying ethnically
unique genes.
Another feared scenario is the possibility, admittedly remote, that a laboratory
accident at a research facility investigating new life forms might wipeout life on earth
as we know it. This is the theme in the 2007 movie I am Legend where an accidental
plague based on a genetically engineered virus aimed at eliminating cancer kills most
of humanity and transforms the rest into ogres, while the sole survivor (played by
Will Smith) struggles heroically to find a cure. These issues are also discussed in
Chap. 3.

1.5 Cosmetic Neurology

Recent scientific developments in the neurosciences—especially advances in neu-

ropsychology and neuropharmacology—are yielding exciting treatments for often
crippling neurological diseases like narcolepsy, epilepsy, Alzheimer’s disease, Pick’s
disease and Parkinson’s disease. While these treatments are aimed at patients with
neurological disease, it is now apparent that that many of these treatments may also
be applied to “normal” individuals free of disease as a means of achieving “quality
of life” improvements. This enterprise is sometimes called “cosmetic neurology”
(Chatterjee 2004; Cakic 2009; Launis 2010; Frati et al. 2015). Such enhancements
might variously make one more intelligent, more able to memorize large amounts
of information, better at mental arithmetic or at chess, more personable, and so on.
The technical, safety and bioethical issues associated with the possibilities offered
by pharmacologic enhancement is the subject of Chap. 4.
1.6 Personhood Theory 5

1.6 Personhood Theory

In recent decades a field of philosophical study has emerged, referred to as “person-

hood theory” (Jones 1984; Gillon 1996; Takala 2007). Influenced in good measure
by the writings of John Locke, it holds that for an entity to be a person, that entity
must variously be conscious, self-aware, take purposive action, have the ability to
reason, possess the ability to communicate, and/or meet other criteria, such as hav-
ing a “longitudinal identity”. The term “entity” is used here rather than “human”
to deal with the possibility that there may exist nonhuman persons. For instance,
based on the argument that many apes have consciousness, the Great Ape person-
hood movement is an effort to create recognition of chimpanzees, bonobos, gorillas,
and orangutans (the great apes) as bona fide legal persons on the basis that they have
mental abilities similar to humans (Cavalieri and Singer 1994). As an example, the
late chimpanzee Washoe, who lived from 1965 to 2007, was the first non-human to
learn to use American Sign Language for communication. Washoe even passed on
some of her knowledge to her adopted son, Loulis. Similarly, the recently deceased
gorilla Koko had a sign language vocabulary of over 1000 words, which she used
in formulating complex statements and questions. She even has her own legacy
web site: http://www.koko.org.
To many philosophers, drawing on Lockean criteria for personhood, persons may
not necessarily be humans (some animals may merit personhood) while some human
entities such as embryos, fetuses or severely brain damaged adult patients may not
qualify for personhood. Under such a scheme, some of the great apes may qualify
for personhood while some people afflicted with severe dementia from Alzheimer’s
disease or severely impaired cognition as a consequence of traumatic brain injury
may not.
A related question is concerned with when a human embryo becomes a human
being (Suckiel 2008; Chan and Harris 2010). Certainly, in the early stages of preg-
nancy some people might say “this is not yet a human being, only a small mass of
cells”, while others might say “this is a potential human being, but not yet a full
human being.” This question has been the subject of enormous debate (Gilbert 2004;
Kamm 2005; Wood 2005; Evans 2005; Hug 2006; Suckiel 2008; Chan and Harris
2010; Uppal et al. 2012).
Yet another associated issue is “Can there be degrees of humanness?” To reflect
on this question, consider that some “properties of state” are binary in nature while
others permit many conditions. Binary biological properties allow only two states,
such as: alive versus dead, pregnant versus nonpregnant, HIV positive versus HIV
negative. Other properties of a biological system may more allow for many more, or
even an infinite number, of states. Examples here include: height, weight, age, and
so on. But which of these two approaches best applies to the notion of humanness?
These and many other related issues are also the subject of this book.
Table 1.1 later in this chapter provides a list of thought-provoking questions related
to humanness and personhood that has captured the imagination of a great many
philosophers. The list is offered to illustrate the vast number of deep philosophical
6 1 Introduction

Table 1.1 Some philosophical questions related to humanness and personhood, some of which are
addressed in this book
• Does being “human” have the same meaning as being a “person”? Are all persons human? Are
all humans necessarily persons?
• Is a severely degraded human still a person? (For example, patients in a chronic vegetative
state). When does a permanently degraded human lose personhood?
• What are the characteristics of an organism that are necessary or that are sufficient for an
organism to be considered a person? Can animals be persons?
• Can intelligent, sentient machines be persons?

• What determines the “moral standing” of an organism?

• Does the degree of post-conception biological development of a human zygote determine

whether or not that organism is a person?
• Does the genetic makeup of an organism determine whether or not the organism is human?
(What about adding human genes to plants and animals?)
• What are the characteristics of an individual’s genome that are necessary or that are sufficient
for an organism to be considered a human?
• Do human enhancement technologies impact on whether or not an “enhanced” individual is
still a person or a human?

• Is it possible to enhance an animal to the extent that they merit a change in moral standing?

• What of humans who have been “frozen” before death (cryonic suspension)?

issues associated with matters of humanness and personhood. Since each of these
questions could ultimately be expanded into a complete treatise, the present effort
will necessarily be limited. Driven both by personal curiosity as well as by the practi-
cal need for moral clarity as advanced medical technologies see clinical application,
in this book I have chosen to focus on issues of personhood, moral standing, eugenics
and human enhancement. I also consider the moral status of cryonically suspended
individuals (most of which are “living” in the USA). Of these various interrelated
topics, I have put special emphasis on the issues involved in pharmacologic enhance-
ment, reflecting my view (a view based on observing many rapid developments in
contemporary neuropharmacology) that the matter of pharmacologic enhancement
represents one of the more pressing contemporary ethical challenges that awaits us.
Closely related to the discourse on what constitutes humanness or personhood are
issues of moral standing, individual rights and ethical responsibility. For instance,
it is commonly held that all individuals meeting personhood criteria are deserving
of at least some individual rights and that only persons (and not, for instance, lower
animals) are expected to be ethically responsible for their actions. Another ongoing
philosophical debate concerns whether people (who may or may not be persons)
1.6 Personhood Theory 7

deserve greater rights and higher moral standing than non-people; the rights of non-
human animals are an example (Howard 2005; Sagoff 2007; Johnson 2013).
These issues are more than theoretical. For instance, the previously mentioned
Great Ape Project (http://www.greatapeproject.org) is an international organization
of animal advocates who are promoting the position that the United Nations should
pass a “Declaration of the Rights of Great Apes” to confer basic legal rights to chim-
panzees, bonobos, gorillas, and orangutans. These proposed rights would include the
right to life, protection of individual liberty, release from captivity, and protection
from torture.

1.7 Death

The philosophical issues associated with death are the subject of Chap. 5. This
is a particularly important chapter that breaks new philosophical ground since it
contributes substantially to the philosophical debate on where the line between life
and death should be drawn.
Traditionally, death has been defined as the permanent cessation of the heart-
beat and respiration. Modern developments in clinical resuscitation, however, have
forced a reappraisal of this concept (Calixto and Leisman 2009). Today, in hospitals
around the world, ventilators, dialysis equipment and drug infusions that sustain the
circulation often permit the bodies of critically ill patients to be artificially supported
despite severe physiological insults, including death of the brain itself. In addition,
the advent of transplantation surgery has provided a strong clinical motivation to
allow death to be defined in terms of loss of brain function (brain death) or in terms
of a relatively brief period of asystole (cessation of cardiac activity) in some patients
(non-heart-beating donors).
Issues such as these have led to animated discussion in the academic medical
literature as the concept of death and brain death in particular can be said to be
in evolution (Truog and Fackler 1992; Machado 1994; Egonsson 2009; Iltis and
Cherry 2010). Finally, some thinkers argue that ongoing and future developments
in cryonics and nanotechnology may require further reappraisal of when a person
is really dead. Recent studies into the biochemistry of physiological (apoptosis) and
pathological (necrotic) cell death in mammalian organisms have led to new insights
into the concept of death on the micro scale (at the cellular level) as well as at the
macro scale, i.e., the death of the entire biological organism.
As a result of these insights, some individuals have advanced the philosophical
position that organismal death is not an event so much as it is a process, and that life
and death are not distinct binary states, but entities with degrees and gradations. Thus,
while a patient may be legally declared to be dead a few minutes after the continued
cessation of cardiac activity (as is done, for example, with non-heart-beating organ
donation protocols), nevertheless, these individuals argue, the cellular changes which
occur in the period following cardiac arrest may be potentially reversible following
the application of appropriate clinical interventions, especially under hypothermic
8 1 Introduction

conditions. Indeed, if all cells and organs in an organism died fully and completely
immediately following the last heartbeat, any retrieved organs would be completely
unsuitable for transplantation. These thinkers are now speculating that future devel-
opments in nanotechnology may permit repair and rejuvenation of organ tissue that
is either dead or nearly dead by classical criteria (Merkle 1992; Hughes 2004).
With such issues in mind, some scholars have argued that it is helpful to distinguish
between the definition of death based on cessation of the heart beat and a “more
substantial” form of death, such as exists following cremation. In the latter case,
sometimes called “absolutely irreversible death” or “information-theoretic death”
destruction of the brain has occurred to such an extreme that any information it may
have ever held is irrevocably lost for all eternity. This, some people argue, is the only
real (irreversible) form of death.

1.8 Cryonics

Cryonics and suspended animation are the primary concern of Chap. 6. Like
Chap. 5, it contributes substantially to the philosophical debate on where the line
between life and death should be drawn.
The ultimate aim of cryonics is to achieve nondestructive freezing (cryopreser-
vation) of advanced organisms like humans so that they can be safely thawed in the
future, usually with a view to obtaining advanced medical treatment not currently
available (Best 2009; Romain 2010). Although cryonics is usually dismissed by tradi-
tional cryobiologists as pseudoscience (Shermer 2001), citing intracellular ice crystal
formation that permanently damages cellular structures, there is now evidence that
such damage might eventually be mitigated through the use of cryoprotectants such
as glycerol (Pegg 2007). In fact, advocates of cryonics take pains to point out that
they do not actually want to freeze their patients, but rather subject them to “vitrifi-
cation”, a process that produces solidification of cellular materials in an amorphous
glassy state that avoids cell-damaging ice formation (Vajta et al. 2009). While vit-
rification just prior to death from an illness would be expected to offer a far better
chance of successful recovery (“thawing”), the clinically less desirable but legally
more acceptable option of being vitrified a brief period after legal death is the method
used in actual practice. As an example of ongoing advances in this field, in recent
years Gregory M. Fahy has achieved successful vitrification and autotransplantation
of a rabbit kidney through the use of a special vitrification solution (Fahy et al. 2009;
Fahy and Wowk 2015).

1.9 Critique of Transhumanism

Chapter 7 is one that is particularly rich in philosophical arguments. The main focus
is on dissecting the arguments against transhumanism that have been raised by a
1.9 Critique of Transhumanism 9

number of prominent philosophers and other individuals. Based on the critiques of

transhumanism offered by critics such as Leon Kass, Francis Fukuyama, and Michael
Sandel, I critically assess five commonly raised arguments why human enhancement
by artificial means should not be undertaken: fairness, human dignity issues, “slippery
slope” arguments, the “repugnance” argument, and safety issues. The weakness of
“slippery slope” arguments and “repugnance” arguments are given special attention.
In the end I conclude that safety issues are the most realistic concerns that the pursuit
of transhumanism raises.

1.10 Transhumanism and Religion

Finally, Chap. 8 is concerned with the intersection of transhumanism, neurology

and religious belief. The role of various brain structures in religious experiences
(especially the frontal lobes) is discussed, including a discussion of how pathological
brain conditions such as epilepsy can influence religious beliefs.
Chapter 2
Biomedical Ethics

Science cannot stop while ethics catches up—and nobody

should expect scientists to do all the thinking for the country.

(http://thinkexist.com/quotation/science_cannot_stop_while_eth
ics_catches_up-and/160138.html) Elvin Stackman

Abstract This chapter is an outline of the basic issues in biomedical ethics and is
intended to serve as a foundation for later chapters that draw on the concepts dis-
cussed. The chapter begins with an examination of the various categories of bioeth-
ical concerns as well as a look at the Hippocratic origins of medical ethics. Various
instances of historical lapses in bioethics are then presented to the reader to serve
as cautionary examples. The chapter then discusses various ethical theories, includ-
ing Kantian ethics, principlism, virtue ethics and utilitarianism. Additional topics
discussed include consent, medical futility, therapeutic privilege and a sampling of
pertinent legal cases.

2.1 Introduction

Given that this work has as a central theme an exploration of the ethical issues related
to life, death and transhumanism, an appropriate starting point would be to provide
the reader with a brief background concerning bioethical concepts. Consequently,
in this chapter a variety of topics related to the principles of bioethics is presented
with the ultimate aim of establishing a contextual framework for the discussions
presented in subsequent chapters. In particular, any discussion of the ethical propriety
of transhumanist interventions (e.g. neurological enhancement via electronic devices,
life extension via genetic engineering or cryonic preservation) is best preceded by a
background discussing the various bioethical approaches available to systematically
deal with these issues. In addition, a selection of material less directly germane to
the central narrative of the book has been provided because of its central importance

© Springer Nature Switzerland AG 2018 11

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_2
12 2 Biomedical Ethics

to bioethics. With this background the reader will be aided in his or her efforts to
understand how the issues associated with the various debates related to life, death
and transhumanism will necessarily depend on the conceptual “lens” through which
these issues are explored.
Note that the discussion that follows, however, presents only the dominant posi-
tions in current bioethical discourse, and that a number of less well-established
positions (e.g., feminist ethics, Marxist ethics, etc.) are not covered here. For infor-
mation on these lesser known positions the reader is referred to standard sources
(e.g., Singer 1996; Beauchamp and Childress 2013).

2.2 Overview of Ethics and Bioethics

Ethics is that branch of philosophy which seeks to address questions about proper
conduct, rightness and wrongness, goodness and evil, virtue, honor, integrity, jus-
tice and related notions. It is often divided into a number of overlapping branches.
Applied ethics is concerned with the problem of how ethical outcomes might be
achieved in real-world situations. Applied ethics includes subfields such as business
ethics, military ethics, judicial ethics, bioethics, and professional ethics. Descriptive
ethics is concerned with documenting and interpreting what moral principles people
actually abide by. The famous work of Kohlberg (1971) is an example of this field,
although his work also overlaps with the field of moral psychology. Descriptive
ethics stands in contrast with normative ethics, which is concerned with ethical the-
ories that prescribe how people ought to act (as opposed to merely describing how
people actually act.) Normative ethical theories include deontological approaches
(e.g., Kant’s Categorical Imperative), consequentialist approaches, (e.g., utilitarian
ethics), virtue ethics, and other theories. Finally, according to the Stanford Ency-
clopedia of Philosophy, meta-ethics “is the attempt to understand the metaphysical,
epistemological, semantic, and psychological, presuppositions and commitments of
moral thought, talk, and practice” including such questions as “Is morality more a
matter of taste than truth? Are moral standards culturally relative? Are there moral
facts? If there are moral facts, what is their origin?”1
A number of arbitrary overlapping subdivisions of bioethics can be envisioned.2
Clinical bioethics is concerned with the day-to-day ethical decisions clinicians such
as physicians and nurses encounter in caring for patients. Clinical bioethics may
itself be subdivided into several subfields, such as nursing bioethics, pain manage-
ment bioethics, critical care bioethics, surgical bioethics, genetics bioethics, neonatal
bioethics, anesthesiology bioethics, biomedical engineering ethics, etc. Some exam-
ples may be helpful to clarify these subdivisions.

1 http://plato.stanford.edu/entries/metaethics/.
2 Although this particular categorization is my own, it has undoubtedly been influenced by both my

prior classroom exposure to bioethics as well as by my reading of various canonical texts (e.g.,
Beauchamp and Childress 2013).
2.2 Overview of Ethics and Bioethics 13

An example of a nursing bioethical issue concerns the appropriateness of nurses

participating in judicial executions in a technical role such as establishing vascu-
lar access for lethal injection. An example of a pain management bioethical issue
concerns the appropriateness of being “generous” in the administration of poten-
tially addictive opiates such as morphine in patients with severe nonmalignant pain
syndromes. An example of an anesthesiology bioethical issue concerns the appro-
priateness of aggressively resuscitating terminally ill DNR (“Do Not Resuscitate”)
patients who are doing poorly while undergoing palliative care surgery. An example
of a biomedical engineering ethical issue concerns the safety testing requirements
for a new medical product awaiting clinical deployment, for example, a new drug
infusion pump.
A second major division of bioethics, foundational bioethics, is concerned with
the philosophical foundations of bioethics. This field is concerned with issues such as
the merits of the deontological approach versus the utilitarian approach to approach-
ing ethical issues, or the problem of handling an ethical issue when a conflict in ethical
principles arises. Note, however, that not all bioethical approaches are principle-
based; some approaches emphasize the moral context over categorical principles
(e.g., situational ethics, feminist ethics).
A third division of bioethics, cultural bioethics, is concerned with ethical ques-
tions in relation to cultural and social settings. Ideological, religious, and historical
dimensions often influence the discourse here. For instance, some feminists advocate
an approach to bioethics emphasizing an ethic of caring where human relationships,
feelings and emotions are more pertinent to making ethical decisions than traditional
top-down rationalistic approaches based on abstract philosophical principles (most
of which have been developed by male philosophers) (Sherwin 1992).
Some examples of cultural bioethical questions may help here. Is male circumci-
sion a form of genital mutilation? Should patients who are being clinically harmed
by their cultural or religious beliefs be provided with information that is critical of
their beliefs with a view to changing their “toxic” belief system? Should a husband
have any say over the medical care his wife is to receive? What should be the role
of government in the delivery of health care? What philosophical principles might a
Marxist-Leninist physician practicing in North Korea use as the basis for providing
ethical care to her patients?
Finally, regulatory and policy bioethics is concerned with ethical issues such as
clinical trial design, drug approval ethics, use of embryonic tissue in research and
clinical treatment, human cloning, organ procurement for transplantation, xenotrans-
plantation, assisted suicide, euthanasia, formulation of brain death policy, allocation
of scarce health care resources, etc.
14 2 Biomedical Ethics

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and
goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation
- to reckon him who taught me this Art equally dear to me as my parents, to share my
substance with him, and relieve his necessities if required; to look upon his offspring in the
same footing as my own brothers, and to teach them this art, if they shall wish to learn it,
without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I
will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples
bound by a stipulation and oath according to the law of medicine, but to none others. I will
follow that system of regimen which, according to my ability and judgment, I consider for the
benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no
deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not
give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life
and practice my Art. I will not cut persons laboring under the stone, but will leave this to be
done by men who are practitioners of this work. Into whatever houses I enter, I will go into
them for the benefit of the sick, and will abstain from every voluntary act of mischief and
corruption; and, further from the seduction of females or males, of freemen and slaves.
Whatever, in connection with my professional practice or not, in connection with it, I see or
hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning
that all such should be kept secret. While I continue to keep this Oath unviolated, may it be
granted to me to enjoy life and the practice of the art, respected by all men, in all times! But
should I trespass and violate this Oath, may the reverse be my lot!

Fig. 2.1 The Original Hippocratic Oath, translated from ancient Greek. Source MIT tech classics
collection at http://classics.mit.edu/Hippocrates/hippooath.html

2.3 Hippocratic Origins of Bioethics

In antiquity, Hippocrates (c. 460 BCE–c. 370 BCE), a profoundly influential Greek
physician born on the Greek island of Cos, developed a professional oath for his
student physicians (Davey 2001) (Fig. 2.1). This was one of the first professional
codes of ethics, and remains important to this day.
Although not all of Hippocrates’ teachings have stood the test of time (for instance,
he taught that illness resulted from an imbalance of the four humors in the body:
blood, black bile, yellow bile and phlegm), his ethical precepts have left an important
legacy, and a modified version of his oath is often taken by medical students prior to
graduation from medical school.
As is evidenced in Fig. 2.1, the original Hippocratic Oath forbids a number of
activities, such as abortions, bladder stone surgery, euthanasia, disclosure of confi-
2.3 Hippocratic Origins of Bioethics 15

dential information without the patient’s permission, and sex with patients (and their
slaves!). Obviously, some of these rules have changed over time and are no longer
appropriate to contemporary medical practice (for example, the rule against bladder
stone surgery would upset many urologists), which explains why medical students
today usually take a modified Hippocratic Oath (or an entirely different oath) rather
than the original Hippocratic Oath (Friedlander 1982; Kao and Parsi 2004).
Since the time of the Hippocratic Oath, many variations have been promulgated
in an attempt to deal with some of the difficulties identified above, as well as to adapt
to changing medical practices and cultural circumstances. We briefly discuss some
of these variations below both to show how medical ethics thinking has evolved over
time as well as to provide context for discussions to follow.3
The World Medical Association (WMA) has published their version of the Hip-
pocratic Oath in October 1949. Known variously as the Declaration of Geneva or
the WMA International Code of Medical Ethics, the most recent revision, published
in 2006, can be viewed online at http://www.wma.net/en/30publications/10policies/
c8/index.html. It is notably different from the original Hippocratic Oath in that no
mention is made of prohibitions to conducting abortions, bladder stone surgery, or
(surprisingly) euthanasia.4
The World Medical Association has also issued a companion policy document
widely known as the Declaration of Helsinki. (World Medical Association 2002;
Diamant 2002; Puri et al. 2009). It is a set of ethical principles for the medical
community regarding human experimentation and is widely regarded as the ethical
foundation for human research.5
As a consequence of these and other developments, in 1979 the USA has issued its
own policy document on the ethical conduct of research involving human subjects.
Known as the Belmont Report after the conference center where the document was
drafted, it is the basis for the complex regulatory framework that governs human
subject research in the USA (Cassell 2000; Smith 2001; Marshall 1986; Beauchamp
2004).6
Although the Belmont Report is central to American bioethics policy, it has not
escaped criticism. Criticisms include concerns that the approach is “one size fits all”
in nature and that the underlying ethical analysis fails to take into account poten-
tially important factors, such as racial, ethnic, cultural, gender, and geographical
considerations (Miller 2002).

3 The reader may note, for example, a shift from a set of specific governing rules (e.g., from the
Hippocratic oath: “I will not cut persons laboring under the stone”) to a set of broad-based gov-
erning principles (e.g., from the Nuremberg Code: “The voluntary consent of the human subject
is absolutely essential”) as one moves from the original Hippocratic Oath and its variants to more
recent ethical guidelines such as the Nuremberg code, the Declaration of Helsinki, and the Belmont
Report.
4 I use the word “surprisingly” because the prohibition against euthanasia is a long-standing, central

tenet of classical medical ethics.

5 The most recent revision, issued in 2008, may be viewed online at http://www.wma.net/en/30pub

lications/10policies/b3/index.html.
6 The report may be viewed online at http://ohsr.od.nih.gov/guidelines/belmont.html.
16 2 Biomedical Ethics

2.4 Lapses in Medical Ethics I: The Origins of Formal

Bioethics

During World War II a sizable number of Nazi physician-scientists performed med-

ical experiments using concentration camp prisoners at Auschwitz, Buchenwald,
Dachau, and Sachsenhausen (Barondess 1996). While a great many of these exper-
iments were worthless amateur efforts, reflecting a lack of planning and discipline,
some of the experiments were comparatively well-executed (from a strictly amoral
perspective) and resulted in potentially useful scientific information. Regardless, all
these experiments were highly unethical. First, nearly all the experimental subjects
endured tremendous unnecessary suffering and distress. Second, the experimental
protocols were usually designed with a fatal outcome as the end-point (primarily to
allow for post-mortem examination). And third, the participants were all enrolled
against their will (Lifton 1986).
Following the war, twenty Nazi doctors were charged with War Crimes and Crimes
Against Humanity before the International Military Tribunal at Nuremberg, and it
was there that the full horror of their shameful endeavors came to the attention of the
world (Katz 1996). At the tribunal one of the more pragmatic experimental programs
to be identified concerned developing possible means to mitigate the clinical response
to hypothermia, an issue dear to the heart of Luftwaffe pilots, who were known to
occasionally crash land into the cold North Sea following enemy fire. In response
to this need, and with the explicit support of Reichsführer Heinrich Himmler, Dr.
Sigmund Rascher, a physician as well as a Luftwaffe officer, initiated a research
program at Dachau in which prisoners were immersed in ice water baths. While
immersed, rectal temperature, heart rate, the level of consciousness and the degree of
shivering were meticulously recorded. In all, 300 individuals were sacrificed (Berger
1990). Perhaps the most important thing learned was that victims of hypothermia
will usually die (from ventricular fibrillation it turns out) when the rectal temperature
drops below 25 °C (77 °F).
Not all the test subjects died, at least not immediately, since some of the rewarm-
ing methods studied were evidently quite effective. While immersion in warm water
proved to be one highly effective method (and remains in use to this day), the exper-
imenters—allegedly at the suggestion of Himmler himself—even placed some male
test subjects in a warm bed with a naked woman (also a camp prisoner) to explore
the re-warming potential of sexual intercourse.7
One ethical issue that arose decades later with the Nazi hypothermic data con-
cerned the ethics of incorporating this information, previously unpublished, into a
scientific review of the topic. This issue faced the editor of the New England Journal
of Medicine in the late 1980s when then editor Arnold Relman, ultimately refused
permission to publish parts of the Nazi hypothermia data as a component of a poten-
tially life-saving research report from the Hypothermia Laboratory at the University

7 http://www.bordeninstitute.army.mil/published_volumes/ethicsVol2/Ethics-ch-15.pdf.
2.4 Lapses in Medical Ethics I: The Origins of Formal Bioethics 17

of Minnesota (Angell 1990).8 Naturally, such a position has the unfortunate con-
sequence that potentially important information that may help patients may end
up being denied to these individuals and, furthermore, the process of repeating the
experiments so that they are in full compliance with regulations may expose new
experimental subjects to new risks so as to obtain information that was already avail-
able. As a result, some ethicists favor a policy for such cases where the paper in
question is accepted, but is published with an accompanying editorial in which the
ethical aspects of the manuscript are critically discussed.
One very important consequence of the horrible Nazi medical experiments was
the recognition that there existed a pressing need for a formal code of ethics to guide
medical research involving human subjects. In fact, during the Nuremberg trials
some of the accused had argued that there was no law or code that differentiated
between legal/ethical and illegal/unethical medical experiments.9,10 The result was
a ten-point policy statement that constituted the “Nuremberg Code” (Kious 2001;
Temme 2003; Becker 2005; Lemaire 2006; Adam 2007) (Fig. 2.2).
Since the time of its launching, the Nuremberg Code has had a profound influence
on biomedical ethics, establishing such principles as informed consent for experi-
mental procedures (and by extension, for ordinary clinical procedures), the need
to ensure against force and coercion, the need for properly planned and executed
scientific experimentation, and the need to protect the interests of experimental par-
ticipants.
For the most part, the code has stood up under changing times and circumstances
to serve as a timeless guide to biomedical research ethics (Shuster 1997).11

8 Relman was probably less concerned about the quality of the experimental data (although the
project’s chief investigator, Sigmund Rascher, was admittedly a clinician and not a qualified sci-
entist) than about the ethical propriety of publishing experimental data obtained in clear violation
of the Nuremberg Code and the traditions of the journal, which had earlier published a sizeable
number of seminal articles in the field of bioethics. For an interesting discussion on this matter, the
reader is directed to a commentary by Berger (1990).
9 Despite the absence of any code of ethics, the Nazi experiments were considered unethical on the

principal grounds that the experiments were not conducted with the consent of the participants.
Some experiments were judged to be unethical because there was an a priori reason to believe that
either death or a significant injury would occur. Some experiments (such as those conducted by Dr.
Joseph Mengele) were additionally unethical because they stood no chance of providing clinically
useful information despite posing substantial risks and suffering to the experimental subjects.
10 It is interesting to ask whether there would have been a need for a formal code of ethics to guide

medical research if the Holocaust experiments had never taken place. My answer is that ethical codes
such as the Nuremberg Code would still have arisen (albeit perhaps not as historically early) both
because other identified ethical lapses in medical research would have made the need apparent, as
well because of a perceived need by ethically sensitive medical researchers dealing with increasing
complex experimental paradigms.
11 Some authorities argue that the Nuremberg Code’s requirement that animals be used in lieu of

humans in the early phases of research and testing are based on scientifically outdated principles, and
serves no useful function. One basis for this position concerns important genetic differences in how
drugs are handled across various species. A specific example is the drug isoproterenol, once used
to treat asthma, which turned out to be harmful to humans in the amounts originally recommended
based on animal studies. Authors such as Greek et al. (2012) argue that the Nuremberg Code’s
18 2 Biomedical Ethics

NUREMBERG CODE

Fig. 2.2 The Nuremberg Code. Reprinted from Trials of War Criminals before the Nuremberg
Military Tribunals 208 under Control Council Law No. 10, Vol. 2, pp. 181–182. Washington, D.C.:
U.S. 209 Government Printing Office, 1949. See also http://ohsr.od.nih.gov/guidelines/nurem210
berg.html.

requirement for animals testing only serves to “increase the cost of drug development, and prevent
2.5 Lapses in Medical Ethics II: The Tuskegee Syphilis Study 19

Fig. 2.2 (continued)

2.5 Lapses in Medical Ethics II: The Tuskegee Syphilis

Study

Although the Nazi medical experiments are perhaps the best-known collection of
medical ethics violations, it is important to emphasize that there have been a great
many others. For instance, in the USA a serious lapse in medical ethics took place
that had an impact arguably comparable to that of the Nazi medical experiments. This
was a clinical study conducted by the U.S. Public Health Service between 1932 and

otherwise safe and efficacious drugs and therapies from being implemented.” In addition, some
authorities argue that, in this particular respect, the Nuremberg Code fails to consider the moral
rights of animals. For additional insight into this interesting and important problem see Shanks et al.
(2009). For a comprehensive discussion on the moral rights of animals see Singer (1975).
20 2 Biomedical Ethics

1972 in Tuskegee, Alabama. Investigators recruited African-American sharecroppers

to study the natural progression of untreated syphilis. While no effective treatment
was available when the study was launched, a serious ethical lapse took place when
in the late 1940s penicillin become available as an effective treatment for syphilis,
yet the Tuskegee scientists continued the study, withholding penicillin treatment and
information about it from the patients (Katz et al. 2008a, b; White 2006a, b).
Victims of this moral misadventure included study participants who died of
syphilis, sexual contacts who contracted the disease, family members who cared
for the infected individuals, and children born with congenital syphilis.
The study ended suddenly in 1972 when the leaked story was reported in the
Washington Star on July 25, 1972 and became front-page news in the New York
Times the following day. The US Centers for Disease Control, which was responsible
for advocating the continuation of the study in 1969 despite numerous legal and
ethical objections, offers further details online at http://www.cdc.gov/tuskegee/inde
x.html.12

2.6 Lapses in Medical Ethics III: Japanese Wartime

Medical Atrocities

During World War II Japanese physicians and researchers performed barbarous bio-
logical experiments on living humans in programs such as Unit 731 (Harris 1992;
Watts 2002). For instance, some prisoners were injected with pathogens to study
their effects, while others were used to test flame throwers and grenades positioned
at various distances and positions.
In a second breach of ethics, acting in “the national interest”, at the end of the war
the US government secretly granted immunity from war crimes prosecution to the
perpetrators (Dickman 1988; Chen 1997; Nie 2006; Blumenthal and Miller 1999).

2.7 Ethical Theory

One of the first philosophers to systematically explore the philosophical foundations

of ethics was Aristotle (c. 384 BCE–c. 322 BCE), famous for his Nicomachean Ethics
and numerous other works (Allmark 2006). Philosophers who have additionally con-

12 While justification for continuing the study following the availability of effective treatment is

difficult to envision, the arguments offered were that continuing the study would provide information
about the natural history of syphilis not readily available by other means, that the participants were
receiving free medical care that they would likely not otherwise receive, and that the study might
even show the pharmacologic treatment of syphilis to be unnecessary. Some physicians, believing
that only autopsies would provide definitive information about the natural history of syphilis, lacked
an interest in seeing their experimental subjects survive.
2.7 Ethical Theory 21

tributed greatly to ethical theory include Thomas Aquinas, Immanuel Kant, Baruch
Spinoza, Jeremy Bentham, John Stuart Mill and a great many others.
Ethical theories are the foundations upon which ethical analysis is conducted; they
are the viewpoints from which moral guidance can be obtained. Each ethical theory
emphasizes a different aspect of ethical decision making in reaching an ethically
“correct” decision (Beauchamp and Childress 2013; Lawlor 2007).13
One approach to morality is to focus on the consequences of a particular moral
action. The consequentialist approach determines moral responsibility by weighing
the consequences of one’s actions (Beauchamp and Childress 2013). According to the
consequentialist view, correct moral actions are determined by careful deliberation
concerning the anticipated consequences (e.g. costs, benefits, preferences etc.) of an
action for the various stakeholders involved. Several subtypes of consequentialism
have been proposed: (1) the view that an action is morally correct if its consequences
are more positive or favorable than negative to the person performing the action
(ethical egoism); (2) the view that an action is morally correct if the consequences
of that action are more positive than negative to everyone except the person doing
the action (ethical altruism); and (3) the view that an action is morally correct if the
action’s consequences are more positive than negative to everyone (utilitarianism).
Utilitarianism can be further subdivided, as is discussed in the next paragraphs.
Act utilitarianism takes the position that, when facing a moral choice, one must
consider the expected consequences of various potential actions and, based on this
analysis, choose to do what we believe will generate most happiness or pleasure for
the most people. A rule utilitarian, by contrast, analyses a moral dilemma by looking
at potential rules of action that may be applicable, and adheres to the rule that would be
expected to produce the most happiness or pleasure. Negative utilitarianism requires
us to act so as to produce the least amount of evil or harm for the greatest number of
people. In the case of preference utilitarianism, advocated by Professor Peter Singer
(Jamieson 1999), the goal is to meet the preferences of the greatest number of people.
This is discussed in Sect. 2.11.
Another approach to morality is to focus on duties and responsibilities instead of
consequences. The deontological approach to morality (from the Greek word deon,
meaning obligation or duty) is based on specific obligations or duties. These can be
either positive/prescriptive (such as to care for our family) or negative/proscriptive
(such as not to steal). This approach is also sometimes called nonconsequentialist

13 In the present treatment the terms “moral” and “ethical” are used interchangeably, as per the

practice of a number of authors. A number of other authors, however, clearly distinguish between
the two terms, where ethics is taken to be that branch of philosophy which addresses questions about
morality, while morality is taken to signify the moral principles of a particular tradition, group, or
individual (http://plato.stanford.edu/entries/morality-definition/). In addition, some authors would
restrict the use of the term “moral” to philosophical systems such as that developed by Kant, based
on notions such as duty, obligation, and principles of conduct. Other authors state that ethics refer
to the series of rules provided to an individual by an external source, such as their profession, while
morals refer to an individual’s own principles regarding right and wrong. A distinguishing example
sometimes offered is that a lawyer’s personal morals may tell him that murder is reprehensible and
that murderers should be punished, but his professional ethics as a defense attorney may require
that he defend his client with enthusiasm, even if he suspects that the client may actually be guilty.
22 2 Biomedical Ethics

since these principles are held to be obligatory regardless of any good or bad conse-
quences that might result. For example, it is wrong to kill even if it results in great
benefit.
Other deontological approaches to ethics are “duty theory” popularized by Ross
and “rights theory” (concerned with rights that all people have, and which the rest of
us must respect) (Beauchamp and Childress 2013). Ross’s duty theory defines duties
of beneficence, non-malfeasance, justice, self-improvement, reparation, gratitude
and promise-keeping. He calls these prima facie duties. This approach was developed
as an alternative to utilitarianism because of perceived failures of utilitarianism as a
satisfactory moral theory:
[Utilitarianism] seems to simplify unduly our relations to our fellows. It says, in effect, that
the only morally significant relation in which my neighbours stand to me is that of being
possible beneficiaries of my action. They do stand in this relation to me, and this relation is
morally significant. But they may also stand to me in the relation of promisee to promisor,
of creditor to debtor, of wife to husband, of fellow countryman to fellow countryman, and
the like; and each of these relations is the foundation of a… duty. (Ross 1930)
As noted above, rights theory is concerned with rights that all humans have, and
which other humans must respect. A right is a benefit (e.g., a liberty, a power, a
prerogative, an immunity) that someone gains by virtue of his or her particular status
as a citizen, a human being, a woman, a man, a child, a minority, a sentient animal
etc. Rights can be positive, such as rights to food, clothing, and shelter, or negative,
such as the right to be left alone. Rights theory thus offers an approach to moral
action in that actions that violate the rights of others are said to be immoral.
As can be seen from the above discussion, a number of approaches to tackling
ethical issues are available. In the following sections we elaborate on some of the
points made above.

2.8 Kantian Ethics

Immanuel Kant (22 April 1724–12 February 1804) was a profoundly influential Ger-
man philosopher of the Enlightenment. His work The Critique of Pure Reason (1781)
is often cited as one of the most significant works of modern philosophical history
while his Groundwork for the Metaphysics of Morals (1785) explains his views on
ethics and morality. Fundamental to Kantian ethics is the principle (“categorical
imperative”)14 that we must always treat people as ends in themselves, and never
only as a mere means to an end. By this Kant intended that we should always treat

14 A categorical imperative is an absolute, unconditional moral requirement that applies to all

circumstances. It is distinguished from a hypothetical imperative, where certain ends apply (e.g., if
I wish to tame my hunger, I must eat a meal). Note that while it is common to identify the categorical
imperative as a principle, it is easy to get the wrong idea about what Kant takes it to be. Kant’s
categorical imperative is a command, an unconditional command, and as such is neither true nor
false. And although its form can be taken to be a self-generated, self-directed command, it is not an
object of knowledge. It is essentially practical—something we do.
2.8 Kantian Ethics 23

people with humanity and dignity, and never use individuals as “mere instruments”
as a means to further our own happiness (Gensler 1985; Morelli 1999; Gunderson
2004; Bernstein and Brown 2004; Heubel and Biller-Andorno 2005). Another way
of expressing Kant’s Categorical Imperative is: “Always act in such a way that the
maxim of your action can be willed as a universal law.” In other words, one should act
only in such a way that one would want all persons to act, and not treat individuals as
mere “means to an end.” Kant’s moral philosophy is an example of a deontological
approach15 to ethics (vide infra).
Related to Kantian ethics is the concept of a maxim. Simply stated, a maxim is any
simple and memorable rule or guide for living, as with Shakespeare’s maxim from
Hamlet: ‘neither a borrower nor a lender be’.16 Kant saw maxims as a “principle of
action” in the sense that in Kantian ethics, the categorical imperative allows one to
test candidate maxims to determining whether the actions they refer to are morally
permissible.
In his Critique of Practical Reason, Kant provides an example of a maxim and
of how to apply the categorical imperative test: “I have, for example, made it my
maxim to increase my wealth by any safe means. Now I have a deposit in my hands,
the owner of which has died and left no record of it…. I therefore apply the maxim
to the present case and ask whether it could indeed take the form of a law, and
consequently whether I could through my maxim at the same time give such a law
as this: that everyone may deny a deposit which no one can prove has been made. I
at once become aware that such a principle, as a law, would annihilate itself since it
would bring it about that there would be no deposits at all.”17

2.9 Principlism

One commonly used approach to tackling bioethical problems in the Western world
is to invoke the guiding principles of the “Georgetown School” of bioethics, a philo-
sophical system with origins in the University of Georgetown that has become popular
and profoundly influential by virtue of its suitability for addressing many real-world
bioethical problems.
The Georgetown School calls upon four ethical principles (Beauchamp and
Childress 2013). These are [1] respect for autonomy (the right to actively participate
in medical decisions concerning oneself without being dictated to or controlled by
other parties); [2] beneficence (the requirement that caregivers, all else being equal,
should do what they can to improve the patient’s situation); [3] non-malfeasance
(the requirement to avoid bringing harm to the patient); and [4] justice (requiring

15 As discussed herein, deontological approaches to ethics judge the ethical propriety of an action

based on the action’s adherence to one or more rules.

16 Hamlet, Act 1, scene 3, 75–77.
17 Kant, Immanuel; translated by Mary Gregor [1788] (1997). Critique of Practical Reason. Cam-

bridge University Press. pp. 25/5:27. ISBN 0-521-59051-5.

24 2 Biomedical Ethics

the fair and impartial treatment of all persons, especially in the context of resource
allocation).
These principles, as discussed in the Belmont Report on the protection of human
research subjects (discussed above), are also the foundation for U.S. federal regu-
lations that govern clinical research [e.g., Code of Federal Regulations; Protection
of Human Subjects 45 CFR 50 and Code of Federal Regulations; Food and Drugs;
Institutional Review Boards 21 CFR 56.]
Of these four bioethical principles, the principle of autonomy is one that is central
to a good deal of contemporary bioethical discourse and appears as an important
issue in a number of present-day bioethical debates, such as therapeutic abortion,
voluntary euthanasia, medical research on human subjects, and the right of patients
to refuse clinically necessary medical treatments.
It should be emphasized that Principlism has its critics. For example, in a paper
entitled “In praise of unprincipled ethics”, Harris (2003) makes the case against
Principlism as a basis for biomedical ethics, stating that “while the four principles
constitute a useful “checklist” approach to bioethics for those new to the field….it is
an approach which if followed by the bioethics community as a whole would… lead
to sterility and uniformity of approach of a quite mindbogglingly boring kind.”18
He goes on to state that “while in ethics generally and bioethics in particular, doing
good, avoiding harm, protecting justice, and respecting rights and interests are never
likely to be far from our minds, they are neither necessarily the best nor the most
stimulating way of approaching all bioethical dilemmas.”
Other concerns have been raised by Clouser and Gert (1990), where they argue
that the underlying principles in Principlism “lack any systematic relationship to
each other, and they often conflict with each other” and that these conflicts “are
unresolvable, since there is no unified moral theory from which they are all derived.”
They conclude that in using principles to replace both general moral theory and
particular moral rules in handling the moral conundrums that arise in clinical practice,
Principlism fails to provide a useful framework for medical ethics.
In a later work Clouser (1995) elaborates on his concerns with Principlism. Here it
is argued that “unlike the principles of Kant, Mill, and Rawls” the guiding principles
behind Principlism “are not action guides that stem from an underlying, integrated
moral theory” with the result that problems inevitably arise in reconciling the prin-
ciples with each other, such as conflicts that sometimes arise between the principle
of “respect for autonomy” and the beneficence principle. Additionally, Clouser sees

18 It is not clear why uniformity of approach to tackling bioethical problems should be a bad thing. At

a minimum a uniform approach would be expected to produce more consistent outcomes compared
to an approach that draws on different philosophical bases on different days. The criticism that
Principlism is “sterile” is arguably meaningless (at least in the sense used by the logical positivists),
but in any event fails to appreciate the real value that it so often offers in dealing with the complex,
real-world bioethical problems encountered in real life. While it is undoubtedly true that the central
tenants in Principlism sometimes come into conflict (most notably, respect for autonomy versus
beneficence) it is not clear that other approaches to dealing with ethical issues are free of similar
difficulties. For example, both the deontological and consequentialist approaches to ethics have
important limitations that are discussed later in this chapter.
2.9 Principlism 25

difficulty in interpreting the elements of Principlism as guides to moral action “since

they have no content in and of themselves.” He goes on to state that (p. 223):
… each principle [within Principlism] functions mostly as a reminder that there is an ethical
value that the agent ought to take into account—the principle does not tell the agent what
or how to think, or how to deal with the value in a particular instance—but it reminds him
to consider it. So he does. But receiving no guidance, he deals with it in his own way, gives
it his own weight, gives it his own interpretation, and grants his own exceptions—and then,
as validation of his position and conclusion, he cites the relevant principle—which in effect
only says something like “Think about justice” or “Think about helping people.”

Clouser offers us the following additional commentary (p. 224) that reflects some of
the concerns that are discussed later in this chapter (Sect. 2.22):
The use of the principles of principlism seems to accentuate what Gert and I have called the
“anthology syndrome” in bioethics. It is a kind of relativism espoused (perhaps unwittingly)
by many books (usually anthologies) of bioethics. They parade before the reader a variety of
“theories” of ethics—Kantianism, deontology, utilitarianism, other forms of consequential-
ism, and the like—and say, in effect, choose whichever of the competing theories, maxims,
principles, or rules suits you for any particular case. Just take your choice! They each have
flaws—which are always pointed out—but on balance, the authors seem to be saying, they
are probably all equally good!
Similarly the principles of principlism are unconnected with each other, and, although each
embodies the key concern from one or another theory of morality, there is no account of how
they should relate to each other. One just chooses the principle that appears most important
in any particular case. Thus principlism obscures and confuses moral reasoning by its failure
to provide genuine action guides and by its not having an underlying moral theory.

Beauchamp (1995) has offered a rebuttal to those who advocate different

approaches19 to moral problem solving, stating that while “often presented as rival
methods or theories, these approaches are consistent with and should not be consid-
ered adversaries of a principle-based account.”

2.10 Ethical Conflicts in Principlism: Autonomy as “First

Principle Among Equals”

As noted above, it is sometimes possible that some of the principles in a system of

morality come into conflict with each other. For example, in the case of Principlism,
ethical difficulties may arise when a competent adult patient’s desires conflict with a
caregiver’s beneficent duty to work for the best clinical interests of the patient. The
best-known example of this is the Jehovah’s Witness patient who refuses a clinically
necessary blood transfusion or a patient with severe peripheral vascular disease who
refuses to quit smoking. In Western culture, it is held that as long as the patient is a
competent adult and understands the consequences of the decision, then the physician

19 Examplesof different approaches would include, for example, Impartial Rule Theory, Casuistry
(Jonsen 1995), and (3) Virtue Ethics (Pellegrino 1995).
26 2 Biomedical Ethics

should respect the patient’s decision despite the fact that the decision is unwise and
imprudent.
However, not everyone is comfortable with such a position. For example, in coun-
tries like China, where personal autonomy is often taken to be less important than
the needs of the state, one could imagine bioethicists offering a different position.
For anesthesiologists dealing with Jehovah’s Witness patients another dilemma can
sometimes arise: because many Jehovah’s Witness patients are not likely to be fully
informed about possible inconsistencies in church doctrine regarding medical issues,
should anesthesiologists attempt an in-depth discussion to encourage a rational and
truly autonomous decision (for instance, using information provided by the Jeho-
vah’s Witness “reform” movement [www.ajwrb.org]), or should they remain silent
regardless of the degree to which they might find the patients’ views to be misguided,
so as to avoid the perception of “religious interference”?

2.11 Peter Singer

We saw earlier (Sect. 2.7) that classical utilitarianism advocates the principle of
providing “the greatest happiness to the greatest number” as the basis for assess-
ing the morality of various actions. Over the years utilitarianism has undergone a
number of refinements, such as “act utilitarianism,” “rule utilitarianism,” “negative
utilitarianism” and “preference utilitarianism” (Gillon 1985).
Peter Singer, professor of bioethics at Princeton University’s Center for Human
Values, is a profoundly influential contemporary philosopher who espouses rational-
ist, atheist, and utilitarian viewpoints. Within the latter category he is known as an
advocate of “preference utilitarianism.” This form of utilitarianism is rather different
from the classic definition of providing the greatest happiness to the greatest number
of people. Because of the difficulty of measuring happiness, his approach aims at
satisfying the “preference” of those affected. A moral decision thus amounts to deter-
mining the strongest preferences of all those affected by the decision. This approach
has led him to articulately challenge closely held beliefs on infanticide, euthanasia,
and the moral status of animals (Singer 1975, 1996, 2009; Jamieson 1999).
Two fundamental ethical precepts are at the heart of Singer’s philosophy. Firstly,
one should not inflict unnecessary pain on any living thing; and secondly, the defining
characteristic of a “person” is self-awareness. Singer would thus see it as ethically
correct to allow the killing of unwanted neonates born with severe neurological
disabilities. He would argue that they are not self-aware and therefore not persons.
Since neonates can feel pain, Singer’s first ethical precept dictates that this killing be
done as painlessly as possible—for example, by lethal injection. He would see this
as more humane than allowing death through withdrawal of care (Jamieson 1999;
Singer 1996; Howard 2005).
Singer advocates a “quality-of-life” ethic as a replacement for the more traditional
“sanctity-of-life” framework advocated by many established moral philosophers and
religious leaders. In particular, he is a proponent of a “journey model of life”, which
2.11 Peter Singer 27

establishes the wrongness of killing by the degree to which this would frustrate a
person’s (not necessarily a human person’s)20 life goals. He also holds that a person’s
right to life is fundamentally tied to that person’s mental capacity to have preferences,
to feel pain and to experience pleasure.
As a result of this latter position, for example, Singer offers a utilitarian approach
to abortion that weighs the preferences of a mother against the preferences of the
fetus. Since a fetus, at least in the early weeks of pregnancy, has no capacity to
think, to suffer or to hold preferences, there is nothing to weigh against a mother’s
preferences to undergo an abortion.21 This makes Singer see abortion as morally
permissible.
Such examples demonstrate a surprising openness and frankness of thought that
makes Singer’s opinions unusual in their clarity and their transparency—Singer stu-
diously avoids euphemisms that muddy the waters, such as calling a “killing” some-
thing other than what it is. This makes his ethical philosophy clear and direct even
if it is at times counterintuitive.
In the realm of animal rights, Singer argues that human beings do not have primacy
over other species merely because they are human. He regards such notions as the last
bastions of pre-Darwinian (or pre-Copernican) thought that once permitted slavery.
Singer argues that increasing moral awareness and ethical sensitivity mean that future
generations will see our current treatment of animals with the moral outrage we now
reserve for slavery. This has obvious implications for researchers using animal models
(Singer 1975).

2.12 A Transplantation Example

A clinical example adapted from Thomson (1985) may help explain utilitarianism.
Consider a transplantation specialist with four patients. One needs a new liver, one
needs a set of lungs, one needs a heart, and one needs a kidney. An act utilitarian
would theoretically be comfortable with the idea of hunting down and kidnapping
the first healthy person he encounters with a view to using him as an organ source.
While this is obviously in violation of the rights of the kidnapped man, the fact that
four other people and their families are made very happy by the arrangement makes
it morally acceptable from the viewpoint of an act utilitarian.
By contrast, a rule utilitarian would look at the rule, rather than the act, that would
apply to cutting up the kidnapped man for parts. Since the proposed applicable rule
in this case—that one may kill a healthy man for his organs—if instituted widely
would lead to particularly bad social consequences, a rule utilitarian would argue that

20 As discussed in detail in Sect. 3.3, not all persons are human and not all humans are persons.
Personhood requires that one (ordinarily) be in possession of continuous consciousness over time
and that one be capable of mental representations concerning the world, as well as able to consider
options, develop tactics and act on plans.
21 It could be argued, of course, that our humanity is precisely situated in our ability and willingness

to protect those who cannot fend for themselves.

28 2 Biomedical Ethics

we should in fact implement the opposite rule: “don’t kidnap healthy people for their
organs to transplant into sick people.” Since negative utilitarianism requires us to act
so as to produce the least amount of evil or harm for the greatest number of people,
kidnapping a healthy man as a source of organs would obviously be immoral. In the
case of Singer’s preference utilitarianism, at issue is that all parties’ preferences are
met as much as possible. In the macabre example above, it is very likely that none
of the parties involved would prefer to kidnap a healthy man as a source of organs.
It should be noted that, while utilitarianism has had a strong influence on the
intellectual landscape of recent philosophical discourse and, in particular, in ethical
theory, as in the example above, it sometimes falters badly when it is applied to
questions of social or individual justice. Because classical utilitarianism seeks to
maximize the total amount of a particular “utility” (like happiness or preferences)
over an entire society or social group, it seeks whichever arrangement achieves
maximum utility. But, as already emphasized, such an arrangement might be achieved
by distributing benefits and burdens in a way that violates common notions of justice.

2.13 Critique of Utilitarianism

Utilitarianism has been attacked for reasons such as for violating common-sense
notions of justice and fairness. Perhaps the most quoted example of how classical
utilitarianism sometimes violates common-sense is the scenario where killing one
individual would save the lives of many. As already noted, under the act utilitarian
ethical model such action would be appropriate. As another example, such a situation
arose in the 1968 movie “The Magus,” where the mayor of a small Greek village
under WW II German occupation is ordered by the Nazi Commandant to personally
kill three Greek freedom fighters responsible for the death of German soldiers. If
the mayor refused, the Germans would kill both the freedom fighters and all the
villagers.
Another example: The use of slaves might greatly help maximize the net happiness
in a society, but common-sense notions of justice almost always take slavery to be
wrong (with apologies to both Aristotle and Thomas Jefferson, two great intellectuals
who were unapologetic slave owners).22
Another serious criticism of utilitarianism is that under the goal of maximizing
happiness or some other utility, the wishes and desires of sadists and perverts are
lumped in with the wishes and desires of everyone else when an overall determination

22 Thomas Jefferson appears to have felt that slavery was wrong but evidently never spoke against
it publically, perhaps to avoid charges of hypocrisy. The January 1862 issue of The Atlantic makes
passing reference to this issue. It can be read at http://www.theatlantic.com/past/politics/presiden/j
effslave.htm.
2.13 Critique of Utilitarianism 29

of utility is made. By espousing a system in which the satisfaction of all desires is

to be maximized, utilitarianism can end up violating our intuitive precepts of natural
justice.23

2.14 John Rawls

Such paradoxes as those identified above led the philosopher John Rawls and others
to take the position that we must reject most forms of utilitarianism and instead
develop a robust understanding of what is right and wrong as a basis for making
ethical decisions. What is needed, Rawls argues, is a moral-political theory with
justice-as-fairness at its core. Although a detailed explanation of his philosophy as
set forth in his book, A Theory of Justice (Rawls 1971), is well beyond the scope of
this discussion, in essence he argues that a fair and rational person operating behind a
“veil of ignorance” would choose two general principles as the basis for social justice.
The first principle is the Principle of Equal Liberty, where each person in a society
would have an equal right to the most extensive liberties compatible with similar
liberties for all. The second principle has two components. The first of these, called
the Difference Principle, would require that any social and economic inequalities in
a society should be the result of an arrangement that provides the greatest benefit to
the least advantaged persons, while the second component, known as Fair Equality
of Opportunity, holds that offices and positions must be open to everyone.

2.15 Virtue Ethics

Virtue ethics is yet another approach to handling ethical issues (Gardiner 2003;
Begley 2005, 2008; Arries 2005). This third approach focuses on the character of
the person (moral agent) handling the moral issue, not on any specific ethical rules
(as the deontological approach emphasizes) or on the consequences of any ethical
decision (as the utilitarian approach requires).
A virtue (Latin: virtus, Ancient Greek: ¢ρετή “arete”) is a characteristic or qual-
ity deemed to be morally good and thus suitable as a basis for moral excellence.
Frequently identified virtues include courage, dignity, discipline, dutifulness, friend-
liness, industriousness, justice, mercy, modesty, prudence, temperance, tenacity, and
truthfulness. The ancient Greek philosopher Aristotle emphasized the importance of
developing a virtuous character in order for a person to flourish and achieve happi-
ness (eudaimonia). In his Nicomachean Ethics, he provides the reader with a list of

23 Additionally, maximizing the happiness of all is not the same as maximizing ‘the satisfaction of

all desires’, with the result that these two approaches could conceivably contradict each other. Also,
a solution offered by one form of utilitarianism (e.g. one choosing the greatest good as the desired
utility) would be expected to be different from a different approach, such as an approach based on
preferences.
30 2 Biomedical Ethics

virtues similar to that offered above, and states that the individual who possesses a
virtuous character must do the right thing, at the right time, in the right way, and for
the right reason. As such, many philosophers regard Aristotle as the father of virtue
ethics.
What differentiates virtue ethics from approaches such as consequentialism or
deontology is the supremacy of virtue within the theory (Arries 2005; Gardiner
2003). While consequentialist philosophers might see virtues as characteristics that
produce desirable outcomes and deontologists might see virtues as traits possessed
by individuals who reliably complete their duties and responsibilities, virtue ethicists
take a very different tactic. Simply put, virtue ethicists resist attempts to define virtue
in terms of some other notion taken to be more fundamental and place virtue in its
various forms as the fundamental element in virtue ethics.
Virtue ethics is not without its critics. One criticism is that, in principle, virtue
ethics is often unable to provide specific guidance to direct moral action, as it is
“agent-centered” rather than “act-centered” (Arries 2005; Begley 2005). Some virtue
ethicists might respond to this concern by rejecting the assumption that virtue ethics
ought to be in the business of providing an account of right action in the first place,
but if this is the case there still remains a need for providing some sort of account to
handle the practical ethical conundrums encountered in the real world. Proponents
of virtue ethics who choose to retain the concept of right action additionally face the
challenge of occasionally conflicting moral virtues, such as a conflict between justice
and mercy that sometimes arises in situations where castigation and punishment must
be meted out.
A practical clinical example may help differentiate virtue ethics from other ethical
theories. Consider the question as to whether it is ever moral for a physician to lie to
a patient “for their own good.” For instance, an anesthesiologist might be asked by
a patient about to undergo emergency surgery whether the surgeon about to do the
case is highly qualified. Suppose that, in fact, the anesthesiologist does not hold the
surgeon in high regard, since he seems to lose far more blood than other surgeons.
However, he is concerned that the patient might refuse to undergo clinically necessary
surgery should his reply not be favorable. What, then, should his reply be?
In this situation a deontologist would be expected to argue that lying to a patient
is always wrong, regardless of any future “good” that would be expected to result,
that the rightness or wrongness stems from the character of the act itself rather than
the outcome of the act. A consequentialist would argue, however, that the morality
of the act would depend on the expected outcome, and that lying to a patient might
be appropriate if the result is that the patient’s life is saved. Finally, a virtue ethicist
would focus on what a virtuous physician would do in such a setting.
As can be seen from the above discussion, a number of moral theories are available
to consider for adoption. What, then, are the characteristics of a “good” moral theory?
2.16 Characteristics of a Good Moral Theory 31

2.16 Characteristics of a Good Moral Theory

Any good moral theory has a set of traits that characterizes the theory as being philo-
sophically sound. These characteristics are needed to avoid a number of philosophical
flaws that might otherwise occur. These include: bias, cultural imperialism/cultural
ideology, prejudice, racism, sexism and other defects in logic and thinking.
I would also argue that the following traits are valuable (but not necessarily
essential) characteristics of any moral theory. First, a moral theory should be
consistent—i.e., be free of internal contradictions and yielding similar results in
similar settings. Suppose, for example, that a soldier believes that it is wrong to
disobey his commandant (having taken an oath of obedience) and also believes that
it is wrong to disobey the recognized rules of war (having taken a second oath to that
effect). Suppose further that one day the commandant insists that the soldier torture a
prisoner in an attempt to obtain intelligence. The situation leads to an inconsistency
among moral principles: the soldier can either obey his commandant or can obey
the rules of war, but not both.
A second trait is that the theory should be universal—i.e., if the theory applies
to one individual, then it should apply to all individuals. For example, in the case
of the torture example above, the universality of “just war” moral principles held by
combatants holds that American soldiers (as an example) are not exempt from the
rules of war with respect to the torture of prisoners.
Finally, a moral theory should also be intuitive—i.e., the theory should ideally
fit our moral intuition. In the requirements that a moral theory be both consistent
and universal, it will be immediately understood that an inconsistent theory or one
that applied only to some people but not others would be undesirable. However, it is
less obvious that a moral theory should fit our moral intuition, since moral intuition
may have strong cultural influences. On the other hand, a moral theory that fits our
intuition is more likely to be understood and followed.
Additionally, ethical action is often counter-intuitive; some ethical actions might
go against one’s intuition, but makes sense when rationally considered. An example:
my intuition tells me to help beggars by giving them money; however, some beggars
remain beggars because the money received supports an addiction, which keeps
them disempowered. Therefore, rationally speaking, it sometimes makes sense not
to merely give money to beggars, but to seek other ways to help them.
To this list one might add other possible desirable characteristics, such as a need for
the theory to be understandable by non-philosophers (certainly a requirement for any
practical theory), or the need for the theory not to be based on any religious teachings
(although arguably this is already covered by the second requirement above). One
might also add the requirements of any moral theory being time-invariant (that the
principles hold true over time) and trans-cultural (that the principles apply to all
cultures), but these requirements are arguably also covered by the second requirement
above.
One might also axiomatically take the position that any moral theory must respect
all forms of human life, no matter how degraded, while animal rights advocates might
32 2 Biomedical Ethics

similarly emphasize that a moral theory must necessitate respect for all sentient life
forms, not just humans.
Note also that some utilitarian philosophers such as Peter Singer (discussed ear-
lier) would likely take issue with any requirement that a moral theory be intuitive.
Singer’s moral positions are often seen to be counterintuitive and sometimes even
repugnant, especially in the matters of euthanasia and infanticide, although he makes
his case lucidly in his many writings (Jamieson 1999). Singer and others in his camp
argue that reason and logic should trump moral intuition in making moral decisions.
This thought-provoking issue is considered in more detail in some of the following
sections.
Finally, one final qualification should be noted. It has been argued that rigid
ethical theories are not useful because they do not provide guidance in individual or
exceptional instances where the situation demands interpretation of the theory or rule
(Williams 1985). Ethical decision making is, more often than not, not merely a case
of applying a rule. The realm of ethics demands interpretation and judgment on the
part of the involved parties. The challenge is to come up with a rule that is general
enough to offer guidance across the board, while being ‘flexible’ enough to also
allow for application in cases that do not conform to what is generally applicable
to the population. Additionally, as soon as we venture into the field of ethics, we
necessarily move in the world of meaning, where, in general, there are only opinions
and (often conflicting) interpretations of opinions.

2.17 Bernard Williams

In his book, Ethics and the Limits of Philosophy, Williams (1985) argues that while
philosophical discourse on questions of an ethical nature can help us identify a variety
of ways to think about ethical problems, philosophy cannot justify why anyone should
be moral. Williams argues that any justification for morality, for example that moral
rules form the basis for a social contract that all reasonable people should agree to, or
that such rules maximize the overall well-being of society, or that moral rules result
from our natural moral inclinations, will only appeal to people who already want to
be moral.
As an example, Kant famously justifies moral behavior on rational grounds, stating
that categorical imperatives24 are duties that we must carry out to be rational actors.
But, argues Williams, Kant’s line of argument fails in individuals who see no value in
letting reason dictate their moral actions.25 In dealing with utilitarian-based attempts

24 A categorical imperative is an absolute, unconditional moral requirement that applies to all

circumstances. It is distinguished from a hypothetical imperative, where certain ends apply (e.g., if
I wish to tame my hunger, I must eat a meal).
25 For example, many religious traditions have rules of behavior that are revealed via sacred scripture

rather than being the result of rational discourse. Wrote Martin Luther: “Reason is the greatest enemy
that faith has; it never comes to the aid of spiritual things, but more frequently than not struggles
2.17 Bernard Williams 33

to justify morality, Williams doubts whether the analytic impartiality utilitarianism

requires is actually possible, even if agreement might be found concerning the best
variant of utilitarian analysis to invoke. In sum, Williams fears that any attempt to
justify morality in a way that does not presuppose an existing commitment to morality
will fail. Instead of providing a system of moral philosophy, Williams steadfastly
maintained an overarching skepticism about attempts to create a solid foundation for
moral philosophy. Somewhat similar views have been offered in his book Shame and
Necessity (Williams 1993), where he argued that moral theories are insufficient to deal
with real life complexities, particularly given the deep-seated pluralism encountered
in contemporary societies. Our ethical life, Williams contends, is simply too muddled
to be captured by any systematic moral theory.

2.18 Reason Vs. Moral Intuition

Earlier, the characteristics of a “good” moral theory were discussed. Of this list of
characteristics, one characteristic in particular remains the subject of considerable
debate and discussion: whether or not a moral theory should always fit our moral
intuition. It is on this point that an interesting controversy has arisen that has sharply
divided the academic bioethics community. Distilled to its essence, the debate centers
on whether moral intuition should take precedence over reason and logic in making
ethical decisions. This issue is discussed next.
Consider the following example. Should the lives of severely deformed neonates
ever be actively terminated? Some moral philosophers such as Peter Singer regard this
as sometimes acceptable, even desirable, arguing that this follows as a consequence
of utilitarian ethical principles. Others, such as Leon Kass, argue that the natural
repugnance of this act should serve as a clear moral guide against such actions.
Kass, in his famous essay, the “The Wisdom of Repugnance” (Kass 1997) argues
that we should avoid interventions such as genetic human enhancement based on the
simple notion of repugnance. That is, Kass argues that notions that are revolting to
our sensibilities—for instance, the idea of making human-animal hybrids—should
be viewed as being unethical on the basis of the revulsion they generate (rather than,
as Singer has argued and most transhumanists would be expected to argue, on the
basis of the moral consequences they entail.) Kass and his philosophy is discussed
in more detail below and in Sect. 7.4.

against the divine Word, treating with contempt all that emanates from God.” (www.godlessgeeks.
com/LINKS/Quotes.htm).
34 2 Biomedical Ethics

2.19 Sanctity of Human Life

Leon Kass and his bioconservative philosophical schoolmates view Singer’s philo-
sophical positions and many of those of the transhumanist movement as bizarre and
absurd, since they are so profoundly counterintuitive. They argue that the notion of
“sanctity of human life”, even if only a mere intuitive notion, should triumph over all
other philosophical positions in matters regarding human life. Other bioconservatives
in Kass’s fold argue that Singer’s “absurd” conclusions follow necessarily as logical
outcomes of a defective moral theory, preference utilitarianism. They argue that if
there is a problem with Singer’s conclusions, it is entirely because of flaws inherent
in the moral theory of preference utilitarianism, and not from flaws in Singer’s logic.
Deploying a variation of the ancient “reductio ad absurdum” argument (in which a
proposition is disproven by following its implications to a logical but absurd conse-
quence), they argue that since Singer’s impeccable logic yields completely ridiculous
results, the philosophical foundations of preference utilitarianism are thereby proven
to seriously flawed.

2.20 Further Concerns About Singer

Concerns about Singer’s views on utilitarianism and personhood have arisen from a
number of conservative philosophers other than Kass. Charles Weijer, a bioethicist
at Dalhousie University in Halifax, Canada, elaborates on some of Singer’s radical
positions (Weijer 2000): “Singer variously concludes that experimenting on a human
embryo is preferable to doing so on a mouse; that chimpanzees are properly called
“people,” but humans with profound cognitive impairments are not; and the heart
of a handicapped newborn human might be legitimately excised to save a baboon
in need of a new heart.” Philosophers such as Kass and Weijer see Singer as being
irresponsible in letting logic dominate over intuition. For instance, Charles Weijer
later states: “Doing ethics responsibly involves more than logical reasoning alone.
Moral intuition acts as an important check on ethical reasoning, telling us that at
times it is the theory, not our actions, that must be changed.”
Similar concerns have been offered by Donald Demarco in his article, “Peter
Singer: Architect of the Culture of Death” (DeMarco 2003), where he writes:
Professor Singer underscores the importance of reason, broadmindedness, and compassion.
But his emphasis on reason displaces human feelings. His advocacy of broadmindedness
causes him to lose sight of the distinctiveness of the human being (he does not object to
sexual “relationships” between humans and non-human animals). And his sensitivity for
compassion is exercised at the expense of failing to understand how suffering can have
personal meaning. In the end, his philosophy is one-sided and distorted. It plays into the
Culture of Death because it distrusts the province of the heart, fails to discern the true
dignity of the human person, and elevates the killing of innocent human beings — young
and old — to the level of a social therapeutic.
2.21 Logic in Philosophical Discourse 35

2.21 Logic in Philosophical Discourse

As the above discussion makes clear, Kass, Weijer, Demarco and others would have
us place human feelings and moral intuition over logic and rational discourse, at
least in some settings. However, any philosophical position emphasizing the role of
moral intuition over logic and rationality has its own potential flaws. From the time
of the ancient Greeks, philosophers have repeatedly emphasized the importance of
logic in philosophical discourse. Aristotle held that we can use reason to determine
the best way to achieve the highest moral good. More recently, Kurt Baier in his
book, The Moral Point of View (Baier 1958) argued that moral decision making
involves a search for the best reasons for or against a particular course of action.
He notes that moral reasoning parallels legal and scientific reasoning whereby one
collects relevant facts and weighs arguments on all sides of the issue. Only then is a
judgment made. By contrast, appeal to moral intuition bypasses this process. Thus, an
appeal to moral intuition raises a number of rather difficult questions. Why suspend
logic merely because the results of its application are unappealing? And how does
“moral intuition” differ from mere “gut feeling”?
Clearly, the moral intuition approach has potential dangers. Ethical issues become
purely social-cultural considerations rather than based on logic and evidence, with
the consequence that cultural relativity predominates moral thought. (Cultural ethi-
cal relativism teaches that morality is relative to a given culture and that it is wrong
for individuals in one culture to judge the moral practices of another culture.) Fur-
thermore, ethical relativism violates the principle of universality presented earlier.
Finally, as discussed in Chap. 7, the moral intuition approach sometimes suffers
from a fallacious appeal to emotion: “It’s disgusting, so it has to be wrong!” The ulti-
mate underlying premise in the moral intuition position seems to be that emotional
responses should trump the rule of reason.

2.22 An Axiomatic Approach

Which approach, then, is the most philosophically solid? As noted, earlier, Singer’s
camp suffers from a problem common to most forms of utilitarianism—that of pro-
ducing counterintuitive moral proclamations—while followers of Kass, holding that
we should respect moral intuitions about the special value of being human, cannot
identify reasons to support such notions. Since intuition is often subject to serious
cultural and cognitive biases, this approach is problematic as well.
Because the intuition approach to ethical quandaries allows one to bypass formal,
rational philosophical analysis in favor of what ultimately amounts to a “gut feeling”,
one should have serious reservations about this approach. After all, if philosophy is
about anything, it is about the use of logic, analysis and reason. But one should also
be somewhat uncomfortable with Singer’s utilitarianism. For example, how does one
ultimately decide which particular flavor of utilitarianism to choose as a philosophi-
36 2 Biomedical Ethics

cal foundation? Also, why would Singer have us pick preference utilitarianism over
earlier forms, such as act utilitarianism? Since all forms of utilitarianism have philo-
sophical flaws, a sound means of selecting among them is needed. Unfortunately, no
philosopher seems to have successfully tackled this difficult problem.
All mathematicians recognize that all systems of mathematics, such as Euclidean
geometry, start from an initial set of axioms. Axioms are starting principles that
cannot be proven to be true; their truth is so immediately evident that no reasoning
or demonstration can make it plainer. Similar to Euclid’s axioms, in philosophy
there are some principles that one cannot imagine to be otherwise. An example is
Aristotle’s law of contradiction: A cannot be B and not be B at the same time and in
the same manner. An even better-known example is Descarte’s Cogito.26 And just as
in mathematics, philosophical axioms cannot be proven—they are either accepted as
self-evident or rejected.
However, one guiding principle that has not seen universal acceptance concerns
the sanctity of human life. While some moral philosophers argue that the mainte-
nance of human life by ordinary means, even in severely degraded forms, should
be an axiomatic moral imperative, others would allow actions such as suicide and
euthanasia, at least under some circumstances. It is on this principle that a great
divide in moral philosophy can be seen to exist.
As just emphasized, all proposed solutions to bioethical dilemmas are entirely
predicated on which starting philosophical principles or axioms one chooses. Unfor-
tunately, individuals seeking to analyze bioethical dilemmas appear to be left utterly
to their own devices to decide upon a set of starting philosophical principles; they
are expected to draw on their own moral or philosophical instincts as a guide to mak-
ing this choice. Of course, relying on one’s instincts would be expected to produce
a number of incompatible ethical approaches, just as political opinion inevitably
varies among individuals asked to provide a political judgment. I suppose this is why
philosophers so frequently disagree. Kimberly (2002) has summarized the disagree-
ment (in the context of human cloning) as follows:
Kass proposes that society yield to repugnance as an ethically relevant factor, since the
elicitation of such repugnance signifies the defilement of human nature. However, such
an application of repulsion and offense to human nature leads to improbable conclusions
and internal contradictions that soundly repudiate the acceptance of such a principle. Thus,
rather than pre-analytically yielding to visceral emotions and passions, individual rational
agents–and the public generally–ought to thoroughly analyze all of the relevant factors
surrounding cloning before, and perhaps instead of, rejecting the technology simply because
it elicits repugnance.

26 Cogito ergo sum is a Latin proposition offered by René Descartes in his Discourse on Method.

Usually translated into English as “I think, therefore I am” it became a founding pillar of Western
philosophy, purporting to form a secure foundation for knowledge in the face of radical doubt
(wherein one refuses to accept anything as true unless it appears to be “clearly and distinctly”
true). Descartes argued that while other kinds of knowledge could actually be a figment of one’s
imagination, a deception, or a mistake, the very act of questioning one’s own existence necessarily
confirms the reality of one’s own mind.
2.22 An Axiomatic Approach 37

Ultimately, then, it seems how one views Singer and Kass and their respective camps
depends on which philosophical foundations one eventually (but perhaps arbitrarily)
chooses as a starting point for moral philosophy. The moral rationalism approach
is based heavily on reason and logic, following in the philosophical footsteps of
Aristotle. By contrast, the moral intuition approach relies on instinctive notions as to
how things should be, bypassing traditional philosophical methods of analysis for an
approach that relies on gut feeling and emotion. In the end, while both approaches can
be shown to have noteworthy philosophical difficulties, my opinion is that Singer’s
moral rationalist position can be seen to be philosophically more robust in the sense
that it utilizes traditional philosophical methods of analysis rather than relying on
intuition and emotion.

2.23 Consent

Another issue of central importance in bioethics is consent. As noted earlier, the

historical origins of the principle of autonomy stems in part from a need to develop a
philosophical framework for ethically managing randomized controlled trials (where
patients are administered one of a number of forms of medical treatment on the basis
of chance alone). Additionally, it originated as a response to clear ethical abuses that
have occurred in the past. Finally, a number of legal decisions have reinforced the
notion of patient autonomy.27
Informed consent arises in two principal contexts; clinical and experimental,
although overlap between the two does occur. In the clinical context, patients are
provided with information pertaining to the risks, benefits, and the alternatives to
proposed medical interventions such as surgical procedures. Usually, but not always,
the process includes the use of a paper consent form that is signed, dated and wit-
nessed.
In the experimental context, research subjects (who in medical research studies
are often also patients) agree to participate in an approved experimental protocol that
may not have the benefit of the experimental subject as a primary or even as a likely
outcome (e.g., testing the safety of a new drug on healthy human volunteers).
In either case, establishing informed consent from the individual is the central
ethical concern, and both require that the individual is capable of understanding the
issues involved and (in the case of research studies) additionally require that special
safeguards be employed if the individual is a member of a “vulnerable” population,
such as children, prison inmates, or pregnant women.
Consent can be implied or explicit, the latter involving a more or less formal pro-
cess carried out verbally with or without explicit documentation in writing. Implied
consent exists (for instance) when one unhesitatingly rolls up one’s shirt sleeve in

27 Schloendorff vs. Society of New York Hospital and Malette vs. Shulman are two notable examples.

Both these important legal cases are discussed in Sect. 2.29.

38 2 Biomedical Ethics

preparation for a blood test or when an unconscious patient is taken to hospital for
emergency treatment of life-threatening injuries.
Explicit consent is usually sought prior to clinical interventions that entail some
risk of harm or have the potential to cause a substantial degree of pain or discomfort.
Some institutions have a policy that a consent form must be signed by the patient
prior to surgical procedures but may not have a similar requirement for other risky
interventions such as blood transfusion, central line insertion, or lumbar puncture. If
a signed and witnessed consent form is not required, and the intervention involves a
non-trivial risk, clinicians are usually advised to write a detailed note in the patient’s
medical record to establish that the consent process has taken place, with specific
mention of risks, benefits, and alternatives.
As emphasized earlier, central to informed consent is an explanation of the risks,
benefits, and alternatives associated with any proposed clinical or experimental inter-
vention. However, in some cases, such data may not be fully available, while, in some
other cases, the amount of information available may be so large that it has the poten-
tial to overwhelm even well-informed and experienced patients. In addition, special
problems may occur in providing risk information to patients. For instance, the only
risk information available for an intervention may be that for the medical community
at large and may not be specific to a particular institution or a particular clinician.
In some situations, such as complex cancer treatments, the issues involved may
be so multifaceted that, at times, only highly-trained individuals can fully understand
the issues involved. This is particularly true in controversial areas of medicine where
competing viewpoints may arise as a result of methodological and even cultural
differences. As a result, providing full information may potentially require special
methods of patient education or may be so complex that it is beyond the cognitive
capabilities of some patients.
A final issue concerns how much information to provide to patients. Some clin-
icians and bioethicists suggest that patients should be told of common risks with
low morbidity as well as rare risks with a high associated morbidity, but need not
necessarily be provided with an exhaustive list of all possible risks regardless of their
likelihood or their severity. Of interest, this is precisely the position taken by some
legal authorities (vide infra).
Finally, it may be helpful to distinguish between the risks of a medical intervention
and any uncertainties that may be associated with the procedure. An example will help
explain the distinction. In some cases, the risks of a common procedure have been
well-established by actuarial means, such as the risk of a stroke or death following
coronary artery bypass grafting surgery. But when an individual patient deviates
significantly from the sample population upon which the actuarial data is based
(for example, being extremely elderly, or having a rare co-morbidity that would be
expected to predispose to perioperative complications) this risk data is no longer
accurately representative of the true risks involved, and additional uncertainties are
necessarily introduced into the discussion.
2.24 Medical Futility 39

2.24 Medical Futility

A number of ethicists argue that in cases where there is no hope for improvement
for a medical condition such as terminal cancer or advanced AIDS that no course of
treatment is called for other than “comfort measures” (Weijer et al. 1998; Gampel
2006; Burns and Truog 2007; Mickelsen et al. 2013). That is, to apply treatments with
zero chance of efficacy is wasteful of valuable resources and only serves to provide
false hope. Of course, not every clinician or patient will agree as to when no further
benefit to an intervention is to be expected. Still, there are situations where agreement
amongst clinicians is almost universal. An example is the patient who properly meets
the criteria for brain death. Such patients have zero chance of recovery and are often
used as a source of organs for transplantation. Family members, however, seeing a
rhythm on the electrocardiogram display and feeling a pulse at the wrist, and hoping
for a miracle, sometimes request continuing care in an Intensive Care Unit (ICU)
even though such care is futile. This creates an ethical dilemma for some clinicians
who feel that it is wrong to provide medical care to a (brain) dead person (Luce 1995;
Burt 2002; Bernat 2005).
A key case in the debate on medical futility was Baby K. Baby K was born in
an anencephalic state on October 13, 1992, at Fairfax Hospital in Fairfax, Virginia.
She was born missing almost all of her brain; in fact, all that remained was the
“brainstem”, that primitive part of the brain responsible (in part) for autonomic and
regulatory function, such as the control of respiration, the heart beat and blood pres-
sure. In almost all cases anencephalic infants are not aggressively resuscitated since
there is zero chance of the infant ever achieving a conscious existence. Instead, the
usual clinical practice is to offer hydration, nutrition and comfort measures and “let
nature take its course.” Artificial ventilation, surgery (to fix any co-existing congen-
ital defects), and drug therapy (such as antibiotics) are usually regarded as being
pointless. Some clinicians see no point in even providing nutrition and hydration,
arguing that withdrawal of nutrition and hydration is morally and clinically appro-
priate in such cases.
One should understand that anencephalic babies are technically not brain dead,
as they usually have intact brainstem reflexes. Yet there is strong clinical consen-
sus that valiant efforts should not be employed to keep these infants alive. In fact,
anencephaly and brain death may be the only two clinical situations that virtually
all knowledgeable clinicians agree are futile to treat (except possibly to the extent
necessary to allow organ harvesting).
Occasionally parents want clinicians to use all available means to keep anen-
cephalic infants alive as long as possible. However, in most of these cases parents
eventually come to realize that there is no possibility of a good outcome from such
efforts and end up agreeing with the clinical team. Despite this, in the case of Baby
K., Ms. H., the mother, wanted the hospital to continue with advanced supportive care
(primarily ventilatory support) against the wishes of the clinical team, and sought
legal support for her position. Ms. H. knew of her baby’s condition from the second
trimester of her pregnancy, but, motivated by a strong religious conviction that “all
40 2 Biomedical Ethics

life is precious” and that God alone should decide how long the baby would live, she
remained adamant that Baby K. be kept alive as long as possible.
The hospital’s position was that such care would be futile. At the trial,28 expert
testimony was given to demonstrate that provision of ventilator support for anen-
cephalic infants goes beyond the accepted standard of care. The legal team for Baby
K’s mother adhered to a religious sanctity-of-life principle as the basis for their case.
In the end, in a particularly controversial decision, the U.S. District Court ruled that
the hospital caring for Baby K must put her on a mechanical ventilator whenever
she had trouble breathing. In particular, the court interpreted the Emergency Medical
Treatment and Active Labor Act (EMTALA) to require continued ventilation for the
infant. The wording of this act requires that patients who present with a medical
emergency must get “such treatment as may be required to stabilize the medical
condition” before the patient is transferred to another facility. The court took the
position that “it is beyond the limits of our judicial function to address the moral
or ethical propriety of providing emergency stabilizing medical treatment to anen-
cephalic infants. We are bound to interpret federal statutes in accordance with their
plain language…” As a result of the decision, Baby K was kept alive much longer
than most anencephalic babies, living to age 2 ½.

2.25 Doctrine of Double Effect

The “doctrine of double effect” (Saini 1999; McIntyre 2004) is a principle of ethics
potentially applicable in many ethical dilemmas. First espoused by St. Thomas
Aquinas in his Summa Theologica, the doctrine states that it is sometimes permissi-
ble to cause a harmful side effect in bringing about a good end result even though it
would not be ethical to cause such a harm directly. According to the Stanford Ency-
clopedia of Philosophy the doctrine “is often invoked to explain the permissibility
of an action that causes a serious harm, such as the death of a human being, as a side
effect of promoting some good end”. 29
As a case in point, the Stanford Encyclopedia of Philosophy goes on to provide
the following example: “A doctor who intends to hasten the death of a terminally
ill patient by injecting a large dose of morphine would act impermissibly because
he intends to bring about the patient’s death. However, a doctor who intended to
relieve the patient’s pain with that same dose and merely foresaw the hastening of
the patient’s death would act permissibly.”

28 Matter of Baby K. 16 F.3d 590 (4th Cir. 1994), n. 9 at 598.

29 http://plato.stanford.edu/entries/double-effect/.
2.26 Therapeutic Privilege 41

2.26 Therapeutic Privilege

The term “therapeutic privilege” refers to the withholding of material information

by the clinician during the “consent” process in the belief that the disclosure of such
information would lead to the psychological harm or unnecessary suffering for the
patient. That is, therapeutic privilege is invoked as an exception to the doctrine of
informed consent.
The philosophical argument behind “therapeutic privilege” is that beneficence
should take precedence over autonomy in cases where a conflict between these two
principles exists. Historically, therapeutic privilege was invoked by some doctors
when they withheld the diagnosis of a terminal condition from patients whom they
expected would not be able to handle the information, and would consequently lose
an interest in living. In many cases, such information was withheld at the specific
request of family members (Elwyn et al. 2002).
Another example concerns patients born with ambiguous genitalia. Some past
practices involved the use of deception and/or incomplete communication of facts
about the infant’s condition and early surgical intervention to make a “definitive” sex
and gender assignment (Côté 2000).
Today, with the collapse of paternalism in modern clinical care, therapeutic priv-
ilege is invoked only rarely, if at all. This is so both as a result of medico-legal
prudence (vide infra) and in response to a cultural shift that emphasizes individual
autonomy more than in previous times. Furthermore, some clinicians argue that, if
a person feels that providing a patient with relevant clinical information may be so
upsetting to the patient as to cause extreme psychological harm, the patient should
be assessed for mental competency.
Still, therapeutic privilege has its cautious supporters. For instance, (Etchells et al.
1996), discussing the Canadian situation, make the case that therapeutic privilege
may sometimes be appropriate. They write:
The need for sensitivity to cultural norms may potentially support the exercise of therapeutic
privilege. In some cultures therapeutic privilege is widely invoked, and it is unclear whether
patients from these cultures should always be subjected to Western standards of consent.
However, given the legal status of therapeutic privilege in Canada, clinicians should avoid
invoking therapeutic privilege. It is better for the clinician to offer information and allow the
patient to refuse or accept further disclosure.

2.27 The Permissible Death Problem

Few legal drugs are used as ubiquitously as Tylenol, the popular nonprescription anal-
gesic known by the scientific names of acetaminophen (and paracetamol). Although
the use of acetaminophen is advocated for a number of mild-to-moderate pain con-
ditions such as headaches and arthritis, it is less well-known that in large doses
acetaminophen can be lethal. In fact, acetaminophen liver toxicity, often from an
intentional overdose, causes more than 450 deaths annually in the United States, and
42 2 Biomedical Ethics

this number appears to be on the rise (Bridger et al. 1998; James et al. 2003; Larson
2007). While there is little doubt that this number could be substantially reduced by
restricting access to the drug, such as removing its nonprescription status, or even
removing the drug from the market entirely (as happened with the painkiller Vioxx),
the fact is that regulatory authorities like the U.S. Food and Drug Administration
(FDA) must view this number of deaths as being acceptable in light of the enormous
overall clinical benefits the drug provides. This example illustrates the concept of
“permissible deaths”, a thorny ethical issue that regulators and policy makers must
deal with in a great many settings. In the context of this book, this difficult problem
arises in the context of risk versus benefit in a variety of potential transhuman-
ist interventions (e.g., genetic engineering methods, pharmaceutical enhancement
technologies, neural augmentation via surgical implants) that may become widely
available in the future.
The problem of “permissible deaths” is hardly unique to the regulation of drugs;
there are many other instances where this nasty issue shows up. For example, generals
conducting military campaigns must decide how many combatant deaths on either
side are tolerable, as well as decide how many unavoidable innocent civilian deaths
are acceptable (“collateral damage”) (Alexander 2001; Arya 2007).
Similarly, safety engineers must strike a balance between the cost of a safety
feature and the number of lives saved, since, for instance, relatively few people
would be willing to buy a car costing $300,000 no matter how safe (Viamonte et al.
2006). Likewise, adding numerous extra safety features to nuclear power plants, to
commercial aircraft or to invasive medical equipment could conceivably make these
products too expensive to be affordable.
This issue even comes up in surgery. In high-risk procedures such as cardiac
surgery, how many deaths are acceptable? In 1998 the British General Medical
Council, the regulatory agency that monitors British doctors, charged that two heart
surgeons under their scrutiny were guilty of operating on children despite knowing
that their fatality rates were unacceptable (Treasure 1998; Bolsin 2002). This natu-
rally raises the issue as to what an acceptable death rate might be and how such a rate
should be determined. (In some US states like New York where the fatality rates for
all heart surgeons are publicly available, one unintended consequence has been for
heart surgeons to simply refuse to take on very high-risk cases for fear of adversely
affecting their “batting average”.)
Another medical situation concerns permissible deaths related to the use of medi-
cal equipment. For instance, patient-controlled analgesia (PCA) machines that allow
patients to self-administer morphine after painful surgical procedures are inherently
risky. While potential benefits of this technology include superior pain control, auto-
matic electronic documentation and improved utilization of nursing resources, unfor-
tunately, unanticipated flaws in the design of these machines can sometimes lead to
adverse drug events such as overdoses, and even death (Lin et al. 2001; Vicente
et al. 2003). One particularly notorious unit is the Abbott Lifecare 4100 PCA Plus
II machine. In 1997 three deaths that occurred while patients were connected to this
device were documented. Investigations revealed that part of the problem was an
unfriendly user interface that made user errors more likely. Unfortunately, despite
2.27 The Permissible Death Problem 43

being amply notified of this problem, the manufacturer was unwilling to upgrade
the unit to a safer design, claiming that there was no problem with the unit in the
first place that could not be handled with proper user training. In the end no design
change was ever implemented and the unit remained in clinical use until recently
(Doyle 2007).
Clearly, complex technologies like automobiles and nuclear power plants offer
personal and social benefits at a price that necessarily produces occasional injury
and death. Still, when government regulators license drugs or medical devices, they
implicitly require that the perceived benefits exceed the perceived risks. In the case
of drug products, when this relationship is no longer obvious, the drug may be
withdrawn (as happened to the drug Vioxx in the USA) or its indications restricted
(as happened to the drug Avandia in the USA). In the case of medical devices like
PCA machines, when preventable deaths or injury have occurred regulatory agencies
may require that the device be recalled from clinical service so that safety upgrades
can be instituted. But, as in the case of the Abbott PCA machine, this is not always
the case.
Failure to mandate a recall of medical devices that harm patients may occur for
several reasons. First, the remedy may be so expensive as to be impractical. Second,
the medical device may involve an old design that is approaching the end of its life
cycle anyway. Third, regulatory agencies with limited resources must prioritize their
goals, with the result that medical devices that injure or kill only a small handful
of people may not get the regulatory attention that victims and their families would
otherwise like. In such cases, legal remedies may be the only option available.

2.28 Legal Perspectives

A number of bioethical issues have emerged as legal cases. Here we offer a small
sampling of such cases from Australia, Canada, England and the USA. They are
presented here with the goal of presenting some important real-world bioethical
issues from a legal standpoint. In particular, these cases show how the concept of
patient autonomy and the related notions of informed consent and individual liberty
have become firmly established in modern bioethical discourse, reflecting a change
in mindset from paternalistic attitudes of earlier eras.

Schloendorff Vs. Society of New York Hospital

In the USA, the legal case that definitively established the right of competent adults
to refuse medical treatment was tried in 1914 in a case known as Schloendorff vs.
Society of New York Hospital.30 In this case, the plaintiff agreed to undergo a gyne-
cologic examination under general anesthesia, but she explicitly refused consent for
any surgical intervention (Friedlander 1995). However, at the time of the procedure,

30 Schloendorff vs. Society of New York Hospital, 105 N.E. 92,1914.

44 2 Biomedical Ethics

surgically correctable pathology was identified, and the surgeon decided to correct
the problem despite instructions to the contrary.
Unfortunately for all parties, serious unexpected complications followed the
surgery, and, as a result, a lawsuit was launched. The litigation was resolved in
favor of the plaintiff. In his opinion, the presiding judge wrote, “Every human being
of adult years and sound mind has a right to determine what shall be done with his
own body” (Sreenivasan 2003). (Given that the plaintiff was a woman, the gender in
the wording of the judge’s opinion can only be viewed with dismay!)
Despite this favorable legal ruling, in the end, the patient actually lost her case
because the hospital was a charitable institution and consequently was immune
from liability under the laws of the time. Still, this case firmly established the
notion of informed consent and of the right of a competent adult patient to
choose or refuse medical treatment. Since the time of this landmark case, a large
number of American legal decisions have reinforced the right of a competent
adult to choose his or her treatment, even when the decision is not clinically sound.

Malette Vs. Shulman

The Jehovah’s Witnesses are a Christian religion whose followers believe the Bible
to be the true and literal word of God. Witnesses view Jehovah as the ultimate moral
authority and do not salute flags, join service organizations, enlist in the military,
vote in public elections, or take an interest in civil government.
Traditionally, orthodox Jehovah’s Witnesses will not accept homologous or autol-
ogous whole blood, packed red blood cells, plasma, platelets and white blood cells,
even when “clinically necessary” (Letsoalo 1998; Ridley 1999). The determination
that blood transfusions were a violation of God’s law was made in 1945 and is
primarily based on three biblical passages (Benson 1989):
Every moving animal that is alive may serve as food for you. As in the case of green
vegetation, I do give it all to you. Only flesh with its soul – its blood – you must not eat.
(Genesis 9:3, 4)
As for any man of the house of Israel or some alien resident who is residing as an alien in
their midst who eats any sort of blood, I shall certainly set my face against the soul that is
eating the blood and I shall indeed cut him off from his people. (Leviticus 17:10–16)
The Holy Spirit and we ourselves have favored adding no further burden to you, except these
necessary things, to keep abstaining from things sacrificed to idols and from blood and from
things strangled and from fornication. If you keep yourselves from these things you will
prosper. (Acts 15:28, 29)

This prohibition can result in a challenging dilemma for physicians because a rou-
tine, safe, and potentially life-saving medical intervention is unacceptable to the
patient (Rothenberg 1990; Mann et al. 1992; Benson 1989). Anesthesiologists are
particularly affected because they are almost always responsible for intraoperative
transfusion management. This sometimes puts clinicians in very difficult ethical sit-
uations (Harnett et al. 2000; Baldry et al. 2000).
In Canada, an important legal precedent regarding patient consent in this respect
was the case of Malette vs. Shulman (Sneiderman 1991) . In this landmark case,
2.28 Legal Perspectives 45

the court established that emergency treatment should not be administered without
patient consent if there is substantial reason to believe that the patient would refuse
the treatment if he or she were able.
The specifics of the case are as follows. Dr. Shulman was an emergency room
doctor caring for a woman who was unconscious as a result of hypovolemic shock
from blood loss following a serious motor vehicle accident. After a quick clinical
assessment, Dr. Shulman administered a medically necessary blood transfusion to the
patient, saving her life as a result. Unfortunately for Dr. Shulman, the patient carried
a wallet card indicating that she was a Jehovah’s Witness and did not want to receive
a blood transfusion under any circumstances. Also, complicating this situation was
the fact that the card was written in the French language, and was signed but undated
and unwitnessed, thus casting some doubt on the legal significance of the card, at
least in the mind of Dr. Shulman. However, in the end, Dr. Shulman weighed the
pros and cons of transfusing and decided to go for life.
Although the blood transfusions Dr. Shulman administered were responsible for
saving the patient from death, the patient sued. To the surprise of the Canadian
medical community, the court found that Dr. Shulman was liable for battery. In his
decision, the judge wrote: “To transfuse a Jehovah’s Witness in the face of her explicit
instructions to the contrary would, in my opinion, violate her right to control her own
body and show disrespect for the religious values by which she has chosen to live
her life” (Sneiderman 1991).
Rogers Vs. Whitaker
An important Australian case known as Rogers vs. Whitaker involved the issue
whether a doctor has a duty to warn patients of any significant risk involved in a
proposed procedure (Chalmers and Schwartz 1993). In this case, the plaintiff lost
her sight after unsuccessful surgery in her right eye, which eventually led to “sym-
pathetic” blindness in her left eye. This was a rarely encountered complication that
occurs in approximately 1 out of 14,000 cases. The plaintiff argued that, while there
was no question that the surgery had been performed with skill, the surgeon’s failure
to warn that blindness in the good eye could develop constituted negligence. The
defense position was that the doctor acted within the purview of common practice,
a position that the court ultimately rejected.
Hills Vs. Potter
The courts have not universally supported a position such as that of Rogers vs.
Whitaker. For example, in the British case of Hills vs. Potter,31 a patient who devel-
oped paralysis following elective neck surgery sued, arguing that the surgeon failed to
provide information necessary to make an informed decision whether to undergo the
surgery. However, the court dismissed her claim, rejecting the doctrine of informed
consent commonly prevailing in American and Canadian law, under which a physi-
cian has a duty to disclose all material risks which patient might view as being

31 Great
Britain. England. Queen’s Bench Division. Hills vs. Potter. All Engl Law Rep. 1983;
3:716–29.
46 2 Biomedical Ethics

important. Legal decisions such as Hills vs. Potter serve to illustrate how courts in
various nations, on the basis of differing legal precedents and other (e.g., cultural)
factors, may take very different perspectives on similar issues.

2.29 Conclusion

This chapter was written to provide a background for issues to be discussed in

subsequent chapters. These include the criteria for humanness and personhood, the
moral standing of human and nonhuman sentient beings, the morality of human
enhancement via technical and pharmacological means, and related concerns. In
particular, in Chaps. 5 and 6 it is shown that the line between life and death is at
times more apparent than real, a fact that—as well shall see later—raises important
challenges to moral philosophers and medical practioners alike.
Chapter 3
Humans, Transhumans and Humanoids

Man is an artifact designed for space travel. He is not designed

to remain in his present biologic state any more than a tadpole is
designed to remain a tadpole.

William S. Burroughs (http://quotes.dictionary.com/Man_is_an_

artifact_designed_for_space_travel)

Abstract This chapter introduces the reader to the field of transhumanism and some
of the most important philosophers contributing to this recent movement. Related
philosophical issues such as moral standing and personhood theory are presented.
The possibilities of genetic engineering as a means to fundamentally alter the nature
of humankind are discussed, along with the concepts of animal-human hybrids,
computer-human hybrids, and fully artificial beings. These ideas are presented to
support the premise that there is no unique and unalterable biological form that
constitutes humanity, and that our concept of what it means to be human will be
forced to evolve in the face of new biotechnologies such as genetic engineering,
molecular biology, and nanotechnology, all of which have the potential to alter our
nature and character in ethically profound ways.

3.1 Introduction

Following on the discussion of ethics and ethical theory introduced in the previous
chapter, which summarized and critiqued the various approaches to tacking problems
in moral philosophy, this chapter introduces the transhumanist movement and some of
the most important philosophers contributing to this movement. Related philosoph-
ical issues such as moral standing and personhood are presented. The possibilities
of genetic engineering as a means to fundamentally alter the nature of humankind
are discussed, along with the concepts of animal-human hybrids, computer-human
hybrids, and fully artificial beings. These ideas are presented to support my contention
that there is no unique and unalterable biological form that constitutes humanity, and

© Springer Nature Switzerland AG 2018 47

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_3
48 3 Humans, Transhumans and Humanoids

that our concept of what it means to be human will be forced to evolve in the face
of brave, new biotechnologies such as genetic engineering, molecular biology, and
nanotechnology, all of which have the potential to alter our nature and character in
ethically profound ways.1 Readers interested in learning about recent books dealing
with transhumanism are referred to the Appendix at the end of this work.

3.2 Moral Standing

The notion of moral standing is a central concept in ethical discourse, particularly as it

relates to the treatment of nonhuman individuals. This notion is presented and devel-
oped here in order to show how, just as the moral treatment of animals came to be an
important philosophical topic in earlier decades, it arises once again in the discussion
as to what constitutes the moral treatment of entities such as animal/human hybrids,
computer/human hybrids, and other beings with a human component (sometimes
known as “parahumans”).
The “moral standing” of a being determines the degree to which its welfare and
well-being must be given ethical consideration. That is, a being merits moral standing
if we believe that it makes a difference, morally speaking, how that being is treated,
and that we should take into account that individual’s interests for the individual’s
own sake and not merely for our benefit or the benefit of someone else. Consider the
following helpful example from the Markkula Center for Applied Ethics2 :
Take, for example, a doctor who attends to the physical welfare of her patients and believes
that it would be morally wrong to mistreat them. Suppose that she believes this, not because
of any benefits she will derive from taking good care of them nor because she is afraid
of being sued, but only because she has a genuine concern for her patients’ well-being.
Her patients have moral standing for her. On the other hand, take a farmer who looks after
the welfare of his cows and who also believes that it would be morally wrong to mistreat
them. But suppose he believes this only because mistreating them would decrease their milk
production and their milk is an essential source of nourishment and income for his family.
Although this farmer considers his cows’ welfare, he does so only for the sake of his family
and not for the sake of the cows themselves. For the farmer, the cows have no moral standing.

A great philosophical question that continues to this day asks the question whether
any beings other than humans merit moral standing. One commonly held position is
that only beings with the actual or potential capacity to reason merit moral standing.
Another commonly held position is that any beings that have the capacity to suffer

1 One example might be to alter our central nervous system so as to reduce the likelihood that
individuals would go into a rage when upset, or (perhaps even better) reduce the likelihood that
individuals would get emotionally disturbed under adverse circumstances. Another example would
be altering our central nervous system to make us become more caring and empathetic to other
individuals. More mundane examples of enhancement might include improvements so that we
retain facts with improved reliability, respond faster to dangerous or adverse situations or simply
have improved physical strength.
2 https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/who-counts/.
3.2 Moral Standing 49

ought to have some form of moral standing afforded to them that should at least make
gratuitous cruelty against them immoral (Singer 1975; Cavalieri and Singer 1994;
Singer 2011).
Peter Singer, in his seminal book Animal Liberation (Singer 1975), argues the
case that animals do merit a degree of moral standing, with rights that extend far
beyond merely preventing them from experiencing pain and suffering. For instance,
he argues that humans are often guilty of “speciesism”, the assigning of different
moral standings to various biological entities on the basis of their species membership
rather than on the basis of more appropriate properties such as their cognitive capacity.

3.3 Personhood

As noted earlier, the recognition of an entity as being a person is known as person-

hood. The philosophical literature offers many definitions as to what constitutes a
“person”, often drawing in large part on the work of philosophers such as Descartes,
Locke and Hume, and usually focusing on criteria such as self-awareness, a sense of
self that is maintained through time, or similar criteria.
One especially notable work in the study of personhood is Kim Atkins’ Self and
Subjectivity (Atkins 2005). This volume of classical philosophical writings with
accompanying critical commentary examines how philosophers have historically
conceived of personhood and the related notions such as self and subjectivity. Noting
that humans, perhaps unique among beings, “have the capacity to reflect upon and
evaluate their thoughts, feelings, and actions” and this ability for self-reflection “is the
essence of philosophy” (Atkins 2005) the author offers the reader perspectives from
philosophers such as Descartes, Locke, Hume, Kant, Nietzsche, Strawson, Frankfurt
and Parfit and Simone de Beauvoir. Let us briefly examine some of these thinkers.
Descartes famously characterized the human subject in terms of the mutually
exclusive realms of matter (res extensa) and thought (res cogitas), a position known
as Cartesian dualism. This position is in contrast with (for example) physicalism,
the ontological position that there is nothing over and above the physical and what
we take to be mental events are simply “epiphenomena”. (In physicalism, mental
phenomena are seen as entirely dependent on physical events and consequently have
no independent existence).
While the British philosopher John Locke is often regarded as the founder of
empiricism, he also contributed greatly to the problems of personhood and per-
sonal identity, and his approach to the matter continues to be influential to this day.
According to Locke, a living thing retains its personal identity by maintaining the
organization of its component parts, that is, by maintaining a continued longitudinal
existence. Locke defines a “person” as “a thinking intelligent being that has reason
and reflection, and can consider itself as itself, the same thinking thing, in different
50 3 Humans, Transhumans and Humanoids

times and places”.3 It is the Lockean approach to personhood that this work draws
strongly upon, as is discussed in further sections.
In the “naturalist” epistemological tradition,4 personhood is usually taken to des-
ignate any “agent” who is ordinarily in possession of continuous consciousness over
time5 and who also is capable of mental representations concerning the world, as
well as able to consider options, develop tactics and act on plans.
Writing some decades after Locke, David Hume was a Scottish atheist and philoso-
pher in the empiricist tradition who while best known for his attacks on religion, also
contributed to the philosophy of personhood and personal identity. In his Treatise
of Human Nature (1738) Hume attacked Descartes’ notion of res cogitas, arguing
as an empiricist that since we do not perceptually experience any metaphysical self
we cannot have knowledge of it. Hume additionally argues that it is erroneous to
posit an entity such as “the self” and that to do so is to mistake the connectedness of
conscious experience for the existence of a soul.
Immanuel Kant, arguably the most important of the Enlightenment philosophers,
continued the Lockean tradition of grounding philosophy in what we are able to know,
especially in his famous book, Critique of Pure Reason (1781). Here Kant recon-
structs Descartes’s idea that knowledge is grounded in the human subject, arguing
that while all knowledge begins with experience, it does not all arise out of experi-
ence. Thus Kant, like Hume, rejects Decartes notion of res cogitas but unlike Hume
does not regard the self as a mere fiction, but instead as part of the composition of
consciousness itself. That is, like most contemporary neuroscientists, Kant held that
the composition of our conscious experience—and especially our sensory experi-
ences—necessarily depends on the structure and function of the brain itself.
The philosopher Nietzsche rejected the Enlightenment ideal of reason guiding
the progress of humankind, with its associated belief in self-sovereignty through
reason. In fact, Nietzsche felt that an unwarranted emphasis on reason was responsible
for a “herd-like” way of living and an associated decline in human creativity and
individuality. In contrast with Decartes’ res cogitas and res extensa, Nietzsche held
that the notions of “mind” and “body” do not actually refer to distinct entities but are
simply terms that help us refer to different aspects of our existence. His books The
Genealogy of Morals and The Birth of Tragedy discuss his philosophical positions
on these issues in great detail.
The Oxford philosopher Sir Peter Strawson offered a perspective on personal
identity rather different from his predecessors. Strawson argued that metaphysics
is concerned with the description of the basic structure of material existence, that
is, the entities we take for granted in our concept of reality. He calls these entities

3 John Locke, An Essay Concerning Human Understanding, II, ed. Raymond Wilburn, Chapter
XXVII (London: Dent and Sons, [1690] 1948), p. 9. quoted in Atkins, 2005:20.
4 Naturalistic epistemology is an approach to the theory of knowledge that emphasizes the application

of methods, results, and theories from the empirical sciences. It contrasts with approaches that
emphasize a priori conceptual analysis or insist on a theory of knowledge that is independent of the
particular scientific details of how mind-brains work (From http://www.iep.utm.edu/nat-epis/).
5 This phrasing allows for periods of unconsciousness, such as when general anesthesia is adminis-

tered. Note that sleep is not taken to be an unconscious state.

3.3 Personhood 51

“basic particulars” and includes “persons” among these (but not “bodies”), posit-
ing that persons are basic material entities with both physical and mental proper-
ties. Understandably, Strawson rejects the physicalist claim that mental states are
mere predicates of the brain, arguing that psychophysical reductionism (incorrectly)
describes all human activity in terms of the laws of physics. Strawson’s nonreduc-
tionist approach nonetheless has the advantage of retaining the possibility of moral
agency.
The Princeton University moral philosopher Harry Frankfurt has written exten-
sively on the conceptual and moral aspects of personhood, especially as the notion
pertains to moral responsibility. In his well-known essay, “Freedom of the Will and
the Concept of a Person,” Frankfurt argued that freedom of the will allows individ-
uals to impose a moral structure on one’s self through a system of held principles
and values, and that those individuals who do not achieve self-control in this manner
lack personhood. (He calls such individuals “wantons”). Frankfurt further argues
that Strawson’s concept of personhood is too broad to capture what is specific about
persons, noting that some animals meet the definition of a being to whom both mental
and physical predicates can be ascribed but nevertheless still do not have freedom
of the will. Frankfurt emphasizes that critical self-reflection and self-determination
based on a system of values are requirements for the moral fabric that distinguishes
a person from a wanton. In this respect, only persons are moral agents, and so only
persons are members of the moral community. Finally, it should be noted that the
requirement for critical reflection as a necessary condition for personhood has met
with criticism from philosophers who argue that such a requirement would exclude
from personhood both infants as well as some neurologically damaged adults. In
addition, this requirement is seen by some as doing an injustice to animal ethics.
The Cornell University philosopher Sydney Shoemaker, in an essay entitled “Per-
sonal Identity: A Materialist’s Account” argues that persons exist as a “temporal
whole”, existing not at a single point in time, but rather extended over the entire
period of their lives. To Shoemaker persons are divided into temporal parts (“time
slices” or “person-stages”), which are the collection of properties attributable to a
person at any time, so that a person is the totality of his or her existence across all that
individual’s person stages. Shoemaker offers this approach to avoid the continuity
of consciousness problem6 of the Lockean approach. In the Shoemaker approach,
one need not establish that there is an identical consciousness stream at each stage
of a person’s life, but that there is instead continuity of memory connecting the
person-stages in an individual’s life.
Derek Parfit, at All Souls College, Oxford, is best known for his book, Reasons and
Persons. Like Shoemaker, Parfit considers personal identity to consist in memory-
connectedness. However, unlike Shoemaker and many other philosophers, Parfit
offers us a reductionist position that does away entirely with the concept of “person”.

6 Simply stated, the problem is this: if, as Locke holds, personhood depends on consciousness, what

happens to personhood when one’s body relinquishes consciousness, such as with general anesthe-
sia? Additionally, since personal identity is based on consciousness, and that only oneself can be
aware of his consciousness, exterior human judges may never know if they really are judging—and
punishing—the same person, or simply the same body.
52 3 Humans, Transhumans and Humanoids

His position is based on a fascinating thought experiment involving teleportation (as

in the Star Trek series); the interested reader is directed to Parfits’ book and Atkins’
commentary (Atkins 2005) for further explanation.
Finally, it is of interest to explore one of the feminist perspectives on personhood,
in this case that of Simone de Beauvoir. In The Second Sex (1949), Beauvoir notes
that a woman is defined only by her relation to men, whereas a man is defined in
terms of himself standing alone. Similarly, what men carry out is routinely assigned
legitimacy, but the actions of woman require justification by men. This arrangement of
“physiological destiny”, Beauvoir argues, leaves men free to pursue authentic, self-
affirming activities while trapping women in a setting of domestic imprisonment.
Beauvoir’s concerns, however, should not be interpreted to means that women do
not merit full-fledged personhood, only that women often find themselves trapped
in situations where they are not able to achieve their full potential.
As can be seen from the foregoing, a variety of different perspectives on personal
identity have been advanced by philosophers. Let us see how such notions might be
extended to nonhuman organisms.
Hughes (2004) has extended the work of Locke and others in the Lockean tra-
dition to consider a spectrum of rights in organisms varying in the extent to which
they exhibit consciousness and other morally important properties (Table 3.1). Four
degrees of personhood are described in his scheme: individuals with mature person-
hood (e.g., adult humans), individuals with personhood (children, some apes), beings
with sentience (e.g., fish), and nonsentient entities (e.g., embryos and plants).
Some philosophers argue that the classic view of personhood identified above
suffers from the problem that it defines personhood in terms of an ability to per-
form certain tasks. This approach makes it difficult to distinguish between persons
as we understand them intuitively and advanced machines capable of complex adap-
tive behavior. Consequently, some philosophers such as Charles Taylor propose that
personhood be based on a view emphasizing personal significance rather than on
function (Taylor 1985):
What is crucial about agents is that things matter to them. We thus cannot simply identify
agents by a performance criterion, nor assimilate animals to machines… [likewise] there are
matters of significance for human beings which are peculiarly human, and have no analogue
with animals.

Other philosophers have similarly argued against a view of personhood based on

function. For example, philosopher Harry G. Frankfurt argues that the concept of a
person is closely connected to human volition, and describes the makeup of human
volition in terms of first- and second-order desires (Frankfurt 1971):
Besides wanting and choosing and being moved to do this or that, [humans] may also want
to have (or not to have) certain desires and motives. They are capable of wanting to be
different, in their preferences and purposes, from what they are. Many animals appear to
have the capacity for what I shall call “first-order desires” or “desires of the first order,”
which are simply desires to do or not to do one thing or another. No animal other than man,
however, appears to have the capacity for reflective self-evaluation that is manifested in the
formation of second-order desires.
3.3 Personhood 53

Table 3.1 Modification (elaboration) of Hughes’s classification of the future continuum of con-
sciousness and rights in organisms (Hughes 2004)
Type of Organism Consciousness Rights
• Conventional adult humans Full personhood • Right to vote
• Cognitively enhanced • Right to make contracts
humans (“Post-humans”) • Right to humane treatment
• Fully sentient androids and
cyborgs with full adult
human intellectual
capabilities
• Adult human clones
• Young children Limited personhood • Full right to life
• Adult great apes • Right to humane treatment
• Human adults with impaired
cognition
• Selected mammals (e.g.
Dolphins)

• Newborn infants Sentience (the capacity to feel, • Limited right to life

• Adults with severe cognitive perceive or experience • Right not to suffer
impairment subjectively but not unnecessarily
• Fish and birds necessarily able to reason)
• Human fetuses at the stage
of advanced neuronal
development
• Permanently unconscious Non-sentient (unable to feel, • No rights: property of family
humans expeience or suffer) or owners (in case of plants)
• Embryos and early fetuses
• Brain dead humans
• Anencephalic newborns
• Anencephalic or headless
human clones
• Plants

Philosopher Thomas I. White, in developing an argument that dolphins are “non-

human persons”, argues that the criteria for personhood should be as follows (White
2007): the candidate being (1) is alive, (2) is aware, (3) feels positive and negative
sensations, (4) has emotions, (5) has a sense of self, (6) controls its own behavior,
(7) recognizes other persons and treats them appropriately, and (8) has a variety of
sophisticated cognitive abilities.
Beauchamp, on the other hand, cautions against approaches such as those listed
above. Emphasizing that moral personhood is quite distinct from metaphysical per-
sonhood (as only the former demands moral agency and moral motivation), he writes
(Beauchamp 1999):
54 3 Humans, Transhumans and Humanoids

The belief persists in philosophy, religion, science, and popular culture that some special
cognitive property of persons like self-consciousness confers a unique moral standing. How-
ever, no set of cognitive properties confers moral standing, and metaphysical personhood is
not sufficient for either moral personhood or moral standing. Cognitive theories all fail to
capture the depth of commitments embedded in using the language of “person”.

Beauchamp’s concerns notwithstanding, the traditional Lockean approach (or

variations thereof) to discussing personhood remains an important, and influential
philosophical tool accepted by a great many moral philosophers including individuals
such as Hughes and others discussed above.

3.4 Nonhuman Personhood

To many philosophers, drawing on the above Lockean criteria for personhood, per-
sons may not necessarily be humans (some animals may merit personhood) while
some human entities such as embryos, fetuses or severely brain damaged adult
patients may not qualify for personhood. As examples, under such a scheme, some
of the great apes may qualify for personhood while some people afflicted with severe
dementia from Alzheimer’s disease or traumatic brain injury may not.
Closely related to the discourse on what constitutes personhood are issues of moral
standing, individual rights and ethical responsibility. For instance, it is commonly
held that all individuals meeting personhood criteria are deserving of at least some
individual rights and that only persons (and not, for instance, lower animals) are
expected to be ethically responsible for their actions. Another ongoing philosophical
debate concerns whether people (who may or may not be persons) deserve greater
rights and higher moral standing than non-people; the rights of nonhuman animals
are an example (Howard 2005; Sagoff 2007).
These issues are more than theoretical. For instance, it is now generally accepted
that many Great Apes can learn to communicate with humans using signs and sym-
bols (such as using lexigrams or American Sign Language), although the exact extent
of their capabilities still remains a matter of ongoing debate among anthropologists
and primatologists. As a consequence of new considerations such as the above,
the Great Ape Project has been launched. With an online presence at http://
www.greatapeproject.org, the Great Ape Project is an international organization of
animal advocates who are actively promoting the position that the United Nations
should pass a “Declaration of the Rights of Great Apes” that would confer basic
legal rights to chimpanzees, bonobos, gorillas, and orangutans. These proposed rights
would include the right to life, protection of individual liberty, release from captivity,
and protection from torture.
Two recent legal cases exemplify developments in this arena. In an Argentinian
court decision rendered on December 18, 2014, a great ape living in Buenos Aires
was recognized as having the same basic rights as her human captors. The female
3.4 Nonhuman Personhood 55

orangutan, living in the Buenos Aires Zoo for the last two decades, now has the rights
of life, liberty and freedom from harm.7
Similarly, in the USA, in 2013, the Nonhuman Rights Project launched three legal
claims on behalf of four chimpanzees in New York State.8
In this and earlier sections of this chapter we examined some of the issues pertain-
ing to personal identity, moral standing and personhood. In the following sections
of this chapter we use this background to additionally explore how various forms of
human biological manipulation (e.g., eugenics, and genetic engineering) also impacts
on these same concerns.

3.5 Classical Eugenics

Eugenics is a social philosophy that takes the position that the human gene pool can
be improved through interventions targeted at the “genetically unfit” via techniques
such as sterilization, selective breeding, and (sometimes) even euthanasia (Kevles
1985; Black 2003). Eugenics has also been defined as the self-direction of human
evolution.
A line of argument frequently raised against the visions and goals of those who
would improve the design of the human body by techniques such as genetic engineer-
ing is concern for abuses that have occurred in the past in the name of eugenics. One
need only look to the state-sponsored murdering of millions of Jews by the Nazis
in the name of racial purity to be wary of any mention of eugenics. In more recent
times, “ethnic cleansing” in the Balkans or in Myanmar has led to similar concerns.
Finally, other critics point to sterilization programs in the USA and elsewhere
that were aimed at eliminating genetic defects from the gene pool. For instance,
Margaret Sanger, an American feminist well-known as an early advocate of birth
control, argued for: “A stern and rigid policy of sterilization and segregation to that
grade of population whose progeny is already tainted or whose inheritance is such
that objectionable traits may be transmitted to offspring” (Sanger 1932).

3.6 Liberal Eugenics

Given the obvious ethical lapses of classical eugenics, some thinkers have considered
how the aims of classical eugenics might be met without moral peril. This is the aim
of liberal eugenics. The central notion in this instance is that society should non-
coercively employ modern biological technologies to enhance the human organism
and its genetic composition. As noted above, the term is used in distinction from

7 http://www.scientificamerican.com/article/argentina-grants-an-orangutan-human-like-rights/.
8 http://www.nonhumanrightsproject.org/2015/04/20/judge-recognizes-two-chimpanzees-as-legal-

persons-grants-them-writ-of-habeas-corpus/.
56 3 Humans, Transhumans and Humanoids

the classical “authoritarian” eugenics programs of the early and mid-1900s, which
used unethical coercive methods to decrease the frequency of “undesirable” hered-
itary traits via programs of racial hygiene, sterilization, extermination, and ethnic
cleansing. In contrast to these “negative” means of improving the human condition,9
liberal eugenics focuses on the “positive”, with its actions and goals carried out by
individuals ethically exercising “procreative liberty” with a view to achieving “pro-
creative beneficence”. For instance, Nicholas Agar’s 2004 book Liberal Eugenics: In
Defence of Human Enhancement (Agar 2004) he argues the case that parents should
be permitted to enhance their children’s genetic composition via available biological
methods and argues against often-raised concerns that such actions would “divide
society into genetic haves and have-nots” or would “lead to a single view of human
excellence”.
Unlike some transhumanists, Agar does not argue that we have a moral duty to
employ enhancement technologies to improve the human condition. Nor does he
offer arguments based on any particular philosophical school, such as the teachings
of Immanuel Kant or any utilitarian philosophers. Rather, he simply argues that to
maintain consistency with the prevailing liberal democratic values of freedom of
choice and self-determination, we must agree to the deployment of human enhance-
ment technologies by parents wishing to do so.10
Similarly, in 2006 Johann Hari, a writer for the British newspaper The Independent
offered the following argument in favor of liberal eugenics11 :
The criticism that deserves more careful consideration comes from disability rights activists
like Adrienne Asch. They argue that this attempt to eradicate disability is an assault on
disabled people. By trying to eradicate disabilities, we are saying disabled people are worth
less – “errors in the gene pool” - and clearing the way for them to be treated even more badly.
But is this true? By making sure that no more mothers take thalidomide during pregnancy,
are we implicitly saying that thalidomide people have worthless lives and should be killed?
Of course not. We are simply saying that a person is more likely to be able to live the kind
of life they want to with fully formed arms and legs. By ensuring that the number of able-
bodied babies are maximized, we are simply acknowledging that - however harsh it might
seem to say it - lacking an ability to hear or see or walk is not simply a difference. It is a
disability nobody would voluntarily choose, and that you are better off without. Nor does the
evidence suggest greater screening and treatment will lead to the remaining disabled people
being treated worse. Since amniocentesis was introduced, people with Down syndrome are,
if anything, treated better.

In essence, Agar, Hari and similarly minded individuals argue that acting proac-
tively to best ensure that all babies are the best that they can be, for example free
of medical problems that would be expected to limit their life choices, is an option

9 For a more detailed discussion of what I mean by “human condition” see Chap. 4.
10 That being said, the state may choose to limit what a parent may do on behalf of his or her
child on the basis of safety, because of a concern about child exploitation, or for other reasons. For
example, in the interests of safety governments may mandate that a child be vaccinated against a
newly emerging virus or may limit the extent to which children are allowed to work outside the
home to help prevent child abuse.
11 http://www.independent.co.uk/voices/commentators/johann-hari/johann-hari-why-i-support-lib

eral-eugenics-8689688.html.
3.6 Liberal Eugenics 57

that should be available to future parents, at least in principle.12 This is not to sug-
gest that the humanity and value of disabled individuals are less in comparison to
other individuals, just that freedom of choice, independent of any particular ethical
or religious framework, should be afforded to parents who want to provide the best
opportunities for their babies.

3.7 Introducing Transhumanism

Transhumanism is a relatively recent intellectual and cultural movement that pro-

motes an interdisciplinary approach to understanding and evaluating potential means
for enhancing the human organism, the human race and the human condition, as well
as removing some of its limitations. The potential goals of transhumanism are numer-
ous and diverse, but as a rule, transhumanism seeks to produce “posthumans” who
will variously live longer, be smarter, be stronger, be more peace-loving, or otherwise
constitute an improvement over regular humanity in some nontrivial manner. In this
sense, transhumanism is rather similar to the field of liberal eugenics discussed ear-
lier. A more complete understanding of the goals of transhumanism can be achieved
by studying the Transhumanist Declaration, displayed as Table 3.2, as well as by
visiting their website at http://humanityplus.org.
Transhumanism aims to achieve its goals primarily but not exclusively via techno-
logical innovation in the fields of genetic engineering, neuropharmacology (as well
as other branches of pharmacology), computer technology, artificial intelligence,
molecular nanotechnology and a number of other scientific domains.
Some of the less mainstream transhumanist themes include efforts to develop
conscious, self-aware computers, efforts to reanimate individuals deemed to be dead
by ordinary clinical criteria, and altering humans with a view to facilitating space
colonization.
For example, a few transhumanists are involved in the cryonics movement, which
involves attempting to freeze (cryopreserve) humans so that they can be thawed
in the future, usually with a view to obtaining advanced medical treatment not yet
available. So confident are some individuals that continuing medical advances will
eventually lead to cures for most diseases that they want to have their bodies frozen
just before dying of a terminal illness. (For legal reasons, however, the clinically less
desirable option of being frozen a brief period after dying is a far more practical
option. However, it should be noted that the application of cryonics to patients who
are already clinically dead is a particularly controversial aspect of cryonics, as many
authorities compare the use of cryonics in this setting to the selling of false hope in
the extreme).
A basic undercurrent in most transhumanist writings is a vision of wisely using
human ingenuity to develop technology to improve the human condition, a vision

12 Real-world limitations such as cost and safety considerations may, however, limit the extent that

such interventions are practical.

58 3 Humans, Transhumans and Humanoids

Table 3.2 The Transhumanist Declaration, 2009 revision. World Transhumanist Association
The Transhumanist Declaration
1. Humanity stands to be profoundly affected by science and
technology in the future. We envision the possibility of
broadening human potential by overcoming aging, cognitive
shortcomings, involuntary suffering, and our confinement
to planet Earth
2. We believe that humanity’s potential is still mostly
unrealized. There are possible scenarios that lead to
wonderful and exceedingly worthwhile enhanced human
conditions
3. We recognize that humanity faces serious risks,
especially from the misuse of new technologies. There are
possible realistic scenarios that lead to the loss of
most, or even all, of what we hold valuable. Some of
these scenarios are drastic, others are subtle. Although
all progress is change, not all change is progress
4. Research effort needs to be invested into understanding
these prospects. We need to carefully deliberate how best
to reduce risks and expedite beneficial applications. We
also need forums where people can constructively discuss
what should be done, and a social order where responsible
decisions can be implemented
5. Reduction of existential risks, and development of means
for the preservation of life and health, the alleviation
of grave suffering, and the improvement of human foresight
and wisdom should be pursued as urgent priorities, and
heavily funded
6. Policy making ought to be guided by responsible and
inclusive moral vision, taking seriously both
opportunities and risks, respecting autonomy and
individual rights, and showing solidarity with and
concern for the interests and dignity of all people
around the globe. We must also consider our moral
responsibilities towards generations that will exist in
the future
7. We advocate the well-being of all sentience, including
humans, non-human animals, and any future artificial
intellects, modified life forms, or other intelligences to
which technological and scientific advance may give rise
8. We favour allowing individuals wide personal choice over
how they enable their lives. This includes use of
techniques that may be developed to assist memory,
concentration, and mental energy; life extension
therapies; reproductive choice technologies; cryonics
procedures; and many other possible human modification and
enhancement technologies
Source http://humanityplus.org/learn/transhumanist-declaration/
3.7 Introducing Transhumanism 59

free of concerns about whether “playing God” or deeply altering our human character
is ethically problematic. Not surprisingly, however, it is exactly such concerns that
critics of transhumanism raise. These issues are discussed in later sections of this
work. But first, let us briefly look at three important contemporary philosophers who
are especially sympathetic to transhumanist principles.

3.8 Nick Bostrom

Nick Bostrom is director of The Future of Humanity Institute at Oxford University as

well as the author of a vast number of publications on a diverse variety of philosoph-
ical topics (e.g., existential risk, implications of consequentialism, the simulation
argument, transhumanist issues). However, it is his interest in transhumanism (he
co-founded the World Transhumanist Association) that primarily interests us here.
Bostrom has made significant contributions to such transhumanism-related topics
such as human enhancement, artificial intelligence, superintelligence, mind upload-
ing, nanotechnology, and cryonics. His anthology, Human Enhancement (Savulescu
and Bostrom 2008) provides a comprehensive look at the question of human enhance-
ment by artificial means, with commentaries by authorities from both transhumanist
and bioconservative (“anti-meliorist”) camps.

3.9 Julian Savulescu

Julian Savulescu is Uehiro Professor of Practical Ethics at the University of Oxford as

well as Editor-in-Chief of the Journal of Medical Ethics. His approach to bioethical
issues is principally utilitarian. Savulescu argues that stem cell research requiring
embryo destruction is justifiable even if the embryo is seen as a person (Savulescu
2002), that parents have a responsibility to select the best children they are able
(procreative beneficence) (Savulescu 2001b), and that the destruction of embryos and
fetuses as a source of material for transplantation to adults can be morally acceptable
(Savulescu 1999a). Savulescu also argues that genetic testing for genes for criminality
is a moral imperative (Savulescu 2001a) and that—based on respect for procreative
autonomy—a strong argument exists to allow parents to select the sex of their children
(Savulescu 1999b; Savulescu and Dahl 2000).

3.10 John Harris

Bioethicist John Harris, Sir David Alliance Professor of Bioethics at the University of
Manchester, is perhaps best known for his book Enhancing Evolution (Harris 2007),
in which he makes a well-articulated case in support of genetic enhancement, designer
60 3 Humans, Transhumans and Humanoids

babies, stem-cell research, and even human cloning. Previous books by Harris include
On Cloning (Harris 2004) and Clones, Genes, and Immortality (Harris 1998), both
of which, like Enhancing Evolution take a libertarian-utilitarian-consequentialist
position advocating that humanity should act to improve the human organism (and in
so doing, the human condition) through science, technology and imagination. Harris
argues that science is a moral good that should be harnessed to improve humanity,
and not repressed as many detractors have attempted to do13 (Harris 2005a). He has
also argued in favor of sex selection (Harris 2005b, c), argued for the acceptability
of using drugs like methylphenidate to enhance performance (Harris 2009), and
suggested that drugs might also be helpful in the moral enhancement of humanity
(Harris 2011; Chan and Harris 2011). Harris has even suggested that it could be
ethical to sell organs in the marketplace (Erin and Harris 2003).
As mentioned above, Harris justifies his arguments by drawing on libertarian-
utilitarian-consequentialist lines of ethical reasoning, stating that scientific develop-
ments that would be expected to improve humankind should be encouraged, even if
they might initially appear to be repugnant or repulsive. Harris argues that we have a
“positive duty” to enhance humankind in that enhancements, by definition, are good.
In particular, Harris supports this claim by stating that—drawing on the principle
of beneficence—we have a moral obligation to prevent forms of serious harm such
as those that genetic diseases so often cause. Thus to Harris, the cloning of human
organisms, while widely condemned or outlawed, has the potential for bringing about
good, for example as a research technique to understand and treat human hereditary
diseases. Consequently, Harris argues, the cloning of human organisms should not
be universally forbidden.
Harris argues that gut feelings are poor guides to moral decision making, that
personal prejudices are a poor way to address life’s thorny questions. Harris notes
that just as “test-tube babies” are now widely accepted despite an initial outcry, we
can expect that various forms of human enhancement will eventually gain acceptance
as well once their benefits to humankind become fully appreciated.
Critics of Harris generally offer arguments along several lines. Some, like Kass
(see Sect. 7.4), suggest that repugnance can be a guide to moral decision making.
Some others argue that the utilitarian-consequentialist ethical model that Harris draws
on is too fundamentally flawed to serve as a moral compass, especially in matters
involving the “sanctity” of human life, where a duty to respect and preserve human life
is fundamental (see, for instance, Sect. 2.2). For additional critical commentary the
interested reader is directed to detailed discussions by Brassington (2007), Shapshay
and Pimple (2007) and Stjernschantz Forsberg et al. (2014).

13 For an American perspective on how political forces sometimes act against scientific interests,
the reader is invited to read Mooney’s The Republican War on Science (2006).
3.11 Charles Tandy 61

3.11 Charles Tandy

Another important contemporary Transhumanist thinker is Charles Tandy, whose

research interests include the possibility of immortality via interventions such as
genetic engineering, nanotechnology and cryonics. Tandy places a particular empha-
sis on Robert C. W. Ettinger’s monograph, The Prospect of Immortality (Ettinger
2005a) and his book, Man Into Superman (Ettinger 2005b) as two of the most
important early works in this realm. Tandy also provides valuable insights into
Ettinger’s philosophy in his 2002 book The Philosophy of Robert Ettinger (Tandy
2002) as well as in a number of his other works readily accessible via his website
(DoctorTandy.com).

3.12 Enhancing Human Performance for Spaceflight

As an interesting example of one of many possible transhumanist themes, consider

how one might enhance human performance for spaceflight, for instance using phar-
macologic enhancement. (Gibson 2006) has considered the ethical issues in enhanc-
ing human performance in such a setting. For instance, for decades, military aircrews
have employed pharmacologic assistance using drugs such as amphetamines to aid
in completing their missions. While this is sometimes said to be done only under
medical supervision and only under wartime circumstances, it is a well-documented
practice (Kenagy et al. 2004). Consequently, one could also imagine that similar cir-
cumstances might arise in space travel, and as a result, considerable study has gone
into exploring just how drugs might be wisely deployed in such a setting. (We will
look at the issue of pharmacologic enhancement in detail in the next chapter).
Similarly, just as scientists and military personnel involved in Antarctica missions
are sometimes required to have a prophylactic appendectomy before beginning a
mission where they would be snowbound for extended periods (Schmidt 1965), such
a policy might also be sensible prior to long duration spaceflights, such as a mission
to Mars. In the same way, corneal remodeling surgery, such as the Lasik laser eye
procedure, may be valuable in such a setting.
At issue, however, in such cases, is how extensive such surgical procedures or
other interventions might be before becoming unethical. As an extreme case in point,
Gibson provides the example of a bilateral leg amputation that might be carried
out in order to “enhance tolerance to gravitational forces”. Similarly, the question
arises concerning the point at which the surgical implantation of devices (or similar
interventions) to enhance human performance would become unethical.
In a comparable manner, while the genetic modification of an existing individual or
an unborn individual to cure an ailment might be considered ethically acceptable for
present or future astronauts, Gibson points out that conducting genetic modifications
to alter an individual’s performance characteristics and personality traits is less likely
to be acceptable to most people.
62 3 Humans, Transhumans and Humanoids

While it could be argued that all that is ethically germane in such situations is
that all participants provide informed consent, this may not be enough, as in the very
controversial example of individuals from developing countries who would consent
to sell a kidney to help feed their family (Epstein 2007; Friedman and Friedman
2006). Almost all bioethicists maintain that it is unethical for one to sell a kidney
even when complete informed consent is present.14

3.13 Animal/Human Hybrids and Other Strange Creatures

Some scientists are now putting human genes into animals for research and clinical
purposes.15 Others are thinking about why one might want to put animal genes into
humans. Others are working on the development of part-human, part-animal cells
and embryos for research purposes. Such considerations raise issues as to what it
means to be a human. If we put human genes into animals, does that make the animals
more human? Is it morally wrong to produce animal/human hybrids? In the following
sections we begin an exploration of these issues.

3.14 Putting Human Genes into Animals

For some time, transplant surgeons have been interested in using animal organs in
human hosts (xenotransplantation) as an alternative to transplanting human organs
(Cox and Zhong 2005; Rowiński 2007). The primary motivation for this is a shortage
of human organs available for transplantation. Unfortunately, attempts at using ani-
mal organs for transplantation in humans have met with universal failure in that organ
rejection is almost inevitable. This rejection occurs even when employing aggres-
sive anti-rejection therapy and occurs as a direct result of immunological differences
between animals and humans.
The basis for this is as follows. All cells in humans and animals have on their
surfaces molecular markers that can be recognized by the immune system. If the
immune system sees markers that indicate that the cells being scrutinized are “for-
eign”, a complex series of biological actions are initiated whereby the foreign material
is attacked. When the material being attacked is a transplanted organ, organ rejection
occurs.
Because the immunological markers located on cell surfaces are coded by a cell’s
DNA, consideration has been given to producing genetically modified animals whose

14 A notable exception is John Harris (Erin and Harris 2003).

15 One of the most important recent developments in is this field is a radical new gene-splicing
technique called “clustered regularly interspaced short palindromic repeats” (CRISPR). CRISPR
is a new tool to edit DNA with unprecedented precision. For more information, a highly readable
account is available at http://gizmodo.com/everything-you-need-to-know-about-crispr-the-new-to
ol-1702114381.
3.14 Putting Human Genes into Animals 63

cell surface markers will not trigger an immunological response. One proposed
scheme is to place appropriate human DNA in an animal’s genome such that the
cell’s surface markers indicate that the cell is human rather than, say, porcine in
origin, fooling the new system in a “fox in sheep’s clothing” manner.
Another situation where scientists may wish to place human DNA is in an animal
to produce pharmaceutical agents. For instance, one might wish to produce cows
whose milk is rich in human insulin, human growth hormone or somatostatin. This
is similar to earlier research programs that had bacteria produce human insulin and
other agents.

3.15 Language Genes

In 2001, scientists studying a family in which many members were unable to speak
identified a gene central to spoken language (Lai et al. 2001). The gene, known as
FOXP2, is not unique to humans; however, humans have a unique form of FOXP2
that is essential to language production (Vernes et al. 2006). For instance, the human
variant of the gene differs at two critical points from the chimpanzee FOXP2 gene,
implying that these changes may be responsible for the fact that humans can speak
while chimpanzees cannot. Such a situation makes one wonder whether primates
provided with the human form of the FOXP2 gene via genetic engineering techniques
might be made to exhibit a degree of language production superior to that of ordinary
(“unmodified”) animals. Of interest, in a recent study of mice engineered to express
humanized Foxp2, the mice learned to run a maze much more quickly than normal
mice and were also better at turning mindful actions into behavioral routines.16

3.16 Human/Animal Chimeras

A chimera, named after a monster in Greek mythology that had a lion’s head, a
goat’s body, and a serpent’s tail is a mixture of two or more species in one organism.
Scientists have now started to blur the once clear line between what is human and
what is animal by producing chimeras that are part human and part animal. This
process is distinct from the gene transfer methods alluded to above in that it involves
fusing two entirely different cell types.
For instance, scientists at the Shanghai Second Medical University have fused
human cells with rabbit eggs as part of a means to produce stem cells while at Stanford
University’s Institute of Cancer/Stem Cell Biology and Medicine in California, using
somewhat similar techniques, Irv Weissman has created mice with brains that are
about one percent human and plans to eventually produce mice that have 100%

16 http://newsoffice.mit.edu/2014/language-gene-0915.
64 3 Humans, Transhumans and Humanoids

human brains.17 The process of producing these chimeras involves injecting human
neurons into the brains of embryonic mice. With a view to understanding the process
of neuronal development, before being born the mice are killed and dissected to
determine if the neuronal architecture appropriate to a human brain has formed.
As implied above, it is usually not the intent that such embryonic organisms
be brought to term but rather that they be destroyed after a particular number of
cell divisions. Arguments in favor of developing such hybrids center on their utility
in biological research. Arguments against often present a “sanctity” or “dignity”
argument about human life and its pricelessness but may also focus on safety issues
that apply when generating new life forms.
As a rule, the more genetically human-like the research animals are, the better
scientists will be able to study the progression of human diseases in animal models,
as well as test new drugs for efficacy and toxicity. Thus some investigators are con-
sidering the development of human-chimpanzee chimeras. Given that chimpanzees
are already very closely related to us, sharing about 98% of the human genome,18
adding the right additional genetic material by such means as fusing a human and a
chimpanzee embryo might be expected to produce a perfect test vehicle for research
into human disease, as well as provide an excellent source of organs and tissue for
transplantation purposes. But naturally, the development of such a “humanzee” would
raise difficult ethical questions. Should such an organism enjoy some rudimentary
form of human rights? Might it be forced into doing menial labor or even used to
perform dangerous jobs, like cleaning up nuclear spills?
A related concern would be that of creating an organism with human consciousness
trapped in an animal body, perhaps directly or indirectly as a result of mating two
such especially endowed animals. While admittedly far-fetched to some individuals,
from a scientific point of view the possibility of this happening is less than remote
and requires critical consideration.
As a result of such issues, some scientists and scientific organizations such as the
National Academy of Sciences have developed stem cell research guidelines that
prohibit the breeding of animals that carry human stem cells. As a further measure,
some ethicists and scientific organizations would forbid the transplantation of human
stem cells into higher primates like chimpanzees to even further reduce any chance of
producing a humanized animal with human intelligence. Because animals that have
been “humanized” by stem-cell transplant techniques may offer excellent opportuni-
ties for testing new drugs and therapies, such research initiatives will continue to be
developed. Presumably, however, the more human content is present in such animals,

17 Mott M. Animal-Human Hybrids Spark Controversy. National Geographic News. January 25,

2005. Accessed from http://news.nationalgeographic.com/news/2005/01/0125_050125_chimeras.

html. See also the following account from 2013 by Jonathan Moreno entitled “Researchers
Put Human Brain Cells in Mice. Why Aren’t Conservatives Freaking Out?”, available online
at http://www.slate.com/blogs/future_tense/2013/03/15/why_aren_t_conservatives_upset_about_r
esearchers_putting_human_brain_cells.html.
18 See, for instance, http://www.ornl.gov/sci/techresources/Human_Genome/faq/compgen.shtml.
3.16 Human/Animal Chimeras 65

the more likely they are to be a useful model to study human diseases. There may
thus be a temptation to continue to add human material until the end result is more
human than animal, which of course brings all the problems of moral standing in its
wake.

3.17 Inserting New Genes in Existing Humans

If inserting human genes into animals is morally intriguing, the idea of inserting
new genes (perhaps animal genes) into humans is surely equally intriguing. Gene
therapy involves adding one or more genes to a person’s genome for some therapeutic
purpose, such as ensuring that an important enzyme is produced (Mammen et al.
2007).19 Viruses are sometimes used to transport the extra DNA into cells, a process
that is still experimental and, as described in Sect. 7.13, occasionally hazardous.
As gene therapy improves its safety profile and becomes better understood it is
envisioned that treatments will become available for a number of genetic afflictions.
Perhaps extra copies of some special genes might be added with a view to providing
extra strength, extra brain power, or whatever is associated with the special added
gene.
Consider the following (so far) hypothetical example. Humans possess somewhere
between 20,000 and 25,000 different genes. But if some individuals were to possess
multiple copies of a particularly desirable gene in their genome, the expected result
would be that more protein coded by the gene would get produced. In the case of
the protein coded for by the AQP7 gene, which functions as an important element in
transporting materials across the cell membrane, the protein allows water and glycerol
to enter the cell, where they are used to produce energy. It is thus speculated that
having multiple copies of the AQP7 gene might be valuable in endurance athletics
such as marathon running, when the body needs to mobilize energy molecules from
fat stores.

3.18 Human/Computer Hybrids and Neuroprostheses

For some time, futurists and science fiction writers have described how direct
computer-brain interfacing might be used for human enhancement. In fact, in recent
years significant advances in this general area have been made, with neuroprosthetic
developments such as cochlear implants for deaf individuals (Papsin and Gordon

19 An example would be a treatment for Cystic Fibrosis. This disease is caused by a defective gene
encoding a protein known as cystic fibrosis transmembrane conductance regulator (CFTR), and
is characterized by chronic lung infections and progressive lung damage that ultimately results in
early death (Lee and Southern 2013).
66 3 Humans, Transhumans and Humanoids

2007), spinal cord stimulators for the treatment of intractable pain (Kuchta et al.
2007), and deep brain stimulators for managing Parkinson’s disease (Starr et al.
1998).
In addition, research into retinal prostheses (Mokwa 2007), deep brain stimulation
for the treatment of depression (Larson 2008), and even for drug addiction treatment
via electrical stimulation of the nucleus accumbens(Van Kuyck et al. 2007) is taking
place. In particular, research into “neuro-chips” where living brain cells and silicon
circuits are coupled together shows special promise. It is hoped that this technol-
ogy will lead to the development of improved neural prostheses, allow scientists
to evaluate the in vitro effects of new drugs on neurons, and perhaps even lead to
hybrid computers that will operate using living neurons in conjunction with ordinary
silicon integrated circuits. Regardless, it is entirely reasonable to expect that these
technologies might be employed to enhance human capabilities rather than just treat
neurological disabilities and other clinical conditions.
The possibility that such technologies might also be employed for mind-control
purposes must also be considered (Delgado 1969). However, because these technolo-
gies have not been widely advocated as a means to enhance human capabilities, they
have stayed well under the “social radar”. Nevertheless, the ethical issues involved
with these technologies are not substantially different than those associated with the
enhancement of human capabilities by other means, such as by way of pharmaco-
logical efforts, by genetic manipulation, or by surgical intervention. In addition, just
because individuals with electronic neural prostheses are “partly electronic” should
not make them any less human; they would still pass the usual criteria for human-
ness, such as DNA makeup, the ability to reason, and so on. And because they meet
the usual criteria for humanness, they necessarily merit the moral standing given
to human persons. This includes non-derogable rights (the right to life, the right to
be free from slavery, the right to be free from torture and the right to be free from
retroactive application of penal laws) as well as other rights, such as freedom of
speech and freedom of movement. 20
Although it should be obvious that human persons enhanced by pharmacological
means, by genetic manipulation, by surgical intervention or by other means still
merit the moral standing deserving of all human persons, the issue becomes less
obvious when we consider the more radical idea of “artificial beings” who may have
a physical embodiment completely different from human beings, such as being made
mostly or even entirely of silicon circuitry. This is considered next.

20 The fact that many nation-states do not honor these rights in no way diminishes the fact that

human persons are morally deserving of a number of rights and freedoms; this fact merely points
to the moral corruption of certain nation-states. An additional issue concerns the debate between
scholars who advocate moral relativism and those who argue for moral universalism. The former
argue that human rights are culturally contingent social constructs while the latter hold that human
rights have always existed, and apply to all people regardless of ethnicity, race, culture, education,
sex, or religion.
3.19 Robots, Androids and Artificial Persons 67

3.19 Robots, Androids and Artificial Persons

As noted in the introduction to this book, for many decades, science fiction writers
have written stories about sentient computers, about intelligent robots serving humans
as companions, about cyborgs made from a blend of human and machine parts, and
about fully organic humanoids who were not at all human in any traditional sense. As
today’s scientists draw on developments in computer technology, robotics, artificial
intelligence, molecular neuroscience, nanotechnology, and other emerging fields it
is reasonable to expect that some of these notions will gradually move from science
fiction towards scientific reality. There are already quite a few examples that could
be cited to support such a trend.
One ongoing scientific effort on the fringes of science and engineering is to
attempt to create sentient artificial beings embedded with consciousness. One partic-
ularly interesting philosophical issue in this context is whether a sufficiently complex
machine might ever become self-aware. Most people agree that the “seat” of con-
sciousness lies in the brain. And virtually all neuroscientists attempt to explain the
workings of the brain as if the brain were a machine, albeit very possibly the most
complex machine in existence.21 But if the brain is just a conscious machine gov-
erned by physical laws, could it not be possible, at least in principle, to construct a
computer that is conscious just like a biological brain. Wooldridge (1968) expresses
this point as follows:
… all intelligence whether of computer or brain, is a natural consequence of the powerful
symbol-manipulating capabilities of complex switching networks and therefore the ordinary
laws of the physical scientist are adequate to account for all aspects of what we consider to
be intelligent behavior.

Wooldridge (1968) also takes the position that consciousness is determined by

physics:
The content of consciousness, as well as its presence or absence, is determined in detail by
the physical structure and electrochemical state of the material of the brain.

He later elaborates on this issue (p. 159):

The nonscientist may feel that there is something unnatural about the suggestion that con-
sciousness may be suitable for absorption into the subject matter of physics. It may even
seem to him that even if the lawful relations between the content of consciousness and the
physical state of matter are eventually established, this will not really explain consciousness;
we still don’t know what it is or where it comes from. And this is true - nothing yet proposed
provides any hope of explaining consciousness in any fundamental way. Further, it is safe to
predict that no such explanation will ever be discovered. But precisely the same statement
could be made about mass, electricity, or gravity.

21 Note that some thinkers suppose the computer model to be a poor fit to understand human

consciousness. In his 1989 book The Emperor’s New Mind, Roger Penrose speculated that quantum
mechanical processes inside individual neurons gave humans special cognitive advantages over
machines. Hubert Dreyfus has argued that human intelligence and expertise depends primarily on
unconscious instincts rather than conscious symbolic manipulation, and that these unconscious skills
cannot be captured as formal (algorithmic) rules employed by contemporary computers (Dreyfus
1979, 1986, 1992).
68 3 Humans, Transhumans and Humanoids

Arguably, the question as to whether machines can ever be conscious may be

related to the question whether consciousness in the brain is active or passive. A
passive consciousness is one which, while possibly arising as a natural consequence
of a particular structural organization, nevertheless does not causally influence any
material entities (such as neurons). Rather, it is a passive bystander, a result, rather
than a cause. By contrast, an active consciousness is one which can actively “will”
events, one which can be an initiating cause in a sequence of neuronal events. The
active consciousness position views consciousness as an actual causal agent, one
which allows for free will.
Although most neuroscientists do not write about consciousness issues explic-
itly, they most certainly marvel over the mystery of consciousness. However, most
adopt the position that consciousness is passive in nature, implicitly allowing for
the scientific investigation of behavior and intelligence without any consideration of
consciousness. Simply put, while physical processes in the brain are held to exert
considerable influence over consciousness, the passive consciousness position holds
that consciousness does not exercise influence over physical activities within the
brain. This is related to the position of “Strong AI”, discussed next. Free will is not
held to exist in such a setting.
Regardless of this issue, since the physical basis of consciousness is not yet
understood except possibly in the broadest of strokes, many scientists regard the
goal of producing an artificial sentient being as unachievable in the near future, if at
all. Indeed, some philosophers such as McGinn, in his 1999 book The Mysterious
Flame: Conscious Minds in a Material World, regard the problem of consciousness
to be too intractable for the best of ordinary human brains to solve, just as a cat
surely does not have the cognitive capacity to solve even the simplest of quadratic
equations. Other thinkers, like Roger Penrose are cautiously optimistic. In his book
Shadows of the Mind (Penrose 1996) Penrose outlines four potential positions about
the possible neurocomputational basis of consciousness:
Viewpoint A All thinking is computation; feelings of conscious awareness are
evoked merely by the carrying out of appropriate computations on the
appropriate physical substrate. (This is known as the “Strong Artifi-
cial Intelligence (AI)” position).
Viewpoint B Awareness is a feature of the brain’s physical action; and whereas
any physical action can be simulated computationally, computational
simulation cannot by itself evoke awareness. (This is known as the
“Weak AI” (Soft AI) position).
Viewpoint C Appropriate physical action of the brain evokes awareness but this
physical action cannot be properly simulated computationally. (This
is Penrose’s personal position).
Viewpoint D Awareness cannot be explained by physical, computational, or any
other scientific terms. (This is similar to McGinn’s “mysterian” posi-
tion, although McGinn readily acknowledges that minds greater in
capability than those possessed by humankind might, at least in prin-
3.19 Robots, Androids and Artificial Persons 69

ciple, eventually be able to come to understand consciousness and

self-awareness in purely scientific terms).
Penrose argues that “we must look beyond the reaches of known sciences if
we are ever to find any kind of explanation of the phenomenon of consciousness”
(p. 16). According to him, the problem of conscious awareness is a scientific one
(not mystical, as in Viewpoint D), even if the appropriate science is not yet at hand.
He also allows for graduations between A, B, C, and D. In his earlier book The
Emperor’s New Mind (Penrose 1989) he articulates a position opposite to strong
AI by arguing that “there must be an essentially non-algorithmic ingredient in the
action of consciousness” and has even gone so far as to speculate that the microtubular
structures present in neurons may be important in understanding the physical basis
for consciousness.22
The above concerns notwithstanding, it is interesting to ask two questions. First,
if one were able to produce a conscious artificial being, what tests might one deploy
to establish that the new entity is indeed self-aware? And secondly, to what extent
should such entities be deserving of moral standing and personhood? That is, what are
the philosophical and bioethical consequences of possible future technologies that
would be capable of conjuring self-aware beings? These questions are addressed
next.

3.20 Consciousness, Artificial Beings and the Turing Test

If we were able to produce a conscious artificial being, what tests might we deploy
to establish that the new entity is indeed self-aware? This question is a variant of the
well-known “Other Minds Problem”, which may be briefly summarized as follows:
given that I can only observe the behavior of others and am not granted privileged
access to their minds to directly experience their mental events, how can I truly
know that any other beings have minds? The problem here is that mere observation
of behavior, no matter how sophisticated and complex, does not allow one to infer
with complete and absolute certainty that there are mental events associated with this
behavior. Some extreme skeptics argue, for instance, that it may actually be the case
that all the other people in the universe are in fact unconscious biological automata
(“zombies” in the technical parlance used by a number of neurophilosophers). Argu-
ing in this manner that there exist no minds other than one’s own and that attempting

22 Like McGinn, I am not so confident that we will ever find out what causes consciousness to

emerge from mere neurons. I expect that in real scientific life, identifying the neuro-computational
structures which support conscious existence may be impossible because of overwhelming technical
problems related to the complexity of the brain. That is, it might be possible to propose completely
accurate brain models without being able to actually do a full test (which might require in vivo
brain recordings, for instance). Cosmology has a similar problem with cosmological models such
as black holes and baby universes. And, finally, there is even a distant connection of this problem to
Godel’s Theorem, which tells us that there exist true mathematical statements that cannot be proven
to be true.
70 3 Humans, Transhumans and Humanoids

to establish the existence of other minds is futile is a position known as “solipsism”,

a position first espoused by the Greek presocratic sophist, Gorgias (c. 483–375 BC).
In the field of Artificial Intelligence (AI) one occasionally offered approach to
this problem is the “Turing Test”, which may be explained informally as follows. A
human judge converses with one human and one computer (or other machine), each of
which does its best to appear human. The conversation can be via text communication
(for instance via SMS messaging) or by audio, and all participants are isolated from
one another to prevent visual cues. If the judge cannot tell the machine from the
human, the machine is said to have passed the Turing Test of machine intelligence.
The Turing Test was introduced by Alan Turing in his famous 1950 paper, “Com-
puting Machinery and Intelligence” (French 2000; Turing 1950) and over the follow-
ing decades it has turned out to be both extremely influential as well as extensively
criticized. In 1991 Dr. Hugh Loebner started the annual Loebner Prize competition,
offering a prize of US $100,000 and a Gold Medal to the author of the first computer
program to pass an unrestricted Turing Test. To date, no computer system has passed.
To encourage ongoing efforts, however, each year an annual prize of US $2000 and
a bronze medal is awarded to the best effort achieved to date.23
It is worth emphasizing that Turing offered his test as an operational means to
establish whether a machine could “think”. Specifically, his introductory remarks in
the paper begin as follows:
I propose to consider the question, “Can machines think?” This should begin with definitions
of the meaning of the terms “machine” and “think”. The definitions might be framed so as
to reflect so far as possible the normal use of the words, but this attitude is dangerous. If the
meaning of the words “machine” and “think” are to be found by examining how they are
commonly used it is difficult to escape the conclusion that the meaning and the answer to
the question, “Can machines think?” is to be sought in a statistical survey such as a Gallup
poll. But this is absurd. Instead of attempting such a definition I shall replace the question
by another, which is closely related to it and is expressed in relatively unambiguous words.

As noted earlier, a number of criticisms of the Turing Test have been raised over
time. For instance, it is sometimes said to be more a test of a machine’s ability
to imitate a human being than a test of thinking ability. Another criticism that is
sometimes offered is that even if the Turing Test is a test for thinking, this does not
necessarily imply that it is a test for consciousness. For a full discussion of this topic,
the interested reader is referred to an excellent review by French (2000).
To conclude, while the Turing Test has been offered as a means to consider the
question, “Can machines think?”, even if it is accepted as a satisfactory test for
thinking (despite objections that it is better understood as a test of ability in imitating
a human being), it does not follow that the Turing Test is a test for sentience or
consciousness, a property necessary to being granted moral standing. Discussion on
this matter continues below.

23 For
the computer enthusiast considering entering the contest, full details are available at http://
www.loebner.net/Prizef/loebner-prize.html. In addition, the transcripts for the 2009 bronze medal
winner may be reviewed at http://www.worldsbestchatbot.com/Competition_Transcripts.
3.21 Artificial Beings and Moral Standing 71

3.21 Artificial Beings and Moral Standing

Earlier, we asked the question as to the extent to which sentient artificial beings are
deserving of moral standing and personhood. Although in the previous section it
was made clear that there is no means to establish with absolute certainty that any
putative sentient artificial being is in fact sentient, it is reasonable to consider the
issues of moral standing and personhood in such beings nonetheless. After all, the
“Other Minds Problem” is also applicable to everyday humans and to many advanced
species of animals, yet this fact is evidently not an impediment to our considering
the issues of moral standing and personhood in these beings.
What then should be our approach? I would propose that an elaboration of the
Hughes classification of consciousness and rights provided in Table 3.1 (see Sect. 3.3)
be used for just such a purpose. Simply put, any artificial being (robot, cyborg,
humanoid, computer etc.) would be classified as to consciousness and rights based
upon its behavior and its properties just as humans, animals, embryos and plants are
classified in the Hughes classification. I suspect, however, given the likely difficulties
of constructing sentient artificial beings, that it will be quite some time before this
issue arises in the real world of practical ethics.

3.22 Moral Robots and Robot Ethics

An interesting issue that has arisen among robotics experts in recent years is the
possibility of the development of autonomous robots that are programmed with a set
of rules regarding their moral behavior. Such a development raises the interesting
issue whether moral behavior is a trait unique to humans.24
Two examples from the military arena come to mind. Autonomous robots are
now entering the theater of war, at least at the conceptual level. Such robots might
seek and destroy enemy fortifications and enemy personnel, either operating on the
ground or even from the air (perhaps in the form of a small armed helicopter equipped
with a video camera and other sensors). The hope among some thinkers is that such
“autonomous armed robotic platforms” (as the roboticists like to call such units)
will reduce noncombatant casualties and other forms of collateral damage by their
unswerving ability to adhere to the “Laws of War” better than even the best trained
human combatants. Of course, one can also envision potentially serious problems
with such an arrangement, such as problems related to programming errors, ambigu-
ous operational specifications or limitations in the robot’s computational power. This
is why complex systems such as modern aircraft and nuclear reactors are always
designed to allow human “overrides” in their automatic operation.

24 A related issue concerns moral behavior in higher animals such as the Great Apes. For an inter-
esting discussion on this topic visit http://www.youtube.com/watch?v=GcJxRqTs5nk.
72 3 Humans, Transhumans and Humanoids

These robots would initially be programmed with a series of specific rules of

engagement that might eventually be expanded into a more comprehensive set of
guiding principles intended to provide guidance for unanticipated novel situations
not covered by a more restricted set of military rules of engagement. In the latter
situation, however, the question naturally arises as to which set of guiding principles
might be adopted for this purpose.
One might imagine a number of possibilities how such robots might operate. For
instance, such robots might have rules not to engage in combat with individuals
under a specific height (to avoid harming children), individuals waving a white flag,
individuals standing with their arms raised high in the air, or individuals lying prone
on the ground with their hands clasped together on their head. Such robots would
also be expected to have the means to recognize friendly personnel in the theater of
operations, perhaps on the basis of their distinctive uniform or (more reliably) on the
basis of an implanted RFID chip that, when interrogated, would respond with a code
identifying them as friendly combatants.
A potentially less sinister version of the battlefield combat robot would be a
battlefield medic robot that would assist in the extrication of injured soldiers from
the battlefield. Like human medics operating in a theater of war, such robots would be
armed to defend the patient they are rescuing from the battlefield in order to transport
them to a nearby field hospital.
Central to all these scenarios, however, is a set of guiding principles. Thinkers such
as Ronald Arkin have proposed that the rules of the 1949 Geneva Convention would
be a reasonable starting point for such an initiative.25 Such rules include principles
such as the use of proportionality of force in a conflict, avoiding unnecessary damage
to property and noncombatants, the humane treatment of prisoners of war, respectful
treatment of corpses, the strict avoidance of torture, and so on.

3.23 Conclusion

In conclusion, developments in fields such as of genetic engineering, neurologi-

cal technology, artificial intelligence and robotics have forced a reexamination of
some basic philosophical problems, such as determining what nonhuman and future
parahuman entities are deserving of moral standing and by which criteria. An impor-
tant consequence of this reexamination was to establish that various degrees of moral
standing are due to nonhuman and future parahuman entities on the basis of their
cognitive capacities and their ability to experience suffering. These developments
have also greatly influenced the growth of the transhumanist movement, as ideas that
were once solidly in the realm of science fiction now emerge from laboratories and
clinics around the world.

25 Ronald C. Arkin, Governing Lethal Behavior: Embedding Ethics in a Hybrid Delibera-

tive/Reactive Robot Architecture. Undated Technical Report GIT-GVU-07-11 http://www.cc.gat

ech.edu/ai/robot-lab/online-publications/formalizationv35.pdf.
3.23 Conclusion 73

In the next chapter we address these issues from an additional perspective, that
of altering the central nervous system by pharmacological means and by electrical
brain stimulation with a view to changing the conditions under which humans live
their lives.
Chapter 4
Pharmacologic Enhancement
of the Human Condition: Possibilities
and Perils

… there is always soma, delicious soma, half a gramme for a

half -holiday, a gramme for a week-end, two grammes for a trip
to the gorgeous East, three for a dark eternity on the moon…

Aldous Huxley, Brave New World

Abstract This chapter is concerned with the technical, safety and bioethical
issues associated with human pharmacologic enhancement. Although neuroscien-
tific advances are now providing valuable treatments for patients with neurological
diseases, many of these treatments may also be applied to “normal” individuals free of
disease as a means of achieving “quality of life” improvements, an enterprise some-
times called “cosmetic neurology”. Although such enhancements might variously
make one happier, more serene, more intelligent, better at mental arithmetic, more
personable, and so on, they also raise an important philosophical question—could
such interventions lead to a mind-blunting effect that would diminish one’s capac-
ity to appreciate life in all its dimensions, making us “unauthentic” humans living
a banal, anesthetized existence as uncritical participants in the affairs of the world?

Although the term “human condition” is used in widely different ways by various authors, I use
the term here to describe the unique joys and challenges of being human, i.e., to describe the
constellation of features of humanity that are innate to humans independent of factors such as
race, culture or social class. Core issues related to the human condition include the search for the
meaning of life, an awareness of the inevitability that life will end, a quest for purpose, gratification
and self-actualization, and a host of other issues of a philosophical or psychological nature.

© Springer Nature Switzerland AG 2018 75

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_4
76 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

4.1 Introduction

As we learn more and more about the brain and how it works, and especially how the
brain’s varied receptors and pathways are affected by different classes of pharmaceu-
tical agents, a new age of possibility looms on the horizon. In a mere few decades,
continuing advances in the neurosciences will likely come to offer us humans the
prospect of safely enjoying a “mood optimized” synthetic existence—an artificial
paradise, so to speak—made possible through recent and future advances in neu-
ropharmacology. Such advances may—at least in theory—allow discontented indi-
viduals (or even completely normal people) to be pharmacologically liberated from a
good number of the negative aspects of the human condition, but—and again, at least
in theory—without the many destructive effects of many of today’s mood-altering
drugs.
Of course, neuropharmacologic enhancement naturally raises specific questions
in the context of what it means to be human, although these questions are arguably
not substantially different from other potential forms of human enhancement, such
as enhancement by way of computer-based neural prostheses, or even by means
of manipulating the body’s genetic machinery to produce a more favorable gene
expression profile. One central question here is this: “To what extent, if any, do
enhancement techniques of this kind change our humanness?” This question raises
the related question, “What does it mean to be human?”, which is, of course, a central
theme of this work.
Additionally, I would like to initiate a dialog on two other questions related to the
possibilities of neuropharmacologic enhancement: “What might be the anticipated
social effects of neuropharmacologic enhancement?” and “Even if such enhancement
might be realized without social or personal detriment, should we partake?” Later in
the chapter I propose that the while the anticipated social effects of neuropharma-
cologic enhancement might well be “improved personal and social harmony”, the
question as to whether we should partake raises important philosophical concerns
about the implicit valuation of always feeling ‘happy’ at the expense of what might
be considered more authentically human emotions.1

4.2 Might Pharmacological Interventions Help Humanity?

Let us begin by taking a look at some recent developments in pharmacology. To start,

it would be prudent to remember the many people whose lives have been totally ruined
by drugs. Drugs like methamphetamine (“crystal meth”), cocaine, and heroin, and
even prescription drugs like Oxycontin, have at times devastated the social fabric of

1 This question is itself a philosophically problematic issue, of course—who determines the dividing

line between what is “authentic” and what is “inauthentic”, and based on to what criteria?
4.2 Might Pharmacological Interventions Help Humanity? 77

entire neighborhoods,2 with enormous social costs (Mosher and Yanagisako 1991;
Drucker 1999; Hall and Lynskey 2009; Elliott 2004).3
On the other hand, a great many drugs have highly desirable clinical properties:
antibiotics that cure pneumonia or meningitis, anticancer drugs that melt away malig-
nant tumors, or anesthetic drugs that make modern surgery possible. These drugs are
all given for clear clinical purposes.
Complicating this dichotomy, however, is the fact that pharmacologists are now
working on developing new drugs that might be best classified as being “cosmetic” in
nature (Cakic 2009; Lynch and Gall 2006; Normann and Berger 2008; Morris 2008;
Lanni et al. 2008). These drugs would not necessarily be given to treat a specific patho-
logical condition like narcolepsy, epilepsy or Alzheimer’s disease (although some of
these new drugs would indeed help in such conditions), but instead would be given
to “normal” individuals lacking any pathological condition or disease. Such drugs
would be given with a view to providing a competitive advantage or other enhance-
ment, such as improving one’s memory, augmenting a person’s mental agility, or
making them more sociable.
Other drugs in early development are expected to provide mood enhancement
or even actual euphoria in normal people, but (hopefully) without the addictive or
destructive properties of older generation “recreational” drugs. As an example, as
the neurochemical correlates of romantic love are slowly being unraveled, it may
ultimately be possible to provide a similar mental state by pure pharmacologic means
(Debiec 2007; Marazziti et al. 1999; Zeki 2007).
In Peter D. Kramer’s book, Listening to Prozac, (Kramer 1993) the author suggests
that Prozac (fluoxetine) is a drug that can provide enhanced peace and contentment to
psychologically normal individuals who wish to favorably change their personality
to one that is more socially rewarded. Thus a psychologically normal but melancholic
individual might take Prozac to become more socially engaging or to develop more
self-confidence. Kramer calls this “cosmetic pharmacology”—the controlled use of
psychoactive medications by psychologically normal individuals for the purpose of
psychological enhancement rather than treating any identifiable pathological state.
Other individuals have called this exciting new field of study “cosmetic neurology”
(Chatterjee 2004).
Kramer compares cosmetic pharmacology to cosmetic surgery—the exact same
clinical intervention can be therapeutic (as in a rhinoplasty procedure to fix a nasal

2 For a poignant account of how crack cocaine destroyed a Boston neighborhood

see http://www.boston.com/news/local/massachusetts/articles/2011/04/10/boston_neighborhood_r
ecalls_devastation_of_crack/. Even better, read the 1997 book, The Corner: A Year in the Life of
an Inner-City Neighborhood written by Baltimore Sun reporter David Simon and former Balti-
more homicide detective Ed Burns. For a more recent (2013) report on the drug-related devastation
in some Mexican neighborhoods, the interested reader is directed to a report published by The
Economist: http://www.economist.com/blogs/americasview/2013/06/violent-crime-mexico.
3 Drucker (1999) notes that in the USA the period 1979–1996 saw a tenfold increase in imprisonment

for drug charges. In 1999, USA “drug enforcement activities constituted 67% of the $16 billion
Federal drug budget and more than $20 billion per year in state and local enforcement expenditures,
compared with $7.6 billion for treatment, prevention, and research”.
78 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

obstruction that makes breathing difficult) or cosmetic (as in a rhinoplasty to “fix”

an ugly nose that nevertheless is perfectly adequate for its intended physiological
purpose).
For a variety of reasons, it is possible that in some countries any future “cosmetic
drugs” might require a prescription, even if their safety was well-established. For
example, in the USA a great many drugs that are available without prescription
elsewhere in the world (because of their well-established safety record) nevertheless
require a prescription in the USA. One interesting consequence of this is that, in a
way, it may end up putting physicians in the unusual role of being a gatekeeper to
a satisfying and happy life for psychologically normal individuals. This would be
a rather significant change in the usual role of the physician. Additional possible
concerns are the likelihood of an illegal market for these drugs (and the need for
police action to deal with this problem) as well as demands by the populace that the
drugs be made available without prescription, especially if their safety profile proved
to be exemplary.
A number of companies are already hard at work developing a variety of other
drugs to enhance the human condition. RespireRx Pharmaceuticals Inc. (formerly
Cortex Pharmaceuticals, Inc.) is investigating a class of compounds called AMPA
receptor modulators, which enhance the glutamate-based transmission between neu-
rons (Ward et al. 2010). Memory Pharmaceuticals, now acquired by Roche and co-
founded by Nobel laureate Eric Kandel, is working on an investigational drug called
MEM 1003, “an L-type calcium channel modulator”, for the treatment of Alzheimer’s
disease (Rose et al. 2007). Another company, Targacept (now merged with Catalyst
Biosciences), is hoping that drugs acting on neuronal nicotinic receptors will lead
them to riches and fame (Bencherif and Lippiello 2010). As basic research continues
to yield dividends into the understanding of the brain’s chemistry, there is little doubt
that more intriguing pharmaceutical developments are in our future.
It is not as if researchers are deliberately searching for drugs that might be
useful in normal individuals. Rather, the cognitive enhancing properties of these
drugs are being discovered serendipitously in research on neurological diseases
such as epilepsy, dementia and narcolepsy. As an example, studies in laboratory
rats (Goldstein and Davis 1990) and preliminary studies in humans (Aichner et al.
2002) suggest that small doses of amphetamines may be able to help stroke patients
undergoing physical therapy to relearn motor skills like tying shoes, buttoning
shirts, and using utensils, since it seems to promote neuroplasticity, the process
whereby the brain forms new synaptic connections or strengthens existing ones.
Although the value of amphetamines in this setting is a matter of some dispute
(Walker-Batson et al. 2001), there appears to be little doubt that some approaches
to brain enhancement are likely to be spectacularly successful in the long-run.
Such observations make one wonder whether or not the day may come when
healthy individuals will take an amphetamine tablet before a golf lesson, knowing that
it may enhance the neuronal rewiring that underlies a perfect golf swing, or whether
the day will come that surgeons in training will use similar neuropharmacologic tricks
to help master the art of constructing the perfect vascular anastamosis. Consider the
following examples.
4.2 Might Pharmacological Interventions Help Humanity? 79

Scenario One: Movement Enhancement

Consider that future pharmacologic or even surgical interventions might result in

higher performance in conducting gross and fine motor skills. While such interven-
tions might be considered to be unethical for professional athletes or even profes-
sional musicians (perhaps by virtue of arguments about an unfair advantage being
present), fewer individuals would be expected to object to surgeons improving their
psychomotor skills so that complex and risky operations can be completed with
greater skill and less morbidity and mortality.

Scenario Two: Creativity Enhancement

The question as to whether drugs might be successfully used as a means to enhance

creativity has been debated for some time. Samuel Taylor Coleridge (1772–1834)
likely wrote his famous poem Kubla Khan under the influence of an opium dream.4
Marijuana was publicly used by Jazz musicians in the 1920s before it became illegal.
And, as we discuss later, the famous mathematician Paul Erdös used the drug Ben-
zedrine as a cognitive energizer when tackling unsolved problems in mathematics.

Scenario Three: Performance Enhancement in Emergencies

Research suggests that pilots may perform complex tasks better in simulated emer-
gencies when they take donepezil, a drug normally used to treat dementia (Yesavage
et al. 2002). Donepezil, an acetylcholinesterase inhibitor, acts by decreasing the
activity of acetylcholinesterase, the enzyme which breaks down acetylcholine into
choline and acetyl-CoA. By reducing the breakdown of acetylcholine, an increase in
the level of brain acetylcholine occurs.
Similarly, Caldwell et al. (2003) reviewed the use of dextroamphetamine
(Dexedrine® ) as a fatigue countermeasure for use in sleep-deprived military pilots.
Their review showed it to be “effective for maintaining flight skills, psychologi-
cal mood, and physiological activation” (as measured via electroencephalography).
Of special importance, the benefits of the drug were not offset by marked disrup-
tions in recovery sleep, although sleep was lighter for several hours following drug
administration. The authors concluded that dextroamphetamine “is a viable remedy
for fatigue in aviation sustained operations”, although “not a substitute for proper
crew-rest scheduling because there is no replacement for adequate restful sleep”.
Such findings raise the issue whether pilots might occasionally be expected (or
even required) to take performance enhancing medications, especially in war time
or in the setting of a national disaster.

4 Although Kubla Khan was apparently written under the influence of opium, the degree to which
he experimented with the drug as a creative enhancement remains unclear. Although Coleridge kept
his opium addiction as hidden as possible, it became public knowledge with the 1822 publication
of Confessions of an English Opium Eater by his friend Thomas de Quincey.
80 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

4.3 Some Pharmacophilosophical Questions

The future possibilities discussed above, even if implemented with perfect safety,
raise interesting ethical, legal and social questions (Dees 2004). In the case of drugs
that enhance a person’s mental agility, should such drugs be forbidden when writing
university entrance examinations or competing in a chess tournament? What about a
mediocre scientist who uses performance enhancing drugs to become a great scientist
as a result of enhanced mental skills? This latter idea is not quite as absurd as it might
seem to some individuals. As mentioned earlier, the famous mathematician Paul
Erdös (1913–1996), did almost all of his highly acclaimed work under the influence of
Benzedrine, an early member of the amphetamine family. Or consider the following
description of a writer who experimented with Adderall, another amphetamine5 :
As an experiment, I decided to take Adderall for a week. The results were miraculous. On
a recent Tuesday, after whipping my brother in two out of three games of ping pong — a
triumph that has occurred exactly once before in the history of our rivalry — I proceeded to
best my previous high score by almost 10 percent in the online anagrams game that has been
my recent procrastination tool of choice. Then I sat down and read 175 pages of Stephen
Jay Gould’s impenetrably dense book The Structure of Evolutionary Theory. It was like
I’d been bitten by a radioactive spider.

Of course, Adderall, being an amphetamine, is a potentially dangerous drug,

although not so much as methamphetamine, which continues to cause wholesale
devastation in some regions of the world (Buxton and Dove 2008).6 I would also
remind the reader that in many countries it is a felony to possess Adderall with-
out a prescription. In fact, in the USA selling and distributing Adderall is a felony
punishable by a $10,000 fine or a prison term up to 45 years.7
But what if a drug were produced that was like Adderall, with all the beneficial
effects described above, but without any deleterious or negative consequences? Many
would view such a development as positive. For instance, the Dalai Lama, referring
to a method of deep brain stimulation in a talk delivered to the Society for Neuro-
science Congress in November 2005, stated: “If it was possible to become free of
negative emotions by a riskless implementation of an electrode—without impairing
intelligence and the critical mind—I would be the first patient”.
The US Declaration of Independence contains the famous words: “We hold these
truths to be self-evident, that all men are created equal, that they are endowed by
their Creator with certain unalienable Rights, that among these are Life, Liberty and

5 http://www.slate.com/articles/health_and_science/medical_examiner/2005/05/the_adderall_me.

html.
6 Buxton and Dove (2008) state that “nearly 25 million people worldwide are estimated to have used

amphetamine and methamphetamine in the past 12 months” and note that “crystal meth is more
likely to cause dependence than other forms of methamphetamine”.
7 Dolce N. Adderall use increases, doctors warn of consequences. The Daily Orange. March 7, 2010.

Accessed from http://www.dailyorange.com/2.8656/adderall-use-increases-doctors-warn-of-conse

quences-1.1249380.
4.3 Some Pharmacophilosophical Questions 81

the pursuit of Happiness”. Surely these words should serve to reinforce the words of
the Dalai Lama in American minds.8
It is likely that there are a large number of individuals who, despite having no signs
of psychopathology, would benefit from safe pharmacological enhancement of their
life using drugs likely to be developed in the not-too-distant future. These would not
be drugs that are intoxicating or that produce a “high”, but rather drugs that would
simply make life more pleasant and meaningful. They would be ‘happy’ pills. And as
the US Declaration of Independence appears to tell us, happiness or ‘flourishing’ is a
legitimate life aspiration. However, might not the pursuit of happiness by completely
artificial means be fraught with potential difficulties?
One concern about the notion of the pharmacological enhancement of mood,
human performance and the like is that it could ultimately (at least hypothetically)
lead to unsatisfactory or undesirable outcomes even if found to be biologically safe.
Consider a neurochemical agent or other intervention that would bring on the feelings
of joy, contentment and romantic love that are so often experienced in newly-wed
couples (Bartels and Zeki 2000, 2004). Might chronic use of these or similar agents
of happiness produce undesirable permanent brain alterations the way that some
currently employed recreational drugs do (Clemens et al. 2004, 2005; Melega et al.
2008; Krasnova et al. 2010)? Or could it just be that the negative aspects actually
turn out to be small relative to the benefits, at least in some cases? Such questions
cannot be definitively answered at this time, and will remain unanswered until our
understanding of neuropharmacology is vastly improved.
Consider the example of clinical anesthesia. In the story of the human conquest
over pain, clinicians had to deal with naysayers who objected to using anesthesia for
surgery and childbirth (Farr 1980; Swanson 2005). Some individuals even postulate a
spiritual or moral value to suffering, claiming that it ennobles them, opening them to
new avenues of beauty and splendor and better permitting them to embrace God (Ellis
2002; Carnevale 2009).9 Might objections to the safe pharmacological enhancement
of mood eventually be viewed to be as misguided as early objections against the safe
relief of pain and suffering by anesthetic drugs?
Finally, as mentioned earlier, one should consider the judgment implicit in being
in a state of perpetual contentment and happiness at the expense of what might be
“authentic” human emotions. This last issue is discussed in Sect. 4.7.

8 Note that the phrase “the pursuit of happiness”, while often taken to have hedonistic overtones in
contemporary parlance, meant something more akin to “the exercise of flourishing” in the language
of the time (1776).
9 On this matter, W. Somerset Maugham wrote: “I knew that suffering did not ennoble; it degraded.

It made people selfish, mean, petty, and suspicious. It absorbed them in small things. It did not make
them more than human beings; it made them less…” Quote in Phillips D. Z. The Problem of Evil,
in Reason and Religion, ed. Brown S. C., London: Cornell University Press, 1977, p. 114.
82 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

4.4 Imagining a World Without Negative Emotions

Consider for a moment what a world without negative emotions would be like.
Imagine a world without hate, anger, resentment, and hostility. Arguably, one possible
result would be improved social harmony. Perhaps there would be more stable family
units, maybe even less conflict and war.10
In the past in a number of “primitive” cultures, marijuana, psilocybin and other
drugs played an important role in community life (Nencini 2002). For instance,
according to the Dominican friar Diego Durán in his book The History of the Indies
of New Spain (published c. 1581), hallucinogenic mushrooms were eaten in festivities
celebrating the occasion of the accession to the throne of Aztec emperor Moctezuma
II in 1502. Similarly, mescaline (in the form of peyote) has been used for millennia
by Native Americans in Mexico.
One important goal of ingesting these drugs was to induce a religious or spiritual
experience that extended beyond normal perception and served to bring social healing
and community harmony (Nencini and Grant 2010). For example, Aldous Huxley’s
1954 book, The Doors of Perception describes the use of cactus peyote, a psychedelic
drug which has been used in American and Mexican Indian religious ceremonies for
thousands of years (Huxley 1954).
Similarly, in his 1902 classic book The Varieties of Religious Experience, William
James suggests that there may be a neurological (and ultimately neurochemical) basis
for spiritual experience and religious belief. A century later, this notion has devel-
oped into the new academic discipline of neurotheology, the study of correlations
of neural phenomena (both natural and pathological) with subjective experiences of
religiosity and spirituality.11 (Related to this is a similar quest to understand the brain
mechanisms underlying moral or ethical decision making, a field sometimes known
as “neuroethics”).
Consider the words of Devinsky and Lai (2008) writing on the neurobiology of
spirituality and religion in patients with temporal lobe epilepsy:
Neocortical areas also may be involved, suggested by the presence of visual and auditory
hallucinations, complex ideation during many religious experiences, and the large expanse
of temporal neocortex. In contrast to the role of the temporal lobe in evoking religious
experiences, alterations in frontal functions may contribute to increased religious interests as
a personality trait. The two main forms of religious experience, the ongoing belief pattern and
set of convictions (the religion of the everyday man) versus the ecstatic religious experience,
may be predominantly localized to the frontal and temporal regions, respectively, of the right
hemisphere.

10 This may be more a psychoneurological question than a philosophical one, given that the study

of the underpinnings of human emotions is a field of active scientific research. For instance, the
journal Emotion (http://www.apa.org/journals/emo/) is only one of a number of scholarly journals
dealing with the scientific study of emotion.
11 Neurotheology has potential philosophical implications for addressing the mind-body problem.

For example, atheists who subscribe to a materialist conception of mind may argue for a mechanistic
understanding of religious experiences to support arguments that religious belief is a mere artifact
of brain function.
4.4 Imagining a World Without Negative Emotions 83

In a similar manner, Muramoto, a clinical neurologist with a long-standing inter-

est in religion, has hypothesized that the medial prefrontal cortex is important in
understanding human religious activity at the neuronal level (Muramoto 2004). He
writes that under this hypothesis “optimal functions of the medial prefrontal cor-
tex, such as error detection, compliance to social norms, self-reflection, and theory
of mind, are a key prerequisite to the maintenance of integrated religious activity”
and further suggests that hyperreligiosity may be the result of “hyperfunction of the
medial prefrontal cortex”. For further discussion on this fascinating topic, a recent
review by Kapogiannis et al. (2009) is recommended.
Although increasing community religiosity and spirituality by pharmacologi-
cal means might conceivably lead to improved social harmony, it is interesting
to explore whether pharmacological approaches might lead to social harmony by
means independent of an effect on religiosity and spirituality. Might drugs eventu-
ally become available that will increase human compassion and empathy? The recre-
ational drug 3,4-methylenedi-oxymethamphetamine (MDMA, ecstasy, “hug drug”)
is well-known to increase empathy in those who consume it (Pham and Puzantian
2001). Unfortunately, developing evidence that the drug is neurotoxic with chronic
use (as a result of serotonin depletion leading to subtle cognitive and memory impair-
ment) suggests that its ultimate role may be only as a stepping stone in an effort to
produce a safer drug with similar effects (Gouzoulis-Mayfrank and Daumann 2006).
In a similar vein, it might be expected that drugs that reduce aggression in humans
would also contribute to social harmony. For example, some antiepileptic drugs may
reduce aggression in individuals exhibiting neuronal hyper-excitability mediated
aggressive behavior (Huband et al. 2010). Other studies suggest that SSRI drugs like
Prozac may help control aggressive or violent behavior. In a canine study, fluoxetine
(Prozac) was found to be effective in managing dominance aggression(Dodman et al.
1996) Similar results have been found in studies of male lizards (Anolis carolinensis)
(Deckel 1996).
In humans and in animals, low levels of brain serotonin have been associated with
a propensity to impulsive behavior and aggression (Ferris 1996; Haller and Kruk
2006; De Boer et al. 2009). In addition, a number of studies have demonstrated a
solid link between testosterone and aggression (Archer 1991, 2006; Olweus et al.
1988), suggesting that drugs that block the effect of testosterone in the brain might be
useful as a means to pacify some aggressive individuals. Finally, and perhaps most
importantly, there is increasing scientific evidence that the neurochemicals oxytocin
and vasopressin can favorably influence social behavior and social cognition (Insel
1997, 2010; Carter and Altemus 1997; Veenema and Neumann 2008; MEYERLIN-
DENBERG 2008; Donaldson and Young 2008; Heinrichs et al. 2009).
Of the above possibilities for neurochemical intervention to influence the human
condition, SSRI drugs have received special attention by neuropharmacologists. As
an example, consider the following blinded study using normal human volunteers.
Knutson et al. (1998) gave subjects either 20 mg/day of paroxetine or placebo for
4 weeks. Relative to placebo, those getting the paroxetine displayed less hostility
84 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

and a decrease in negative mood (affect). In addition, the drug was found to increase
measures of social affiliation. The study authors concluded that “central serotonergic
function may modulate a dimension of normal personality characterized by reduced
negative affective experience and increased affiliative behavior”.

4.5 Brain Enhancement Via Electrical Brain Stimulation

Dr. José Manuel Rodriguez Delgado

Although pharmacologic manipulation of the brain to achieve enhancements in mood

or performance appears to be something that we can increasingly expect in the
future, it should be pointed out that similar alterations in brain function might also
be achieved using electrical methods of brain stimulation.
One of the earliest pioneers in this field was Dr. José Manuel Rodriguez Delgado
(1915–2011). In experiments with cats and later with monkeys and humans, Delgado
explored the role of electrical stimulation via surgically implanted electrodes as a
means to influence behavior.
In one particularly spectacular example, Delgado surgically implanted electrodes
in the aggression center of the brain of a belligerent bull. This brain area could be
stimulated electronically via remote control. In an interesting public demonstration
that was widely reported in the media, Delgado stepped into a bull ring with the
bull. When the bull began to charge at Delgado, he pressed a remote control but-
ton that instantly stopped the bull from charging. His book, Physical Control of the
Mind: Toward a Psychocivilized Society (1969), Delgado explored the various pos-
sibilities that might be developed with further research in this technology. While
the notion of physical control of the mind naturally conjures up an image of people
with implanted electrodes responding to a master who controls their thoughts and
actions (as appeared to be the case with the example of Delgado’s bull), Delgado
goes to lengths to attempt to dispel such notions, emphasizing that the value in these
methods is primarily to obtain an improved understanding of how the human brain
functions, not to construct robots out of humans. That being said, the final chapter of
Delgado’s book outlines a plan for “conquering the human mind” through increased
neurobehavioral research that would have critical implications for our understanding
of personhood. This is because altering the temperament and outlook of a person via
pharmacological, neurobehavioural and other methods of intervention changes their
very nature. They are no longer their own person, but have been shaped, altered and
edited. While Delgado suggests that when a person’s behaviour conflicts with society
so seriously to result in, say, incarceration, such intervention could be justified, it
should still be clear that the post-intervention individual is not the same person—thus
the implication for our understanding of what it means to be a person. Note that while
such interventions may completely change an individual’s nature, this fact in itself
does not imply that same individual necessarily undergoes a loss of personhood and
4.5 Brain Enhancement Via Electrical Brain Stimulation 85

the moral standing that accompanies personhood—these individuals simply become

different persons rather than nonpersons.
One intriguing field related to Delgado’s research is that of electrical stimulation,
via implanted electrodes, of the brain’s “pleasure center”, usually (but not always)
taken to be the nucleus accumbens (Ikemoto and Panksepp 1999). The nucleus
accumbens is a dopaminergic structure, part of the limbic system, believed to play
an important role in the “high” obtained from certain recreational drugs, as well as
to play a part in sexual arousal (Ikemoto and Panksepp 1999). Stimulation of the
nucleus accumbens has been studied in humans in efforts to treat severe obsessive
compulsive disorder (Huff et al. 2010) severe depression and anxiety (Bewernick
et al. 2010) and even drug addiction (Stelten et al. 2008).
In one case of a 47-year-old woman with “chronic treatment-refractory obsessive-
compulsive disorder, nicotine dependence, and obesity,” treatment with deep brain
stimulation of the nucleus accumbens for obsessive-compulsive disorder resulted
in “unintended, effortless, and simultaneous smoking cessation and weight loss”
(Mantione et al. 2010). The authors suggested that “deep brain stimulation of the
nucleus accumbens could be a possible treatment of patients with a dependency
not responding to currently available treatments”. Such a clinical report has explicit
philosophical relevance in so far as it exemplifies the tight coupling between the
operation of the brain and the operation of the mind. This has obvious implications
for the notions of “self” and “identity”, given that the operation of the mind (which
embodies self and identity) can be so fully changed via physical interventions.
Finally, it is an interesting aside to note that the nucleus accumbens is now believed
to be an important neurophysiological structure central to the placebo effect (Scott
et al. 2007; Zubieta and Stohler 2009).
While some critics, especially in Delgado’s time, expressed concerns that such
electronic implants might be used in humans to reduce individuality and control
behavior that deviated from the norm,12 experience in the last few decades since his
pioneering work has gone in a rather different direction, with other recent application
of this technology directed at the management of conditions such as Parkinson’s
disease (Wood et al. 2010), Tourette syndrome (Porta et al. 2009), the management
of chronic pain (Levy et al. 2010), epilepsy (Kahane and Depaulis 2010) and cervical
dystonia (Huh et al. 2010).
Transcranial Direct Current Stimulation
The brain stimulation methods mentioned so far involve implanted electrodes placed
via a neurosurgical procedure. However, recent research suggests that some forms
of cognitive enhancement might be achieved much more easily, using direct current
applied via simple scalp electrodes. Known as Transcranial Direct Current Stimula-
tion (tDCS), it involves supplying a weak electrical current (typically 2 mA or less),
usually for a period of 5–30 min. A variety of electrode placement options exist,
depending on the intended effect (Thair et al. 2017; Stagg and Nitsche 2011).

12 Remember that in Delgado’s time the horrors of Nazism and Stalinism were still strong in many
people’s minds.
86 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

Because studies on tDCS suggest that it can accelerate learning and boost task per-
formance as well as improve mood and social cognition (Parasuraman and McKinley
2014) it has been the subject of investigation by both professionals and hobbyists
(visit www.diytdcs.com for a sample hobbyist hangout). However, the use of tDCS
by hobbyists worries some individuals, who are concerned that it is too soon be sure
that tDCS is as safe as it appears to be, that it should only be administered by specially
trained individuals who use only established and tested protocols, and that it might
be administered without full informed consent, or even administered to children by
parents wishing to provide their school-aged child with a cognitive advantage (Chi
et al. 2010; Lifshitz-Ben-Basat and Mashal 2018). Additionally, should tDCS be
proven to be as effective as methods involving implanted electrodes (so far the evi-
dence appears to suggest otherwise) the ethical issues discussed later related to brain
enhancement via implanted electrodes would also apply.
The pharmacologic and brain stimulation studies outlined here suggest that the
possibility of improving the human condition and increasing social harmony by
widely-applied pharmacologic means (and/or by electrical means) is no longer simply
a wild pipe dream. One can even imagine controlled alteration of a nation’s water
supply to achieve these goals in a manner similar to the fluoridation of water to reduce
dental caries. The question, however, thus appears to be not “can we?”, but rather
“should we?” In the next sections we will explore this issue from an existentialist
perspective.

4.6 But Should We Partake?

Supposing that such a pharmacologic paradise as we have been discussing might

actually be possible, that a drug or series of drugs or other intervention might make
our lives more joyous and fulfilled, it is still not immediately clear that it would be
prudent to partake, even if apparently safe.
Of course, any apparent safety might still be an illusion. For instance, when
heroin was first synthesized by the Bayer Company in 1897 it was not believed to be
addictive! (Metzger 1998). (It was first sold as a cough suppressant). But, given the
great advances in drug safety that have taken place in recent decades, perhaps safety
issues should not be our primary concern.
Instead, I would like to raise a rather different concern. Let us focus instead on
the impact on personhood and the human existential condition. Could it be that
such mind-altering interventions might lead to a mind blunting effect that would
diminish one’s capacity to appreciate life in all its dimensions? Would not getting
joy and fulfillment via a pill risk making us “unauthentic” humans living a banal,
anesthetized existence as uncritical participants in the affairs of the world? In this
scenario, injustices would not bother us, moral outrage would fade away, and shame
at wrong-doing would simply no longer bother us.
The reader may be reminded of Aldous Huxley’s classic dystopian novel Brave
New World, where the drug soma was used ubiquitously for mood enhancement.
4.6 But Should We Partake? 87

Similarly, Michael J. Sandel’s book The Case Against Perfection: Ethics in the
Age of Genetic Engineering (Sandel 2007) offers similar concerns. Whether it is
called “Paradise Engineering”, “false happiness” or “sugar-coated pseudo-realism”,
thinkers such as Sandel argue that it would be best to decline participation in this
future until its consequences become more obvious. Let us explore these concerns
further, drawing on some existentialist notions.

4.7 What Does It Mean to Be an “Authentic” Human

Being?

Since the time that Socrates commented that “the unexamined life is not worth living”
philosophers have examined what it means to be authentic, albeit in a variety of
culturally contingent guises. The word “authentic” may be defined as “conforming
to fact and therefore worthy of belief”, or “the quality of being genuine or not
corrupted from the original”, or “of undisputed credibility”.13 Among existentialist
philosophers the concept of authenticity has been particularly well developed, often
with reference to the extent to which one is true to one’s own character despite the
pressures and forces of the world we inhabit.
Søren Kierkegaard (1813–1855) was a Danish philosopher who is widely consid-
ered to be the father of existentialist philosophy. Kierkegaard wrote widely on issues
of personal choice and commitment, especially in the context of religion, where he
is best known for his concept of “leap of faith”, an act of accepting the unprovable.
Martin Heidegger (1889–1976), whose analyses of Dasein in his 1927 magnum
opus, Sein und Zeit paved the way for subsequent existentialist philosophies, empha-
sized that to lead an “authentic” life, one must exercise one’s personal freedom to
establish a meaningful existence for oneself and take responsibility for the conse-
quences of our choices, rather than follow a path of self-deception where one simply
follows orders, accepts conformity, and is concerned only with the here and now.
One of Heidegger’s most important concepts in relation to authenticity is “Being-
toward-death”. To Heidegger, Being-toward-death forges a truly authentic being, as
death belongs only to the one who experiences it; it cannot be shared. Being-toward-
death acknowledges one’s finitude, and therefore the facticity of being-in-the-world,
i.e. what it means to “live in the now”.
Heidegger points out that leading an authentic life is not always easy, as the process
entails uncertainty and anxiety, and requires considerable courage. (Undoubtedly,
Heidegger would have rejected the idea of taking “happy pills” as a measure against
existential angst!).
Another existentialist philosopher concerned with authenticity was Jean Paul
Sartre (1905–1980), who shared a “common philosophical ancestry” with Heidegger
in that both were concerned with the problem of existential worry in a meaningless,
even absurd, world. Sartre’s novels repeatedly describe characters and anti-heroes

13 http://en.wiktionary.org/wiki/authenticity.
88 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

who succumb to external pressures in order to have a more comfortable existence.

They do this even though in succumbing to these pressures their actions are contrary
to their own moral and aesthetic principles. (For example, one might avoid fighting
against oppressive political or social circumstances by saying “I am not free to risk
my life in any such struggle—I have a family to support”). Sartre calls this “bad
faith”, a psychological phenomenon whereby one denies one’s freedom in order to
avoid taking action with respect to one’s circumstances, of seeing oneself not as a
free person but as a powerless object.
The classic example of bad faith that Sartre provides is that of a restaurant waiter
whose exaggerated behaviours (pleasing but scripted tone of voice, perfect stance,
etc.) are all aimed at satisfying his clients. He acts as an automaton whose essence
is to be a waiter rather than a human being, adopting false values and ignoring their
innate freedom.
(Since reading of Sartre’s waiter many years ago, I have come to recognize an
interesting parallel in my own interactions as an anesthesiologist dealing with anxious
patients who are about to undergo surgery. Rather like Sartre’s waiter I too frequently
utilize reassuring but subtly scripted phrases and behavior to make my patients more
comfortable as they are about to undergo what is very often one of the most terrifying
experiences of their life. In addition, at least until the patient is rendered unconscious,
I attempt to provide an atmosphere of extreme professionalism that, despite being
partly scripted and staged, is nevertheless very reassuring to the patient. But is this
not also like being an automaton or robot, one whose essence is to act as best as
possible like a caring and compassionate physician? To the extent that such actions
are played out using an informal script optimized over time for maximum patient
psychological comfort, instead of being based on one’s natural personality, is this
not also a form of “bad faith”?). In the final analysis, however, I see an important
weakness in this analogy: the physician acting to obtain the best clinical outcomes
and providing the best possible care to his or her patients can hardly be said to be
adopting false values and acting inauthentically.14
A number of thinkers have discussed the issue of authenticity in the context of
psychopharmacology and pharmacological enhancement. For instance, Aldous Hux-
ley’s book Brave New World and a number of lesser known literary works address this
issue in various ways. In the case of Brave New World, Huxley described a dystopian
world where a drug called Soma played a central role. Many years later, Huxley wrote
Island, a novel with a distinctly utopian theme, also containing a psychopharmacol-
ogy thread. But while Brave New World emphasized drug use for pacification of the
populace, Island emphasized the potential of psychopharmaceuticals for the more
noble purposes of enlightenment, improved learning and enhanced self-knowledge
(Schermer 2007).

14 There is something paradoxical in the physician–patient relationship: on the one hand he/she must

always be the objective scientist who—to an extent—objectifies the patient. On the other hand, the
physician must also be subjective in the sense that he/she realizes that the object is a human being
like the physician themselves. Thus, the physician–patient relationship is both a subject-object
relationship and a subject–subject relationship.
4.7 What Does It Mean to Be an “Authentic” Human Being? 89

More recent thinkers have added to this discussion. Elliott (Elliott 1998a, 2003)
expresses an unease concerning the administration of psychopharmacological sub-
stances to psychologically normal individuals suffering from existential angst that
is more a consequence of the human condition than any mental pathology. Argu-
ing that psychopharmacological enhancement threatens our human dignity and our
connection to reality, Elliott raises the concern of living an inauthentic life, a life
giving you (for example) a better, more pleasant personality, but one that is not your
personality.
On the other hand, DeGrazia (2005) takes the position that a “lucid” understanding
of human nature and human identity, along the clear concepts of enhancement and
authenticity “largely neutralizes” such concerns, which DeGrazia holds to be “se-
ductive, but unsound”. Bolt (2007) offers a similar line of argumentation, although
he argues that DeGrazia’s conception of authenticity is inadequate to the task, as “his
conception of authenticity does not explain the reason why we find inauthentic values
objectionable”. In fact, from a philosophical point of view, as we have seen, both
“enhancement” and “authenticity” are value-laden concepts subject to considerable
debate.
Schermer (2007) takes the position that we should not “get stuck in an opposi-
tion of dystopian and utopian views”, such as those presented by Huxley, but should
instead focus on real-world issues: the “evaluation and governance of enhancing psy-
chopharmacological substances in democratic, pluralistic societies”. Thus Schermer
would have us employ a scientific, rational, risk-based approach to drug policy rather
than the politically-driven process that so often dominates the current discourse on
drug policy.
Erler (2011) considered the question whether memory modification technologies
“might lead us to live inauthentic lives”. Distinguishing between memory enhance-
ment and memory editing (for example, to eradicate painful memories), Erler argues
that while memory enhancement does not raise serious authenticity concerns, mem-
ory editing does: “first, by threatening its truthfulness, and secondly, by interfering
with our disposition to respond in certain ways to some past events”.
Kraemer (2011) argues against the sometimes espoused position that psychophar-
macological interventions will always lead to diminished emotional authenticity.15
He argues instead that clinical case studies “reveal that some psychotropic drugs
such as antidepressants actually cause people to undergo experiences of authentic-
ity, making them feel ‘like themselves’ for the first time in their lives”. He develops
the position that the so-called “authenticity standard” for emotions (requiring that
emotions not be the result of artificial interventions, such as from drugs) is not always
the best standard, and that other ways of assessing emotions, such as a “rationality
standard” or a “coherence standard” (looking for harmonized experiential, behav-
ioral, and physiological responses) may be more appropriate in parsing the ethical
debate on psychopharmacological manipulation of emotions.

15 For
an examples of this point of view, see Fukuyama’s Our Posthuman Future (Fukuyama 2002)
and Elliot’s The Tyranny of Happiness (Elliott 1998b).
90 4 Pharmacologic Enhancement of the Human Condition: Possibilities …

4.8 Back to Religion

A similar “authenticity” argument has at times been offered to critique the role
that religion sometimes plays in influencing how one copes with one’s present life
circumstances. It is certainly a truism that many individuals find extreme contentment
and fulfillment in religion. However, some critics have argued that a religious belief
in a glorious afterlife in paradise can serve to diminish concerns about oppression
and injustice on earth, with inaction against injustices being justified on the basis
that the whole point of life on earth is simply to make it into heaven, not to achieve
happiness and fulfillment in this life. For example, in his 1886 book Beyond Good and
Evil and his 1887 book On the Genealogy of Morality, Nietzsche famously argues
that Christian morality is a life-negating product of self-deception that reflects an
inferior, subservient (“slave”) morality. Christianity, he argues, does not encourage
individuals to flourish but instead asks believers to suppress human instinct and
passion and become passive human beings stripped of those very properties that
make them most human.16
Although Marx was probably not the first to make the suggestion that “religion is
the opiate of the people”17 he is famously known for his contempt of religion and his
proposal to replace belief in God with a materialist philosophy that makes no appeal
to the supernatural. It is undeniably true, however, that when man’s existence on earth
becomes intolerably brutal and nasty, the assurance of an afterlife in paradise can be
extremely comforting for some individuals, regardless of whether or not the belief is
ultimately justified. The debate as to whether any particular set of religious beliefs is
warranted by the evidence is beyond the scope of the present discussion. However,
the evidence that a great many individuals act as if afterlife in paradise awaits them
is undeniable, as evidenced, for instance, by suicide bombers who readily sacrifice
their life for a distorted and pathologic vision of what is right and just.
To the extent that belief in a set of religious principles, misguided or otherwise,
can lead to contentment and happiness, it can be argued that religion can be made
to play a role in ameliorating the human condition, as also might pharmacologic
enhancement or even merely finding oneself in the midst of a joyous relationship
with friends and family. Arguably, it is only when adherence to a set of religious
beliefs leads to social disorder and personal suffering that they can be seen to be not
helping improve the human condition.
What, then are we to make of all the above? Will the pharmacologic future that
awaits us ultimately improve the human condition, as did the invention of anesthesia,
or does it open more dystopian possibilities of a more sinister nature? My view is
that it still too early to tell, and on careful reflection I must concede that given the
enormous complexities of the human mind, the question as to the desirability of

16 These comments notwithstanding, it is also a truism that many religious people are selflessly

devoted to trying to help improve humanity and its future. Additionally, not all religions believe in
an afterlife.
17 See http://www.quotecounterquote.com/2011/10/religion-is-opium-of-people.html for an inter-

esting, if brief, discussion.

4.8 Back to Religion 91

such exciting possibilities is ultimately an empirical question that simply cannot be

answered at this time.
That being said, based on what we know from the existing debate, I rather expect
that the pharmacologic future that waits will ultimately improve the human condition,
at least in a number of settings. And should such options for improvement ultimately
take place, they will necessarily cause many individuals to reevaluate what it means
to be human.
Chapter 5
Life, Death, and Brain Death

It remains for the doctor and especially the anaesthesiologist, to

give a clear and precise definition of “death” and the “moment
of death” of a patient who passes away in a state of
unconsciousness.

Pope Pius XII (Address to an International Congress of

Anesthesiologists (November 24, 1957), in Acta Apostolicae
Sedis, 49 (1957), p. 1030).

Abstract This chapter is primarily concerned with the issues associated with defin-
ing death and the philosophical debate on where the line between life and death
should be drawn. While traditionally death has been defined as the permanent ces-
sation of the heartbeat and respiration, modern clinical developments have forced a
reevaluation of the both the concept of death in general and of brain death in partic-
ular. Future developments in cryonics and nanotechnology may require even further
reappraisal of when a person is really dead. This chapter advances the philosophical
position that organismal death is not an event so much as it is a process, and that
life and death are not distinct binary states, but entities with degrees and gradations.
Finally, it advances the notion that it is helpful to distinguish between the defini-
tion of death based on mere cessation of the heart beat and a “more substantial”
form of death, such as exists following cremation (“absolutely irreversible death” or
“information-theoretic death”).

5.1 Introduction

In previous chapters we discussed what it means to be a human and what it means to be

a person in a world complicated by astonishing advances in biomedical technology.
In both cases, the presumption that we are dealing with a living organism is made,
as the dead are considered neither to be humans nor to be persons. In this chapter the
moral, ethical and legal problems associated with brain death in both its complete and
incomplete forms are presented. It is argued that although the notions of personhood
© Springer Nature Switzerland AG 2018 93
D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_5
94 5 Life, Death, and Brain Death

and personal identity are central to the discussion, the notions of “life” and “death”
are surprisingly ambiguous. In this sense this chapter and the next one dealing with
cryonics break new philosophical ground in their contribution to the debate on where
the line between life and death should be drawn.

5.2 What Is Life?

The exact nature of life has puzzled biologists (and no small number of philoso-
phers) for a great many centuries. “Living organisms are autopoietic systems: self-
constructing, self-maintaining, energy-transducing autocatalytic entities” in which
information needed to construct the next generation of organisms is stabilized in
nucleic acids that replicate within the context of whole cells and work with other
developmental resources during the life-cycles of organisms, but they are also “sys-
tems capable of evolving by variation and natural selection: self-reproducing entities,
whose forms and functions are adapted to their environment and reflect the compo-
sition and history of an ecosystem” (Harold 2001).1
“What is Life?” is the title of a 1944 book by Erwin Schrödinger, the 1933 winner
of the Nobel Prize in physics for his seminal contributions to quantum mechanics.2
Among other things, Schrödinger’s book asks “how can the events in space and time
which take place within the spatial boundary of a living organism be accounted for
by physics and chemistry?” (p. 3). Based on the observation that all living organisms
have the ability to remain in a state of order (decreased entropy) despite the natural
tendency for all things to decay into disorder, Schrödinger postulated that all living
matter evades decaying towards a thermodynamic equilibrium (as would ordinarily
be expected as a consequence of the second law of thermodynamics) by feeding
on “negative entropy” (negentropy).3 This is yet another approach to understanding
what is meant by “life.”
The above commentary notwithstanding, a number of scientists argue that matters
concerning the definition of life are not as nearly clear-cut as they might appear.
Cleland and Chyba (2002) note the following:
There is no broadly accepted definition of “life.” Suggested definitions face problems, often in
the form of robust counter-examples. Here we use insights from philosophical investigations
into language to argue that defining ‘life’ currently poses a dilemma analogous to that faced
by those hoping to define ‘water’ before the existence of molecular theory. In the absence

1 Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/life/.

2 The book can be downloaded at http://csustan.csustan.edu/~tom/life/What-is-Life.pdf.
3 The second Law of Thermodynamics states that the entropy (degree of disorganization) of a system

tends to get larger as time progresses. Living things, however, behave in an opposite manner, orga-
nizing their environment for their own biological needs, creating order from disorder. Schrödinger
uses the term negentropy to identify this fundamental ability of living systems, an ability to not only
avoid entropy production—as dictated by the second law—but to do just the opposite, to increase
organization, exporting entropy to keep its own internal entropy low.
5.2 What Is Life? 95

of an analogous theory of the nature of living systems, interminable controversy over the
definition of life is inescapable.

Similarly, Oliver and Perry (2006) write:

Although there have been attempts at a definition of life from many disciplines, none is
accepted by all as definitive. Some people believe that it is impossible to define ‘life’ ade-
quately at the moment. We agree with this point of view on linguistic grounds, examining the
different types of definition, the contexts in which they are used and their relative usefulness
as aids to arriving at a scientific definition of life.

As a practical example, one issue of continuing controversy in biology is whether

or not viruses and prions should be considered to be forms of life.4 Most biologists
argue that these entities should not be considered forms of life, since (for instance)
viruses do not metabolize, do not react to stimuli and cannot reproduce without
invading a cell and altering its molecular machinery.
A related issue is what constitutes human life. This is a matter that has been
addressed on and off in earlier sections of this work and is a matter we will continue
to be concerned with in the following chapters.
A final issue deals with the question of when human life can be said to have ended.
This is an unexpectedly complex issue that is discussed next.

5.3 The Traditional Concept of Death

Biologists frequently define death as the permanent cessation of all biological func-
tions that define a living organism. To clinicians, however, death of the human
organism has traditionally been defined more simply as the permanent cessation
of the heartbeat and respiration. Although this determination is usually not difficult
to make, mistakes occasionally occur. For example, in Victorian times there were sto-
ries of individuals mistakenly being declared dead and later ‘returning to life’ when
embalming began. See, for instance, Edgar Allen Poe’s horror story “The Premature
Burial”, published in 1844, as well as Antoine Wiertz’s similarly titled 1854 painting
produced in homage to Poe’s story. In fact, the fear of being buried alive in Victorian
times was so prevalent that some individuals requested that following their apparent
death that they be buried in a coffin with an external bell mechanism that they could
operate from inside their coffin should they ever regain consciousness while buried.
Even today, mistakes in the diagnosis of death occasionally occur. A 2005 article
in the New York Times5 recounts the appalling story of a man (Larry Green) found
at the scene of a car accident, “where he was examined by paramedics and declared
dead”, then “zipped into a black vinyl bag, taken to the morgue and slid into a
refrigerated drawer.” Only later, when other personnel “noticed what appeared to be

4A prion is an infectious agent consisting of a misfolded protein and containing no nucleic acids.
Prions are responsible for Creutzfeldt-Jakob disease and a number of other infectious conditions.
5 http://www.nytimes.com/2005/02/13/national/13dead.html.
96 5 Life, Death, and Brain Death

an in-and-out movement in Mr. Green’s chest and abdomen,” did it become apparent
that the initial diagnosis of death was a regrettable and tragic error, one likely based
on an excessively cursory clinical examination conducted at the scene of the accident.
Despite the attractive simplicity of diagnosing death based on absent pulse and res-
piration, modern developments in clinical resuscitation have forced a reappraisal of
this appealing but outdated notion. Today, in hospitals around the world, ventilators,
dialysis equipment and drug infusions that sustain the circulation often permit the
bodies of critically ill patients to be artificially supported despite severe physiological
insults, including death of the brain itself. In addition, the advent of transplantation
surgery has provided a strong clinical motivation to allow death to be defined in
terms of loss of brain function (brain death) or in terms of a relatively brief period of
asystole (cessation of cardiac activity) in some patients (so-called non-heart-beating
organ donors). Finally, some thinkers argue that future developments in cryonics
and nanotechnology may require further reappraisal of when a person is really dead.
These issues are the subject of this and later sections, which present as a central
theme the notion that the concept of death is neither crisp nor static but rather has
elements of indistinctness and ambiguity, at least at the extreme margins of human
existence.

5.4 Brain Death

While the notion of death as permanent cardio-respiratory arrest has been familiar
to physicians since biblical times, the notion of brain death is much more recent,
having been developed in the 1960s as advances in transplantation medicine and
medical technology provided a motivation to allow death to be defined in terms of
loss of brain function (Truog and Robinson 2003). This was because the success of
transplantation surgery depends critically on the use of viable organs uncompromised
by circulatory failure.
In a typical clinical scenario, a patient with a massive brain injury (for example,
from a ruptured cerebral aneurysm) is treated in an intensive care unit. While there,
the patient’s neurological status is periodically assessed and if there is suspicion
that the patient is brain dead, a formal evaluation for possible brain death is carried
out. If the patient is found to meet brain death criteria, the patient’s relatives are
often approached regarding possible organ donation. If they agree, cessation of life
support measures are carried out after organ retrieval for transplantation has taken
place. Cardiopulmonary collapse and classical death usually follows promptly.
A key pathophysiological event in brain death is a severe elevation of intracra-
nial pressure (ICP) from causes such as hemorrhage (bleeding) or edema (swelling).
When the ICP rises to approach arterial blood pressure, cerebral perfusion pressure
(CPP) approaches zero, cerebral perfusion (blood flow to the brain) stops and brain
death ensues. Autopsy findings of the brain depend on the precipitating event but
may include total liquification in cases of prolonged artificial life support (sometimes
known as “respirator brain”). With primary hemispheric lesions (e.g., large unilateral
5.4 Brain Death 97

tumors), transtentorial or tonsilar herniation are often present. A careful neurological

examination centering on the assessment of brain-stem reflexes is the basis for the
determination of brain death. The diagnosis of brain death is determined primarily
on the basis of clinical findings, and depends on investigations such as electroen-
cephalography, Doppler blood flow studies and cerebral angiography only in special
cases (vide infra).

5.5 Early Brain Death Criteria

Associated with the concept of brain death is the need for a reliable, structured
method of diagnosis. A variety of such criteria have been published. Of these, the
original Harvard Criteria (Ad Hoc Committee of the Harvard Medical School to
Examine the Definition of Brain Death 1968) are perhaps the best known. They
include the following requirements: (a) unresponsivity to intensely noxious stimuli
(unresponsive coma), (b) total absence of spontaneous breathing, (c) absence of
brainstem and spinal reflexes, (d) absence of postural activity such as decerebration,
and (e) a flat electroencephalogram (EEG). Hypothermia and the presence of CNS
depressants such as barbiturates and benzodiazepines must also be excluded. Finally,
the clinical and EEG findings should be unchanged in a second evaluation at least
24 h later.
More relaxed criteria such as the Minnesota Criteria (Mohandas and Chou 1971)
were later proposed. Notably absent from this criteria list are requirements for
absent spinal reflexes and a study of electroencephalographic (EEG) activity (elec-
troencephalography being viewed as an optional confirmatory investigation in this
instance). The key elements of the Minnesota criteria are: (a) absence of spontaneous
movement, (b) absence of spontaneous respiration over a four-minute test period, (c)
absence of brain reflexes as evidenced by: fixed dilated pupils; absent gag, corneal
and ciliospinal reflexes; absent doll’s eye movements; absent response to caloric
stimulation, and absent tonic neck reflex, (d) unchanged status for at least twelve
hours and (e) responsible pathological process deemed irreparable.
Over time, continuing refinements to brain death criteria have taken place. In
1981 the legal basis for brain death in the USA became established based on an
important report by the President’s Commission for the Study of Ethical Problems
in Medicare and Biomedical and Behavioral Research (1981). Since that time this
report has been used as the basis for a great deal of the discussion on the criteria
for brain death. Finally, note that Although not explicitly noted in all criteria for
brain death, hypothermia, the presence of central nervous system (CNS) depressants
such as opiates, ethanol, barbiturates and benzodiazepines, and the presence of severe
metabolic abnormalities (such as severe hypoglycemia or severe hyponatremia) must
also be excluded.
98 5 Life, Death, and Brain Death

5.6 Ancillary Tests for Confirming Brain Death

Although the diagnosis of brain death is a clinical one, that is, not based on laboratory
tests, from time to time the clinician may seek guidance from a variety of ancillary
tests. Perhaps the most common such test is electroencephalography, the expected
finding being a “flat” or “isoelectric” electroencephalogram (EEG). As well, confir-
mation of brainstem death can be facilitated by observing a flat auditory brainstem
response (ABR). Absence of cerebral circulation can be demonstrated by four-vessel
angiography as well as by radionuclide methods. More recently, absent flow signals
on transcranial Doppler ultrasonography has also been suggested as a method to
demonstrate the absence of cerebral circulation in brain death.
All these methods suffer from potential technical issues in that they require skilled
technical support to make the techniques meaningful and reliable in the clinical
environment. In addition, reasonable, experienced clinicians will sometimes disagree
about when ancillary tests are appropriate in confirming the diagnosis of brain death.

5.7 Death of the Entire Brain as a Requirement for Brain

Death

As noted earlier, as clinical experience evolved, criteria for brain death continued to
be refined so that in 1981 the legal basis for brain death in the USA came to be based
on a profoundly influential report by the President’s Commission for the Study of
Ethical Problems in Medicare and Biomedical and Behavioral Research (President’s
Commission for the Study of Ethical Problems in Medicine and Biomedical and
Behavior Research 1981). The commission defined brain death as the “irreversible
cessation of all functions of the entire brain, including the brain stem.” Operational
criteria for diagnosing brain death were not explicitly addressed in the report; this
aspect was dealt with by another committee composed of medical experts rather
than bioethics experts who published a contemporaneous report in the Journal of the
American Medical Association (JAMA).
Since that time this report has been used as the basis for much of the discourse on
brain death. For instance, influenced by this report, the World Medical Association
has written that in declaring brain death “[i]t is essential to determine the irreversible
cessation of all functions of the entire brain, including the brain stem”.6

6 World Medical Association Declaration on Death, available at http://www.wma.net/en/30publica

tions/10policies/d2/index.html.
5.8 Ignoring the “Death of the Entire Brain” Rule in Declaring Brain Death 99

5.8 Ignoring the “Death of the Entire Brain” Rule

in Declaring Brain Death

While august bodies such as the President’s Commission for the Study of Ethical
Problems in Medicare and Biomedical and Behavioral Research and the World Med-
ical Association have defined brain death in terms of “irreversible cessation of ALL
functions of the ENTIRE brain,” in the years since this definition has been widely
adopted it has become very clear that many (perhaps most) patients diagnosed with
brain death (and who have undergone organ harvesting) do not actually meet this
requirement (Halevy and Brody 1993). In particular, many patients diagnosed with
brain death still have some residual function in the hypothalamus, a part of the brain
that contains a number of important nuclei, some linking the central nervous system
to the endocrine system via the pituitary gland (hypophysis). Even more surpris-
ingly, evaluation of hypothalamic function is not part of any brain death protocols in
common use in the USA (or, apparently, elsewhere in the world).
To many thinkers, such a state of affairs borders on the incredible. It is, how-
ever, true beyond question. But then, how can the global clinical community simply
ignore hypothalamic function in declaring brain death? Could it be that many patients
declared to be brain dead are not actually fully brain dead? And surely, “not fully
brain dead” is not really dead at all. Not surprisingly, inconsistencies of this kind in
the declaration of death are troubling to a great many clinicians, who would prefer
that any possible logical inconsistencies in the declaration of brain death be avoided,
no matter how small or clinically unimportant they may appear to be (Baron et al.
2006). Philosophers, too, are obviously entitled to some degree of intellectual bewil-
derment on this matter. In addition, so are some individuals who have signed organ
donor cards.

5.9 Some Brain Stem Nuclei Are not Tested When Testing
for Brain Stem Death

The above inconsistency notwithstanding, testing for brain death requires that irre-
versible cessation of all functions of the entire brain, including all functions of the
brain stem, be present. Consequently, one would expect that all 12 cranial nerves be
shown to be nonfunctional in any declaration of brain death. Cranial nerve testing
for the purposes of brain death testing has been described by Wijdick (2001): testing
according to standard methods require the absence of grimacing or eye opening with
deep pressure on both condyles at the level of the temporomandibular joint (testing
afferent nerve V and efferent nerve VII), an absent corneal reflex elicited by touching
the edge of the cornea (thus testing cranial nerves V and VII), an absent light reflex
(thus testing cranial nerves II and III), an absent oculovestibular response toward the
side of the cold stimulus provided by ice water (thus testing cranial nerves VIII and
III and VI), and an absent cough reflex elicited through the introduction of a suction
100 5 Life, Death, and Brain Death

catheter deep in the patient’s trachea (thus testing cranial nerves IX and X). As can
be seen, this protocol tests cranial nerves II, III, V, VI, VII, VIII, IX and X. However,
not all the cranial nerves are tested when brain death testing is conducted by standard
protocols. Specifically, cranial nerves I, XI and XII are not tested. This is because
some cranial nerves are simply too difficult to test.
This raises an obvious concern. Brainstem testing of cranial nerves only tests
the nerves that are accessible for testing in unconscious individuals. If any of the
testable cranial nerves are actually shown to be operational, then brain stem death
cannot be declared. But, according to current brain death protocols, brain stem death
can be declared should one of the untestable cranial nerves (untestable in unconscious
patients) actually be operational in reality (even though we have no way of testing
the untestable in unconscious patients with current technology).
This is not a mere matter of semantics, as one could imagine a newly developed
test for, say, cranial nerve XI that would allow us to test for its function in uncon-
scious individuals. See, for instance, the following case report abstract concerning
an apparently functioning cranial nerve XI in a patient declared to be brain dead
(Patterson and McShane 1991). This suggests that ancillary tests such as cerebral
angiography may on occasion erroneously establish the absence of cerebral circula-
tion or may not have enough power to detect small amounts of cerebral circulation
sufficient to keep some of the brainstem nuclei alive.

5.10 The Problem of Spontaneous Movements Despite

Brain Death

Both classical criteria such as the Harvard criteria as well as more recent criteria for
the clinical diagnosis of brain death require that the patient display no spontaneous
movements. For instance, Shemie (2006) writes: “Deep unresponsive coma implies a
lack of spontaneous movements as well as an absence of movement originating in the
CNS, such as cranial nerve function, CNS-mediated motor response to pain in any
distribution, seizures, decorticate and decerebrate responses. Spinal reflexes or motor
responses confined to spinal distribution may persist.” Note that some movement in
response to noxious stimuli is permitted, as long as these movements are spinally
mediated and do not originate from the brain itself.

CASE REPORT
A 56 year old woman was admitted to our hospital following a fall in which
she sustained an acute subdural haematoma. She failed to respond to treatment
despite surgical intervention and active brain protection measures. During
brain stem function testing on two occasions she demonstrated movement in
the distribution of the accessory (XI) cranial nerve despite angiographically
confirmed absence of a cerebral circulation. This delayed decision making
5.10 The Problem of Spontaneous Movements Despite Brain Death 101

and organ donation. We report this case in order to highlight this problem
which may be encountered during brain stem function testing (Patterson and
McShane 1991).

Despite these clear and unambiguous recommendations, however, it is well-known

that both spontaneous and reflex movements may occasionally be found in patients
with brain death (Saposnik et al. 2000, 2009). The most common movements are
finger jerks, although “undulating toe flexion sign, triple flexion response, Lazarus
sign, pronation-extension reflex, and facial myokymia” may also be seen (Saposnik
et al. 2000, 2009). For the most part, these movements have been considered to be
spinal in origin, and not cortical or brainstem in origin, but regardless, they clearly
constitute a challenge for the neurological determination of death, especially given
that both classical and recent guidelines clearly require that the patient display no
spontaneous movements whatsoever.

5.11 The Problem of Waxing and Waning of Neuronal

Function

If one accepts the notion that still-living but impaired, temporarily non-working brain
stem nuclei may sometimes recover to a degree as clinical conditions like cerebral
perfusion pressure or arterial oxygenation vary over time, it is then possible that
some brainstem nuclei will wax and wane in function during the period when brain
death testing is performed.
In such a setting it is at least theoretically possible that some clinical findings
supportive of brain death may vanish upon subsequent reexamination of the patient.
Consequently, any loss of brainstem function identified by testing may not necessarily
be permanent—one can imagine situations where a marginal brainstem nucleus later
comes back into action despite not being functional during an earlier testing period.
A related concern is that a nonfunctional brainstem nucleus is not necessarily a
dead brainstem nucleus; as implied above, in some cases a nonfunctional brainstem
nucleus will come back into operation when conditions improve.
Admittedly, this is an issue that may be more theoretical than real, in that “recov-
ery” from brain death is exceedingly rare. This fact notwithstanding, a case report
of a very interesting example has been published by Koberda et al. (1997), who
revived a patient who was “brain dead” from a thrombotic occlusion to the basilar
artery (which supplies blood to the brain stem) through the timely administration of
intraarterial urokinase (which unblocked the artery in question).
102 5 Life, Death, and Brain Death

5.12 Limitations Inherent in All Medical Testing

If we accept the well-established notion that all medical tests have inherent limi-
tations regarding sensitivity and specificity, and the related notion that all complex
diagnostic algorithms may have inherent or unanticipated pitfalls (just as all software
of sufficient complexity will manifest occasional “bugs”), then it will be understood
that testing for brain death is inherently imperfect, and that type I and type II testing
errors will inevitably occur from time to time, even in the setting of diagnosing brain
death.
Recall that sensitivity and specificity are measures of the performance of medical
tests having binary outcomes. Sensitivity is the proportion of true positives correctly
identified (e.g. the percentage of people with condition X who actually have the
condition). Specificity is the proportion of negatives correctly identified (e.g. the
percentage of people who are correctly identified as not having condition X). These
two measures are closely related to the concepts of type I and type II errors. In a
type I error a patient is said to not have condition X when in fact, the patient does.
In a type II error the patient is said to have condition X when, in fact, he or she does
not. A perfect medical test will have 100% sensitivity (i.e. identify all people with
condition X as having condition X) and 100% specificity (i.e. not falsely identify
anyone as having condition X).
This view that type I and type II testing errors will inevitably occur from time
to time in brain death testing is supported by both occasional reports of clinical
conditions mimicking brain death as well as by the earlier discussion about possible
waxing and waning of brain stem neuronal function as clinical circumstances change
over time, for instance as a result of fluctuations in cerebral perfusion.
Such inherent limitations present in all medical testing imply that brain death
testing has the potential for fallibility beyond mere human shortcomings in correctly
carrying out brain death testing procedures.

5.13 Ambiguity in the Definition of Brain Death

In a highly-cited and highly-influential review of brain death, van Norman (1999:

275) wrote:
Accurate criteria for death are increasingly important as it becomes more difficult for the
public to distinguish between patients who are still alive from those who, through the aid of
medical technology, merely look like they are alive even though they are dead. Patients and
their families need to know that a clear line can be drawn between life and death, and that
patients who are alive will not be unintentionally treated as though they are dead. For the
public to trust the pronouncements of medical doctors as to whether a patient is dead or alive,
the criteria must be unambiguous, understandable, and infallible. It is equally important to
physicians that accurate, infallible criteria define death. Physicians need to know that a clear
line can be drawn between life and death so that patients who are dead are not treated as
though they are alive. Such criteria enable us to terminate expensive medical care to corpses.
Clear criteria for death also allow us to ethically request the gift of vital organs. Clear,
5.13 Ambiguity in the Definition of Brain Death 103

infallible criteria allow us to assure families and society that one living person will not be
intentionally or unintentionally killed for the sake of another.

In the following discussion I would like to make the case that, Dr. van Norman’s
position notwithstanding, current brain death criteria are not always unambiguous
and are not necessarily infallible. In addition to the sensitivity/specificity argument
presented earlier in Sect. 5.12, I offer the following additional line of argument based
on imprecision inherent in clinical language.
All major protocols for the declaration of brain death contain language that may
be interpreted differently by different clinical experts. One result of this fact is that
there could conceivably exist situations where one expert concludes that a particu-
lar patient meets the criteria for brain death while another concludes otherwise. For
instance, Canadian guidelines (Shemie 2006) indicate that the presence of “severe
metabolic abnormalities, including glucose, electrolytes (including phosphate, cal-
cium and magnesium), inborn errors of metabolism, and liver and renal dysfunction”
will preclude the diagnosis of brain death. However, clinical experts may reasonably
disagree as to whether a particular metabolic abnormality is truly “severe”. For
instance, when is hypoglycemia “severe” as opposed to merely being “moderate”?
One approach would be to look for a consensus document from the World Health
Organization, the World Medical Association or other international authority. Then
again, clinicians with nationalist tendencies might argue for the use of a national doc-
ument as opposed to using an international reference. However, such considerations
are generally moot, because such consensus documents are generally nonexistent,
not yet having been developed.
One might also consult various clinical authorities for definitions. For instance,
the Institute for Health Improvement suggests that hypoglycemia is severe if glucose
values are less than or equal to 40 mg/dl.7 Other authorities, however, might employ
a clinical definition whereby in addition to a low glucose level, clinical findings
suggestive of hypoglycemia (e.g., one or more signs or symptoms of nervousness,
sweating, intense hunger, trembling, weakness or palpitations) should be present.
This simple example helps illustrate the difficulties in defining the term “severe”
in a clinical context. Similar problems arise in defining the severity of other metabolic
derangements such as hyperglycemia, hypernatermia, hyponatremia, hyperkalemia,
hypokalemia, hypercalcemia, hypocalcemia, hypermagnesemia, hypomagnesemia
etc.
This is not to suggest that such conditions cannot in principle be rigorously defined.
For instance, the Canadian guidelines referenced above define hypothermia as a core
temperature under 34 °C. Even then, however, the determination of core temperature
will still depend to an extent on the specific measurement site employed (e.g., distal
esophagus, pulmonary artery, urinary bladder, etc.).

7 http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Measures/IncidenceofHypoglycemicE

pisodes.htm.
104 5 Life, Death, and Brain Death

Such issues illustrate how clinical judgment is unavoidable in many such cases.
And whenever clinical judgment is employed, expert clinicians will disagree from
time to time. In sum, there is at least a degree of ambiguity in the language used in
most brain death protocols.8

5.14 Further Difficulties in the Declaration of Brain Death

In a manner similar to the problem of language ambiguity, some clinicians have

observed that the criteria for brain death are in some important respects somewhat
arbitrary. For instance, while the original Harvard criteria for brain death requires
the loss of all spinal reflexes (Ad Hoc Committee of the Harvard Medical School
to Examine the Definition of Brain Death 1968) more recent criteria do not (the
American Academy of Neurology 1995). Similarly, the various national guidelines
are not all exactly identical, so it is likely that there on occasion one may encounter
some patients who meet some existing national criteria for brain death yet do not
meet others (Wijdicks 2002; Haupt and Rudolf 1999). Indeed, with the worldwide
spread of transplantation surgery, numerous studies, reviews, and regional guidelines
regarding brain death have been published, many with differing diagnostic criteria.
As an example, the Belgian criteria for brain death requires that three physician
evaluations take place, while only one is required in Poland (Haupt and Rudolf
1999). Similarly, confirmatory repetition of the testing is mandatory in France, Italy
and Luxemberg, but not required in Poland or in the UK (Haupt and Rudolf 1999).
Publications from the Inter-Agency Committee on Irreversible Coma and Brain
Death, the American Neurological Association, the Conference of Royal Colleges
and Faculties of the United Kingdom, the President’s Commission for the Study of
Ethical Problems in Medicine and Behavioral Research and other sources provide
a maze of criteria, cautions, exceptions, and ancillary investigations. Issues such as
these have led to never ending academic discussion in the medical literature, as well
as to the airing of highly controversial television programs such as one from the
BBC entitled: “Transplants: Are the Donors Really Dead?” (Pallis 1980). Clearly,
the details of the concept of brain death can be said to be in evolution as these and
other issues continue to be discussed in various national and international forums.
Finally, it should be clear that the above issues present difficulties with respect to
the notion of personhood, first introduced in Sect. 3.3. This is because being alive is a
necessary (but not sufficient) condition for personhood.9 Note that personhood, dis-
cussed in detail Chap. 3, necessitates a degree of rational activity, hence conscious-

8 An ambiguous statement is one whose meaning is unclear, indistinct, having a double meaning,
or open to more than one interpretation. It is the last sense that I argue that that there is a degree
of ambiguity in the language used in most brain death protocols. This ambiguity exists in large
part because some of the requirements for the declaration of brain death are specified in qualitative
rather than quantitative terms.
9 Note, however, that should non-biological self-aware organisms ever come to pass, the requirement

of being alive to merit personhood will require reassessment.

5.14 Further Difficulties in the Declaration of Brain Death 105

ness and its associated brain activity; personhood cannot simply be equated with
being a human “not being dead”. There therefore exists a personhood “gray zone”
between the neurologically intact human and an individual having been declared
brain dead. Here I suggest that the paradigm based on the work of Hughes (Table
3.1) suffices very nicely.

5.15 The Problem of Indistinct Boundaries: Death

as a Process

Yet another problem with the current approach to the declaration of brain death has
been stated succinctly by Halevy and Brody (1993):
The problem we have identified with the current consensus about brain death is not easily
resolved. We believe that this difficulty is an indication of a fundamental misunderstanding
in the current consensus, one that was first identified by Morison (1971) 20 years ago during
the initial debate about brain death. The consensus presupposes a sharp line between life and
death and tries to identify that line with one or another criterion for death. The data we have
presented challenge this consensus by showing that different aspects of brain functioning
cease at many different times. Thus, any sharp dichotomy between life and death based on
brain functioning, although convenient and appealing, is biologically artificial.

In addition to this issue, recent decades advanced studies into the biochemistry
of physiological (apoptosis) and pathological (necrotic) cell death in mammalian
organisms have led to new insights into the concept of death on the macro scale,
i.e., the death of the entire biological organism. As a result of these insights, some
individuals have advanced the philosophical position that organismal death is not an
event so much as it is a process, and that life and death are not distinct binary states,
but entities with degrees and gradations. Thus, while a patient may be legally declared
to be dead a few minutes after the continued cessation of cardiac activity (as is done,
for example, with non-heart-beating organ donation protocols), nevertheless, these
individuals argue, the cellular changes which occur in the period following cardiac
arrest may be potentially reversible following the application of appropriate clinical
interventions, especially under hypothermic conditions. Indeed, if all cells and organs
in an organism died fully and completely immediately following the last heartbeat,
any retrieved organs would be completely unsuitable for transplantation.
Based on such concepts, Bart Kosko, in his book Fuzzy Thinking (Kosko 1993),
argues that we should think of “death in degrees” rather than death as a simple
binary process. He suggests that the conceptual paradigm of “fuzzy logic”, where
membership in a particular class is taken as continuous rather than discrete, may be
helpful in such a setting. An example may help explain this notion. A patient who
has just had a surgical procedure may be asked to rate his or her pain between 0 (no
pain at all) and 10 (worst pain imaginable). This pain score might be mapped into a
pain “class” in some manner. For example, membership in the class “moderate pain”
might take on 0% membership at a pain score of 4, and take on a 100% membership
value with a pain score of 8. The class “severe pain” might be designed to start at 6
106 5 Life, Death, and Brain Death

and take on 100% membership value at 10, the maximum possible pain score in the
system. In the same vein, Kosko would have us talk about degrees of death, where
one would have 100% death membership following cremation, but perhaps only 90%
membership in the case of cryonic suspension (discussed in Chap. 6).
In a similar manner, the notion of “incomplete” brain death has now arisen in
the medical literature, as might occur in the case of “the patient with a massive
brain injury who meets the criteria for brain death only imperfectly, perhaps because
one small patch of neurons in a brain-stem nucleus is still operating intermittently”
(Doyle and Robichaud 2004). By and large, such patients are not considered to be
dead and so are not considered to be suitable for organ retrieval purposes. Often,
once the hopelessness of the situation is established, in the actual clinical world
such patients are usually withdrawn from life support, and cardiorespiratory arrest
follows inevitably some time later. Tragically, in this setting the organs are almost
never used for transplantation, as they must usually be harvested prior to collapse
of the circulation. Thus, the organs “go to waste” even when the patient has signed
his or her organ donor card and even when the family is enthusiastically in favor of
organ donation.10

5.16 Peter Singer and Brain Death

Readers following the debate on brain death may take an interest in the philosophical
views of Peter Singer, introduced earlier. As we have seen, in his various writings
he has challenged our most closely held beliefs on infanticide, euthanasia, and the
moral status of animals. He also challenges the conventional wisdom on brain death.
In his book Rethinking Life and Death (1995), Singer notes that following the
Harvard Brain Death Committee report published in 1968, most countries have
adopted brain death as an acceptable criterion for declaring a person legally dead. He
also notes that this event transpired with virtually no opposition despite its ground-
breaking nature. What is less widely known, Singer points out, is that this “redefi-
nition” coincided historically with the advent of organ transplantation—a mere nine
months before the Harvard report came out, Dr. Christiaan Barnard performed the
first successful cardiac transplant. Singer doubts that this is a coincidence.
In a manner similar to the discussions in Sects. 5.5 and 5.6, Singer likewise points
out that it is simply not true that all brain function necessarily ceases with brain
death—for instance, pituitary function often continues for some time after formal
criteria for brain death are met.
Singer takes the position that brain dead individuals are still alive, but that organ
harvesting from these individuals is none the less acceptable. His position is that
rather than employ artificial, contrived, or bogus definitions of death, we should
recognize that the only intellectually honest course is to admit that all lives are not
equally valuable and that some lives are indeed in such a degraded and hopeless state

10 That being said, the procedure described in Sect. 5.19 is one means to get around this problem.
5.16 Peter Singer and Brain Death 107

that even though they are technically “alive,” it is still ethically acceptable to utilize
their organs for transplantation. This approach solves the problem of incomplete
brain death addressed in Sect. 5.14.11

5.17 The Diagnosis of Brain Death Compared to a Murder

Trial

The determination of brain death is in some respects analogous to a murder trial.

In both cases there is a rigorous process to establish an outcome. In both cases it is
theoretically possible that the incorrect outcome occurs. An incorrect outcome may
occur either because the appropriate process is not followed or because of imper-
fections in the process. An example of the former in the case of brain death is an
incorrect determination of brain death in a patient who is unresponsive because of a
barbiturate overdose. In such cases an immediate determination to brain death is not
permitted under brain death protocols. Similarly, in a murder trial, if a judge mis-
takenly disallows exculpatory evidence from being presented, an incorrect outcome
may also occur.
In both the medical and legal cases, however, there is the possibility that even
with rigorous adherence to the correct process an incorrect outcome may still result.
This may be because the process itself has flaws, such as being based on a protocol
with inherent vagueness or ambiguity. In the case of the determination of brain
death, for example, expert clinicians may disagree as to what constitutes a metabolic
derangement of sufficient severity that the declaration of brain death cannot be made.
This is because, as indicated earlier, the language in the protocols for the declaration
of brain death often use terminology that is imprecise. Thus, for example, two experts
may disagree as to whether or not a serum sodium level of 127 milliequivalents per
liter (the normal range is 135–145) is a sufficiently severe electrolyte abnormality
that the declaration of brain death cannot be made. Unfortunately, no extant brain
death protocol specifies acceptable ranges for all possible electrolyte and metabolic
parameters: clinical judgment is necessarily involved.
Similarly, in a murder trial, there may be sufficient imprecision and ambiguity
in the applicable legal statute under which the defendant is being tried that various
judges will disagree among themselves as to whether the defendant is guilty or not.
Lawyers that specialize in legal appeals are particularly aware that mistakes occa-
sionally occur during a trial. Similarly, mistakes occasionally occur during the dec-
laration of brain death. Gail van Norman describes some of these mistakes in a
review of the declaration of brain death published in the anesthesiology literature.
For example, she describes the case of a patient who was declared to be brain dead by

11 While the context here is that “lives not equally valuable” refers to brain dead lives in distinction to

human lives generally, Singer also argues that in everyday life, some lives (not only brain dead ones)
are also not equal, e.g. severely impaired spina bifida born infants in comparison with normally
born infants.
108 5 Life, Death, and Brain Death

a neurosurgeon and where the patient was brought to the operating room for organ
retrieval. Towards the end of the case the heart became very tachycardic, and the
anesthesiologist chose to administer the drug edrophonium to slow down the heart
rate. When this happened, the patient started breathing asynchronously with the ven-
tilator. Since any spontaneous breathing is incompatible with the declaration of brain
death, the initial declaration of brain death was reviewed in detail. It was noted that
the declaring neurosurgeon had observed one agonal respiratory effort during the
apnea test, but he had felt that the patient was still “dead enough” to allow the dec-
laration of brain death to be made. What makes this case especially interesting was
that I was the anesthesiologist involved in this case, and this case triggered a career
long interest in the problem of brain death.

5.18 Neomorts

A neomort is a brain-dead individual who still has a blood pressure and a pulse and
is artificially ventilated by machine. Drug infusions are frequently used in addition
to help maintain cardiovascular stability. In most cases neomorts are brought to an
operating room for organ retrieval, after which ventilation is discontinued and the
heart eventually stops. (Note that in most cases a formal declaration of brain death
is not done on a brain damaged patient unless organ retrieval is being considered.)
However, a neomort might be of value beyond merely being a source of organs
for transplantation. For example, a marginal organ (or a good organ not normally
transplanted or not needed for transplantation) could conceivably still be retrieved
for use in a research protocol, such as in studies of possible organ toxicity studies for
new drugs. Another possible approach would to be to use an entire intact neomort
as a research platform rather than to study individual organs. The importance of this
possibility is reflected in the fact that drug testing using animal models have a number
of serious limitations. For example, a number of drugs that tested safe on animals
have proven to be harmful to humans (Vioxx and Rezulin are just two examples).
Similarly, a number of drugs proven to be dangerous to animals are in fact safe for
humans to use. As an everyday example, both chocolate and the popular drug Tylenol
(acetaminophen, paracetamol) can be toxic to canines in doses that are completely
safe for humans.12
Table 5.1 lists some possible research areas using neomorts. This approach might
be appealing to individuals who are happy to serve as a research platform for an
important question but are not enthusiastic about giving away any organs to needy
recipients. In most cases, this would be for cultural or religious reasons. In addi-
tion, many animal rights activists would likely be pleased with any developments
that would avoid the need for experiments involving animals. Table 5.2 lists some

12 These facts notwithstanding, many treatments and drugs for humans and (certain) animals are the

same, especially for non-human primates such as chimpanzees.

5.18 Neomorts 109

Table 5.1 Some potential research areas involving neomorts

• Testing new drugs before experimental use in live humans

• Perfecting new surgical procedures before experimental use in live humans (As an example,
Dr. Sergio Canavero claims to have performed a “dry run” head transplant operation,
apparently using two neomorts, an operation which took 18 h. See http://nationalpost.com/hea
lth/worlds-first-human-head-transplant-successfully-performed-on-a-corpse-scientists-say)
• Testing resuscitation protocols for induced pathophysiological states (e.g., studying the
pathophysiology of venous air emboli using transesophageal echocardiography)
• Using neomorts to test new devices like left-ventricular assist devices, artificial hearts, aortic
stents, artificial livers etc.

Table 5.2 Some potential concerns with neomort research protocols

• Few preparations are available, and they tend not to last long

• Who pays for the extra ICU care, which is very expensive?

• Some argue that this is disrespectful to the dead (but so then would be organ retrieval or use of
cadavers for training medical students)
• How would consent be obtained? (Presumably, via a process similar to that used in organ
donation)
• Potential organ donors can imagine a person directly benefiting from their gift, while the
benefits from neomort-based research are less direct

objections that might arise with the idea of research using neomorts (scenarios that
need a pulse but not a brain).

5.19 Non-heart-Beating Organ Donors

In more recent times, the lack of a sufficient number of organs from brain-dead donors
has led to the occasional use of non-heart-beating organ donors. Here, patients who
are not brain-dead but have no reasonable chance of recovery are brought to the
operating room where they are prepped for surgery, followed by the withdrawal of
all life-support measures.13 Sometime later their heart stops. A period of time later

13 This usually involves the termination of mechanical ventilation and drug infusions supporting
the circulation. In some of these cases, the care team will have run out of treatment options (death
as giving up on the patient based on the limitations of available technology), while in others the
patient or family may have decided that the pain and suffering associated with “going on” is just
not worth the expected result. Note also that in some cases, death does not follow as expected, as in
the famous case of Karen Ann Quinlan. Quinlan unexpectedly survived being disconnected from
110 5 Life, Death, and Brain Death

(typically 300 s after the final heart beat), surgeons quickly rush into retrieve organs
before they deteriorate (Bernat et al. 2006).14
Some individuals have criticized the definition of death used in non-heart-beating
organ donation programs noting that any cessation of cardiac activity (asystole)
might not be permanent as long the heart might be restored by vigorous resuscitation
efforts (Maleck et al. 1998). In addition, several non-heart-beating organ donation
protocols allow ante-mortem drug administration and other interventions that are not
intended to benefit the donor. For instance, high-dose heparin is sometimes given to
prevent blood clotting. However, since the heparin is not administered for the benefit
of the patient, some professionals argue that its administration is unethical (Doig and
Rocker 2003).
Another issue concerns timing. Doig and Rocker (2003) explain the problem as
follows:
With the need to reduce warm ischemia, organs must be recovered as quickly as possible
after the cessation of cardiac activity. The simple question becomes: when in the course of
ascertaining death, is the patient dead, and when can organs be taken?

Referring to a report by the Institute of Medicine (2000) Doig and Rocker also
note (p. 1072):
The recent Institutes of Medicine report identified variability between centres in the duration
of asystole required prior to organ retrieval (2–20 min), and that limited research has been
conducted on the likelihood of spontaneous “auto-resuscitation.” Their report recommended
adoption of five minutes of observed cardiac asystole, with a caveat that further research is
required to confirm that auto-resuscitation does not occur during this interval. Meanwhile,
some centres continue to use an interval of asystole as short as two minutes. Despite the
premise of certainty in determining irreversible death, it is worrisome that centres cannot
agree to adopt a common standard.

5.20 Nanotechnology and the Death of Death15

A number of thinkers are now speculating that future developments in nanotech-

nology may permit repair and rejuvenation of organ tissue that is either dead or
nearly dead by classical criteria. When a cell is on a path towards death, for instance
from oxygen deprivation, a number of complex biochemical events occur as energy
is depleted from the cell. That is, under ordinary normothermic conditions, ongo-
ing energy expenditure is needed to keep a cell alive. The case is rather different

mechanical ventilation following a devastating hypoxic brain injury but remained in a vegetative
state breathing on her own for another decade before succumbing to pneumonia.
14 A variation of such a protocol would also be expected to be of value in cryonic suspension,

discussed in Chap. 6. In such a scenario, instead of organ retrieval, cardiopulmonary bypass, followed
by cryonic preservation, would be initiated a short period of time after the onset of asystole.
15 The term “death of death” is usually taken to be synonymous with “immortality” in the sense

of achieving victory over senescence and disease but not in avoiding accidental death or the entropic
death of the universe predicted by physicists.
5.20 Nanotechnology and the Death of Death 111

under hypothermic conditions, as cellular metabolic rate decreases with decreased

temperature. In fact, some animals can even be subjected to prolonged periods of
freezing temperatures and later revived (e.g., wood frogs [Rana sylvatica]), pre-
sumably because of special components in the cells of these animals that prevent
the formation of intracellular ice crystals that tend to destroy the complex internal
machinery present in all cells.
In James Hughes‘ book Citizen Cyborg (Hughes 2004), the author speculates that
future clinicians may be able to launch nanobots (nanorobots) into patient’s blood-
streams and that these nanobots would be able to enter into cells just as viruses do
today, and, just like today’s viruses, would be able to reconstruct damaged internal
cellular machinery. In the nanobot scenario, just as an ordinary virus can alter cellular
machinery to its own ends, it is imagined that nanobots designed along viral design
principles might be developed that would conduct various kinds of cellular main-
tenance and repairs, such as: repairing damaged DNA, fixing leaks in membranes,
repairing damaged ion pumps.
Drexler (1986) explains the idea this way:
Cell repair machines will be comparable in size to bacteria and viruses, but their more-
compact parts will allow them to be more complex. They will travel through tissue as white
blood cells do, and enter cells as viruses do - or they could open and close cell membranes
with a surgeon’s care. Inside a cell, a repair machine will first size up the situation by
examining the cell’s contents and activity, and then take action. Early cell repair machines
will be highly specialized, able to recognize and correct only a single type of molecular
disorder, such as an enzyme deficiency or a form of DNA damage. Later machines (but not
much later, with advanced technical AI systems doing the design work) will be programmed
with more general abilities.
Complex repair machines will need nanocomputers to guide them. A micron-wide mechan-
ical computer … will fit in 1/1000 of the volume of a typical cell, yet will hold more infor-
mation than does the cell’s DNA. In a repair system, such computers will direct smaller,
simpler computers, which will in turn direct machines to examine, take apart, and rebuild
damaged molecular structures.
By working along molecule by molecule and structure by structure, repair machines will be
able to repair whole cells. By working along cell by cell and tissue by tissue, they (aided
by larger devices, where need be) will be able to repair whole organs. By working through
a person organ by organ, they will restore health. Because molecular machines will be able
to build molecules and cells from scratch, they will be able to repair even cells damaged
to the point of complete inactivity. Thus, cell repair machines will bring a fundamental
breakthrough: they will free medicine from reliance on self-repair as the only path to healing.

Where such repairs turn out to be impractical, Drexler‘s nanobots might instead
be used to trigger programmed cell death (apoptosis) to prevent the development of
malignant cells that subsequently undergo uncontrolled growth.
It is worth emphasizing that molecular repair at the cellular level already
takes place in nature. Consider, for instance, that the normal human cell has
within itself the capability to identify and correct damage to DNA molecules that
may occur as a consequence of factors such as normal cellular metabolism, or
exposure to ionizing radiation or ultraviolet light. Damage to cellular DNA can
induce potentially harmful mutations in the cells genetic makeup, which may be
112 5 Life, Death, and Brain Death

passed on to daughter cells following cellular mitosis (cell division) and in appro-
priate cases may lead to tumor growth or cancer formation.
A number of genes influence the rate of DNA damage and repair. When problems
with these genes occur as result of genetic defects, they may manifest clinically as
syndromes such as xeroderma pigmentosum, where hypersensitivity to ultraviolet
light results in an increased rate of skin cancer.
Some scientists believe that understanding these influences at the molecular level
will allow genetic engineering to be carried out so that DNA damage and its conse-
quences is less of a clinical problem. While such genetic engineering might lead to
treatment for conditions such as xeroderma pigmentosum,16 such treatments might
presumably also reduce the rate at which genetically normal people age and the
frequency with which genetically normal people develop malignancies.
Should these developments actually eventually come to pass, it will require that
we rethink our notions of death once again, since what was once irreversible damage
would now be reversible, at least in some cases. On the other hand, some scien-
tists are highly skeptical; for instance, since cells contain thousands upon thousands
of components that may be damaged, some authorities argue that developing the
required nanobot for each conceivable type of cellular damage may be impossible,
or at least highly impractical. Regardless, with such issues in mind, some thinkers
have argued that it is helpful to distinguish between the definition of death based
on cessation of the heart beat and a “more substantial” form of death, such as exists
following cremation. In the latter case, sometimes called “absolutely irreversible
death” or “information-theoretic death” destruction of the brain has occurred to such
an extreme that any information it may have ever held is irrevocably lost for all
eternity. This, some people argue, is the only real (irreversible) form of death.
I would like to conclude this chapter by once again emphasizing to the reader the
central theme presented in this chapter—that death is not a binary event but rather an
involved process. This fact has both biomedical and philosophical implications, both
of which have been addressed above and will be addressed in more detail in the next
chapter, which deals with cryonic life suspension. In sum, in the present chapter I
have identified a number of problems with the concept of brain death as it is currently
employed in contemporary clinical practice, and have discussed the implications for
personhood (which, I argue earlier, necessitates a degree of rational activity, hence
consciousness and associated brain activity, that cannot simply be equated with “not
being brain dead or clinically dead”).
In the next chapter the discussion is extended to include individuals who have
undergone cryonic suspension, where a number of difficult new issues arise in relation
to moral standing and personhood.

16 Xeroderma pigmentosum is a tragic genetic disorder in which the ability to repair DNA damaged

by ultraviolet light is absent. As a result, multiple basal cell carcinomas and other skin malignancies
tend to occur unless strict avoidance of sunlight is enacted. Less than half of individuals with the
disease live beyond the age of 20, although some victims with less severe cases (eight different
types exist) may live into their 40s before succumbing to cancer.
Chapter 6
Cryonic Life Extension: Scientific
Possibility or Stupid Pipe Dream?

I’ve long thought it a pity that non-transhumanists equate trying

to conquer death with a childish fear of death and a lack of
wisdom. This is like saying Sir Edmund Hillary had a childish
fear of mountains.

Philip Goetz.

Abstract This chapter is concerned with cryonics and suspended animation. Like
the previous chapter, it contributes substantially to the philosophical debate on where
the line between life and death should be drawn. The ultimate aim of cryonics is
to achieve nondestructive freezing (cryopreservation) of advanced organisms like
humans so that they can be safely thawed in the future, usually with a view to
obtaining advanced medical treatment not currently available. In this chapter number
of scientific and philosophical questions presented by cryonics are discussed, such
as whether cryonics is real science or simply a waste of money, the legal and moral
status of cryonically suspended individuals, and how to deal with the possibility
that the thawed individual might end up with some organs working but with severe
neurological impairment.

6.1 Introduction

In previous chapters we examined a variety of issues lying at the intersection of tran-

shumanism and ethics: genetic enhancement, neuro-enhancement, human enhance-
ment through the use of drugs, animal-human hybrids, and computer-human hybrids.
Also explored were the moral, ethical and legal problems associated with brain death
in both its complete and incomplete forms. It was argued that the notions of person-
hood and personal identity were central to the discussion.
In this chapter we explore some of the moral, ethical and legal problems asso-
ciated with another process lying at the intersection of transhumanism and ethics:

© Springer Nature Switzerland AG 2018 113

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_6
114 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

cryonic life extension, the as yet unperfected process of placing patients into a state
of suspended animation using nascent technologies such as “vitrification.” Once
again, the notion of personhood and personal identity can be seen to be central to the
discussion.

6.2 What Is Cryonics?

Important early work in the field of cryonics date back to Ettinger’s seminal work
The Prospect of Immortality (Ettinger 2005a) and his later book Man into Superman:
The Startling Potential of Human Evolution (Ettinger 2005b). In addition, a volume
entitled The Philosophy of Robert Ettinger (Tandy 2002) describes the considerable
impact that Ettinger had on influencing the nascent field of cryonic preservation.
The central scientific quest in cryonics is to develop, test and validate technology
that would reversibly preserve brain-encoded information essential to personhood
after cryonic preservation. Advocates of cryonics seek to use cryoprotectants, vitrifi-
cation and extreme cold (such as immersion in liquid nitrogen) to extend the life of an
individual who can no longer be sustained for long periods by conventional medical
technology. This cryonic life extension is intended to be employed for decades or
even centuries, until safe reversal of the preservation process as well as treatment for
the underlying medical condition becomes feasible as a result of new developments
in medicine and technology.
Such an undertaking is predicated on three important principles, only one of
which is well-established at this time. The first principle of cryonics is that life can
be stopped or suspended as long as appropriate attention is directed at preserving
the basic biological structures upon which life is based. Although this principle is
well-established for a number of animal species as well as for human embryos (Pegg
2007), much needs to be done to extend the principle to include full human beings.
That being said, this is a field of active research in medical science and it is reasonable
to expect that interesting developments will continue to be unveiled by researchers
in these fields.
A second principle is that the use of cryoprotectants and vitrification will be use-
ful in extending the first principle to larger organisms such as adult human beings.
Progress on this second principle is now occurring at the level of entire organs. One
particularly important scientist in this field is Gregory M. Fahy, who has achieved
successful vitrification and autotransplantation of a rabbit kidney using his (propri-
etary) M22 vitrification solution (Fahy et al. 2009; Fahy and Wowk 2015).
The third and most controversial principle is that post-thawing damage to indi-
vidual cells (especially neurons) might be repaired one molecule at a time using the
emerging sciences of nanotechnology and nanomedicine. However, to the extent that
cryonic preservation might eventually be achieved without damage to cellular struc-
tures, or may be achieved through naturally-occurring biological repair mechanisms,
the advanced molecular repair methods referred to above may not be necessary.
6.2 What Is Cryonics? 115

Additionally, it should be emphasized that—at least in principle—damage to indi-

vidual cells may not always result in loss of the information needed to reconstruct a
viable post-suspension organism. Should advanced methods become available to
reconstruct the entire human organism from information reliably preserved and
subsequently exploited despite the presence of cellular damage following cryonic
suspension, this problem might be expected to vanish. One scenario here would
be to clone an entire new body but with the special proviso that the informa-
tion/identity/memories of the original organism be transferred to the new organism.
In such cases the patient would emerge rejuvenated and “better than well” and without
the lifespan limitations of the original cryopreserved tissue. Yet another possibility,
should mind up-loading and down-loading ever become feasible, is that an individual
become recovered in virtual reality.1 This possibility is discussed in Sect. 6.20.

6.3 Is Cryonics Possible in Principle?

Although so far alien to man, the ability to endure winter freezing has developed in
several species of frogs and turtles as well as in a number of species of insects and
microorganisms. This suggests that with appropriate scientific advances reversible
freezing of larger organisms might be possible in principle.
The evidence that reversible freezing of humans may eventually be possible comes
from several sources. First, there is support from nature. For instance, the wood frog
Rana sylvatica utilizes naturally-occurring cryoprotectants in order to survive low
temperatures during winter months. This natural process utilizes glucose, derived
from hepatic glycogen, as well as urea, as cryoprotectants (Costanzo and Lee 2005;
Costanzo and Lee 2008; Muir et al. 2007; Storey et al. 1996). As a result, these frogs
can “endure freezing for at least 2 weeks with no breathing, no heart beat or blood
circulation, and with up to 65% of their total body water as ice” (Storey et al. 1996).
The spring peeper (Pseudacris crucifer) and the gray tree frog (Hyla versicolor) are
other species that can withstand freezing temperatures during winter (McNally et al.
2003).
In recent years, the application of gene screening technology to animals that
tolerate freezing has allowed scientists to identify proteins that contribute to freeze

1I am indebted to High Hixon, an Alcor Research Fellow, for identifying this intriguing possibility
via private correspondence. Mind uploading (whole brain emulation) is the hypothetical process
of transferring a conscious mind from a biological brain to a non-biological substrate (e.g., silicon
computer) via as yet uninvented technical innovations (scanning, mapping, simulation). The new
substrate would run a simulation so faithful to the original that it would behave indistinguishably
from the native brain. For additional discussion on this fascinating issue the interested reader is
invited to read an intriguing paper from Bostrom’s Future of Humanity Institute: http://www.fhi.
ox.ac.uk/Reports/2008-3.pdf. One interesting issue is whether or not the Heisenberg uncertainty
principle in physics—which precludes one from simultaneously knowing the exact position and
velocity of any particle (such as an atom)—makes this possibility impossible in principle. This
issue arises because, accepting physicalism for discussion purposes, the mind is not just a set of
particles with positions w, x, y, and z, but a set of particles with both position and velocity.
116 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

tolerance in animals (Storey 2004; Storey et al. 1996; McNally et al. 2003). These
proteins are in turn coded for by genes (DNA sequences) such as fr10, li16, and fr47
(McNally et al. 2003). As our scientific understanding of these processes improves
over time, it is interesting to speculate as to whether it might be possible to use
genetic engineering means to add these genes to the human genome (if they do not
already exist), or to activate them should they be present in the human genome but
not expressed.
The idea would be that should a patient be diagnosed with an untreatable terminal
illness, genetic engineering interventions aimed at inducing natural cryoprotection
might be expected to be more effective than the methods currently in use. Another
possibility would be to create new babies with the required cryoprotectant genes as
a risk mitigation measure against dying from accidental hypothermia in cold climate
regions like northern Canada.
Although this all might seem quite outlandish, consider that as of this writing
(2018) the structure of DNA has been known only six decades. Consider also that it
took only seven decades for humankind to progress from the first powered flight by
the Wright brothers (1903) to the first manned moon landing in 1969.
A second line of argument that the safe freezing of humans may eventually be
possible stems from the fact that human spermatozoa, oocytes and even embryos are
already routinely frozen in in vitro fertilization clinics around the world. Indeed, a
great many individuals alive today were at one time cryopreserved embryos. In fact,
two embryo cryopreservation methods are in common clinical use: slow freezing and
vitrification (Kattera and Chen 2006; Loutradi et al. 2008; Kolibianakis et al. 2009).

6.4 Vitrification

Vitrification is the technology that advocates of cryonic suspension hold as having the
most promise for eventual success. In vitrification, cellular water is largely replaced
by one or more cryoprotectants. In addition, rapid cooling is carried out so that any
remaining water is transformed directly from its liquid phase to a glassy, vitrified
state that occurs with minimal formation of damaging ice crystals.
This process involves a number of special challenges. First, there are biological
limitations to the degree to which cryoprotectant chemicals will be tolerated by cells
undergoing vitrification. Second, while vitrification of cell clusters has been achieved,
it is much harder to do this with an entire organ or an entire organism. Finally, the
required cooling rates can be a challenge. For instance, for embryo vitrification,
cooling rates between 15,000 and 30,000 °C/min are often used (García-Velasco and
Pellicer 2007 ).2 Despite these challenges, as noted earlier, the successful vitrification
6.4 Vitrification 117

and subsequent transplantation of a rabbit kidney by Fady (Fahy et al. 2009; Fahy
and Wowk 2015) suggests that eventual success is mostly a matter of effort, money
and imagination.

6.5 Substrate Preservation Versus Information

Preservation

In dealing with cryonics, it is helpful to distinguish between the information preserved

in a person’s brain and the substrate used to hold that information. The information
that makes us a person includes our longitudinal memories, as well as our hopes,
our dreams and countless other mental events. As we discussed in Sect. 3.3, this
information is unique to us—it is what makes us persons. How exactly this infor-
mation is encoded into the brain substrate is a field of active neurologic research.
The reader interested in this complex question might start by looking at some of the
articles published in the academic journal Learning and Memory.3 For individuals
who would like a brief sketch on this matter, the following commentary is offered.
One popular theory of how memory is encoded in the brain is based on a hip-
pocampal synaptic plasticity model (Bliss and Collingridge 1993; Shapiro 2001;
Dudai 2004; Conner et al. 2009). The support for this theory comes from a number
of sources. First, in Alzheimer’s disease the hippocampus is one of the earliest brain
structures to suffer damage. That memory problems appear among the first clinical
findings in Alzheimer’s disease suggests that the hippocampus has an important role
in memory formation.
Second, lesions of the hippocampus in humans may prevent the acquisition of
new memories, as in the well-known case of HM. In 1953, a man known as HM
lost substantial portions of his hippocampus, parahippocampal gyrus, amygdala and
anterolateral temporal cortex in a neurosurgical procedure aimed at stopping his
intractable epileptic seizures. While the surgery was successful in eradicating the
seizures, HM ended up with complete anterograde amnesia, although his working
memory and procedural memory remained intact.
Third, hippocampal synapses are known to have “activity-dependent synaptic
plasticity” that provides neuronal level evidence of a possible role in memory. In

2 For vitrification on the human-scale, thermal mass and heat conduction properties conspire to
limit the rate of cooling, with the consequence that novel approaches to vitrification must be
sought. Recognizing that there is non-covalent competitive binding of water molecules between
the biomolecules (which incorporate water as an integral component of their structure), the various
components of the cryoprotectant, and crystalline ice, may be the basis for future developments.
Note that the goal of cryoprotection is to avoid irreversible alteration of biomolecular structures,
which ice does by competitive dehydration; the affinity of the water molecules for the ice is greater
than for the biomolecules. (I am indebted to High Hixon, an Alcor Research Fellow, for making
this point during our private correspondence.)
3 Information about the journal is available at http://learnmem.cshlp.org.
118 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

this arena, a particularly attractive family of molecular candidates for modulating

synaptic plasticity during learning and memory processes are neurotrophins (NTs).
Finally, the importance of the hippocampus to neuroscience in general and mem-
ory research in particular is evidenced by the fact that there is a journal devoted
specifically to it (called, appropriately, Hippocampus).4
A computer analogy may be helpful in explaining this distinction between the
information preserved in a person’s brain and the substrate used to hold that infor-
mation. In order for a computer to be useful its hard drive (or equivalent memory)
must be loaded with a number of kinds of information. For example, the hard drive
will contain an operating system, as well as a number of applications (word pro-
cessing, spreadsheets etc.), as well as a number of data files (such as the text file
containing these very words). For the computer to be useful, it must contain both
the hardware as well as the information that constitutes its “identity” (programs and
data). If the computer is destroyed, for example by fire, mere replacement of the
hardware would be insufficient to restore the computer to its previously useful state.
Instead, all the information that was unique to that computer would have to be added
as well.
In the world of computers, restoring this information is a relatively simple task
using backup programs that are commonly available. In the case of the brain, there
is as yet no way to achieve this task. In the realm of science fiction brain backups are
done using methods whereby the state of the brain is measured in sufficient detail
that it can be reconstructed on demand. In this sense, there is a rough analogy to
teleportation, another popular science fiction theme.
The importance of this distinction between the substrate and the information
encoded on the substrate is that it could turn out that cryonic brain preservation ends
up preserving brain tissue (substrate) but might still not be sufficient to preserve the
information the brain retains.

6.6 The Two Usual Cryonics Scenarios

In the USA, Alcor, a facility located in Scottsdale, Arizona, is one of several compa-
nies offering a cryonic suspension service. (Although other cryonics organizations
exist, their services, policies, and clinical approaches are similar.5 ) Candidate patients
carry an alert bracelet requesting that as soon as possible after death, a large dose
of heparin (an anticoagulant) be given intravenously and the newly “dead” patient
be placed on cardio-pulmonary bypass to allow continuing organ perfusion prior to
freezing.

4 Information about the journal is available at http://www.wiley.com/WileyCDA/WileyTitle/produ

ctCd-HIPO.html.
5 A listing of various services is available at http://www.benbest.com/cryonics/CryoFAQ.html#_V

II__.
6.6 The Two Usual Cryonics Scenarios 119

Two options are offered: a whole-body option (cost: $200,000 and up) and a less
expensive option where only the head is cryonically suspended (cost: $80,000 and
up). In either case the hope is that at some future time the body (or head) will be
able to be unthawed and repaired, although in the case of the head only option, the
problem of finding a matching body exists unless: (1) a new body can be constructed
(perhaps via a variant of cloning or by advanced tissue engineering methods), or if (2)
the newly reanimated head is configured to exist as an isolated perfused preparation
(vide infra), or (3) the head’s information contents are transferred to an entirely new
biological entity (again, perhaps constructed via a variant of cloning), or (4) somehow
a new organism is made to exist entirely in silico.

6.7 Living as an Isolated Head

In the situation where only the head would be preserved, one can imagine three
possible outcomes: (1) failure to successfully reanimate the individual in question
(certainly a possibility, at least in the early experimental phases of any cryonics
research), (2) existence as a conscious, reanimated head attached to a new body (a
situation with numerous challenges beyond mere successful thawing of the head),
and (3) existence as a conscious, reanimated head existing independently from a
body via an artificial cardio-pulmonary-renal-endocrine support system.6
About 50 years ago, White et al. were able to isolate a series of five monkey brains
by surgically removing all anatomical structures surrounding each brain except a
small basal plate of bone and the central portion of the skull (White et al. 1963,
1964, 1965, 1996). These brains were completely isolated from the donor monkey’s
body neurogenically and vascularly, and were perfused in vitro for 30–180 min via
extracorporeal circulation using an immunologically compatible second monkey.
That the isolated perfused brain remained alive and working in this setting was
demonstrated by showing persistent electro-encephalographic activity at the cortex
as well as by showing that the brain was appropriately extracting oxygen from its
blood supply (by obtaining expected differences in oxygen content between the blood
entering the brain and the blood leaving it).
A year later White’s team successfully repeated the experiments using a mechan-
ical extracorporeal system (instead of using the body of another monkey as a life-
support system for the isolated monkey brain). In addition, White’s team was able
to transplant the head of one monkey onto the body of another. The procedure was a
success to the extent that the transplanted head was able to smell, taste, hear, and see,

6 Although this last possibility—that of a conscious human existence somewhat like the “brain in a
vat” scenario so often discussed in introductory philosophy courses - seems to be almost ludicrous,
the situation may be technically possible, at least for moderate periods of time. Regardless, it should
be emphasized that the usual “brain in a vat” scenario is a philosophical thought experiment often
employed as an argument for philosophical skepticism and solipsism, and has nothing to do with
cryonics.
120 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

even though the animal was quadriplegic (since the spinal cord was not connected).
The animal even occasionally tried to bite some of the staff.
Of interest, White’s team was not the first to show that conscious existence as a
severed head was possible. Many years earlier, in 1928, Bryukhonenko and Tchetchu-
line at the Institute of Experimental Physiology and Therapy in the USSR showed
that life could be maintained in the isolated head of a dog for a moderate period of
time by connecting the carotid arteries and jugular veins to a system for extracorpo-
real perfusion and oxygenation that used the lungs from a second dog as part of the
setup (Brukhonenko and Tchetchuline 1929a, b; Adamenko 1969). Bryukhonenko
went on to pioneer a number of important clinical developments that lead to the first
Soviet open-heart operation in 1957. For these achievements, Bryukhonenko was
posthumously awarded the Lenin Prize.
Evidence that the isolated perfused dog head was alive and responsive to stimuli
comes from the following New York Times report (Kaempffert 1943):
When the eye was touched it twitched. After twenty minutes there were more signs of life.
The eyes were open by that time and looked alive. The head responded to a whole series
of stimuli. Eyelids blinked when hairs on the brow were plucked. Particularly noticeable
was the response when the mucous membrane of the nose was irritated. In fact, it was often
necessary to hold the head on the plate by force. The muzzle was opened and the teeth were
bared in a snarl. When quinine was placed on the tongue there was every sign of repugnance.
Pieces of sausage were swallowed and ejected through the top of the alimentary canal. In
short, the head behaved just as if it were attached to the body. And in this condition it
remained for about three and a half hours.

A 1940 public domain film “Experiments in the Revival of Organisms” demon-

strating the experiment is available at the Prelinger Archive (http://www.archive.or
g/details/prelinger). The film may also be viewed at http://www.youtube.com/watc
h?v=ap1co5ZZHYE.

6.8 Head Transplantation

In 2013 Dr. Sergio Canavero, director of the Turin Advanced Neuromodulation

Group in Turin, Italy, announced plans to launch a human head transplant program
(Canavero 2015; Canavero and Ren 2016; Li et al. 2017). Given White’s pioneering
work, many of the surgical details related to head transplantation have been worked
out. In addition, White’s work has recently been replicated in China as a means to
further move ahead with head transplantation.7
Still, Canavero and co-workers face two significant obstacles that will have to
be overcome: [1] fusing the donor and recipient spinal cord into a neurologically
integrated unit, and [2] preventing rejection of the graft (an interesting question
arises here—is the graft the body or is it the head?).

7 http://www.iflscience.com/health-and-medicine/surgeons-claims-head-transplant-monkey-has-b

een-successfully-carried-out/.
6.8 Head Transplantation 121

Experience in composite graft (e.g., face) transplantation suggests that the

immunological problem, while undoubtably formidable, can likely be overcome,
so getting the recipient and donor spinal cords to fuse meaningfully will be the cen-
tral obstacle to deal with. However, given that polyethylene glycol has been shown
to prompt the growth of spinal cord nerves in animals (Borgens and Shi 2000; Ren
et al. 2017; Kim et al. 2017), this impediment may eventually be manageable as well.
Some proposed technical refinements that extend White’s pioneering work have
been offered by Canavero, the lead scientist/evangelist in the initiative (Canavero
and Ren 2016). First, the recipient’s head and the donor body will undergo thera-
peutic hypothermia to extend the time that the tissues are exposed to any necessary
hypoxic/ischemic insults related to the procedure. Cleanly severing both spinal cords
so as to avoid ragged ends is another key step. Following approximation of the donor
and recipient ends of the spinal cords, implanted electrodes would be used to pro-
vide therapeutic electrical stimulation to the spinal cord (Mondello et al. 2014). Also,
should the application of polyethylene glycol fail to do the job, the use of stem cells
(Tukmachev et al. 2015; Schroeder et al. 2015; Zhao et al. 2015; Li et al. 2014; Ren
et al. 2017) or olfactory ensheathing cells (Tabakow et al. 2014) are two additional
therapeutic approaches that the team is considering.
Of interest, Canavero’s team is not the only group working on this formidable
challenge. A Chinese team (Ren et al. 2014; Ren and Laugel 2013) continue to
work on allo-head and body reconstruction in a murine (mouse) model. Their novel
approach involves “retaining the donor brain stem and transplanting the recipient
head”, an approach that has the advantage of preserving respiratory and circulatory
function. Recently, Canavero has been formally collaborating with Ren and other
Chinese scientists.
Undoubtable, a number of ethical issues are involved in going forward in early
human trials. For example, what should be the role of animal trials before moving
forward to humans? Consider, for instance, item 3 of the Nuremberg Code, which
states that prior animal experimentation be used before moving to human trials: “The
experiment should be so designed and based on the results of animal experimentation
and a knowledge of the natural history of the disease or other problem under study
that the anticipated results will justify the performance of the experiment.”
A completely different ethical issue has been raised by Corlett (2001), although
not in this specific context. He makes the argument that we have a duty to die
inexpensively rather than squander money on a therapy with very limited utility (as
would very possibly be the case with head transplantation). Basically, in a setting
of limited health care resources, argues Corlett, we have a duty to spend the money
only where the impact will have the greatest value.
Let’s end this section with a specific hypothetical scenario. A famous quadriplegic
scientist has developed terminal body failure and, having only months to live, requests
that Dr. Canavero attach his head to the body of an available brain-dead man whose
family is agreeable to donating more than just the customary organs. The scientist
knows the risks as fully as anyone might, and while he is hopeful for the return of
full spinal cord function, quadriplegia is an outcome he can (and does) live with.
122 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

The family is honored by the possibility that their son’s body will be so wonderfully
recycled. You are on the hospital’s ethics board. How do you vote?

6.9 An Interesting Hypothetical Scenario

Let us now consider two thought experiments, presented in this and the following
sections. As with most philosophical thought experiments, these are offered to the
reader as a method to explore the consequences of particular philosophical positions.
It is 2045. Generalissimo Sanchez rules the nation of Sanchiva with an iron
fist. Unfortunately for him (but perhaps not for his subjects) he is diagnosed with
metastatic melanoma with an exceedingly poor prognosis. He now has only a few
months to live, despite having access to the best possible medical care and a mas-
sive personal fortune. To everyone’s surprise he decides to step down and put his
eldest son in power. Even more surprising, he decides to be cryonically suspended
before his anticipated death, with a view to be reanimated at some future time when
effective treatment becomes available. To this end, he hires a team from the Mayo
Clinic and from Alcor to induce general anesthesia, establish anticoagulation and
cardiopulmonary bypass, and then freeze his body under general anesthesia accord-
ing to the Alcor protocol, which now has advanced to the point that their technology
to prevent cell damaging ice crystal formation has become very reliable (at least in
animal studies). Following this, the Generalissimo has his frozen body placed in a
special mausoleum featuring triply redundant cooling systems and advanced elec-
tronic monitoring, as well as a well-guarded viewing station for the convenience of
the populace.
This bizarre and macabre scenario raises a number of interesting questions: Is the
Generalissimo Sanchez now dead or alive? What moral standing does the Generalis-
simo now have? How would one gauge the success of any reanimation efforts?

6.10 A Second Hypothetical Scenario

Field Marshal Perrera has adeptly but firmly ruled the oil-rich European island nation
of Novacia since he overthrew the democratically elected but corrupt government
over a decade ago. He now wishes to institute a uniquely bizarre form of capital
punishment. To avoid criticisms that his shady judicial system might kill innocent
citizens via capital punishment, he sentences people found guilty of capital crimes
to indefinite cryonic suspension. That way, should exculpatory evidence become
available, clearing the accused and resulting in a more favorable judicial outcome,
there is at least a theoretical chance of a post-thaw recovery. On the grounds that a
better outcome would be expected if the freezing is done before death has actually
occurred, a protocol identical to that described in the earlier scenario is used.
6.10 A Second Hypothetical Scenario 123

As in the previous scenario, some interesting questions are raised. What are the
legal and moral standings of such cryonically suspended individuals? Based on the
argument that the suspended individuals are not really dead, would such an arrange-
ment still be acceptable if Novacia sought admission to the European Union (which
forbids capital punishment)?

6.11 Cryonics as “Borderlands Science”

The information and scenarios presented so far raises a number of intriguing sci-
entific, philosophical, social and ethical questions. Let us explore some of these
questions, starting with the question of whether cryonics is real science.
Many professional cryobiologists do not regard cryonics as worthy of serious
study, particularly when the possibility of nanobots carrying out post-thaw cellular
repairs is raised. For instance, since cells contain thousands upon thousands of com-
ponents that may be damaged, some authorities argue that developing the required
nanobot for each conceivable type of cellular damage may be impossible, or at least
highly impractical. As another example of the skepticism raised by scientists, con-
sider the words of Shermer (2001) writing in Scientific American:
Cryonicists believe that people can be frozen immediately after death and reanimated later
when the cure for what ailed them is found. To see the flaw in this system, thaw out a can of
frozen strawberries. During freezing, the water within each cell expands, crystallizes, and
ruptures the cell membranes. When defrosted, all the intracellular goo oozes out, turning
your strawberries into runny mush. This is your brain on cryonics.8

Shermer also writes:

This is what I call “borderlands science,” because it dwells in that fuzzy region of claims
that have yet to pass any tests but have some basis, however remote, in reality. It is not
impossible for cryonics to succeed; it is just exceptionally unlikely. The rub in exploring
the borderlands is finding that balance between being open-minded enough to accept radical
new ideas but not so open-minded that your brains fall out. My credulity module is glad
that some scientists are devoting themselves to the problem of mortality. My skepticism
module, however, recognizes that transhumanistic-extropian cryonics is uncomfortably close
to religion. I worry, as Matthew Arnold did in his 1852 poem “Hymn of Empedocles,” that
we will “feign a bliss/Of doubtful future date,/And while we dream on this/Lose all our
present state,/And relegate to worlds yet distant our repose.

Shermer is arguably unfair, however, in some of his criticisms of cryonics, espe-

cially in his strawberry analogy. He fails to mention, for instance, that it is the goal

8 In cryonics circles this is known as the “strawberry man” argument. Needless to say, this is NOT
what happens with successful cryonic vitrification. Shermer’s failure to mention vitrification in
his article, despite it being the center-piece of cryonics, and the refusal of the editor of Scientific
American to publish a letter to this effect, is an example of publication bias in science. For additional
commentary on this and related issues, the interested reader is directed to http://www.alcor.org/pr
ess2001SciAm.html and http://www.icsu.org/publications/cfrs-statements/bias-in-science-publish
ing.
124 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

of vitrification science to avoid irreversable denaturation of cell biomolecules at

low temperatures, and that this process does occur in nature in some organisms (as
discussed earlier in this chapter).

6.12 Cryonic Reincarnation?

Another issue is that it is conceivable that a thawed individual might end their lengthy
cryonic slumber with a substantial degree of information loss, so that the longitudinal
memories that define us as persons would be substantially gone. The thawed individ-
ual would in a way have become a “Tabula Rasa”, ready for “reprogramming” with
new experiences and memories but unaware of his or her past. This is a possibility
I call “cryonic reincarnation.” To the extent that the long-term goal of cryonics is
to develop technology to reversibly preserve brain-encoded information essential to
personhood, it should be clear that cryonic reincarnation would actually be a form
of failure. After all, the goal of cryonics is to preserve both the substrate and the
information held by the substrate—mere preservation of the substrate alone, while a
marvelous biotechnical achievement is still a failure of cryonics. Also, the simpler
objective of mere substrate preservation could likely be achieved by human cloning,
a process much simpler than cryonic preservation.

6.13 Some Philosophical Considerations

Smith (1983) has argued that both cryonics and genetic engineering, in replacing
natural processes with technological processes, “disturb the delicate balance of the
triad of life which each individual experiences–faith, health, and justice.” As a con-
sequence, Smith argues, these new biological technologies raise a number of difficult
legal, social and philosophical issues, such as how should the legal system deal with
faith and religion issues surrounding the cryonics patient and how should it respond
to the cryonics physician “who views death as a disease which is curable?” One
problem with Smith’s analysis is that from the dawn of time human beings have been
replacing natural processes with technological processes. Would Smith have us live
like Stone Age creatures? The limiting cases are “in a state of nature”, which humans
departed from many thousands of years ago, and—at the other extreme—“anything
allowed by physics”.
One particularly interesting issue concerns the legal and moral status of cryon-
ically suspended individuals. It is completely unwarranted to argue that cryonics
patients will certainly be resuscitated in the future. On the other hand, it would be
wrong to unconditionally rule out the possibility of eventual success. In this sense,
cryonically suspended individuals lie somewhere on a continuum between being
unequivocally alive and being irreversibly dead. However, neither our legal system
6.13 Some Philosophical Considerations 125

nor our conventional approaches to medical ethics are currently well-equipped to

deal with uncertainties of this kind.
Another unresolved issue concerns the legal and moral status of any thawed indi-
viduals who end up technically alive but with severe neurological damage, such
ending up in a chronic vegetative state (vide infra).9

6.14 Some Bioethical Considerations

As discussed earlier, central to cryonics is that notion that life and death are not
always simple binary events. Similarly, some authorities have argued that the classic
notion of basing the definition of death on cessation of the heartbeat is philosophically
problematic. This is because, as discussed earlier in Chap. 5, death is not an event that
happens instantaneously when the heart stops, but rather is a complex process involv-
ing a series of biochemical events at the cellular level that takes time to complete
once tissue perfusion stops as a result of the cessation of cardiac contractions.
In fact, in cases where the heart can be restarted, the clinical result may some-
times still be excellent, without any obvious neurological impairment or damage
to other organs. For instance, cold water drowning victims have been resuscitated
without clinical sequellae after periods of submersion and cardiac arrest in excess of
30 min. Some critics have argued that the concept of death based on classical criteria
such as cardiac asystole or resuscitation failure is in fact a mere social construction
lacking a rigorous scientific foundation. Consider the following commentary from
Whetstine et al. (2005): “…few if any patients pronounced dead by today’s physi-
cians are in fact truly dead by any scientifically rigorous criteria.” It is with this
approach to death that cryonicists work, hoping to cryopreserve their patients before
sufficient brain damage has occurred that absolutely irreversible death has set in.
In this regard, Hershenov (2003) has emphasized that most definitions of
death—whether cardiopulmonary or on neurological grounds—implicitly require
irreversibility. Thus, mere cessation of cardiac or neurological function should be
insufficient grounds to declare death. However, current clinical rules for the declara-
tion of death do not actually require that irreversibility be rigorously established. For
instance, in the case of organ donation after cardiac death, it might well be possible to
restart the heart after the required period of asystole for the declaration of death has
passed. And even if the heart might not be restartable, one could emergently institute
cardiopulmonary bypass and install one of the fully implantable artificial hearts now
commercially available. (In my opinion, the AbioCor artificial heart would show
special promise in such a scenario).

9 Arguably, though, before thawing is attempted, the brain should be repairable to the extent that
basic functioning would likely be fully restored, even if pre-preservation memories are not. And
such memories in turn might be reconstructed to an extant from records, especially if the patient
made a special effort to record past experiences, etc. (I am indebted to Mike Perry, Ph.D., an Alcor
employee, for making this observation to me in private correspondence.)
126 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

Hershenov also emphasizes that the thorny issue of the definition of death likewise
arises in the context of cryonic suspension: “in the future, millions of cryogenically
frozen human beings could spend centuries in a non-dead state because of the future
technological breakthroughs; or large numbers of ‘frozen’ people are dead for eons
but coroners are not able to declare them so because they are unaware of what
biological conditions science will never be able to reverse.”
It would thus appear that true irreversibility of death is incompatible with suc-
cessful cryonic revival, but fortunately for enthusiasts of cryonics, true irreversibility
is not always present at the time that death is declared in most clinical situations.
Accordingly, cryopreservation with the possibility of future resuscitation requires a
“window of opportunity” between legal death and irreversible death.

6.15 Some Negative Bioethical Considerations

One aspect to the debate hinted at above but not emphasized in the cryonics literature
is the very real possibility that any initial “successes” with cryonic reanimation
may be accompanied by severe neurological injury, such that the revived individual
would remain comatose or in a minimally conscious state or exhibit other profound
impairments that would render life too degraded to be worth living. The result would
be that the revived individual would not get the outcome that was hoped for, with the
additional complication of now having a patient who requires complex medical care
with very little likelihood of improvement.
Possible counterarguments to this concern are twofold: first, the expectation is
that a “last in, first out” process will take place where the oldest cases will be the
most difficult and the last to be attempted. Secondly, if technology able to resuscitate
cryopreserved people comes to be developed, then it is hoped that other companion
technologies will also become available so that the worst likely deficit will be some
degree of amnesia.
Other potential objections to cryonics exist. For instance, Shaw (2009) has sum-
marized some of the practical and ethical objections to cryonics: it “would change the
very concept of death”; “it is ‘against nature’”; “no friends or family of the ‘freezee’
will be left alive” following thawing; the science of cryonics “might not advance
enough to ever permit revival”; “reanimation might not take place due to socio-
political or catastrophic reasons”; and “cryonics could lead to premature euthanasia
in order to maximize chances of success.”
After reviewing these and other arguments, Shaw offers a variation of Pascal’s
Wager as an argument in favor of utilizing cryonic suspension. (Recall Pascal’s
Wager: even though the existence of God cannot be established through pure recourse
to reason, one should still live life as though God exists, because in doing so one has
eternal life to gain, and little to lose.)
However, I disagree with Shaw in this matter. My clinical opinion is that the likely
outcomes following thawing, at least in the early years, will be predominantly neg-
6.15 Some Negative Bioethical Considerations 127

ative, consisting variously of a recovered individual with no memories, a recovered

individual with severe neurological impairment or a thawed individual with some
organs working but no brain function at all. Pascal’s Wager is worthwhile only if there
is little to lose if the wager is lost. In my opinion, these likely negative outcomes
hardly constitute “little to lose.”10

6.16 Burden on Society?

Dr. John Baust has made the comment that an “individual who freezes himself or
herself to come back in the future makes the assumption he will be a contributor to
that society and that they would want him”.11 Such a comment carries with it both
interesting practical and ethical perspectives. The practical aspect here is that the
recovered individual might require complex, lengthy and expensive medical care to
fix the problems that led to them undergoing cryonic suspension in the first place
unless means such as growing new bodies via tissue engineering become perfected.
Patients who were frozen as severed heads would have the special challenge of finding
(or constructing) a body to which their head would be attached. Also, funding to deal
with all of these issues would likely not be in place, resulting in a burden on society.
The ethical issues involved in Baust’s comment run deep. Many individuals, espe-
cially those who regard human life as being sacred, would take issue with the implied
notion that human beings have value to society only to the extent that they are wanted
(for example by family members) or are able to make social contributions. On the
other hand, as noted in Sect. 6.8, Corlett (2001) argues that in health care contexts
“there is a moral duty to die inexpensively.” Certainly, cryonic suspension would be
viewed by a great many of its detractors as a particularly expensive way to die.

6.17 A Waste of Money?

Dr. Kenneth Goodman, a bioethicist writing in the Miami Herald, has commented
“If you have enough money (for cryonics), then you have enough money to help
somebody in need today.” 12 In a similar vein, Jean Medawar is said to have com-
mented “Money invested to preserve human life in the deep freeze is money wasted,

10 I should point out that many in the cryonics community don’t think these are “likely outcomes.”

They argue that should cryonic resuscitation become possible, contemporaneous technological
developments will also make it possible that an individual will awaken without neurological deficits.
11 Quoted at http://www.alcor.org/notablequotes.html.
12 Quoted at http://www.alcor.org/notablequotes.html.
128 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

the sums involved being large enough to fulfill a punitive function as a self-imposed
fine for gullibility and vanity.”13
Both these comments raise interesting ethical issues. The first comment about not
spending money on membership in a “cryonics club” so that others might benefit from
that same money applies equally well to a number of more expensive expenditures
that most ethicists do not criticize. For instance, as of this writing, the annual cost
of membership with Alcor for adults in the U.S. is $800. Additional adult family
members pay $490, minors, $156. This is in addition to the whole-body preservation
cost of $200,000, which is often achieved from a life insurance policy payout. While
these are not small sums, many Americans maintain (for example) luxury estates
or second vacation homes at much higher costs than that of a cryopreservation plan
without being seen as being unethical for not having given this money to help others.
On the other hand, Peter Singer has argued exactly this—that we in the West are
morally obligated to live a relatively modest life, living below our means so that
the resulting discretionary money can be used to substantially improve the lives of
others. In his book The Life You Can Save: Acting Now to End World Poverty (Singer
2009), Singer suggests that we are not required to choose between asceticism and
self-indulgence, but that a middle solution based on unpretentious living can free up
money to allow us to donate to charities where a mere few hundred dollars can save
a life.
Singer provides the following example to make his point. Imagine that you are
walking in the park and you find a little girl drowning in a water fountain. Do you
help? Almost everyone would agree that would be the right thing to do. Similarly,
argues Singer, the same reasoning applies to helping solve global poverty. The only
difference is that in the former case the person being helped is located directly in
front of you while in the other case the person being helped is far away.
A related ethical issue arises with the suggestion implied by the second comment
(by Medawar) that paying for cryonics services is a form of “fool’s tax” or a “tax
on hope”. But arguably similar issues arise with other experimental endeavors with
very uncertain outcomes. Would one label Louis Washkansky, the recipient of the
first heart transplant (Cape Town 1967), as being “gullible and vain” because he took
a great gamble but lived only 18 days after the transplant? Similarly, does the use
of newly developed genetically engineered drugs that cost thousands of dollars per
dose yet are not fully guaranteed to be helpful constitute a waste of money? (Burrows
et al. 2002).

6.18 Some Legal Considerations

The legal issues that arise in cryonics will vary from location to location, and usually
depend to a large extent on applicable definitions of death and protocols regarding

13 http://people.ucalgary.ca/~kmuldrew/cryo_course/cryo_chap15_1.html#02. Note also that many

have said the same for donating to religious institutions.
6.18 Some Legal Considerations 129

interment. In the USA a particularly interesting legal case pertaining to cryonics

was the case of Donaldson versus Van de Kamp (Pommer 1993). Donaldson, suf-
fering from an inoperable brain tumor sought the legal right to obtain antemortem
cryonic suspension of his body, knowing that this was technically preferable to a
postmortem suspension. However, both the trial court and the appellate court ruled
against Donaldson, arguing that the cryonic process in this case would be a form of
physician-assisted suicide, and that Donaldson did not have a constitutional right to
such a form of death. Specifically, the court determined that “the state’s interest in
preserving life, preventing suicide, protecting innocent third parties, and maintaining
the ethical integrity of the medical profession” trumped Donaldson’s interest in cry-
onic suspension until treatment for his brain tumor was available (California. Court
of Appeal, Second District, Division 6 1992).
This case suggests, however, that should physician-assisted suicide ever become
legal in the USA, antemortem cryonic suspension, with its greater likelihood of favor-
able outcomes compared to postmortem cryonic suspension (at least theoretically),
could be legally practiced.

6.19 Religious Perspectives

Like a belief in an afterlife found in many religions, participants in cryonics take a

leap of faith that future resuscitation with a worthwhile outcome will be possible.
In truth, however, the future repair technologies assumed by cryonics enthusiasts
remain at best hypothetical and are certainly unproven, in a manner similar to a
number of religious beliefs.14
Likewise related to religion, for many thinkers a fundamental issue is whether
cryonic suspension should be regarded as a form of interment or as a form of medical
intervention. Some religious thinkers who define death in terms of the soul leaving the
body argue against cryonics because “only God can resurrect the dead”. However, a
potential counterargument that can be offered to believers in such a setting is that the
soul leaves the body only with the onset of irreversible death, and, as with the above
discussion concerning organ donation after cardiac death, a “window of opportunity”
between ordinary clinical death and irreversible death once again can be seen to exist,
with the soul fully leaving the body only with the onset of irreversible death.
Chapter 8 discusses some other religious issues related to transhumanism.

14 Thatbeing said, cryonicists’ expectations fall within the realm of physical law, while most reli-
gions place faith in the supernatural.
130 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

6.20 Whole Brain Emulation and Mind Uploading

“Whole brain emulation” (also known as “mind uploading”, “mind copying” or

“mind transfer”) is a term used by transhumanists to refer to the emulation of a brain
on a (presumably digital) computer.15 In essence, it refers to the hypothetical process
of transferring a conscious mind from a biological brain to a non-biological substrate
(e.g., silicon digital computer) via technical developments (scanning, mapping, sim-
ulation) that are as yet uninvented. The idea is that the new substrate would run a
simulation so faithful to the original that it would behave indistinguishably from
the native brain, complete with the emergence of consciousness along with one’s
memories and experiences.
Two possible hypothetical methods are envisioned. In the first hypothetical
method, mind uploading would be achieved by high-resolution 3D scanning, map-
ping, modeling and characterization of all relevant features of an individual’s biolog-
ical brain, and then running the derived brain model in a high-powered host computer
system.
In the second hypothetical method neurons in the biological brain would be grad-
ually replaced by synthetic versions until the individual’s brain would be entirely
synthetic.
In either case, some transhumanists view the possibility of whole brain emula-
tion as an important putative life extension technology, either as an alternative to
cryonic preservation or as a technology that would serve as a supplement to cry-
onic preservation in cases where unrecoverable brain damage is encountered after
thawing.
Whole brain emulation has also been proposed as one possible approach to
advance progress in Artificial Intelligence, the idea being that advances in whole
brain emulation will allow for developments in Artificial Intelligence not possible
by ordinary means, such as the creation of conscious, sentient artificial beings.
It should be emphasized, however, that many transhumanists are skeptical of
these possibilities. Some argue that whole brain emulation is not possible in princi-
ple, believing that artificial intelligence equivalent to human intelligence—so-called
strong AI—is not possible, i.e. not computable.
Other thinkers point out that the operation of any biological brain depends on
time-varying electrical (action potential) and biochemical (neurotransmitter) signal
exchange between dendrites, axons and other neuronal structures, so that capturing
the brain state in a single “frozen” state will likely prove to be insufficient to fully
capture the information needed for whole brain emulation.
Still others believe that whole brain emulation may be contrary the laws of
physics—specifically, the Heisenberg Uncertainty Principle. (The Heisenberg Uncer-
tainty Principle precludes one from simultaneously knowing the exact position and

15 Highly readable popular accounts are available at https://www.popsci.com/article/science/neuro

scientist-who-wants-upload-humanity-computer as well as in book form: Keith Wiley, Taxonomy
and Metaphysics of Mind Uploading, Alautun Press, 2014, available at https://www.amazon.com/
dp/B00NJZHGM8.
6.20 Whole Brain Emulation and Mind Uploading 131

velocity of any particle (such as an electron) at any chosen point in time. Conse-
quently, accepting mind physicalism for discussion purposes, the mind is not just a
set of particles with positions w, x, y, and z, but a set of particles with both position and
velocity.) Thus the idea that future technology might allow one to scan the brain in
precise detail such that the characteristics of every neuron, synapse, and dendrite and
the position and velocity of every neurotransmitter molecule and electrical impulse
in the human brain would be known exactly would likely be contrary to the laws of
physics.
Finally, some thinkers believe that even if whole brain emulation is possible
in principle, the required resources for whole brain emulation will never become
obtainable within the anticipated life of the universe.
Whole brain emulation is associated with some philosophical issues not unlike
those discussed earlier in this chapter in the context of cryonic suspension. Whole
brain emulation is predicated on the notion of mind physicalism, that the human
mind can be adequately represented by axons, dendrites, synapses etc. This mind
model is thus potentially in opposition to the dualism model offered by Descartes
and other philosophers of mind who would have us possess an immaterial soul in
addition to a material body.
Another issue, discussed earlier in Chap. 3, concerns the rights and responsibilities
of newly created conscious, sentient artificial beings produced via brain emulation
technologies. Related to this is the concern that partially successful whole brain
emulation might conceivably produce a “philosophical zombie” that is excellent at
symbol manipulation (as in Searle’s Chinese Room argument) but is not in possession
of sentience or consciousness.
In closing this discussion, it should be noted that such philosophical issues are
surprisingly old. In 1775 Thomas Reid wrote in a letter to Lord Kames16 :
I would be glad to know your Lordship’s opinion whether when my brain has lost its original
structure, and when some hundred years after the same materials are fabricated so curiously
as to become an intelligent being, whether, I say that being will be me; or, if, two or three
such beings should be formed out of my brain; whether they will all be me, and consequently
one and the same intelligent being.

6.21 Conclusion

In conclusion, the possibility of human cryonic suspension, while admittedly remote

and far-fetched to many, raises a number of fascinating philosophical and ethical
questions (Smith 1983; Tandy 2002). Special concerns discussed in this chapter
included the matters of moral standing, the nature of personhood and what it means to
be a living human being. It was emphasized that central to the possibility of successful
human cryonic suspension is the idea of a “window of opportunity” between legal
death and irreversible death—a clearly enticing philosophical notion. Of course,

16 http://www.benbest.com/philo/doubles.html.
132 6 Cryonic Life Extension: Scientific Possibility or Stupid Pipe …

even better from a purely technical point-of-view would be antemortem cryonic

suspension.
Chapter 7
Defending Attacks Against
Transhumanism

All truth passes through three stages. First, it is ridiculed.

Second, it is violently opposed. Third, it is accepted as being
self -evident.

Arthur Schopenhauer, German philosopher (1788–1860) (As is

the case with some earlier quotations used at the beginning of
previous chapters, this quotation is offered as “food for thought”
and not as a philosophical stance defended in the chapter.).

Abstract This chapter is one that is particularly rich in philosophical arguments and
has as its main focus the critical evaluation of the arguments against transhumanism
that have been raised by a number of prominent philosophers and other individuals.
Based on the critiques of transhumanism offered by critics such as Leon Kass, Fran-
cis Fukuyama, and Michael Sandel, the chapter critically assesses five commonly
raised arguments why human enhancement by artificial means should not be under-
taken: fairness, human dignity issues, “slippery slope” arguments, the “repugnance”
argument, and safety issues. The weakness of “slippery slope” arguments and “re-
pugnance” arguments are given special attention. In the end it is concluded that safety
issues are the most realistic concerns that the pursuit of transhumanism raises.

7.1 Introduction

Transhumanism remains a subject of considerable controversy among thinkers. As

discussed earlier, the principal aim of transhumanism is to develop and make widely
available ethical human enhancement technologies that will improve the human con-
dition. Thinkers favoring the wise use of human enhancement technologies are indi-
viduals such as James Hughes, author of Citizen Cyborg, Nick Bostrom and Julian
Savulescu of Oxford University, John Harris of the University of Manchester, as well
as many other lesser known members of the transhumanist community. Such individ-
uals favor the voluntary, rational deployment of human enhancement technologies

© Springer Nature Switzerland AG 2018 133

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_7
134 7 Defending Attacks Against Transhumanism

to improve on humankind, regardless of whether or not any pathology needing cor-

rection is present.
Similarly, The Center for Cognitive Liberty and Ethics, which maintains an online
presence at http://www.cognitiveliberty.org, is a network of scholars debating the law,
policy and ethics of freedom of thought with a mission “to develop social policies
that will preserve and enhance freedom of thought into the 21st century.” They argue
that the “definitions of ‘medicine’ and ‘mental health’ are expanding from treatment
and prevention, to improvement and enhancement” and that the capabilities of the
human mind should not be limited: “So long as people do not directly harm others,
governments should not criminally prohibit cognitive enhancement or the experience
of any mental state” (http://www.cognitiveliberty.org/mission.html).

7.2 Transhumanism as Fringe Science

One concern that has arisen among commentators discussing transhumanism is that
many aspects of transhumanism constitute “fringe science”, defined here as scientific
investigation in a traditional field of inquiry (e.g., biology) that departs significantly
from accepted theories, and consequently lies in the “fringes” of a mainstream aca-
demic discipline. One example of a transhumanist domain that is sometimes accused
of existing in the fringes is Aubrey de Grey’s anti-senescence program, which is
based on the notion that a scientific program aimed at mitigating seven identified
types of biological aging processes could extend the human life-span by a great
many decades (De Grey 1997). However, as science progresses over time from rela-
tive ignorance to a more comprehensive understanding it necessarily passes through
a transition phase where confusion and uncertainty predominate. This would be the
case, for instance, for the beginnings of evolutionary theory in biology and for the
early years of quantum mechanics.

7.3 Ethical Concerns

While many individuals dismiss transhumanist ideas as mere impractical fringe sci-
ence, a number of opponents to transhumanism offer ethical concerns as the basis for
their opposition, such as a fear that human enhancement technologies would debase
us and undermine our human dignity, or concerns that such technologies would be
deployed unfairly, benefiting only the wealthy. With respect to the latter issue, Francis
Fukuyama has expressed a fear that deploying transhumanist approaches to improv-
ing the human condition necessarily redirects needed resources from implementing
(arguably more practical) social solutions (Fukuyama 2004).
Other critics advance the notion that it is fundamentally wrong to alter humanity
and human nature in the first place. For instance, Leon Kass famously argues that
we should avoid these technologies because they are repugnant (Kass 1997), while
7.3 Ethical Concerns 135

other “bioconservatives” such as Michael Sandel, George Annas, Jeremy Rifkin and
Wesley Smith all offer related reasons why human enhancement technologies are, in
their opinion, ethically suspect.1
Certainly, some of the scenarios described in earlier sections of this book raise
troubling (or at least interesting) ethical questions. If the aim of the medical profession
is to enhance the health and the quality of life of individuals who are sick, is it
ethical that medical knowledge be used to improve the lives of folks who are already
quite healthy? Will university faculties of education eventually have departments
of educational pharmacology to help advance learning enhancement by chemical
means? Will medical students be allowed to use pharmacologic assistance in order
to prepare for their pharmacology finals, or will they perhaps instead be required to
provide a post-test urine sample to establish the opposite?2
There is also the practical question about the potential for long-term harm for
some proposed human enhancement methods that rely on pharmacologic methods.
While many individuals would like to think faster and more clearly as well as hold
more things in memory, and perhaps even be able to wonder about things that cannot
ordinarily be conceived, they may also ask “At what cost to brain function and to life
in general does this enhancement come?”
As developments in neuropsychology and neuropharmacology provide new treat-
ments for neurological conditions like Alzheimer’s disease it appears that many of
these treatments may be of interest to “normal” individuals as a means of achiev-
ing “quality of life” improvements, such as becoming better at mental arithmetic or
developing a better memory. But such enhancements are now associated with a new
ethical debate, with proponents arguing for their use on the basis of the principle
of “cognitive liberty” and with opponents arguing against their use on the basis of
concerns such as safety and social fairness.

7.4 Leon Kass and the Wisdom of Repugnance

For instance, the conservative University of Chicago philosopher, Leon Kass, men-
tioned earlier, is an opponent of research into life extension, stem-cell techniques and
other enhancement technologies (Kass 1997). One basis for his opposition is a prac-
tical concern for safety. Another concern cited above is based on the simple notion of
repugnance, as exemplified in the following comments he has made on cloning: “We
are repelled by the prospect of cloning human beings not because of the strangeness
or novelty of the undertaking, but because we intuit and feel, immediately and with-
out argument, the violation of things that we rightfully hold dear” (Kass 1997). That

1 The term “bioconservative” is used here and elsewhere (Sect. 7.7) without any intended pejorative

sense, reflecting a well-developed philosophical position with which, as discussed in further sections,
I am in general disagreement. The term “bioluddite” is sometimes used when contempt is intended.
2 It has not escaped my attention that university students already often use pharmacologic assistance

in an attempt to earn higher marks.

136 7 Defending Attacks Against Transhumanism

is, Kass argues that notions that are repugnant to our sensibilities—for instance, the
idea of making human-animal hybrids—should be viewed as being unethical on the
basis of the revulsion they generate.
Not surprisingly, many people in the transhumanist community find such an argu-
ment to be weak and even preposterous, being based, they argue, on an appeal to
emotion and a rejection of rationalism (Roache and Clarke 2009; Turner 2004). As a
simple example, much of what is done every day in hospital operating rooms around
the world is repugnant to many nonclinicians, but this does not stop surgery from
being conducted. Or, for that matter, it does not stop a good number of people from
enjoying steak tartar and sushi.

7.5 Francis Fukuyama

Another noted opponent of human enhancement technologies is the political

economist and philosopher mentioned earlier, Francis Fukuyama. Perhaps best
known for his book The End of History and the Last Man, Fukuyama has con-
servative views rather similar to those of Kass. In Fukuyama’s book Our Posthuman
Future (Fukuyama 2002) he argues for banning many human enhancement technolo-
gies. His concern focuses on the potential for social conflict, with the rich having
access to technologies to make them, and their offspring, “smarter, stronger, and
longer-living”. This is a rather different issue than the questions raised by Kass in
that Fukuyama argues that transhumanism, by fundamentally altering the character of
“human nature”, undermines the egalitarian ideals of liberal democracy. As I discuss
later (see Sect. 7.8 in particular), I do not see Fukuyama‘s concern to be a sufficiently
strong argument to hold back advances in transhumanism. In particular, I do not see
it as a given that transhumanist technologies that alter human nature must necessarily
do this at the expense of egalitarian ideals of liberal democracy, since (for example)
it is logical to expect that a number of future cognitively enhanced individuals will
be able to offer to all of humankind a substantial number of scientific, medical and
cultural treasures.

7.6 The President’s Council on Bioethics

Yet another perspective critical of human enhancement technologies is the Presi-

dent’s Council on Bioethics, which in 2003 published its lengthy critique of human
enhancement, entitled Beyond Therapy: Biotechnology and the Pursuit of Human
Improvement (The President’s Council on Bioethics 2003). The report is unusually
comprehensive in its scope, variously considering the use of drugs and gene transfers
to enhance augmenting muscle strength and athletic performance, the use of mind-
altering psychoactive drugs, techniques for controlling the sex of fetuses, techniques
intended to lengthen the human lifespan, and related issues.
7.6 The President’s Council on Bioethics 137

Most of the discussions in the report, however, take on a clear bioconservative,

cautionary tone. This is hardly a surprise, given that the President’s Council on
Bioethics, the overseer of the report, at the time was a politically appointed group
composed almost entirely of individuals with conservative views that were closely
aligned to those of the American (second) Bush administration. As a result, some crit-
ics argue, the report is lacking in balance and perhaps even in scientific accuracy. For
instance, Blackburn and Rowley (2004) write: “In the discussions of preimplantation
genetic diagnosis, the specter of designer babies is raised by implying that selecting
embryos for intelligence and other traits, such as temperament is a possibility. Sci-
entifically, this simply is highly unlikely and indeed may not even be feasible. While
such scientific unlikelihood is mentioned in passing in the report, it is easy to take
away from the report the feeling that such genetic manipulation will happen and is
even imminent.” Similar concerns have been raised by other individuals (Sinsheimer
2004).

7.7 Exploring Bioconservative Arguments

I would like now to add a contemplative component to the commentary by including

discussion of some of my own views. In a nutshell, I have found that the more
that I explore these issues, the more I ultimately find the arguments offered by the
bioconservatives to be unsatisfactory and unconvincing.
In general, bioconservatives offer six broad categories of reasons why human
enhancement by artificial means should not be undertaken. First, they may cite rea-
sons of social fairness. Second, they may cite reasons related to the endangerment
of our dignity or our humanity. Third, they may cite “slippery slope” issues. Fourth,
they may raise a concern about repugnance for transhumanist creations. Fifth, they
may argue against “Playing God.” And finally, they may cite reasons related to safety.
As I discuss in later sections, I regard the first fives lines of argument to be fragile
and weak, while I believe that the last argument (concerning safety) has merit.

7.8 The Fairness Issue

Consider first the fairness issue, exemplified by the arguments offered by Fukuyama
(2002, 2004) who presents the case that human enhancement technologies present
too much potential for social conflict. He is concerned that only the rich and the
socially connected would have access to these technologies. However, this concern,
in my view, is excessively speculative and unsupported by strong evidence.
First, many technologies become vastly cheaper over time, and there is no rea-
son to believe that this would not also be the case for at least some future human
138 7 Defending Attacks Against Transhumanism

enhancement technologies. Using the automobile as an historical example, would an

earlier Fukuyama have banned automobiles in the era before Ford introduced mass
production for the same reasons?
Secondly, it appears to me that the fact that the rich get access to better housing,
better vacations, better automobiles and better schools is not in itself a good reason to
require that all citizens should live at the same standard of living. Would Fukuyama
also ban yachts, truffles, aesthetic surgical procedures like facelifts, and all other
items that the poor generally cannot afford?
Now, an argument can be made that these examples are not things that exacer-
bate social and economic inequality but things that follow from it. Accepting this
line of reasoning for the purposes of discussion, how might one ensure that human
enhancement does not necessarily contribute to social inequality? One approach
is to recognize expected “trickle down” effects, such as the cognitively enhanced
medical scientist who develops a novel cure for (say) ovarian cancer, with benefits
that extend to all womankind, or the cognitively enhanced writer who constructs a
timeless literary masterpiece valued by countless future generations.
Another approach would be to require more substantive contributions to society
from enhanced humans, reminiscent of the Guardian Class in Plato’s Republic.3
Yet another line of argument recognizes the reality that human nature is already
unequal (by virtue of the genetic and social lottery that takes place at conception) and
argues that attempts at the equalization of human nature are simply unrealistic in view
of this reality (and, arguably, in view of failed national experiments in Marxism.)
Instead, it could be argued, differences in human traits, talents and capabilities should
result in differences in expected contributions to society.
In summary, when Fukuyama and others of his ilk argue that transhumanism
fundamentally alters the character of human nature, and thereby undermines the
egalitarian ideals of liberal democracy (thus generating potential for social conflict),
I find these arguments to be weak, unengaging, and ultimately inconsistent with the
principle that individuals using legal and moral means should be free to accumulate
as much wealth as they desire.4

3 Plato envisioned his ideal society as consisting of three classes: the producers,the auxiliaries, and
the guardians. The producers included farmers, craftsmen, merchants, artists, and so forth, and they
did not participate in governing. The auxiliaries were the warrior class, responsible for defense
and policing; they too did not govern. Only the guardians, picked from the ranks of the auxiliaries,
were responsible for governing while living in austere conditions, as they would not own private
property, would live frugal, communal lives, and would have minimal privacy. Plato envisioned that
the guardians would even possess wives and children in common!
4 I say this provided that proportionate contributions to society follow, as with the philanthropy

example provided by Bill Gates. While the principle of liberal freedoms would allow individuals to
accumulate wealth by legal means through hard work, enterprise, innovation and imagination, this
does not suggest that these same individuals do not have a moral responsibility to shift some of their
wealth to less fortunate individuals (notwithstanding the followers of Ayn Rand and her philosophy
of ethical egoism). Such a redistribution of wealth is typically achieved via taxation, although some
thinkers argue that wealth redistribution via philanthropy is an even more acceptable method. Of
course, in this setting the issue is not so much whether such redistribution should take place, but
rather the extent to which wealth should be distributed from the rich to the less fortunate.
7.9 The Dignity Issue 139

7.9 The Dignity Issue

A second category of arguments against transhumanism that bioconservatives some-

times offer is a concern that transhumanism endangers human dignity or denatures
our humanity. As an example in this category, consider the work of Michael Sandel,
a Harvard University professor of government. In his recent book The Case Against
Perfection (Sandel 2007), he presents the argument that pursuits toward attaining
human perfection by artificial means should not be attempted because such activi-
ties are said to endanger our humanity, imperiling the notion of human life as a gift
and eroding our appreciation for the natural talents and endowments that human life
provides.
Thus, for example, according to Sandel, athletes should pursue excellence through
the development of their natural gifts, rather than employ technical mastery over
nature as a means to athletic prowess. Sandel writes: “The problem with eugenics
and genetic engineering is that they represent the one-sided triumph of willfulness
over giftedness, of domination over reverence, of molding over beholding.”
However, as with Fukuyama, I find Sandel‘s arguments to be unpersuasive, in large
part because he confuses what is natural with what is moral. What is natural, however,
is not automatically what is moral, and vice versa. Nature has no moral compass;
she follows no moral principles. Nature is driven by chance and the laws of physics
in the case of inanimate natural phenomena (e.g., earth quakes and hurricanes), and,
in the case of biological organisms, is driven by evolutionary forces as well as basic
biological drives such as hunger.
Sandel offers us convictions, not arguments, and, in the end, I see Sandel’s position
to be mere religious teachings about the sacredness of divine gifts skillfully disguised
along secular lines. In essence, Sandel seems to object to efforts in attaining human
perfection by artificial means primarily because he believes that it represents a mis-
understanding of our place in the Cosmos, of our relation to God. This is certainly
not a secular line of reasoning. Nor is it a line of reasoning that I find to be persuasive.
Consider instead the more convincing line of thinking offered by Bostrom.
In his paper, In Defense of Posthuman Dignity (Bostrom 2005), Bostrom argues
that while bioconservatives are opposed to the use of technology to modify human
nature for reasons such as the fear of producing a debased ‘posthuman’ product or that
they might pose a threat to ordinary folk, their fears are largely unfounded as long as
a concept of dignity that includes posthumans is recognized. Bostrom acknowledges
that some ways of modifying human nature could be debasing, but rightly points
out that obtaining technical mastery over our own nature does not inevitably lead
to dehumanization. He emphasizes that when one examines what one means by the
term “dignity” (the quality of being worthy or honorable; the right to be treated with
respect), dignity is indeed something that a posthuman could possess. With respect
to the second fear (of threats to ordinary humans) Bostrom writes:
Human society is always at risk of some group deciding to view another group of humans as
fit for slavery or slaughter. To counteract such tendencies, modern societies have created laws
and institutions, and endowed them with powers of enforcement, that act to prevent groups
140 7 Defending Attacks Against Transhumanism

of citizens from enslaving or slaughtering one another. The efficacy of these institutions does
not depend on all citizens having equal capacities. Modern, peaceful societies can have large
numbers of people with diminished physical or mental capacities along with many other
people who may be exceptionally physically strong or healthy or intellectually talented in
various ways. Adding people with technologically enhanced capacities to this already broad
distribution of ability would not need to rip society apart or trigger genocide or enslavement.
(Bostrom 2005:206)

7.10 The “Slippery Slope” Issue

A third concern sometimes raised by bioconservatives is the “slippery slope” issue.

For instance, many critics accuse Leon Kass of falling into this trap when he presents
the following concerns about offering complete reproductive freedom in the context
of cloning (Kass 1997):
The principle of reproductive freedom as currently enunciated by the proponents of cloning
logically embraces the ethical acceptability of sliding down the entire rest of the slope –
to producing children ectogenetically from sperm to term (should it become feasible) and
to producing children whose entire genetic makeup will be the product of parental eugenic
planning and choice. If reproductive freedom means the right to have a child of one’s own
choosing, by whatever means, it knows and accepts no limits.5

The slippery slope argument in philosophy is an argument in which a person

asserts that some disastrous event will follow inevitably from a more limited or more
benign prior event, usually without offering any substantive argument for of how
one event will inescapably lead to another. Examples of the slippery slope line of
argument abound in everyday life. An example:
There should be no limits on freedom of speech. Once the government starts banning one
form of speech, they will never stop. Next thing you know, they will be banning free assembly
and free elections!

One of the best known and emotionally compelling arguments of this type has been
put into the form of a poem by Martin Niemöller (1892–1984) about the failure of
the German intellectual community to fight against the Nazi purging of their chosen
targets:
First they came for the communists, and I did not speak out–
because I was not a communist;
Then they came for the socialists, and I did not speak out–
because I was not a socialist;
Then they came for the trade unionists, and I did not speak out–
because I was not a trade unionist;

5 If asked, Kass might argue that he is not using the “slippery slope” argument in the usual way, but
rather is invoking a sequence of logical steps constituting a logical inference. Kass might say that if
X logically entails Y and if Y is morally unacceptable, then X should also be morally unacceptable.
7.10 The “Slippery Slope” Issue 141

Then they came for the Jews, and I did not speak out–
because I was not a Jew;
Then they came for me–
and there was no one left to speak out for me.

(Parenthetically, I have always been captivated by rather similar comments from

Albert Einstein, given after World War II6 : “When the Nazis came to power, I looked
to the universities that prided themselves upon their intellectual freedom, and they
failed me. I looked to the German press, which prided itself on the freedom of the
press, and it failed me. Until at last the churches stood alone, and that for which I
once had little regard earned my respect.”).
In more formal terms the slippery slope argument goes like this.7 If event A
happens, then via a gradual series of small but inevitable steps events B, C, and D
will take place, and so on, in a while leading to events X and Y, and eventually to
event Z. But event Z is a terrible thing to contemplate, and should not be allowed to
happen, since it is truly horrible. Therefore, event A should not be allowed to take
place, either.
It should be emphasized that the slippery slope argument is taken to be a philo-
sophical fallacy in those cases where no substantive argument is offered for how
one event will inescapably lead to another. In the case of the Martin Niemöller poem
provided above it is arguable that the poem does not constitute such a fallacy because
the notion of how one event (purging the nation of Communists) would inescapably
lead to another (purging the nation of Jews) was apparent to anyone familiar with
Nazi ideology.
Slippery slope arguments invoke an image of an inevitable, limitless series of event
relationships. Experience shows, however, that scientists and doctors are generally
capable of making the distinctions needed to establish limits. For instance, morphine
is a useful drug that can be deadly in large doses. But no reasonable person uses
the slippery slope argument to suggest that the clinical use of morphine should be
outlawed because if doctors are allowed to give 5 mg of morphine to eliminate pain,
they will eventually be giving 500 mg doses to eliminate life. One obvious hard limit,
for instance, would be to forbid carrying out procedures (of any kind) on competent
adults against their will. Similar limit rules can also be envisioned in other settings.
It is of interest to policy analysts and lawmakers to see whether slippery slope
arguments have ever been validated empirically following a change in law or pol-
icy that was predicted to have morally disastrous effects. For instance, Ryan (1998),
using data from Australia and the Netherlands, examined the evidence “for the empir-
ical argument that there is a slippery slope between the legalization of voluntary and
non-voluntary euthanasia.” He concluded that “contrary to the warnings of the slip-
pery slope, the available evidence suggests that the legalization of physician-assisted
suicide might actually decrease the prevalence of non-voluntary and involuntary
euthanasia.”

6 http://storiesfortrainers.com/valuesquotes.aspx.
7 http://www.iep.utm.edu/fallacy/.
142 7 Defending Attacks Against Transhumanism

Ryan (1998) also offers the following enlightening commentary on slippery slope
arguments:
The slippery slope is what Daniel Dennett has termed an intuition pump. Intuition pumps
bypass the uncertain and exhausting path of convincing readers with careful and detailed
argument in favour of a more easily travelled byway that speeds readers to a conclusion based
upon their gut feeling. Intuition pumps replace argument with slogans and telling images.
They are designed to convince readers of the truth of what they already suspected.

7.11 The “Repugnance” Issue

A fourth category of anti-transhumanist arguments that some bioconservatives put

forward is the “repugnance” argument. This argument has been popularized by Leon
Kass in his previously mentioned article “The Wisdom of Repugnance” (Kass 1997),
which is principally concerned with the ethics of human cloning. Distilled to its
essence, Kass argues that an intuitive response of repugnance or disgust to an entity
or concept should be taken as evidence that the entity or concept is intrinsically evil
or harmful. He uses this as an ethical argument against human cloning by trying to
make the case that human cloning should evoke disgust:
People are repelled by many aspects of human cloning. They recoil from the prospect of
mass production of human beings, with large clones of look-alikes, compromised in their
individuality, the idea of father-son or mother-daughter twins; the bizarre prospects of a
woman giving birth to and rearing a genetic copy of herself, her spouse or even her deceased
father or mother; the grotesqueness of conceiving a child as an exact replacement for another
who has died; the utilitarian creation of embryonic genetic duplicates of oneself, to be
frozen away or created when necessary in case of need for homologous tissues or organs for
transplantation; the narcissism of those who would clone themselves and the arrogance of
others who think they know who deserves to be cloned or which genotype any child-to-be
should be thrilled to receive; the Frankensteinian hubris to create human life and increasingly
to control its destiny; man playing God.

Speaking candidly, I am surprised that this argument has achieved any acceptance
in intellectual circles, being based on a fallacious appeal to emotion: “It’s disgusting,
so it has to be wrong!” The ultimate underlying premise in Kass’s position seems to
be that emotional responses should trump the rule of reason.
For the sake of completeness, I should point out that there is an interesting body
of scientific literature that is just starting to develop that is concerned with studying
the links between disgust and moral judgment. For instance Schnall et al. (2008)
performed laboratory work to show that “the role of disgust in severity of moral
judgments depends on participants’ sensitivity to their own bodily sensations”, sug-
gesting that gut feelings are sometimes important in moral judgment. Other studies
have used advanced brain imaging methods (“functional MRI”) to determine which
centers in the human brain are involved in the mental processes central to moral
judgment (Moll et al. 2005).
While these studies and those of others (Borg et al. 2008; Gutierrez and Giner-
Sorolla 2007; Wheatley and Haidt 2005) are helpful in understanding the neuro-
7.12 Playing God 143

physiology of intuitive moral judgment, they in no way support Kass’s concept that
repugnance is a reliable guide to determining which actions are immoral.

7.12 Playing God

The expression “Playing God” is usually taken to refer to an individual who is

taking on the role of God, such as in deciding who is to live or die in dire clinical
situations or in the circumstances of “lifeboat ethics.” Alternately, it might be used
to characterize a situation (for example) where a scientist creates a new form of life
(van den Belt 2009). The phrase is often used to invoke a precautionary principle
or mount a charge of human hubris, humans presumably not being allowed to claim
for themselves that which is said to be the sole providence of the Divine (or the sole
providence of nature, if you prefer). Those individuals who hold that only God (or
nature) and not scientists and technicians should create new life forms or enhance
existing life forms are explicitly stating that humans should be morally forbidden
to carry out certain kinds of biological research. As an example, responding to the
news that Craig Venter and his team had invented the synthetic organism Mycoplasma
laboratorium, Pat Mooney wrote8 : “For the first time, God has competition. Venter
and his colleagues have breached a societal boundary, and the public hasn’t even had
a chance to debate the far-reaching social, ethical and environmental implications of
synthetic life.”9
Given that similar arguments about “Playing God” might be made when clinicians
save lives that would otherwise be snuffed out by natural processes like premature
birth, pneumonia or cancer, one wonders what biological interventions opponents of
“Playing God” would forbid. Even something as simple as starting fires and cooking
food could arguably be forbidden on the basis of somehow being “unnatural”. Of
interest, in the case of Craig Venter, he was wise enough to first solicit ethical advice
from a panel of bioethicists and theologians (the so-called Ethics of Genomics Group)
which, upon careful deliberation, identified no serious objections against Venter’s
plans and eventually provided their imprimatur (Cho et al. 1999). The basis for their
position was that while the technology has some abuse potential (e.g. biological
weapons), and cause us to rethink our conception of life, the committee did not see
that construction of new genomes of the type in question was a violation of any
fundamental moral precepts or boundaries.

8 ETC Group (2007) Goodbye, Dolly … Hello, Synthia! J. Craig Venter Institute Seeks Monopoly
Patents on the World’s First-Ever Human-Made Life Form. Retrieved January 7, 2013, from http://
www.etcgroup.org/content/patenting-pandora%E2%80%99s-bug-goodbye-dollyhello-synthia.
9 Arguably, however, this would not be the first time that God has had “competition”, since the same

issue arose decades earlier in the 1970s with the debate on recombinant-DNA methods.
144 7 Defending Attacks Against Transhumanism

7.13 The Safety Issue

A final concern sometimes raised relates to safety, where fears are raised that new
human enhancement technologies may end up causing unanticipated harm. Of the
concerns raised by bioconservatives, this one resonates with me the most. The fol-
lowing cautionary tale will serve to illustrate my unease.
On September 17, 1999 Jesse Gelsinger, an 18-year-old boy, died when an
experimental gene therapy treatment at the University of Pennsylvania went trag-
ically wrong. Jesse suffered from ornithine transcarbamylase deficiency, the result
of an unfortunate sporadic genetic mutation that made him unable to breakdown
much of the ammonia produced as a natural consequence of his body’s breakdown
(catabolism) of dietary protein.
Jesse’s doctors were hoping to treat his condition by implanting the missing
healthy gene into his liver cells using a gene carrier, or vector, in this case a common
virus (adenovirus) directly administered into his hepatic artery. Since some seventeen
patients had been successfully treated for other genetic disorders using similar tech-
niques, they were confident of success, or at least, of not harming Jesse. They were
wrong. Jesse died unexpectedly of multi-system organ failure four days after starting
the treatment, likely from a severe immunological response to the adenovirus. An
inquiry followed that identified a number of problems with the clinical trial process.
Jesse’s father sued and subsequently settled out of court for an undisclosed amount
(Stolberg 1999).
While the above tragic example is thought-provoking, it should also be empha-
sized that such safety concerns are hardly unique to transhumanist endeavours—they
also apply to virtually all fields of science and medicine, at least to some degree. Sim-
ilar issues arose in the early years of aviation, where many pilots lost their lives or,
more recently, with risky medical advances such as open-heart surgery or trans-
plantation medicine. For instance, the famous transplant surgeon Thomas E. Starzl
attempted 5 human liver transplants between March 1 and October 4, 1963. The first
patient bled to death during the operation while the others died after 6.5–23 days.10
Such dismal outcomes led many to criticize his efforts, but in each case a careful
review of the cause of death led to new insights that eventually made the procedure
the highly successful operation it is today, with a five-year survival rate about 72%.11
Sometimes the scientific community makes an unusually special effort to address
potential safety concerns in emerging technologies. In the early days of genetic
engineering, for example, biologists were faced with a series of ethical and safety
questions regarding recombinant DNA technologies not unlike some of the contem-
porary questions that arise in the context of human genomic enhancement. To address
the potential biohazards and a possible need to regulate this biotechnology, a group
of biologists, physicians and lawyers gathered together in February 1975 to draw up
voluntary guidelines to ensure the safety of recombinant DNA technology. Known as
the Asilomar conference, the participants called for, and observed, a series of safety

10 http://www.starzl.pitt.edu/transplantation/organs/liver.html.
11 http://www.mayoclinic.org/tests-procedures/liver-transplant/basics/results/prc-20014076.
7.13 The Safety Issue 145

controls on certain experiments. In addition to regulating certain experiments, the

guidelines12 also forbade the performance of some experiments perceived to be espe-
cially risky, such as the cloning of recombinant DNAs derived from highly pathogenic
organisms (Berg 2008). Conferences modelled after the 1975 Asilomar event are one
obvious approach to dealing with some of the safety issues that arise with human
genomic enhancement and other transhumanist technologies. In fact, in 2015 scien-
tists called for a partial ban on genome editing in human germline cells with a view
to issues not unlike those identified in the original Asilomar conference (Guttinger
2017; Lanphier et al. 2015).
It should be emphasized that transhumanists themselves are generally in favor
of reasonable and thoughtful restrictions on emerging technologies with a view to
mitigating possible risks. Instead, their concern is with unrealistically pessimistic
risk assessments often advanced by ignorant “bioluddites” holding uninformed anti-
scientific views. The contemporary anti-vaccination movement in the USA and else-
where serves as a particularly unfortunate demonstration of how well-meaning but
misguided individuals may hijack the national discourse on a biotechnical issue to
the detriment of society (Leask 2015).
The above comments notwithstanding, however, I still maintain that the safety
issue in transhumanist endeavors remains the most pressing one remaining to be
settled. I am not alone in this matter. For example, the prominent transhumanist
James Hughes has argued that transhumanist technologies necessitate not only that
we take a reasoned approach to their development and deployment, but also have
government bodies regulate such technologies. Hughes argues that this is necessary
not only for safety reasons but also to ensure that individuals are protected from any
dangers such advances may present.13 In a similar vein, the next section presents
additional cautionary commentary from two prominent scientists.

7.14 Existential Risks

In recent years a number of thinkers have become concerned that scientific and tech-
nological innovations may ultimately turn out to be profoundly harmful to humanity,
perhaps even leading to the demise of civilization as we know it. Of course, since the
detonation of the first atomic bomb in 1945 and the subsequent cold war, the concern
that humankind could annihilate itself has figured prominently in the world’s psyche.
Since that time, however, a number of new existential threats have been identified and
debated, many of these being based, arguably, on technologies favored by enthusi-
asts of transhumanism. Examples include (1) the accelerated depletion of the earth’s
resources, with implications for global warming and environmental contamination
(Keller 2003, 2007; Fiore et al. 2012); (2) the deliberate or accidental release of new
viral or bacterial microorganisms with especially virulent properties, such as might be

12 http://profiles.nlm.nih.gov/QQ/B/C/G/D/_/qqbcgd.pdf.
13 http://hplusmagazine.com/2014/07/29/ethics-and-policy-concerns-in-the-transhuman-transition/.
146 7 Defending Attacks Against Transhumanism

constructed in bioweapons laboratories (Nuzzo 2006; Friedman et al. 2010); and (3)
the so-called “grey goo scenario” where out-of-control self-replicating nanorobots
consume all the earth’s resources in an orgy of self-proliferation, resulting in global
catastrophe (Giles 2004).
Faced with such concerns, a number of thinkers have argued that the current
accelerated rate of scientific and technological discoveries poses a clear and present
danger to humanity. For example, in his famous essay, Why the Future Doesn’t Need
Us14 renowned computer scientist Bill Joy argues that human beings are likely to
destroy themselves as a consequence of technological innovation. From his paper:
Thoreau also said that we will be “rich in proportion to the number of things which we can
afford to let alone.” We each seek to be happy, but it would seem worthwhile to question
whether we need to take such a high risk of total destruction to gain yet more knowledge
and yet more things; common sense says that there is a limit to our material needs - and that
certain knowledge is too dangerous and is best forgone.

Neither should we pursue near immortality without considering the costs, without consid-
ering the commensurate increase in the risk of extinction. Immortality, while perhaps the
original, is certainly not the only possible utopian dream.

British Astronomer Royal Martin Rees offers a similar narrative. In his book Our
Final Hour (2003), he argues that innovations in science and technology bring as
much risk of calamity as opportunities for human progress, and while not calling for
an end to scientific activity, he does argue for tighter security in the dissemination
of potentially dangerous scientific information, as well as for better educating the
scientific community as to the potentially hazardous consequences of some forms of
scientific knowledge.15
Such issues are the subject of continuing lively debate within the transhumanist
community. As noted earlier, as a rule, transhumanists do not argue that there should
be no restrictions whatever on emerging technologies but view some of the proposals
circulated by bioconservatives and their fellow travelers as unrealistic and unduly
restrictive, potentially depriving humanity of timely access to badly needed safe,
clean technologies.
Governments have two principal ways to limit scientific initiatives. First, they can
limit the government grant funding needed to support academic research, as the US
government under President George W Bush did to discourage embryonic stem cell
research (Spiegel 2013). Secondly, they can introduce legislation and regulations to
explicitly forbid certain lines of research, regardless of where the needed funding
is obtained. An approach proposed by Bostrom (2002) is to differentially influence

14 http://www.wired.com/wired/archive/8.04/joy_pr.html.
15 A possible example is the publication in the journal, Science, of information concerning the

viral genome of the 1918 Spanish influenza pandemic virus, which killed as many as 50 million
people worldwide, because of fears that this information could be used for evil purposes (Tumpey
et al. 2005).The rationale for this work was altruistic: by reconstructing the virus, researchers
learned which genes were responsible for making the virus so dangerous, which in turn helps in
the development of new drugs and vaccines. For an interesting discussion on this matter, see http://
www.readcube.com/articles/10.1038/sj.hdy.6800911.
7.14 Existential Risks 147

technological development, a process where society would retard the progress of tech-
nologies thought to be possibly harmful, while accelerating the development of tech-
nologies expected to be beneficial. This might be carried out, for example, through
the thoughtful allocation of research funding as well as by regulatory approval. One
problem with this approach, of course, is the difficulty of predicting the risks and
benefits of nascent technologies.
In the final analysis, however, just as generals in the military must accept laws,
policies and regulations from their civilian overseers that they may disagree with
(perhaps because they lack a sound basis in military science) so too scientists may
find themselves restricted in the kinds of experiments that they are able to carry out
by virtue of laws and policies that may be based more on prejudice or ignorance
then on solid scientific evidence. In such cases it is the social responsibility of the
scientific community to educate the public as to why their work is beneficial and
worthwhile.

7.15 Conclusion

Based on the critiques of transhumanism offered by critics such as Leon Kass, Fran-
cis Fukuyama, and Michael Sandel, this chapter critically assessed five commonly
offered philosophical arguments why human enhancement by artificial means is
undesirable. These include the matter of fairness, human dignity issues, “slippery
slope” issues, an argument based on “repugnance”, and safety issues. It is shown that
these arguments are for the most part weak and unpersuasive, although I so argue
that concerns about the safety of some transhumanist endeavors is appropriate.
Chapter 8
Transhumanism and Religion

Religious people generally want to overcome the limitations of

the body and live forever, just like transhumanists.

John G. Messerly (https://reasonandmeaning.com/2015/01/18/tr

anshumanism-and-religion/)

Abstract This chapter is concerned with the intersection of transhumanism, neurol-

ogy and religious belief. The role of various brain structures in religious experiences
(especially the frontal lobes) is discussed, including a discussion of how pathological
brain conditions such as epilepsy can influence religious beliefs. The chapter begins
with a discusuion of how various thinkers such as Marx and Freud imagined that
the influence of religion would weaken over time and continues on to discuss the
evolutionary origins of religious belief, the nature of religious experience as well
as neurological and pharmacological circumstances that may influence a person’s
religious experiences, including hyper-religiosity syndromes and the central role of
the frontal lobes in religiosity.

8.1 Introduction and Motivation

Religion has been a particularly important aspect of almost all cultures from the
beginning of mankind (Atran and Ginges 2012; Peoples and Marlowe 2012; Baumard
and Boyer 2013; Boyer 2003). Even today, while formal religious belief has declined
in Europe in recent years, it remains an important cultural force in much of the world,
and especially in the US.

© Springer Nature Switzerland AG 2018 149

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_8
150 8 Transhumanism and Religion

There are many reasons why understanding the psychological and neurologic
underpinnings of religion is of interest. For example, individuals who study religious
cults1 may suspect that some cult members are “brainwashed” and may wish to
understand the psychological processes involved, either to assist in the process of
“deprogramming” rescued individuals, or, as in the case of CIA psychologists (and
those of other intelligence agencies) to develop brainwashing programs of their own.
Atheists may wish to develop a mechanistic understanding of the religious expe-
rience to support arguments that religious belief is a mere artifact of brain function
(Adelman 2007; Palmer 2006; Bhavsar and Bhugra 2008; Inzlicht et al. 2009; Boyer
2003). Believers, on the other hand, may wish to argue the exact opposite based on
the exact same empirical findings.
Psychiatrists, psychologists and neurologists may be interested in exploring hyper-
religiosity syndromes and other phenomena with a view to determining what neuro-
transmitters, neural pathways and brain structures, if any, are involved in religious
belief or in the experience of “religious ecstasy” as described by William James
in his classic 1902 book The Varieties of Religious Experience as well as by more
recent authors (Bhavsar and Bhugra 2008; Buckley 1981; Parnas and Henriksen
2016; Ng 2007; Beauregard and Paquette 2008). This field is sometimes known as
“neurotheology”.2
Related to the above is a similar quest to understand the brain mechanisms under-
lying moral or ethical decision making, a field sometimes known as “neuroethics”
(Levy 2011; Kolber 2011; O’Connell 2011; Whitehouse 2011; Garnett et al. 2011).
For example, in this field individual being studied may be given an ethical dilemma
to consider (e.g., Is it OK to kill one innocent man to save the lives of one thousand
others?). In this scenario, real-time metabolic brain imaging (e.g. functional-MRI
methods) might be carried out to determine which brain structures are involved in
thinking through such an issue.
Finally, Charlton (2008) has argued that genetic engineering might be employed
by some future clinician-scientists for “genospiritual enhancement” with a view to
making life more “meaningful.” Charlton calls this fascinating possibility “genospir-
itual engineering“ and is an example of a proposed transhumanist enhancement with
clear religious implications. (Genospiritual engineering is discussed in more detail
in Sect. 8.16.)
These and related themes are the subject of this chapter, which is intended as an
all-too-brief overview of the winding yet intersecting roads of religion, psychology
and ethics in the context of neurology and transhumanism. Those readers who thirst

1 Of course, the distinction between a cult and a religion is arguably only a matter of time, size and
perspective. On this matter, the interested reader is directed to an enlightening Wall Street Journal
article entitled “When Does a Religion Become a Cult?, available online at http://online.wsj.com/
article/SB10001424052748703529004576160363526909654.html.
2 For two excellent introductory accounts of neurotheology the interested reader is directed to the

following recent books: The “God” Part of the Brain: A Scientific Interpretation of Human Spir-
ituality and God, by Matthew Alper (http://www.amazon.com/God-Part-Brain-Interpretation-Spi
rituality/dp/1402214529) and The God Gene: How Faith Is Hardwired into Our Genes, by Dean
Hamer (http://www.amazon.com/God-Gene-Faith-Hardwired-Genes/dp/0385720319).
8.1 Introduction and Motivation 151

for more details (admittedly, the present account only lightly scratches the surface
of a complex yet absorbing topic full of philosophical side roads) are directed to the
references listed throughout, where many specialized treatments of the subject are
identified.

8.2 Religion and Modernity: Views from Marx, Freud,

Weber, Einstein, Harris and Dawkins

A number of thinkers such as Marx, Weber and Freud imagined that with the advent
of modernity, the influence of religion on society would diminish.

Marx

Marx, focusing on the notion of social alienation produced by the capitalist system,
argued that religion, which sought to somehow sooth this alienation with promises of
a better life in the afterworld, would vanish as the capitalist system became replaced
by a communist system in a process he described as “historically inevitable” (Marx
and Engels 2002).

Weber

Weber offered a socioevolutionary model of religious progression, arguing that, as a

general rule, societies progress successively from primitive magic through the stages
of polytheism, pantheism, monotheism and finally, a system focusing on secular
ethical principles (Weber 1933).
Freud

Freud saw God as an illusion based on man’s infantile need for a powerful father
figure. He similarly saw religion as an evolutionary adaptation that served to help indi-
viduals restrain their violent impulses. Freud argued that as civilization progresses,
religious beliefs would be set aside, replaced by reason, analysis and science (Capps
2001).
In all the above cases, the predictions made did not come true in America. Cer-
tainly, classical communism has not taken over America or any significant portion
of the world. Nor have religious belief systems been universally set aside in favor of
a more scientific approach, as Freud expected, at least not in America, although this
is largely true in Europe.
In more recent times thinkers such as Einstein, Harris and Dawkins have critically
examined the neurological and psychological underpinnings of religious belief to
offer additional insights.
152 8 Transhumanism and Religion

Einstein
In a 1930 New York Times article, Albert Einstein distinguished three human char-
acteristics which lead to religious belief: fear, a human need for social morality, and
an appreciation of cosmic awe.3 Each of these impulses leads to a different form of
religious belief system.
In primitive societies an unsophisticated appreciation of the physical nature of
causality leads to fear, with the invention of supernatural beings who, when appro-
priately paid homage, offer humans fertility, good harvests etc., while the human need
for love, justice and harmony create a different path to belief in a supreme being. Both
these forms of religious belief system present us with an anthropomorphic concept
of God.
However, Einstein saw the third form of religious belief system, originating from
a profound sense of awe and wonder, as the most mature form, noting that in this
instance the individual feels “the sublimity and marvelous order which reveal them-
selves in nature and in the world of thought.”
Einstein saw science as an antagonist of the first two styles of religious belief, but
as a partner in the third. He writes:
When one views the matter historically, one is inclined to look upon science and religion
as irreconcilable antagonists, and for a very obvious reason. The man who is thoroughly
convinced of the universal operation of the law of causation cannot for a moment entertain
the idea of a being who interferes in the course of events—provided, of course, that he takes
the hypothesis of causality really seriously. He has no use for the religion of fear and equally
little for social or moral religion.

and
I maintain that the cosmic religious feeling is the strongest and noblest motive for scientific
research. Only those who realize the immense efforts and, above all, the devotion without
which pioneer work in theoretical science cannot be achieved are able to grasp the strength
of the emotion out of which alone such work, remote as it is from the immediate realities of
life, can issue.

Harris
Samuel Benjamin “Sam” Harris is the co-founder (with his wife) and chief executive
of Project Reason, an organization that promotes science and secularism. Trained in
philosophy and neuroscience, Harris has written a number of best-selling books that
are deeply critical of organized religion. These include The End of Faith (2004), Letter
to a Christian Nation (2006), The Moral Landscape: How Science Can Determine
Human Values (2010), Free Will (2012), Waking Up: A Guide to Spirituality Without
Religion (2014) and Islam and the Future of Tolerance: A Dialogue (2015) (co-
authored with Maajid Nawaz).

3 AlbertEinstein. Science and Religion. New York Times Magazine, November 9, 1930, pp. 1–4.
Reprinted in Ideas and Opinions, Crown Publishers, Inc. 1954, pp 36–40 and in Einstein’s book The
World as I See It, Philosophical Library, New York, 1949, pp. 24–28. Also available online at
http://www.sacred-texts.com/aor/einstein/einsci.htm.
8.2 Religion and Modernity: Views from Marx, Freud, … 153

In his books, speeches and media appearances, Harris makes the case for a non-
threatening, even gentle, form of religious intolerance, where stated religious beliefs
are weighed against available evidence in a conversational, non-adversarial dialogue
centered on intellectual honesty.
In his 2010 book, The Moral Landscape, Harris makes the case that human
well-being might best be improved via a scientific approach, and he rejects
the notion that religion should determine what activities are good and honor-
able. He writes “Human well-being is not a random phenomenon. It depends
on many factors—ranging from genetics and neurobiology to sociology and eco-
nomics” and he expects that once scientists begin developing moral norms based
on scientific evaluation that moral systems that draw on religion will join “astrology,
witchcraft and Greek mythology on the scrapheap”.4
Dawkins
Richard Dawkins, a British evolutionary biologist and emeritus fellow of New Col-
lege, Oxford, is perhaps best known as a militant atheist. Although many of his
books deal with evolutionary biology, his views on religion are best summarized in
his 2006 book The God Delusion. In this book Dawkins proclaims that belief in God
is not only irrational but has inflicted significant damage to society. Fundamentalist
varieties of Christianity and most Islamic traditions come in for particular scorn from
Dawkins. To Dawkins religion is a divisive and oppressive force without which the
world would be better off.
Dawkins expresses puzzlement how belief in God still exists among individuals
who are scientifically sophisticated. While Dawkins understands that some physicists
may use the word ‘God’ as a metaphor for the awe-inspiring mysteries that physicists
seek to unravel,5 he emphasizes that this metaphor is entirely different from (for
example) the Christian God who conducts miracles, smites evil people and forgives
sins.
Dawkins disagrees with Stephen Jay Gould’s famous principle of nonoverlapping
magisteria, which argues that science and religion each represent different areas of
inquiry, taking instead the position that the question of the existence of God should
be treated as a scientific question like any other question about the world we live in.
He writes6 :
It is completely unrealistic to claim, as Gould and many others do, that religion keeps
itself away from science’s turf, restricting itself to morals and values. A universe with a
supernatural presence would be a fundamentally and qualitatively different kind of universe
from one without. The difference is, inescapably, a scientific difference. Religions make
existence claims, and this means scientific claims.

4 https://www.newscientist.com/article/mg20827822-100-morality-we-can-send-religion-to-the-

scrap-heap/.
5 Forexample, Einstein’s famous quip that “God does not play dice with the universe” was a
metaphorical statement about quantum physics rather than a theological statement.
6 Dawkins, Richard (1998). “When Religion Steps on Science’s Turf”. Free Inquiry. Volume 18,

Number 2. Available online at http://pds4.egloos.com/pds/200709/04/59/Richard_Dawkins_-_

When_Religion_Steps_On_Sciences_Turf.pdf.
154 8 Transhumanism and Religion

8.3 The Evolutionary Origins of Religious Belief

Anthropological Perspectives

Religion has been an important part of human civilization from prehistoric times.
The culturally ubiquitous nature of religion and religious practices has led to the
academic subspecialties of religious anthropology and (more recently) the sociology
of religion. For example, King (2007) points out that both elephants as well as some
nonhuman primates such as chimpanzees and bonobos exhibit proto-religious traits
such as carrying out rituals surrounding the death of community members.
Many evolutionary biologists and (especially) evolutionary psychologists have
argued that the origins of religious thought lie in the evolution of genes that resulted
in a brain of sufficient size and complexity to permit humans to contemplate reli-
gious and philosophical issues (Soeling and Voland 2002; Baschetti 2005; Doebeli
and Ispolatov 2010; Bloom 2012). They also argue that that religion has been evolu-
tionarily programmed into the human brain via natural selection (evolutionary origin
of religions).7 For instance, arguing that the emergence of religious thought requires
a system of symbolic communication, Nicholas Wade in his 2009 book The Faith
Instinct: How Religion Evolved and Why It Endures writes:
Like most behaviors that are found in societies throughout the world, religion must have been
present in the ancestral human population before the dispersal from Africa 50,000 years ago.
Although religious rituals usually involve dance and music, they are also very verbal, since
the sacred truths have to be stated. If so, religion, at least in its modern form, cannot pre-date
the emergence of language. It has been argued earlier that language attained its modern state
shortly before the exodus from Africa. If religion had to await the evolution of modern,
articulate language, then it too would have emerged shortly before 50,000 years ago.

Arguably, if one were to look for the seat of religion in the brain drawing on anthro-
pological and evolutionary perspectives, one would begin with the frontal lobes, as
the frontal lobes are among the “newest” brain structures from an evolutionary view-
point. Indeed, this possibility is supported both by anecdotal clinical evidence and
well as from evidence from neuroimaging studies. These issues are discussed in more
detail in later sections of this chapter.

The God Gene Hypothesis

The God gene hypothesis, suggested by geneticist Dean Hamer, offers us the notion
that a particular gene (specifically, vesicular monoamine transporter 2—VMAT2),
predisposes individuals towards enhanced spiritual/mystic/religious experiences by
altering brain monoamine levels. In his 2005 book The God Gene: How Faith is
Hardwired into our Genes, Hamer elaborates at length on this hypothesis, drawing
on genetic, neurobiological and psychological studies.

7 Mikhail (2007) has taken this matter even further, suggesting that a neurologically-based “universal

moral grammar” may exist in humans, akin to Chomsky’s universal grammar theory (Palmer 2006;
Adelman 2007).
8.3 The Evolutionary Origins of Religious Belief 155

This intriguing hypothesis has met resistance at a number of levels. First, the
VMAT2 gene merely codes for a molecular pump; to reduce religious faith down
to a biological pump that transports neurotransmitters across cell membranes seems
very reductionist. Second, even if the VMAT2 gene ultimately enhances spirituality,
it tells us nothing about whether there is a God. To the atheist, should the God gene
hypothesis be validated, it will merely serve to support his argument that religious
belief can be reduced to mere biology. But to the believer, eventual proof of the God
gene hypothesis would be seen as an ingenious method God chose to help humans
come to embrace the realm of the divine.
In the end, perhaps all that can be said is that the VMAT2 gene, like the condi-
tion of temporal lobe epilepsy discussed later in this chapter, may be an important
neurobiological pathway in the study of the neurobiology of religious belief.
God as an Attachment Figure
Attachment theory, founded by psychologists John Bowlby and Mary Ainsworth
(Bretherton 1992) was initially based in the observation that human beings are born
with an innate psychobiological drive to bond with “attachment figures”. In a 1952
report to the World Health Organization on the importance of attachment,8 Bowlby
emphasized that “the infant and young child should experience a warm, intimate,
and continuous relationship with his mother (or permanent mother substitute) in
which both find satisfaction and enjoyment,” and that failure to do this may have
negative mental health consequences for the child. Subsequent to that report, Bowlby
collaborated with Ainsworth and other individuals to more fully develop attachment
theory (Bowlby 1969, 1976, 1988).
The insights provided by attachment theory have encouraged some thinkers to
conceptualize religious belief in terms of an attachment relationship with a divine
being that emerges as a consequence of neural mechanisms that developed under the
influences of evolutionary psychology (Granqvist et al. 2010; Kirkpatrick 2004).
According to Granqvist et al. (2010) two developmental pathways to religion may
be at play in the context of attachment theory:
“The first is a “compensation” pathway involving distress regulation in the context of inse-
cure attachment and past experiences of insensitive caregiving. Research suggests that reli-
gion as compensation might set in motion an “earned security” process for individuals who
are insecure with respect to attachment. The second is a “correspondence” pathway based
on secure attachment and past experiences with sensitive caregivers who were religious.”

8.4 What Is a Religious Experience?

Central to any discussion concerning the psychological and neurological underpin-

nings of religious experience is a definition of the term “religious experience.” As
the following discussion indicates, this is not a straightforward task.

8 Bolby (1952) Maternal Care and Mental Health, Geneva: World Health Organization. Available
at http://apps.who.int/iris/handle/10665/40724.
156 8 Transhumanism and Religion

The Stanford Encyclopedia of Philosophy offers the following commentary

regarding religious experiences9 :
Reports of religious experiences reveal a variety of different kinds. Perhaps most are visual
or auditory presentations (visions and auditions), but not through the physical eyes or ears.
Subjects report “seeing” or “hearing,” but quickly disavow any claim to seeing or hearing with
bodily sense organs. Such experiences are easily to dismiss as hallucinations, but the subjects
of the experience frequently claim that though it is entirely internal, like a hallucination or
imagination, it is nevertheless a veridical experience…

The encyclopedia also notes that:

Religious experiences can be characterized generally as experiences that seem to the person
having them to be of some objective reality and to have some religious import. That reality
can be an individual, a state of affairs, a fact, or even an absence, depending on the religious
tradition the experience is a part of. A wide variety of kinds of experience fall under the
general rubric of religious experience. The concept is vague, and the multiplicity of kinds
of experiences that fall under it makes it difficult to capture in any general account.

and finally:
Religious experience is also to be distinguished from mystical experience. Although there
is obviously a close connection between the two, and mystical experiences are religious
experiences, not all religious experiences qualify as mystical.

Some authorities classify religious experiences as direct or indirect. In the case

of a direct religious experience the individual experiences a direct communication
from his or her deity.
Indirect religious experiences are subtler, where participants may describe “com-
munion with God” or “oneness with the universe.” This makes the experience some-
what akin to a mystical experience and also bears some similarity to the religious
experiences described by individuals under the influence of some hallucinogenic
drugs like LSD. In both cases, the resulting psychological state is characterized by a
reduced awareness of one’s external environment along with an increased awareness
of spiritual feelings (Saver and Rabin 1997; Nencini and Grant 2010). Additionally,
visions, euphoria, and even frank hallucinations, perceived to be direct communi-
cation from God, may occur (Beit-Hallahmi and Argyle 1977; Persinger 1983). As
an example of direct communication from God, the Old Testament tells the story of
how Abraham experienced a direct communication from God, telling him to kill his
son Isaac10 (Genesis 22).

9 http://plato.stanford.edu/entries/religious-experience/.
10 In this Biblical account, taking place on Mount Moriah, God asks Abraham to sacrifice his son

Isaac. Although God gives Abraham no reason for the request, Abraham agrees without argument.
Fortunately for Isaac an angel stops Abraham at the last minute. This particular story is discussed
at length in Richard Dawkins’ book “The God Delusion” as an example of the potential danger of
uncritical religious obedience. Dawkins also writes: “The God of the Old Testament is arguably the
most unpleasant character in all fiction: jealous and proud of it; a petty, unjust, unforgiving control-
freak; a vindictive, bloodthirsty ethnic cleanser; a misogynistic, homophobic, racist, infanticidal,
genocidal, filicidal, pestilential, megalomaniacal, sadomasochistic, capriciously malevolent bully.”
(p. 31).
8.4 What Is a Religious Experience? 157

Of course, a central issue in this discussion is whether or not such religious expe-
riences are “genuine”. Notwithstanding the difficulties of defining what constitutes a
“genuine” religious experience, difficulties arise as to whether questions of this sort
can even be addressed, much less resolved, by the scientific method.

8.5 William James’ the Varieties of Religious Experience

William James’ classic book The Varieties of Religious Experience: A Study in

Human Nature is based on his famous Gifford Lectures on “Natural Theology”
presented at the University of Edinburgh between 1901 and 1902. Published in 1902,
the book was instantly recognized as a highly-readable yet seminal contribution to
the academic study of religion. Its importance is exemplified by the following closing
comments from the August 1902 New York Times review of the book11 :
Everywhere there is a frolic welcome to the eccentricities and extravagances of the religious
life. Many will question whether its more sober exhibitions would not have been more fruitful
of results, but the interest and fascination of the treatment are beyond dispute, and so, too,
is the sympathy to which nothing human is indifferent.

Examining the topic from historical, philosophical, neurological and psycholog-

ical perspectives, James skillfully discusses issues such the nature and variety of
religious experiences, hopes of an eternal reward in the afterlife, shame and repen-
tance, fears of eternal punishment, religious conversion (e.g., Saint Paul being struck
down from his horse), mysticism, saintliness, religious hallucinations (e.g., Saint
Joan’s voices) and much more.
What makes the book particularly special, however, was the degree to which
James attempted to connect religious experiences to brain phenomena, discussing,
for instance, religious experiences in epileptics (vide infra), the experiences of indi-
viduals suffering from mental illness, and individuals with religious visions experi-
enced under the influence of hallucinogens (where James make specific reference to
ergot poisoning, which produces an effect similar to LSD ingestion).
Although more than a century has passed since James’ book was first published,
it is still commercially available12 and remains an influential classic.

11 A Study of Man: The Varieties of Religious Experience. The New York Times. August 9, 1902.
12 For a commercial copy see http://www.amazon.com/Varieties-Religious-Experience-William-James/d

p/0684842971. A free download is also available at http://www.gutenberg.org/ebooks/621.

158 8 Transhumanism and Religion

8.6 What Can We Learn from the Experiences

of Epileptics?

Epilepsy and Religious Experiences

In both literature (e.g., Fyodor Dostoevsky’s The Idiot 13 ) and in religious tradition
there appears to be an association between epilepsy and mystical/spiritual/religious
experiences. Clinical observations over the past century support an association
between transcendental experiences of this kind in relation to seizure (ictal) episodes,
particularly in temporal lobe epilepsy (TLE).
According to Devinsky and Lai (2008) “between 0.4 and 3.1% of partial epilepsy
patients had ictal religious experiences”, with higher frequencies “found in system-
atic questionnaires versus spontaneous patient reports” and with such experiences
occurring “most often in TLE patients with bilateral seizure foci.” They also point
out that such seizures can be a source of religious conversion.14
Devinsky and Lai also propose a possible neurologic mechanism. They point out
that the limbic system is “often suggested as the critical site of religious experience
due to the association with temporal lobe epilepsy and the emotional nature of the
experiences” while neocortical areas are likely also involved, as “suggested by the
presence of visual and auditory hallucinations, complex ideation during many reli-
gious experiences, and the large expanse of temporal neocortex.” These concepts are
elaborated upon later in this chapter.
The reader will note that earlier, the frontal lobes were offered as a possible site of
religious thought, while the above account suggests that the limbic system may play
an important role. The likelihood is that, as with many complex brain processes, a
number of brain areas are involved, possibly reflecting a variety of types of religious
experiences (e.g., intellectual versus mystical experiences).

Geschwind Syndrome

Some patients with temporal lobe epilepsy eventually develop Geschwind syndrome,
named after Norman Geschwind, who described a cluster of behavioral phenomena
and personality changes evident in some individuals after suffering lengthy periods
of undertreated or refractory temporal lobe epilepsy (Benson 1991; Geschwind 1979;
Veronelli et al. 2017). The syndrome includes five primary features, although not all

13 The story, published serially between 1867 and 1869, concerns Prince Lev Nikolayevich Myshkin,

a sensitive young man of noble Russian lineage, who has recently arrived in St. Petersburg after
spending four years in a Swiss clinic for management of his epilepsy. Myshkin, a man of noble values
(altruism, kindness, compassion, ethical sensitivity) subordinates his romantic feelings to higher,
saintly ideals, but in the end cannot cope in the world of decadence and moral decay that surrounds
him. He ends up returning to the Swiss clinic, the real world apparently being no place for a saint.
The Idiot is considered one of Dostoevsky’s greatest works, along with Notes from Underground
(1864), Crime and Punishment (1866), The Possessed (1872), and The Brothers Karamazov (1880).
14 Was the biblical St. Paul, who underwent a sudden religious conversion on the road to Damascus,

an epileptic? Some experts believe so (Landsborough 1987; Brorson and Brewer 1988).
8.6 What Can We Learn from the Experiences of Epileptics? 159

are present in all cases: hypergraphia (a compulsion to extensive writing), hyperre-

ligiosity (a passionate tendency towards religious and philosophical interests), atyp-
ical (typically diminished) sexuality, circumstantiality (excessive verbal output and
preoccupation with details), and an intensified mental life featuring “deepened cog-
nitive and emotional responses” (Benson 1991). Aggressiveness may also be present
(Garcia-Santibanez and Sarva 2015; Benson 1991).
Garcia-Santibanez and Sarva (2015, Benson 1991) describe a case of a 40-year-
old man with Geschwind syndrome where hyperreligiosity was the only finding. The
hyperreligiosity appeared after the patient unilaterally discontinued his anti-epileptic
medications (topiramate 100 mg twice daily and lamotrigine 200 mg twice daily).
After his anti-epileptic medications were restarted the hyperreligiosity vanished.
The authors offer the following clinical narrative:
On examination, he was uncooperative. He was constantly making religious remarks, saying
“God is with me and I do not need doctors or medications.” He would interpret every question
asked to him as questioning his faith and at times attempted to convert doctors and staff to
Islam. He believed everyone around him was preventing him from obtaining salvation.

Devinsky and Lai, referenced earlier, offer us some rather detailed insight into
possible neurologic mechanisms involved in cases of religious experiences associated
with epilepsy:
Although psychologic and social factors such as stigma may contribute to religious experi-
ences with epilepsy, a neurologic mechanism most likely plays a large role. The limbic system
is also often suggested as the critical site of religious experience due to the association with
temporal lobe epilepsy and the emotional nature of the experiences. Neocortical areas also
may be involved, suggested by the presence of visual and auditory hallucinations, complex
ideation during many religious experiences, and the large expanse of temporal neocortex.
In contrast to the role of the temporal lobe in evoking religious experiences, alterations in
frontal functions may contribute to increased religious interests as a personality trait. The
two main forms of religious experience, the ongoing belief pattern and set of convictions (the
religion of the everyday man) versus the ecstatic religious experience, may be predominantly
localized to the frontal and temporal regions, respectively, of the right hemisphere.

Another account, this time historical, concerns the visionary mystic Wise-Knut,
born in Norway in 1792. His contemporary biographers, who narrated his major life
events in detail, tell us that he heard voices, had religious delusions, and suffered from
severe epilepsy (Brodtkorb and Nakken 2015). This is yet another story substantiates
the notion that epilepsy may have played an important role in the history of religions.
The God Helmet
The God Helmet is an experimental apparatus developed by Stanley Koren and
Michael Persinger to study the effects of magnetic stimulation of the temporal lobes
(Persinger and Healey 2002). The magnetic fields generated by the apparatus are
much weaker than those used on transcranial magnetic stimulation; it instead the
particular pattern of magnetic stimulation (modelled after limbic burst firing) that
is said to be special to the apparatus design (Richards et al. 1993). Reports of users
sensing God’s presence (Persinger uses the more secular term “sensed presence”)
160 8 Transhumanism and Religion

with this device brought considerable public attention and resulted in a number of
television documentaries.15
As an example of the sensed presence experience, here is a description from
obtained a 21-year-old woman (St-Pierre and Persinger 2006):
I felt a presence behind me and then along the left side. When I tried to focus on its position,
the presence moved. Every time I tried to sense where it was, it moved around. When it
moved to the right side, I experienced a deep sense of security like I had not experienced
before.

Persinger and his co-workers hypothesize that the left and right temporal lobes
collaborate to create a unified self and when communication between them breaks
down as a result of appropriate magnetic stimulation, the ‘self’ in the non-dominant
hemisphere ‘intrudes’ into consciousness, a phenomenon Persinger calls ‘inter-
hemispheric intrusion’. Persinger additionally hypothesizes that this phenomenon,
when induced by natural means such as meteorite showers, solar flares or various
geomagnetic phenomena, may help explain mystical/spiritual experiences such as
those experienced by a number of religious leaders (Derr and Persinger 1989).16
To some critics, however, Preminger’s arguments are unconvincing. Some sci-
entists maintain that the “double blinding” done in the experiments was not up to
standard and that suggestibility was at play (Granqvist et al. 2005). Other critics
accept that Persinger is likely describing a genuine biological phenomenon, but
argue that whether the induced “sensed presence” appears as a ghostly apparition,
or as an enhanced appreciation of another individual in the room, or as God peering
over your shoulder, what is at play is not necessarily a “God center” area in the
human brain that is responding to the magnetic stimulus, but more likely simply a
hallucination or illusion of sorts, one induced electromagnetically rather than by the
use of drugs.

8.7 What Pharmacologic Interventions Tell Us

As noted earlier, in James’ book The Varieties of Religious Experience he described

religious experiences induced by ergot poisoning following the ingestion of ergot-
contaminated food. In more recent times LSD has been discussed in the context of the

15 Foran example, visit http://www.sciencechannel.com/tv-shows/through-the-wormhole/videos/

through-the-wormhole-the-god-experience/.
16 One popular magazine tells us Joseph Smith was visited by the angel Moroni before founding

Mormonism, and when Charles Taze Russell started the Jehovah’s Witnesses, powerful Leonid
meteor showers were occurring (http://www.wired.com/1999/11/persinger/).
8.7 What Pharmacologic Interventions Tell Us 161

religious experiences it sometimes provides.17 Consider, for example, the following

anecdote about an LSD-related religious experience provided by Unger18 :
Suddenly, I could see my family handing me great love. It seemed to be pouring out of their
hearts. I cried, not bitter tears, but tears of beauty and joy. A beautiful organ was playing
in the background, and it seemed as if angels were singing. All of a sudden I was back in
eternity. There was music and beauty. Peace and happiness, tranquility—could not possibly
describe my feelings. My heart was filled with joy that was overwhelming. Just a beauty and
peace that I have never known. At this point, I felt that time was thousands of years ago,
thousands of years from now, and now.

Of course, as noted earlier, LSD is hardly the only drug to be linked to religious
experiences. Drugs such as psilocybin (Griffiths et al. 2006) and mescaline have been
part of religious ceremonies in a number of aboriginal cultures for centuries. In recent
years much attention has focused on dimethyltryptamine (DMT), administered either
as a pure chemical or as a component of ayahuasca, a shamanistic concoction used
by some Amazonian Amerindians. Part of the reason for this attention is the claim
by authors such as Rick Strassman, author of DMT : The Spirit Molecule, that DMT
is a naturally occurring “spirit molecule” responsible for near-death and mystical
experiences.
Such insights naturally lead the neurologically inclined to ask about the particular
brain structures involved when drugs like LSD or DMT are administered. This is, in
fact, a largely unexplored field which is expected to gradually expand as functional
MRI (f-MRI) techniques and other brain imaging methods become more commonly
employed for such purposes.19
For now, what is known is that these drugs bind to various brain receptors to
achieve their effect, although the specific details remain far from being fully worked
out.
Psychedelics and Hallucinogens
Contemporary research has led to an understanding that a number of
psychedelic/hallucinogenic agents such as LSD20 are agonists or partial agonists
acting at brain serotonin receptors,21 especially receptors located on apical dendrites

17 See for instance http://onfaith.washingtonpost.com/onfaith/undergod/2008/05/lsd_and_the_religious_

experien.html and http://www.psychedelic-library.org/pahnke3.htm.

18 Unger S. M. The current status of psychotherapeutically-oriented LSD research in the United

States. Unpublished paper read to the New York State Psychological Association on 30 April 1965.
(Quoted in http://www.psychedelic-library.org/pahnke3.htm).
19 Some critics would be quick to point out some of the potential difficulties of conducting brain

imaging studies of psychedelic drugs. First, f-MRI studies are very expensive and are unlikely to
be funded by either conservative government agencies or by sponsoring drug companies. Second,
conservative government agencies like the American DEA would be expected to disapprove most
applications to study such drugs (as is frequently the case, for example, with medical marijuana
studies). Third, many people disagree on principle with the idea of studying psychedelic drugs.
That being said, studies outside the USA are now being undertaken to address such questions
(Carhart-Harris et al. 2016).
20 More specifically, ((5R,8R)-(+)-lysergic acid-N,N-diethylamide (LSD)-25.
21 More specifically, 5-hydroxytryptamine 2A receptors.
162 8 Transhumanism and Religion

of neocortical pyramidal cells in layer V22 (Nichols 2016). (An agonist is a drug
that activates matching receptors in the brain or other organs. Full agonists activate
receptors in proportion to their concentration, while partial agonists offer only partial
efficacy relative to a full agonist, their effect relative to concentration diminishing at
high concentrations.)
Gallimore (2015) has applied the science of “integrated information theory” (IIT),
a contemporary model of consciousness, to help understand the action of psychedelic
drugs at another level. He writes (p. 1):
Using the results of functional neuroimaging data on the psychedelic state, the effects of
psychedelic drugs on both the level and structure of consciousness can be explained in terms
of the conceptual framework of IIT. This new IIT-based model of the psychedelic state pro-
vides an explanation for many of its phenomenological features, including unconstrained
cognition, alterations in the structure and meaning of concepts and a sense of expanded
awareness. This model also suggests that whilst cognitive flexibility, creativity, and imagi-
nation are enhanced during the psychedelic state, this occurs at the expense of cause-effect
information, as well as degrading the brain’s ability to organize, categorize, and differentiate
the constituents of conscious experience. Furthermore, the model generates specific predic-
tions that can be tested using a combination of functional imaging techniques, as has been
applied to the study of levels of consciousness during anesthesia and following brain injury.

Such a detailed understanding of psychedelic/hallucinogenic agents may be help-

ful as clinicians continue to explore the possibility that these molecules may be
therapeutically valuable. For example, Das et al. (2016) write (p. 222):
The great value of LSD lies with its ‘mystical experience’ and ‘self realization’. In a properly
structured therapeutic setting, the patient can quickly develop a level of ‘self understanding’
and ‘self acceptance’. With the therapist’s help, he or she can clearly see the inadequacies
in the value system which has underlain previous behavior. With the gain in ‘openness’ and
altered understanding, the patient tries to improve and alter the previous wrongs.

Additionally, LSD and a number of other drugs may serve as drug models of
schizophrenia (Murray et al. 2013; Steeds et al. 2015). For example, Steeds et al.
(2015) note that “Determining the different molecular effects of those drugs whose
pharmacological effects do and do not mimic the various aspects of schizophrenia
has much to teach us concerning the pathogenesis of the illness.”

8.8 Insights from Functional Neuroimaging Experiments

For some time neurophilosophers and neurotheologians have been interested in deter-
mining what brain structures were responsible to religious thoughts and feelings. As
an example of work in this direction focusing on meditation, Newberg et al. (2001)
measured changes in regional cerebral blood flow during meditation in eight Tibetan

22 An apical dendrite is a one that emerges from the apex of a pyramidal neuron. Pyramidal neurons

(pyramidal cells) are a special type of neuron found throughout the brain, and especially in the
cerebral cortex.
8.8 Insights from Functional Neuroimaging Experiments 163

Buddhists using a radioactive tracer in conjunction with single photon emission com-
puted tomography (SPECT). The percentage change in blood flow to various brain
structures between meditation and baseline was compared. The authors found sig-
nificantly increased flow in the cingulate gyrus, inferior and orbital frontal cortex,
dorsolateral prefrontal cortex, and thalamus during meditation.
Mohandas (2008) has reviewed the scientific literature dealing with the neural
basis of spirituality, mediation and religiosity. He summarizes the results of these
studies as follows:
Neuroimaging studies have shown that meditation results in an activation of the prefrontal
cortex, activation of the thalamus and the inhibitory thalamic reticular nucleus and a resultant
functional deafferentation of the parietal lobe. The neurochemical change as a result of
meditative practices involves all the major neurotransmitter systems. The neurotransmitter
changes contribute to the amelioration of anxiety and depressive symptomatology and in
part explain the psychotogenic property of meditation.

and
The studies point to prefrontal activation, transient hypofrontality, increased frontal lobe and
decreased parietal lobe activity and also to a deafferentation of the posterior superior parietal
lobule (PSPL) in spirituality.

Andrew B. Newberg

Andrew B. Newberg, mentioned earlier, is an American neuroscientist and neurothe-

ology researcher whose research on the development of neurotransmitter tracers
for the evaluation of pathological and normal brain states has received widespread
attention, especially in the context of religiosity. Newberg’s early work on the neu-
rophysiological foundations of religious and spiritual experiences used specialized
brain imaging methods to study Buddhist meditators and Franciscan nuns in prayer.
This work was eventually published in three books, The Mystical Mind (D Aquili
and Newberg 1999), Why God Won’t Go Away (Newberg et al. 2002) and Why We
Believe What We Believe (Newberg and Waldman 2006).
While critics of Newberg’s work have argued that insights from neuroimaging do
not necessarily extrapolate to the broader domain of religious and spiritual phenom-
ena, Newberg himself points out that such studies are only tools to evaluate the brain
during religious and spiritual experiences. Writing at his Web site (http://www.andr
ewnewberg.com), he notes:
Our research indicates that our only way of comprehending God, asking questions about
God, and experiencing God is through the brain. But whether or not God exists “out there”
is something that neuroscience cannot answer. For example, if we take a brain image of a
person when she is looking at a picture, we will see various parts of the brain being activated,
such as the visual cortex. But the brain image cannot tell us whether or not there actually
is a picture “out there” or whether the person is creating the picture in her own mind. To a
certain degree, we all create our own sense of reality. Getting at what is really real is the
tricky part.
164 8 Transhumanism and Religion

8.9 Religion and Psychopathology. Hyper-religiosity

Syndromes

In William James’ book The Varieties of Religious Experience the reader is provided
with a number of anecdotes suggesting that neurological events may be responsible
for the development of a hyperreligiosity syndrome in some individuals. For example,
the earlier mentioned story of the sudden religious conversion of St. Paul during his
journey to Damascus, with Paul subsequently devoting his entire life to Christianity, is
one anecdote of hyperreligiosity that James provides. As noted earlier, Landsborough
(1987) as well as others (Brorson and Brewer 1988) speculate that the event that
changed everything for Paul may have been a form of epilepsy (vide infra).
Muramoto (2004) has developed an elaborate hypothesis/explanation for hyper-
religiosity syndromes focusing on frontal lobe function; this is discussed later in this
chapter, after a discussion on the importance of the frontal lobes in religious and
spiritual thought.

8.10 The Central Role of the Frontal Lobes in Religiosity

If there were one set of brain structures that make humans uniquely human compared
to other animals, it would be the frontal lobe structures. Neuroscientists have known
of the importance of the frontal lobe structures as early as the middle 1800s as a result
of the amazing story of Phineas P. Gage (1823–1860), an American railroad worker
who sustained severe damage to his left frontal lobe as a consequence of having a large
iron rod pass completely through his head in an explosion. Although it was amazing
that Mr. Gage survived such a serious injury, equally amazing were the personality
changes he underwent as a consequence of losing substantial portions of his left
frontal lobe. Although he underwent a long and difficult period of recuperation he
was subsequently able to carry out a relatively normal life, albeit one with substantial
changes in personality. A contemporaneous account of these mental changes has been
provided by Harlow23 :
The equilibrium or balance, so to speak, between his intellectual faculties and animal propen-
sities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest
profanity (which was not previously his custom), manifesting but little deference for his fel-
lows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously
obstinate, yet capricious and vacillating, devising many plans of future operations, which
are no sooner arranged than they are abandoned in turn for others appearing more feasible.
A child in his intellectual capacity and manifestations, he has the animal passions of a strong
man. Previous to his injury, although untrained in the schools, he possessed a well-balanced
mind, and was looked upon by those who knew him as a shrewd, smart businessman, very
energetic and persistent in executing all his plans of operation. In this regard his mind was

23 Harlow
J.M. Recovery from the Passage of an Iron Bar through the Head. Publications of the
Massachusetts Medical Society 1868;2:327–347. Available from: https://en.wikisource.org/wiki/
Recovery_from_the_passage_of_an_iron_bar_through_the_head.
8.10 The Central Role of the Frontal Lobes in Religiosity 165

radically changed, so decidedly that his friends and acquaintances said he was “no longer
Gage”.

Although we are not specifically told how the loss of frontal lobe function impacted
on Gage’s religiosity, we do know from Harlow that he had become “impatient of
restraint or advice” and had become “irreverent, indulging at times in the grossest
profanity.” Indeed, these and other contemporary observations are surprisingly in
line with Muramoto’s characterization of a hypofunctioning medial prefrontal cortex,
discussed next.

8.11 The Muramoto Hypothesis

Muramoto, a now-retired clinical neurologist with an interest in the neurological basis

of religious behavior, has advanced the hypothesis that the medial prefrontal cortex
is central to human religious activity (Muramoto 2004). He points out that everyday
tasks carried out by the medial prefrontal cortex, “such as error detection, compliance
to social norms, self-reflection, and theory of mind” are also tasks that “are a key
prerequisite to the maintenance of integrated religious activity.” He also hypothesizes
that pathological operation of the medial prefrontal cortex may lead to certain kinds
of psychopathology in relation to religion, arguing that “hyperreligiosity may result
from the hyperfunction of the medial prefrontal cortex, including rigid legalism
(excessive error detection), excessive concern over one’s existence (excessive self-
reflection), and delusional interpretation of God’s mind (excess of theory of mind).”
Evidently, Muramoto came to develop this hypothesis in the course of treating a
patient, a longtime pastor, “who showed dramatic changes in his religious behavior
as the earliest symptom” of what is known in the neuropsychiatric community as
“frontal variant frontotemporal dementia.” Muramoto summarizes his experience
with this patient:
In the earliest stage of the disease, he showed no detectable cognitive impairment, yet showed
significant changes in his religious commitment. Magnetic resonance imaging in this stage
revealed distinct focal atrophy in the bilateral medial prefrontal cortex around the area of
the orbitofrontal cortex and the anterior cingulate cortex. There were no other lesions. The
fact that the change in his religious behavior preceded the onset of other symptoms by years
suggests that the medial prefrontal cortex may play a specific role in the integrity of religious
behavior.

With this clinical anecdote and his hypothesis, Muramoto thus provides us with
further insights into the role of the frontal lobes and other brain structures in religious
thought.
166 8 Transhumanism and Religion

8.12 The Problem of “Pathological” Beliefs

Thinkers as far back as Marx and Weber have taken an interest the social con-
sequences of various religious belief systems (Schieman 2010). As an everyday
example, Roman Catholic priests are not permitted to marry; the social costs of this
restriction are at times hotly debated.24
However, a religious issue that is likely to capture our interest even more than
the priestly celibacy debate concerns the recent case of a 62-year-old man who, in
desiring a means to obtain eternal salvation, underwent male genital self-mutilation
after contemplating the following biblical passage from the New Testament:
“For there are some eunuchs, which were so born from their mother’s womb; and there are
some eunuchs, which were made eunuchs of men; and there be eunuchs, which have made
themselves eunuchs for the kingdom of heaven’s sake. He that is able to receive it, let him
receive it.” (Matthew 19:12)

Upon being seen in hospital after his surgical (mis)adventure, it became clear that
the patient was “unaccompanied by his penis”, which he had flushed down the toilet
after surgical excision using a pocket knife.25
This case, and the many similar cases that have been reported in the medical
literature (Clark 1981; Schwerkoske et al. 2012) serve to remind us that there are
potentially devastating consequences to uncritical religious belief systems.

8.13 What Would an Atheist Say? What Would a Believer

Say?

What does this all mean? The answer depends largely on the lens employed to
address the issue. Atheists would be expected to argue that the identification of any
neurologic mechanism behind religious experiences merely supports the notion that
religious beliefs are a mere evolutionary adaptation, one simply made more apparent
by pathophysiological entities like epileptic seizures or intoxication by drugs like
LSD or peyote.
On the other hand, believers might simply state that any such identified neurolog-
ical pathways are part of God’s design to make His presence known.
Yet others may hold that there is simply insufficient information at present to draw
any conclusions from the available data, while still others may hold that the worlds

24 For differing viewpoints on this controversial matter, see, for instance, http://www.catholicedu
cation.org/articles/facts/fm0014.html and http://www.helium.com/items/871255-priests-should-
be-permitted-to-marry.
25 For further details see http://www.world-science.net/exclusives/120612_gospel and http://freeth

inker.co.uk/2012/06/14/doctor-doctor-ive-had-an-attack-of-matthew-1912/.
8.13 What Would an Atheist Say? What Would a Believer Say? 167

of the divine and the physical/biological will forever remain separate and mysterious
realms.26
Finally, the logical positivists27 would be expected to argue that any questions
concerning the divine are entirely “meaningless”.

8.14 Ethical Perspectives

For many clinicians, religious beliefs play central role in medical ethics, especially
concerning issues such as abortion, circumcision, contraception, end-of-life care,
organ donation, and human sexuality (Turner 2003; Brody and Macdonald 2013).
Consequently, respect for religious beliefs can have important and profound bioeth-
ical implications. As a simple example, clinical nutritionists should be aware that
some religious belief systems forbid the eating of meat. A more nuanced example,
discussed next, is the case of the Jehovah’s Witness faith.
There are about six million Jehovah’s Witnesses world-wide. Orthodox Jehovah’s
Witnesses will not accept homologous or autologous whole blood, packed red blood
cells, plasma, platelets and white blood cells, even when “clinically necessary”.
This can result in a challenging dilemma for physicians because a routine, safe, and
potentially life-saving medical intervention is unacceptable to the patient. Anesthe-
siologists are particularly affected because they are almost always responsible for
intraoperative transfusion management. In the realm of cancer treatment, the avail-
ability of platelet and leukocyte concentrates has dramatically improved the patient
care by permitting higher doses of chemotherapeutic agents. However, since these
are products forbidden to Jehovah’s Witnesses, this situation also presents special
challenges in the clinical management of the practicing Jehovah’s Witness.
In the case of Jehovah’s Witnesses, on the surface the central ethical dilemma is a
conflict between beneficence and religious autonomy. But there is another potential
dilemma for those who care for these patients: because Jehovah’s Witness patients
may not be informed about possible inconsistencies in church doctrine regarding
medical issues, should clinicians attempt an in-depth discussion to encourage a “ra-
tional and truly autonomous” decision? Or should clinicians instead remain silent
regardless of the degree to which they might find the patients’ views to be irra-
tional and misguided, in order to avoid the perception of “religious interference”?
Muramoto (1998a, b, 1999) and others (Savulescu 1995; Elder 2000) have taken the

26 Stephen Jay Gould’s Nonoverlapping Magisteria model comes to mind here. Gould holds that

science and religion each have “a legitimate magisterium, or domain of teaching authority,” and
these two domains do not overlap (http://en.wikipedia.org/wiki/Non-overlapping_magisteria).
27 The logical positivists hold religious language to be void of meaning. They argue that statements

like “God is merciful” is an empty claim—neither true nor false—since there’s no mechanism to
verify the statements truth by sense experience. Specifically, logical positivists hold that a propo-
sition makes a genuine truth claim (is true or false) if and only if it is either empirical (testable
by sense experience) [example: “Red ants contain formic acid”] or analytic (true by definition)
[example: “Triangles have three sides”].
168 8 Transhumanism and Religion

position that truly ethical physicians should inform their patients as fully as possible
on all matters affecting their care, seeing any discussions centering on possible reli-
gious inconsistencies as merely an attempt to ensure that their patients have had the
opportunity to be fully informed on an important life-and-death issue. By contrast
Shander (1999) has taken the position that one should remain silent on religious
issues and focus solely on clinical concerns, citing the difficulties of what he sees as
essentially being an attempt at religious conversion. In short, Shander believes that
the clinician has no business influencing a person’s religious views.
While there are those who would dismiss the belief systems of Jehovah’s Witnesses
and similar faiths as dangerous and irrational and thus not worthy of respect by the
clinical community, such attitudes are neither conducive to a healthy therapeutic
relationship nor respectful of one of the pillars of medical ethics—respect for patient
autonomy.

8.15 Dreams and Religion

Dreams consist of a series of images, sensations and thoughts occurring during sleep,
frequently entailing personal significance and carrying emotional overtones. The
content, significance and purpose of dreams remain both a topic of scientific inves-
tigation and the subject of endless philosophical (and psychoanalytical) enquiry.
From personal experience we know that dreams can vary greatly in nature (adven-
turous, magical, bizarre, sexual etc.) involving events mostly outside the control of
the dreamer.
The scientific study of dreams, known as oneirology, aims to understand how
dreaming pertains to the operation of the brain, often with reference to the formation
of memories, understanding the effects of neuropharmaceuticals, and better appreci-
ating the basis for mental disorders. Oneirology is to be distinguished from religious
or psychoanalytical dream interpretation in that the aim of oneirology is to scientifi-
cally study the neurological basis of dreams rather than examining various possible
meanings associated with particular dreams.
Many thinkers see dreams as a connection to the unconscious mind28 while oth-
ers see dreams as having special religious significance. These connections will be
explored in later sections.

Three Schools of Thought on Dreams

Individuals interested in dreams tend to subscribe to one of three different dream

interpretation paradigms:

28 “Dreams are the royal road to the unconscious.”—Sigmund Freud, The Interpretation of Dreams.
8.15 Dreams and Religion 169

School 1. Dreams are a pathway to the unconscious mind that are best explored using
psychoanalytical techniques such as those developed by Freud and Jung.29,30
School 2. Dreams are at times messages from God, and can be sacred, being the
occasional product of Divine agency.31
School 3. Dreams are a poorly understood neurological phenomenon for which little
can be said at the moment except that psychoanalytical techniques and religious
interpretations are not meaningful because they make statements about the world
that are not falsifiable in the Popperian sense.32

Religious Belief Origins Hypothesis

One hypothesis about the origins of religious belief holds that the experience of
dreaming in primitive man contributed to the development of religion. The 19th
century British anthropologist E. B. Tylor,33 expressed this view in his 1871 work
Primitive Culture34 :
The evidence of visions corresponds with the evidence of dreams in their bearing on primitive
theories of the soul, and the two classes of phenomena substantiate and supplement one
another….That this soul should be looked on as surviving beyond death is a matter scarcely
needing elaborate argument. Plain experience is there to teach it to every savage; his friend

29 From Wikipedia: Psychoanalytic dream interpretation is a subdivision of dream interpretation

as well as a subdivision of psychoanalysis pioneered by Sigmund Freud in the early twenti-

eth century. Psychoanalytic dream interpretation is the process of explaining the meaning of the
way the unconscious thoughts and emotions are processed in the mind during sleep. There have
been multiple methods used in psychoanalytic dream interpretation, including Freud‘s method
of dream interpretation, the symbolic method, and the decoding method. The Freudian method
is the most prominently used in psychoanalysis and has been for the last century. Psycho-
analytic dream interpretation is used mainly for therapeutic purposes in a variety of settings.
Although these theories are used, none have been solidly proven and much has been left open
to debate among researchers. Some studies have shown that areas of dream interpretation can be
invalid and therefore a decline in importance has been seen in psychoanalytic dream interpretation.”
(https://en.wikipedia.org/wiki/Psychoanalytic_dream_interpretation).
30 For additional commentary see Revonsuo A. The reinterpretation of dreams: an evolutionary

hypothesis of the function of dreaming. Behav Brain Sci. 2000 Dec; 23(6):877–901; discussion
904-1121 as well as Kramer M. The biology of dream formation: a review and critique. J Am Acad
Psychoanal. 2002 Winter; 30(4):657–71 and Valli K, Revonsuo A. The threat simulation theory in
light of recent empirical evidence: a review. Am J Psychol. 2009 Spring;122(1):17–38.
31 From the Catholic Encyclopedia: “Modern theologians, whilst profiting by the progress of psycholog-
ical research, continue to admit the possibility of dreams supernatural in their origin, and consequently
the possibility of dream-interpretation depending on supernatural communications.” Souvay, C. (1909).
Interpretation of Dreams. In The Catholic Encyclopedia. New York: Robert Appleton Company. Retrieved
August 24, 2016 from New Advent: http://www.newadvent.org/cathen/05154a.htm.
32 From Wikipedia: Falsifiability or refutability of a statement, hypothesis, or theory is the inherent

possibility that it can be proved false. A statement is called falsifiable if it is possible to conceive
of an observation or an argument which negates the statement in question. https://en.wikipedia.
org/wiki/Falsifiability.
33 https://en.wikipedia.org/wiki/Edward_Burnett_Tylor.
34 Digitized book available at https://books.google.ae/books?id=RUMBAAAAQAAJ.
170 8 Transhumanism and Religion

or his enemy is dead, yet still in dream or open vision he sees the spectral form which is to
his philosophy a real objective being, carrying personality as it carries likeness.35

Similarly, Friedrich Nietzsche in his 1880 work Human, All-Too Human, wrote:
Misunderstanding of the dream. The man of the ages of barbarous primordial culture believed
that in the dream he was getting to know a second real world: here is the origin of all
metaphysics. Without the dream one would have had no occasion to divide the world into
two. The dissection into soul and body is also connected with the oldest idea of the dream,
likewise the postulation of a life of the soul, thus the origin of all belief in spirits, and probably
also of the belief in gods. ‘The dead live on, for they appear to the living in dreams‘: that
was the conclusion one formerly drew, throughout many millennia.36

In Judeo-Christian theology dreams figure prominently in the Old Testament37

as well as in the New Testament.38 However, sometimes the reader is also explicitly
warned of false or misleading dreams.39
Kelly Bulkeley’s book Big Dreams: The Science of Dreaming and the Origins
of Religion (Bulkeley 2016) is concerned with a special type of dream—highly
memorable dreams (Bulkeley calls them “Big Dreams”) that leave a lasting impact
on our psyche. He offers the reader a hypothesis about the purpose and significance
of Big Dreams: Big Dreams form a primal source of religious experience and arise
from hard-wired brain circuits present in all neurologically complete humans.
As noted above, whether dreams are meaningful remains a central question still
being hotly debated.40 A central issue is whether dreaming is a random by-product
of REM sleep physiology that does not serve any purpose. Revonsuo41 offers us the
following discussion on this matter:
The form and content of dreams is not random but organized and selective: during dreaming,
the brain constructs a complex model of the world in which certain types of elements,
when compared to waking life, are underrepresented whereas others are over represented.
Furthermore, dream content is consistently and powerfully modulated by certain types of
waking experiences.

35 https://www.psychologytoday.com/blog/dreaming-in-the-digital-age/201501/the-origins-religion-in-

dreaming.
36 https://www.psychologytoday.com/blog/dreaming-in-the-digital-age/201501/the-origins-religion-in-

dreaming.
37 Examples include [1] Numbers 12:6: “He said, ‘Hear now My words: If there is a prophet among

you, I, the Lord, shall make Myself known to him in a vision. I shall speak with him in a dream.”
and [2] Daniel 1:17: “As for these four youths, God gave them learning and skill in all literature
and wisdom, and Daniel had understanding in all visions and dreams.”
38 For example, Matthew 2:12: “And having been warned in a dream not to go back to Herod, they

returned to their country by another route.”

39 For example, Jeremiah 23:25: “I have heard what the prophets have said who prophesy falsely in

My name, saying, ‘I had a dream, I had a dream!’”.

40 In a study by Morewedge and Norton (2009) the authors investigated laypeople’s interpretation of

their dreams and found that participants believed that their dreams contained “hidden truths” and
that dreams provided “more meaningful information about the world than similar waking thoughts.”
41 Revonsuo A. The reinterpretation of dreams: an evolutionary hypothesis of the function of dream-

ing. Behav Brain Sci. 2000 Dec; 23(6):877–901; discussion 904–1121. Review. PubMed PMID:
11515147.
8.15 Dreams and Religion 171

Revonsuo further suggests that the biological purpose of dreaming is to “simulate

threatening events, and to rehearse threat perception and threat avoidance.” He writes:
In the ancestral environment human life was short and full of threats. Any behavioral advan-
tage in dealing with highly dangerous events would have increased the probability of repro-
ductive success. A dream-production mechanism that tends to select threatening waking
events and simulate them over and over again in various combinations would have been
valuable for the development and maintenance of threat-avoidance skills. Empirical evi-
dence from normative dream content, children’s dreams, recurrent dreams, nightmares, post
traumatic dreams, and the dreams of hunter-gatherers indicates that our dream-production
mechanisms are in fact specialized in the simulation of threatening events, and thus provides
support to the threat simulation hypothesis of the function of dreaming.

Another model for dreams comes from Hobson and McCarley, who proposed
the “the activation-synthesis model of dream production.”42 They summarize their
model as follows:
… dreaming sleep is physiologically determined and shaped by a brain stem neuronal mecha-
nism that can be modeled physiologically and mathematically. Formal features of the genera-
tor processes with strong implications for dream theory include periodicity and automaticity
of forebrain activation, suggesting a preprogrammed neural basis for dream mentation in
sleep; intense and sporadic activation of brain stem sensorimotor circuits including reticular,
oculomotor, and vestibular neurons, possibly determining spatiotemporal aspects of dream
imagery; and shifts in transmitter ratios, possibly accounting for dream amnesia. … the auto-
matically activated forebrain synthesizes the dream by comparing information generated in
specific brain stem circuits with information stored in memory.

Hobson and McCarley also note:

The primary motivating force for dreaming is not psychological but physiological since
the time of occurrence and duration of dreaming sleep are quite constant, suggesting a
preprogrammed, neurally determined genesis . . . [I]t casts serious doubt upon the exclusively
psychological significance attached to both the occurrence and quality of dreams. (p. 954)

Freudian Dream Analysis

Freud’s book The Interpretation of Dreams (1900) saw dreams as the “royal road
to the unconscious”, offering accessibility to the unconscious mind not available by
ordinary means. According to Freudian psychoanalytic theory, dreams are customar-
ily driven by a need for “wish fulfillment”, representing an attempt by the unconscious
mind to resolve a past or present conflict. The content in dreams, however, are often
not what they appear to be, and so must be interpreted using psychoanalytic methods.
In Freudian dream analysis, two types of content are distinguished: the “manifest
content” (the images, thoughts, and content remembered upon awakening) and the
“latent content” (the hidden meaning of the dream that must be extracted using
psychanalytic methods such as free association).

42 Hobson J. A., McCarley R. W. The brain as a dream state generator: an activation-synthesis

hypothesis of the dream process. Am J Psychiatry. 1977 Dec; 134(12):1335-48. PubMed PMID:
21570. See also http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=6065AD2B7A81E7B62
17E1FA7D223D0E1?doi=10.1.1.308.7522&rep=rep1&type=pdf.
172 8 Transhumanism and Religion

An example from Freud himself may help here. On the night of July 23, 1895 he
experienced a dream that he called “Irma’s Injection”43 :
A large hall - numerous guests, whom we were receiving. - Among them was Irma. I at
once took her to one side, as though to answer her letter and to reproach her for not having
accepted my ‘solution’ yet. I said to her: ‘If you still get pains, it’s really only your fault.’ She
replies: ‘If you only knew what pains I’ve got now in my throat and stomach and abdomen -
it’s choking me.’ - I was alarmed and looked at her. She looked pale and puffy. I thought to
myself that after all I must be missing some organic trouble. I took her to the window and
looked down her throat, and she showed signs of recalcitrance, like women with artificial
dentures. I thought to myself that there was really no need for her to do that. - She then
opened her mouth properly and on the right I found a big white patch; at another place I saw
extensive whitish grey scabs upon some remarkable curly structures which were evidently
modelled on the turbinal bones of the nose. - I at once called in Dr M, and he repeated the
examination and confirmed it … Dr M looked quite different from usual; he was very pale,
he walked with a limp and his chin was clean-shaven … My friend Otto was now standing
beside her as well, and my friend Leopold was percussing her through her bodice and saying:
‘She has a dull area low down on the left.’ He also indicated that a portion of the skin on
her left shoulder was infiltrated. (I noticed this, just as he did, in spite of her dress.) … M
said: ‘There’s no doubt it’s an infection, but no matter; dysentery will supervene and the
toxin will be eliminated. … We were directly aware, too, of the origin of the infection. Not
long before, when she was feeling unwell, my friend Otto had given her an injection of a
preparation of propyl, propyls … propionic acid … trimethylamin (and I saw before me the
formula for this printed in heavy type) … Injections of this sort ought not to be given so
thoughtlessly … And probably the syringe had not been clean.

In the lengthy discussion that follows this account, Freud provided detailed asso-
ciations for each part of the dream and concluded that the dream was an unconscious
wish to absolve himself of blame for the unsatisfactory outcome in his treatment of
a patient with nose bleeds.44
Jungian Dream Analysis
Swiss psychoanalyst Carl Jung was a disciple of Freud but in time developed his
own ideas about how dreams are formed and how they should be interpreted. Jung
believed that Freud’s idea that dreams represented unfulfilled wishes was too limited
an explanation and suggested that dreams reflected the fullness and complexity of
the entire unconscious mind, both personal and collective.45 Jung saw the psyche as a

43 Sigmund Freud (1900). The Interpretation of Dreams.

44 In March 1895, Freud had treated Emma Eckstein for “hysterical” nose bleeds but without a good

outcome. Freud had asked Wilhelm Fliess, an otolaryngologist and close friend, to examine her
to see if there was a somatic basis to her illness. Fliess, interested in psychanalytic methods, had
hypothesized that the nasal bones and the female sexual organs were somehow connected and that
her symptoms, possibly arising from masturbation, could be cured through nasal surgery. Fliess
removed a turbinate bone from her nose, but she later badly hemorrhaged from infection (antibiotics
would only come to medicine many decades later). Freud then consulted another surgeon, who
discovered and removed the surgical gauze that Fliess had accidently left behind. Eckstein was left
disfigured as a result of Fliess’s botched surgery.
45 From Wikipedia: The collective unconscious, a term coined by Carl Jung, refers to structures of

the unconscious mind which are shared among beings of the same species. According to Jung, the
8.15 Dreams and Religion 173

self-regulating entity in which conscious attitudes and outlooks were unconsciously

moderated by their opposites during the dream state.
Jung offered two approaches to interpreting dreams. In the objective approach to
dream interpretation, every individual in the dream refers to the person they actu-
ally are (e.g., your sister appearing in a dream is actually your sister) while in the
subjective approach, every individual in the dream instead represents an aspect of
the dreamer. Thus, if the dreamer is being chased by a demented man with an axe,
under the subjective approach the dreamer may eventually come to recognize his own
homicidal instincts, while in the objective approach the crazed man would represent
a particular real individual.
Critiques of Psychoanalytical Dream Analysis
As noted earlier, one school of thought concerning dreams holds that dreams are
neurological phenomena for which little can be said at the moment except that psy-
choanalytical techniques and religious interpretations are not meaningful because
they make statements about the world that are not falsifiable in the Popperian sense.
Another offered critique is that psychoanalytic dream interpretation is derived from
case studies, the results of which are difficult to generalize. Yet another criticism
is that elements (images, themes, thoughts, etc.) in dreams will not mean the same
thing to different people, which is another way of recognizing the generalizability
problem. Other concerns are that most dreams are forgotten by the time a person gets
out of bed and that dream characteristics are affected by alcohol and other drugs.
Perhaps, then, all that can be really said about dreams is that they are a neurological
enigma, or as Pagel (2012) states in a more detailed manner: “Whether studied from
behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysio-
logical perspectives, dreaming reveals itself to be a complex cognitive state affected
by a wide variety of medical, psychological, sleep and social variables.”

8.16 Genospiritual Engineering

As mentioned in Sect. 8.1, genospiritual engineering is the (proposed) use of

genetic engineering methods and related technologies to enhance human spiritual
and religious experiences, including the possibility of increasing ethical sensitivity
in humans. Charlton (2008) offers the following explanation:
If technologies are devised which can conveniently and safely engineer genes causal of
spiritual and religious behaviours, then people may become able to choose their degree
of religiosity or spiritual sensitivity. For instance, it may become possible to increase the
likelihood of direct religious experience - i.e. ‘revelation’: the subjective experience of com-
munication from the deity. Or, people may be able to engineer ‘animistic’ thinking, a mode

human collective unconscious is populated by instincts and by archetypes: universal symbols such
as the Great Mother, the Wise Old Man, the Shadow, the Tower, Water, the Tree of Life, and many
more. https://en.wikipedia.org/wiki/Collective_unconscious.
174 8 Transhumanism and Religion

of cognition in which the significant features of the world - such as large animals, trees,
distinctive landscape features - are regarded as sentient and intentional beings; so that the
individual experiences a personal relationship with the world. Another potentially popular
spiritual ability would probably be shamanism; in which states of altered consciousness
(e.g. trances, delirium or dreams) are induced and the shaman may undergo the experience
of transformations, ‘soul journeys’ and contact with a spirit realm. Ideally, shamanistic con-
sciousness could be modulated such that trances were self-induced only when wanted and
when it was safe and convenient; and then switched-off again completely when full alertness
and concentration are necessary.

Charlton suggests that spirituality enhancing technologies might be made avail-

able to individuals who lack “the kind of spiritual or religious experiences which
they wanted (or perhaps even needed) in order to lead the kind of life to which they
aspired.”
One approach to this possibility (and it is only a distant possibility at this point)
would be to look for “genospitituality polymorphisms” in the manner similar to
contemporary investigators studying polymorphisms in adrenergic and dopaminergic
genes.46

8.17 Transhumanism and Chritianity

Various branches of Christianity vary in their stance on Transhumanism. At one

extreme are the Christian Fundamentalists, most who take a strict literal interpretation
of the Holy Bible, which they hold to be historically accurate in all respects. 47 Most
Evangelical Christians also take a similar stance on the Holy Bible being the central

46 Additionally, insights into individual differences in spirituality might be obtained by other meth-

ods. For instance, in an investigation of young adults with respect to individual differences in political
view points Kanai et al. (2011) “found that greater liberalism was associated with increased gray
matter volume in the anterior cingulate cortex, whereas greater conservatism was associated with
increased volume of the right amygdala.” The authors suggest that this observation points to “a
possible link between brain structure and psychological mechanisms that mediate political atti-
tudes.” Similarly, Blum et al. (2012) noted that “political discussions on TV, radio, or other media
may be morphed by one’s reward gene polymorphisms and as such, may explain the prevalence of
generations of die-hard republicans and equally entrenched democratic legacies.” Blum et al. also
note that “voting, voting turnout and attachment to a particular political ideology is differentially
related to various reward genes (e.g., 5HTT, MOA, DRD2 and DRD4).”
47 Not withstanding the belief of fundamentalists that the Holy Bible cannot contain contradictions or

inaccuracies (being the direct word of God), the following biblical passages may cause others to hold
that many passages are not meant to be interpreted literally: [1] Thou shalt not kill—Exodus 20:13
versus Thus sayeth the Lord God of Israel, Put every man his sword by his side and slay every man
his brother…companion…neighbor—Exodus 32:27 [2] And in the fifth month, on the seventh day
of the month…Nebuzaradan…came…unto Jerusalem…—2 Kings 25:8 versus …in the fifth month,
in the tenth day of the month…came Nebuzaradan…into Jerusalem…—Jeremiah 52:12 [3] For by
grace are ye saved through faith…not of works—Ephesians 2:8,9 versus Ye see then how that by
works a man is justified, and not by faith only—James 2:24.
8.17 Transhumanism and Chritianity 175

authority on all matters, whether religious or secular.48 Based on this belief, many
fundamentalist and evangelical scholars of Christianity take what is essentially a
bioconservative posture on Transhumanism, primarily based on their study of the
Holy Bible, but also frequently reflecting an antiscience bias based on their steadfast
belief that the Holy Bible is must be taken as literal truth and cannot contain errors
or contradictions.
As an example documenting the tendency of some Christian factions to dismiss
scientific accounts, consider the comments of Sarah Kroop Brown, National Associa-
tion of Evangelicals Communications Director and Editor of Evangelicals magazine:
“Evangelicals are more than twice as likely as the general public (29% vs. 14%) to
say that science and religion are in conflict and that they are on the side of religion.
Distrust of scientists—their motives, expertise and influence—and the role of science
in society underlie much of the tension.”49
Another example of this anti-science tendency is exemplified in variations of
the fundamentalist slogan “The Holy Bible says it, I believe it, so that settles the
issue.”50 For instance, the fundamentalist organization Answers in Genesis (https://
answersingenesis.org) is an “apologetics ministry” that has been particularly active
in “providing answers to questions about the Bible—particularly the book of Gen-
esis—regarding key issues such as creation, evolution, science, and the age of the
earth” for those individuals seeking biblically-based alternatives to contemporary
scientific accounts. As an illustration, Answers in Genesis offers us the following
explanation regarding the age of the earth: “The earth is only a few thousand years
old. That’s a fact, plainly revealed in God’s Word. So we should expect to find plenty
of evidence for its youth. And that’s what we find in the earth’s geology, biology,
paleontology, and even astronomy.”51
Elsewhere this ministry comments on the infallibility of the Christian Bible: “Al-
most all theologians agree Scripture is in some measure God’s revelation to the
human race. But to allow that it contains error implies God has mishandled inspira-
tion and has allowed His people to be deceived for centuries until modern scholars
disentangled the confusion.”52
Perhaps the best example of the rejection of scientific accounts by Fundamentalist
Christians is the denial of Darwinian evolution, because it contradicts the literal
description of the origins of humankind provided in Genesis. They further argue that
data concerning the age of the earth and related matters obtained via radiometric
dating, the fossil record and other means has been misinterpreted, is fraudulent or is
not trustworthy for other reasons.53

48 For a discussion outlining the differences between Christian Fundamentalists and Evangelical

Christians, see https://www.whatchristianswanttoknow.com/what-is-the-difference-between-funda

mentalists-and-evangelicals/.
49 https://www.nae.net/evangelicals-anti-science/.
50 http://www.nytimes.com/2011/10/18/opinion/the-evangelical-rejection-of-reason.html.
51 https://answersingenesis.org/age-of-the-earth/.
52 https://answersingenesis.org/is-the-bible-true/.
53 https://answersingenesis.org/age-of-the-earth/dating-methods/.
176 8 Transhumanism and Religion

That being said, many other religious traditions are far more open in their response
to scientific discoveries and even the fundamentals of Transhumanism. Many Chris-
tian religions—Roman Catholicism is an example—accept evolution. In the 1950
encyclical Humani generis, Pope Pius XII indicated that there is no fundamental
conflict between Christianity and the theory of evolution, but emphasized that the
individual soul remained a direct divine creation and not the result of purely material
events.54
Consider also the Mormon faith. The Church of Jesus Christ of Latter-Day
Saints (LDS), also known as the Mormon Church, offers its believers the belief
that humans can progress to become “like God”. Their teaching on approaching
godliness is explained at their official website55 :
Through the Atonement of Jesus Christ, all people may “progress toward perfection and
ultimately realize their divine destiny.”

and
Lorenzo Snow, the Church’s fifth President, coined a well-known couplet: “As man now is,
God once was: As God now is, man may be.”

To many Mormons, such theological teachings make transhumanism attractive.

In fact, The Mormon Transhumanist Association is an organization that attempts
to attempt to amalgamate (blend, fuse, syncretize) Mormonism and transhumanism.
Information about the association may be obtained at http://transfigurism.org/ as well
as at http://www.kurzweilai.net/man-will-become-like-god-say-mormons-and-trans
humanists-in-salt-lake-city
Some other Christian groups also specifically embrace Transhumanist principles.
For example, the Christian Transhumanist Association offers the following descrip-
tion of its core principles56 :
Christian Transhumanism takes the Christian idea that we are to become like Christ, and the
Transhumanist idea that we should use science and technology in ethical ways to improve
the world, and sees a strong connection.
Christ exemplifies a life of service and love, and calls us to the work of healing the sick,
feeding the hungry, and bringing life to the dead. Christ embodies acts of creativity and
learning—the core of what we now call science and technology. Christ demonstrates that
human nature is not limited by what we see around us—but is anchored in the continually
unfolding image of God.
Thus, to become like Christ involves using science and technology in ethical ways to improve
the world.

Additionally, members of the Christian Transhumanist Association affirm the

following specific beliefs and values57 :

54 Farrell,John (August 27, 2010). “Catholics and the Evolving Cosmos”. The Wall Street Journal.
https://www.wsj.com/articles/SB10001424052748703846604575447493644515142.
55 https://www.lds.org/topics/becoming-like-god?lang=eng&old=true.
56 https://www.christiantranshumanism.org/faq.
57 https://www.christiantranshumanism.org/.
8.17 Transhumanism and Chritianity 177

1. We believe that God’s mission involves the transformation and renewal of

creation including humanity, and that we are called by Christ to participate in
that mission: working against illness, hunger, oppression, injustice, and death.
2. We seek growth and progress along every dimension of our humanity: spiri-
tual, physical, emotional, mental—and at all levels: individual, community, soci-
ety, world.
3. We recognize science and technology as tangible expressions of our God-
given impulse to explore and discover and as a natural outgrowth of being
created in the image of God.
4. We are guided by Jesus’ greatest commands to “Love the Lord your God with
all your heart, soul, mind, and strength…and love your neighbor as yourself.”
5. We believe that the intentional use of technology, coupled with following
Christ, will empower us to become more human across the scope of what it
means to be creatures in the image of God.

8.18 Conclusion

The foregoing discussion strongly suggests that there exist clear neurological cor-
relates to religious experience. While William James was perhaps the first to sys-
tematically address this issue, developments in neuropharmacology, brain imaging
and epilepsy studies have led to a more complete mechanistic understanding of the
nature of religious experience. Of course, still more needs to be done to improve
our understanding of the neurological/psychological basis for religious experiences,
especially with techniques such as f-MRI imaging. Regardless, it is reasonable to
expect that atheists and believers will interpret any obtained insights through different
philosophical lenses.
Chapter 9
Conclusions

A new scientific truth does not triumph by convincing its

opponents and making them see the light, but rather because its
opponents eventually die, and a new generation grows up that is
familiar with it.

Max Planck (http://en.wikiquote.org/wiki/Max_Planck)

Abstract This chapter wraps up the discussion started in the first chapter of the book,
on Questions such as “What does it mean to be human?”, “When is a nonhuman a
person?” and “When is a human not a person?”, and reminds the reader that these
questions have important moral implications for how we should treat higher animals,
how we should care for humans with severe physical or cognitive impairments, and
what forms of human enhancement are morally acceptable. The reader is reminded
that two main schools of thought dominate this discourse: the transhumanists, who
encourage human enhancement technologies and the bio-conservatives, who argue
against artificial human enhancement. It is concluded that at its core, transhuman-
ism is simply a vision of those who seek to ensure better lives for themselves and
their children using new and existing biotechnologies and that the bio-conservative
arguments against transhumanism are, for the most part, philosophically flawed.

9.1 Conclusions

The question “What does it mean to be human?” and the related questions “When is
a nonhuman a person?” and “When is a human not a person?” have been the subject
of philosophical deliberation for centuries. These questions have important moral
implications for contemporary issues such as how we should treat higher animals,
how we should care for humans with severe physical or cognitive impairments, and
what forms of human enhancement are morally acceptable.

© Springer Nature Switzerland AG 2018 179

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science 3,
https://doi.org/10.1007/978-3-319-94950-5_9
180 9 Conclusions

Although recent scientific advances in fields such as genetic engineering, nan-

otechnology and biomedical electronics have added interesting new dimensions to
these issues, the fact remains that the answers one obtains in response to such ques-
tions will depend substantially on the “lens” through which the discourse is examined.
Two main schools of thought dominate the discourse. The proponents of transhu-
manism would allow (indeed, even encourage) human enhancement technologies
that would be expected to improve the human condition. They favor the voluntary
deployment of safe and ethical enhancement technologies, regardless of whether or
not any pathology needing correction might be present.
Opposing this school of thought are the bio-conservatives, who argue against
artificial human enhancement on a variety of levels. These include safety concerns,
concerns about fairness (as only the rich would have access to human enhancement
technologies), concerns about these technologies contributing to the endangerment
of human dignity, concerns about “slippery slope” issues, as well as a general feeling
of repugnance for anything that is clearly not “natural.”
As emphasized earlier, one fundamental issue in this debate centers on whether
moral intuition should take precedence over reason and logic in making ethical deci-
sions. Consider the example presented earlier: should the lives of severely deformed
neonates ever be actively terminated? We saw that some moral philosophers such
as Peter Singer regard this as sometimes acceptable, arguing that this follows as a
consequence of utilitarian ethical principles. Other philosophers, we saw, argue that
the natural repugnance of such an act should serve as a clear moral guide against
such actions. However, as stressed earlier, any philosophical position emphasizing
the role of moral intuition over logic and rationalism has potential flaws. From the
time of the ancient Greeks philosophers have repeatedly emphasized the importance
of logic in philosophical discourse. In Chap. 2, I similarly argue that reason and
logic should take precedence over intuition in making ethical decisions. However,
since I also accept the fact that reason and logic alone are not sufficient to establish
a set of founding principles upon which to base ethical decision making, I can only
conclude that the thorny issue cannot be definitively resolved by mere recourse to
rational methods.
Chapter 3 introduced the transhumanist movement and related philosophical
issues such as moral standing and personhood. The possibilities of genetic engi-
neering as a means to fundamentally alter the nature of humankind were discussed,
along with the concepts of animal-human hybrids, computer-human hybrids, and
fully artificial beings. These ideas were presented to support the contention that
there is no unique and unalterable biological form that constitutes humanity, and that
our concept of what it means to be human will be forced to change in the face of new
biotechnologies such as genetic engineering and computer-based neuroprostheses.
9.1 Conclusions 181

Another interesting question addressed in the book is whether or not precise phar-
macological interventions might improve the human condition (see Chap. 4). As
advances in the neurosciences develop we can expect that humankind might eventu-
ally come to enjoy the possibility of safely enjoying a “mood optimized” synthetic
existence—an artificial paradise so to speak—made possible through advances in
neuropharmacology. After exploring this possibility in some detail, I suggest that
there is nevertheless the possibility that this might lead to an “inauthentic” existence
that detracts from life’s meaning (if life can be said to have a meaning), although I
concede that this is in the end as much an empirical question as it is a philosophical
one.
Chapter 5 addressed the surprisingly complex problem of establishing when a
human can be said to be alive or said to be dead. Problems in identifying the exact
point of death in both the traditional and neurological approaches to determining
death were discussed, with philosophical difficulties in both approaches being iden-
tified.
Chapter 6 explored the concept of cryonic suspension as a philosophical problem
in the context of establishing when a cryogenically suspended individual is still a live
person and introduced the concept of “cryonic reincarnation” should brain substrate
be restored without a person’s life memories.
Chapter 7 examined the philosophical arguments raised against transhumanism
and found them wanting on several grounds.
Chapter 8 examined transhumanism from the perspective of religious belief sys-
tems.
I would like to close with one final point. To those individuals who believe that the
notions of human enhancement discussed herein are too far-fetched to merit serious
discussion, let me provide them with a list of historical quotations that may help
convince them otherwise (Fig. 9.1). It is almost inevitable that human enhancement
technologies will eventually change humankind in very significant ways. Through
developments in genetic engineering, computer-based neurotechnology, pharmaco-
logical discoveries and other methods, future humans will have opportunities for
unprecedented life enhancements. At its core, transhumanism is simply a vision of
those who seek to ensure better lives for themselves and their children using new
and existing biotechnologies. I join them in that vision, but remain realistic about
the obstacles to progress.
182 9 Conclusions

Fig. 9.1 A sampling of historical quotations that suggest that famous inventors, scientists and
engineers are sometimes poor at predicting the future of technology
9.1 Conclusions 183

Fig. 9.1 (continued)

Appendix

A Short Transhumanist Bibliography

Transhumanist issues have been the subject of a considerable number of books; I

have listed many of these in the following short bibliography. While the list is not
exhaustive, it is highly representative of the transhumanist literature. The list is
presented in order of publication date and includes both works aimed at the
intelligent layman as well as works aimed at the professional academic philosopher.
Note that this list is not offered as a kind of hermeneutic key or guide to the field but
rather merely provided to acquaint the reader with some of the more readable
accounts. In each case in this list I have tried to summarize the key message of the
book in one or two sentences.
Gregory Stock. Redesigning Humans: Choosing our Genes, Changing our
Future. Mariner Books, 2003. Inthis book Stock wants society to give our future
children an edge, even if it involves profound changes of our biological makeup.
Francis Fukuyama. Our Posthuman Future: Consequences of the Biotechnology
Revolution. Picador, 2003. Inthis book the author identifies concerns that the
foundations of liberal democracy may become eroded by unbridled biotechnology
advances,and argues that humanbiotechnology must be regulated to prevent this and
other undesirable outcomes.
James Hughes. Citizen Cyborg: Why Democratic Societies Must Respond to the
Redesigned Human of the Future. Basic Books, 2004. In this bookJamesHughes
arguesthat while biomedical technologies likegenetic engineeringcan funda-
mentally improve our quality oflife, it is important that they be controlled
democratically.
Nicholas Agar. Liberal Eugenics: In Defence of Human Enhancement.
Wiley-Blackwell, 2004. Inthisbook the author makes the case for ethical eugenic
intervention through geneticenhancement of the humanorganism.

© Springer Nature Switzerland AG 2018 185

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science3,
https://doi.org/10.1007/978-3-319-94950-5
186 Appendix

Bill McKibben. Enough: Staying Human in an Engineered Age. St. Martin’s

Griffin, 2004. In this book McKibben argues that developments in genetic engi-
neering, robotics, and nanotechnology threaten what it means to be human, and
that for the sake of humanity we should critically consider the potential dehu-
manizing impact of such technologies before it is too late.
Ronald Bailey. Liberation Biology: The Scientific and Moral Case for the
Biotech Revolution. Prometheus, 2005. In this book the author takes a libertarian
position, attacking both bioconservative thinkers such as Francis Fukuyama and
Leon Kass, as well as critics of transhumanism from the political left.
Simon Young. Designer Evolution: A Transhumanist Manifesto. Prometheus
Books, 2005. In this book, Young argues for scientific rationality and a rejection of
superstition and nihilism as ameans to encourage humanprogress.
Ramez Naam. More Than Human: Embracing the Promise of Biological
Enhancement. Random House, 2005. Written from a libertarian perspective, Naam
reviews the state of the art ingenetic engineering, computer technology and other
fields to make the case that biological enhancementwill improve the humancondition.
Joel Garreau. Radical Evolution: The Promise and Peril of Enhancing Our
Minds, Our Bodies—and What It Means to Be Human. Broadway, 2006. Like
other books of this genre, the author seeks to present a balanced view. Along with a
discussion of how humanity might be improved, Garreau identifies concerns raised
by bioconservative thinkers such as FrancisFukuyama, Martin Rees, Bill McKibben,
LeonKassand MichaelSandelthat while advances in genetics,nanotechnologyand
robotics may help some segments of society, they also posegenuine threats to
humansurvival itself.
Ray Kurzweil. The Singularity is Near: When Humans Transcend Biology.
Penguin Books, 2006. Kurzweil argues that humanity is at the threshold of an era
(“the singularity”) in which our biology will be combined with genetics,nan-
otechnologyand robotics to create anew form of humanorganism with almost no
constraints on our mental, physical and moral capacity.
Michael J. Sandel. The Case Against Perfection: Ethics in theAge of Genetic
Engineering. Belknap Press, 2009. Inthis book the author argues that the pursuit of
perfection via technological enhancement is morally problematic for reasons that
go beyond arguments related to safety and social justice.Sandelcrafts an argument
that the pursuit of perfection by such means represents a bid for mastery and
control that ignores thegifted nature of humanpowers and achievements.
Nicholas Agar. Humanity’s End: Why We Should Reject Radical Enhancement.
Bradford, 2010. In this book Agar argues that the radical interventions envisioned
by some transhumanists could be far less positive than the rosy futures imagined by
Appendix 187

these thinkers, and that any transition to a posthuman future is fraught with moral
challenges, such as the possibility that posthumans might rule tyrannically over
ordinary humans.
Allen Buchanan. Better than Human: The Promise and Perils of Enhancing
Ourselves. Oxford University Press, 2011. This book attempts to present a bal-
anced view on the ethical dilemmas surrounding biomedical enhancement. In the
book, the author argues that the debate over enhancement has been contaminated
by false assumptions and disingenuous rhetoric, and that the existence of “design
flaws” in our biological blueprint should be acknowledged. Consequently,
humanity should be open to attempts to improve thedesign of the humanorganism
(and with it,of course, humannature), while still recognizing that such attempts may
on occasion fail calamitously.
Gregory R. Hansell (Ed.). Transhumanism and Its Critics. Metanexus, 2011.
This volume is a collection of 16 essays presenting the cases for and against
improving humanity via bioengineering methods.
Julian Savulescu and Nick Bostrom (Eds.). Human Enhancement. Oxford
University Press, 2011. This anthology provides a comprehensive look atthe
question of humanenhancement by artificial means, with commentaries by
authorities from both transhumanist and bioconservative (‘anti-meliorist’) camps.
Julian Savulescu and Ingmar Persson. Unfit for the Future: The Need for
Moral Enhancement. Oxford University Press, 2012. The authors argue that our
moral shortcomings “are preventing our political institutions from acting effec-
tively” and that artificial moral enhancement has become essential if humanity is to
avoid catastrophe. Moral enhancement, the authors posit, “would enable us to act
better for distant people, future generations, and non-human animals”.
Calvin Mercer and Tracy J. Trothen (Editors). Religion and Transhumanism:
The Unknown Future of Human Enhancement. Praeger, 2014. A collection of
scholarly essays discussing the issue of whetherreligionandtranshumanismare at
odds with each other.
Daniel Berleant. The Human Race to the Future: What Could Happen—and
What to Do. Lifeboat Foundation, 2014. The author offers us visions of possible
futures ranging from the near-present to many millions of years from now.
David Livingstone. Transhumanism: The History of a Dangerous Idea.
CreateSpace Independent Publishing Platform, 2015. Argues that “transhumanism
is an occult project, rooted in Rosicrucianism and Freemasonry, and derived from
the Kabbalah, which asserts that humanity is evolving intellectually, towards a
point in time when man will become God.”
Juan Enriquez. Evolving Ourselves: Redesigning the Future of Humanity—One
Gene at a Time Revised Edition. Current, 2016. Explains how developments in
genetic engineering such as CRISPR will allow humanity to shape its evolution.
188 Appendix

James Kozubek. Modern Prometheus: Editing the Human Genome with

Crispr-Cas9. Cambridge University Press, 2016. Another book on how CRISPR
will allow humanity to shape its evolution.
Andrew Pilsch. Transhumanism: Evolutionary Futurism and the Human
Technologies of Utopia. Univ of Minnesota Press, 2017. Presents a generally
positive view of the future possibilities offered by the Transhumanist movement.
References

Adam, Yehuda G. 2007. Justice in Nuremberg: The Doctors’ Trial—60 Years Later. A Reminder.
The Israel Medical Association Journal 9 (3): 194–195.
Adamenko, N.P. 1969. Technic of Experimental Resuscitation of Dogs with a Variant of the
Method of Extracorporeal Circulation Using S. S. Briukhonenko’s Autojector Pump and a Live
Parabiotic Donor. Patologicheskaia Fiziologiia I Eksperimental’naia Terapiia 13 (3): 69–71.
Adelman, Barry Eshkol. 2007. An Underdiscussed Aspect of Chomsky (1959). The Analysis of
Verbal Behavior 23: 29–34. https://doi.org/10.1007/BF03393044.
Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.
1968. A Definition of Irreversible Coma. Report of the Ad Hoc Committee of the Harvard
Medical School to Examine the Definition of Brain Death. The Journal of the American
Medical Association 205 (6): 337–340.
Agar, N. 2004. Liberal Eugenics. In Defence of Human Enhancement. Hoboken, NJ: Blackwell.
Aichner, F., C. Adelwöhrer, and H.P. Haring. 2002. Rehabilitation Approaches to Stroke. Journal
of Neural Transmission. Supplementum (63): 59–73.
Alexander, J.B. 2001. An Overview of the Future of Non-lethal Weapons. Medicine, Conflict, and
Survival 17 (3): 180–193. https://doi.org/10.1080/13623690108409578.
Allmark, Peter. 2006. An Argument for the Use of Aristotelian Method in Bioethics. Medicine,
Health Care, and Philosophy 9 (1): 69–79. https://doi.org/10.1007/s11019-005-7225-x.
Angell, M. 1990. The Nazi Hypothermia Experiments and Unethical Research Today. The New
England Journal of Medicine 322 (20): 1462–1464. https://doi.org/10.1056/
NEJM199005173222011.
Archer, J. 1991. The Influence of Testosterone on Human Aggression. British Journal of
Psychology 82 (Pt 1) (February): 1–28.
Archer, John. 2006. Testosterone and Human Aggression: An Evaluation of the Challenge
Hypothesis. Neuroscience and Biobehavioral Reviews 30 (3): 319–345. https://doi.org/10.
1016/j.neubiorev.2004.12.007.
Arries, E. 2005. Virtue Ethics: An Approach to Moral Dilemmas in Nursing. Curationis 28 (3):
64–72.
Arya, Neil. 2007. Is Military Action Ever Justified? A Physician Defends the ‘Responsibility to
Protect’. Medicine, Conflict, and Survival 23 (3): 172–188. https://doi.org/10.1080/
13623690701417311.
Asimov, I. 1991. I Robot. New York: Spectra.
Atkins, Kim. 2005. Self and Subjectivity. Malden, MA: Blackwell Publishing.
Atran, Scott, and Jeremy Ginges. 2012. Religious and Sacred Imperatives in Human Conflict.
Science 336 (6083): 855–857. https://doi.org/10.1126/science.1216902.

© Springer Nature Switzerland AG 2018 189

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science3,
https://doi.org/10.1007/978-3-319-94950-5
190 References

Baier, K. 1958. The Moral Point of View. NY: Cornell University Press.
Baldry, C., S.B. Backman, P. Metrakos, J. Tchervenkov, J. Barkun, and A. Moore. 2000. Liver
Transplantation in a Jehovah’s Witness with Ankylosing Spondylitis. Canadian Journal of
Anaesthesia 47 (7): 642–646.
Baron, Leonard, Sam D. Shemie, Jeannie Teitelbaum, and Christopher James Doig. 2006. Brief
Review: History, Concept and Controversies in the Neurological Determination of Death.
Canadian Journal of Anaesthesia 53 (6): 602–608. https://doi.org/10.1007/BF03021852.
Barondess, J.A. 1996. Medicine Against Society. Lessons from the Third Reich. The Journal of
the American Medical Association 276 (20): 1657–1661.
Bartels, A., and S. Zeki. 2000. The Neural Basis of Romantic Love. Neuroreport 11 (17): 3829–
3834. https://doi.org/10.1097/00001756-200011270-00046.
Bartels, Andreas, and Semir Zeki. 2004. The Neural Correlates of Maternal and Romantic Love.
Neuroimage 21 (3): 1155–1166. https://doi.org/10.1016/j.neuroimage.2003.11.003.
Baschetti, Riccardo. 2005. Evolutionary, Biological Origins of Morality: Implications for Research
with Human Embryonic Stem Cells. Stem Cells and Development 14 (3): 239–247. https://doi.
org/10.1089/scd.2005.14.239.
Baumard, Nicolas, and Pascal Boyer. 2013. Explaining Moral Religions. Trends in Cognitive
Sciences 17 (6): 272–280. https://doi.org/10.1016/j.tics.2013.04.003.
Beauchamp, Tom. 2004. The Legacy and the Future. 30 Years after the Belmont Report,
Beauchamp Sets the Record Straight. Protecting Human Subjects (10): 1–3.
Beauchamp, Tom L. 1995. Principlism and Its Alleged Competitors. Kennedy Institute of Ethics
Journal 5 (3): 181–198.
Beauchamp, Tom L. 1999. The Failure of Theories of Personhood. Kennedy Institute of Ethics
Journal 9 (4): 309–324.
Beauchamp, Tom L., and James F. Childress. 2013. Principles of Biomedical Ethics, 7th ed. New
York: Oxford University Press.
Beauregard, Mario, and Vincent Paquette. 2008. EEG Activity in Carmelite Nuns During a
Mystical Experience. Neuroscience Letters 444 (1): 1–4. https://doi.org/10.1016/j.neulet.2008.
08.028.
Becker, Gary J. 2005. Human Subjects Investigation: Timeless Lessons of Nuremberg and
Tuskegee. Journal of the American College of Radiology 2 (3): 215–217. https://doi.org/10.
1016/j.jacr.2004.11.018.
Begley, Ann M. 2008. Truth-telling, Honesty and Compassion: A Virtue-based Exploration of a
Dilemma in Practice. International Journal of Nursing Practice 14 (5): 336–341. https://doi.
org/10.1111/j.1440-172X.2008.00706.x.
Begley, Ann Marie. 2005. Practising Virtue: A Challenge to the View that a Virtue Centred
Approach to Ethics Lacks Practical Content. Nursing Ethics 12 (6): 622–637. https://doi.org/
10.1191/0969733005ne832oa.
Beit-Hallahmi, B., and M. Argyle. 1977. Religious Ideas and Psychiatric Disorders. The
International Journal of Social Psychiatry 23 (1): 26–30. https://doi.org/10.1177/
002076407702300105.
Bencherif, Merouane, and Patrick M. Lippiello. 2010. Alpha7 Neuronal Nicotinic Receptors: The
Missing Link to Understanding Alzheimer’s Etiopathology? Medical Hypotheses 74 (2): 281–
285. https://doi.org/10.1016/j.mehy.2009.09.011.
Benson, D.F. 1991. The Geschwind Syndrome. Advances in Neurology 55: 411–421.
Benson, K.T. 1989. The Jehovah’s Witness Patient: Considerations for the Anesthesiologist.
Anesthesia and Analgesia 69 (5): 647–656.
Berg, Paul. 2008. Meetings That Changed the World: Asilomar 1975: DNA Modification Secured.
Nature 455 (7211): 290–291. https://doi.org/10.1038/455290a.
Berger, R.L. 1990. Nazi Science—The Dachau Hypothermia Experiments. The New England
Journal of Medicine 322 (20): 1435–1440. https://doi.org/10.1056/NEJM199005173222006.
Bernat, James L. 2005. Medical Futility: Definition, Determination, and Disputes in Critical Care.
Neurocritical Care 2 (2): 198–205. https://doi.org/10.1385/NCC:2:2:198.
References 191

Bernat, J.L., A.M. D’Alessandro, F.K. Port, T.P. Bleck, S.O. Heard, J. Medina, S.H. Rosenbaum,
et al. 2006. Report of a National Conference on Donation after Cardiac Death. American
Journal of Transplantation 6 (2): 281–291. https://doi.org/10.1111/j.1600-6143.2005.01194.x.
Bernstein, Mark, and Barry Brown. 2004. Doctors’ Duty to Disclose Error: a Deontological or
Kantian Ethical Analysis. The Canadian Journal of Neurological Sciences. Le Journal
Canadien Des Sciences Neurologiques 31 (2): 169–174.
Best, Benjamin P. 2009. Nuclear DNA Damage as a Direct Cause of Aging. Rejuvenation
Research 12 (3): 199–208. https://doi.org/10.1089/rej.2009.0847.
Bewernick, Bettina H., René Hurlemann, Andreas Matusch, Sarah Kayser, Christiane Grubert,
Barbara Hadrysiewicz, Nikolai Axmacher, et al. 2010. Nucleus Accumbens Deep Brain
Stimulation Decreases Ratings of Depression and Anxiety in Treatment-resistant Depression.
Biological Psychiatry 67 (2): 110–116. https://doi.org/10.1016/j.biopsych.2009.09.013.
Bhavsar, Vishal, and Dinesh Bhugra. 2008. Religious Delusions: Finding Meanings in Psychosis.
Psychopathology 41 (3): 165–172. https://doi.org/10.1159/000115954.
Black, E. 2003. War Against the Weak. Eugenics and America’s Campaign to Create a Master
Race. NY: Four Walls Eight Windows.
Blackburn, Elizabeth, and Janet Rowley. 2004. Reason as Our Guide. PLoS Biology 2 (4): E116.
https://doi.org/10.1371/journal.pbio.0020116.
Bliss, T.V., and G.L. Collingridge. 1993. A Synaptic Model of Memory: Long-term Potentiation
in the Hippocampus. Nature 361 (6407): 31–39. https://doi.org/10.1038/361031a0.
Bloom, Paul. 2012. Religion, Morality, Evolution. Annual Review of Psychology 63: 179–199.
https://doi.org/10.1146/annurev-psych-120710-100334.
Blum, Kenneth, Marlene Oscar-Berman, Abdalla Bowirrat, John Giordano, Margaret Madigan,
Eric R. Braverman, Debmayla Barh, Mary Hauser, Joan Borsten, and Thomas Simpatico. 2012.
Neuropsychiatric Genetics of Happiness, Friendships, and Politics: Hypothesizing Homophily
(‘Birds of a Feather Flock Together’) as a Function of Reward Gene Polymorphisms. Journal
of Genetic Syndromes & Gene Therapy 3 (112). https://doi.org/10.4172/2157-7412.1000112.
Blumenthal, Ralph, and Judith Miller. 1999. Japanese Germ-war Atrocities: A Half-century of
Stonewalling the World. The New York Times, March, A12.
Bolsin, Stephen. 2002. Mortality and Volume of Cases in Paediatric Cardiac Surgery. Paper
Confirms Poor Quality of Paediatric Heart Surgery at Bristol During 1991–5. BMJ (Clinical
Research Ed.) 324 (7345): 1095–1096.
Bolt, L.L.E. 2007. True to Oneself? Broad and Narrow Ideas on Authenticity in the Enhancement
Debate. Theoretical Medicine and Bioethics 28 (4): 285–300. https://doi.org/10.1007/s11017-
007-9039-8.
Borgens, R.B., and R. Shi. 2000. Immediate Recovery from Spinal Cord Injury through Molecular
Repair of Nerve Membranes with Polyethylene Glycol. The FASEB Journal 14 (1): 27–35.
Bostrom, N. 2002. Analyzing Human Extinction Scenarios and Related Hazards. Journal of
Evolution and Technology 9 (1): 1–37.
Bostrom, Nick. 2003. Human Genetic Enhancements: A Transhumanist Perspective. The Journal
of Value Inquiry 37 (4): 493–506.
Bostrom, Nick. 2005. In Defense of Posthuman Dignity. Bioethics 19 (3): 202–214.
Bowlby, J. 1969. Attachment and Loss Vol. 1. 2 vols. Attachment. London: Basic Book.
Bowlby, J. 1976. Attachment and Loss Vol. II. Separation: Anxiety and Anger.
Bowlby, J. 1988. A Secure Base: Clinical Applications of Attachment Theory. London:
Psychology Press.
Boyer, Pascal. 2003. Religious Thought and Behaviour as By-products of Brain Function. Trends
in Cognitive Sciences 7 (3): 119–124. https://doi.org/10.1016/S1364-6613(03)00031-7.
Brassington, Iain. 2007. John Harris’ Argument for a Duty to Research. Bioethics 21 (3): 160–168.
https://doi.org/10.1111/j.1467-8519.2007.00539.x.
Bretherton, Inge. 1992. The Origins of Attachment Theory: John Bowlby and Mary Ainsworth.
Developmental Psychology 28 (5): 759–775. https://doi.org/10.1037/0012-1649.28.5.759.
192 References

Bridger, S., K. Henderson, E. Glucksman, A.J. Ellis, J.A. Henry, and R. Williams. 1998. Deaths
from Low Dose Paracetamol Poisoning. BMJ (Clinical Research Ed.) 316 (7146): 1724–1725.
Brodtkorb, Eylert, and Karl Otto Nakken. 2015. The Relationship Between Epilepsy and
Religiosity Illustrated by the Story of the Visionary Mystic Wise-Knut. Epilepsy & Behavior
46 (May): 99–102. https://doi.org/10.1016/j.yebeh.2015.04.017.
Brody, Howard, and Arlene Macdonald. 2013. Religion and Bioethics: Toward an Expanded
Understanding. Theoretical Medicine and Bioethics 34 (2): 133–145. https://doi.org/10.1007/
s11017-013-9244-6.
Brorson, J.R., and K. Brewer. 1988. St. Paul and Temporal Lobe Epilepsy. Journal of Neurology,
Neurosurgery, and Psychiatry 51 (6): 886–887.
Brukhonenko, S, and S. Tchetchuline. 1929a. Expériences Avec La Têteisolée Du Chien.
I. Technique et Conditions Des Experiénces. Journal de physiologie et de pathologie générale
29 (1): 31–45.
Brukhonenko, S, and S. Tchetchuline. 1929b. Expériences Avec La Têteisolée Du Chien. II.
Résultats Des Experiénces. Journal de physiologie et de pathologie générale 29 (1): 64–79.
Buckley, P. 1981. Mystical Experience and Schizophrenia. Schizophrenia Bulletin 7 (3): 516–521.
Bulkeley, Kelly. 2016. Big Dreams: The Science of Dreaming and the Origins of Religion.
Oxford, UK: Oxford University Press.
Burns, Jeffrey P., and Robert D. Truog. 2007. Futility: A Concept in Evolution. Chest 132 (6):
1987–1993. https://doi.org/10.1378/chest.07-1441.
Burrows, Richard, R. David Crippen, Phillip Dellinger, David F. Kelly, Stephen Streat, and
Leslie M. Whetstine. 2002. Ethics Roundtable: Using New, Expensive Drugs. Critical Care 6
(6): 473–478.
Burt, Robert A. 2002. The Medical Futility Debate: Patient Choice, Physician Obligation, and
End-of-life Care. Journal of Palliative Medicine 5 (2): 249–254. https://doi.org/10.1089/
109662102753641223.
Buxton, Jane A., and Naomi A. Dove. 2008. The Burden and Management of Crystal Meth Use.
Canadian Medical Association Journal 178 (12): 1537–1539. https://doi.org/10.1503/cmaj.
071234.
Cakic, V. 2009. Smart Drugs for Cognitive Enhancement: Ethical and Pragmatic Considerations in
the Era of Cosmetic Neurology. Journal of Medical Ethics 35 (10): 611–615. https://doi.org/
10.1136/jme.2009.030882.
Caldwell, John A., J. Lynn Caldwell, and Kecia K. Darlington. 2003. Utility of
Dextroamphetamine for Attenuating the Impact of Sleep Deprivation in Pilots. Aviation,
Space, and Environmental Medicine 74 (11): 1125–1134.
California. Court of Appeal, Second District, Division 6. 1992. Donaldson V. van de
Kamp. West’s California Reporter 4 (January): 59–65.
Canavero, Sergio. 2015. The ‘Gemini’ Spinal Cord Fusion Protocol: Reloaded. Surgical
Neurology International 6 (February): 18. https://doi.org/10.4103/2152-7806.150674.
Canavero, Sergio, and Xiaoping Ren. 2016. Houston, GEMINI Has Landed: Spinal Cord Fusion
Achieved. Surgical Neurology International 7 (Suppl 24): S626–S628. https://doi.org/10.4103/
2152-7806.190473.
Capps, D. 2001. Freud and Freudians on Religion: A Reader. New Haven: Yale University Press.
Carhart-Harris, Robin L., Suresh Muthukumaraswamy, Leor Roseman, Mendel Kaelen, Wouter
Droog, Kevin Murphy, Enzo Tagliazucchi, et al. 2016. Neural Correlates of the LSD
Experience Revealed by Multimodal Neuroimaging. Proceedings of the National Academy of
Sciences of the United States of America 113 (17): 4853–4858. https://doi.org/10.1073/pnas.
1518377113.
Carnevale, Franco A. 2009. A Conceptual and Moral Analysis of Suffering. Nursing Ethics 16 (2):
173–183. https://doi.org/10.1177/0969733008100076.
Carter, C.S., and M. Altemus. 1997. Integrative Functions of Lactational Hormones in Social
Behavior and Stress Management. Annals of the New York Academy of Sciences 807 (January):
164–174.
References 193

Cassell, E.J. 2000. The Principles of the Belmont Report Revisited. How Have Respect for
Persons, Beneficence, and Justice Been Applied to Clinical Medicine? The Hastings Center
Report 30 (4): 12–21.
Cavalieri, P., and P. Singer. 1994. The Great Ape Project: Equality Beyond Humanity. New York:
St. Martin’s Griffin.
Chalmers, Don, and Robert Schwartz. 1993. Rogers V. Whitaker and Informed Consent in
Australia: A Fair Dinkum Duty of Disclosure. Medical Law Review 1 (2): 139–159.
Chan, Sarah, and John Harris. 2010. Consequentialism Without Consequences: Ethics and Embryo
Research. Cambridge Quarterly of Healthcare Ethics : CQ : The International Journal of
Healthcare Ethics Committees 19 (1): 61–74. https://doi.org/10.1017/S0963180109990259.
Chan, Sarah, and John Harris. 2011. Moral Enhancement and Pro-social Behaviour. Journal of
Medical Ethics 37 (3): 130–131. https://doi.org/10.1136/jme.2010.041434.
Charlton, Bruce G. 2008. Genospirituality: Genetic Engineering for Spiritual and Religious
Enhancement. Medical Hypotheses 71 (6): 825–828. https://doi.org/10.1016/j.mehy.2008.06.
006.
Chatterjee, Anjan. 2004. Cosmetic Neurology: The Controversy over Enhancing Movement,
Mentation, and Mood. Neurology 63 (6): 968–974.
Chen, Y.F. 1997. Japanese Death Factories and the American Cover-up. Cambridge Quarterly of
Healthcare Ethics : CQ : The International Journal of Healthcare Ethics Committees 6 (2):
240–242.
Chi, Richard P., Felipe Fregni, and Allan W. Snyder. 2010. Visual Memory Improved by
Non-invasive Brain Stimulation. Brain Research 1353 (September): 168–175. https://doi.org/
10.1016/j.brainres.2010.07.062.
Cho, M.K., D. Magnus, A.L. Caplan, and D. McGee. 1999. Policy Forum: Genetics. Ethical
Considerations in Synthesizing a Minimal Genome. Science 286 (5447): 2087.
Clark, R.A. 1981. Self-mutilation Accompanying Religious Delusions: A Case Report and
Review. The Journal of Clinical Psychiatry 42 (6): 243–245.
Cleland, Carol E., and Christopher F. Chyba. 2002. Defining ‘Life’. Origins of Life and Evolution
of the Biosphere 32 (4): 387–393.
Clemens, Kelly J., Jennifer L. Cornish, Kong M. Li, Glenn E. Hunt, and Iain S. McGregor. 2005.
MDMA (’Ecstasy') and Methamphetamine Combined: Order of Administration Influences
Hyperthermic and Long-term Adverse Effects in Female Rats. Neuropharmacology 49 (2):
195–207. https://doi.org/10.1016/j.neuropharm.2005.03.002.
Clemens, Kelly J., Petra S. Van Nieuwenhuyzen, Kong M. Li, Jennifer L. Cornish, Glenn E. Hunt,
and Iain S. McGregor. 2004. MDMA (‘ecstasy’), Methamphetamine and Their Combination:
Long-term Changes in Social Interaction and Neurochemistry in the Rat. Psychopharmacology
173 (3–4): 318–325. https://doi.org/10.1007/s00213-004-1786-x.
Clouser, K.D., and B. Gert. 1990. A Critique of Principlism. The Journal of Medicine and
Philosophy 15 (2): 219–236.
Clouser, K. Danner. 1995. Common Morality as an Alternative to Principlism. Kennedy Institute
of Ethics Journal 5 (3): 219–236.
Conner, James M., Kevin M. Franks, Andrea K. Titterness, Kyle Russell, David A. Merrill,
Brian R. Christie, Terrence J. Sejnowski, and Mark H. Tuszynski. 2009. NGF Is Essential for
Hippocampal Plasticity and Learning. The Journal of Neuroscience 29 (35): 10883–10889.
https://doi.org/10.1523/JNEUROSCI.2594-09.2009.
Corlett, J.A. 2001. Is There a Moral Duty to Die? Health Care Analysis: HCA: Journal of Health
Philosophy and Policy 9 (1): 41–63. https://doi.org/10.1023/A:1011355028021.
Costanzo, Jon P., and Richard E. Lee. 2005. Cryoprotection by Urea in a Terrestrially Hibernating
Frog. The Journal of Experimental Biology 208 (Pt 21): 4079–4089. https://doi.org/10.1242/
jeb.01859.
Costanzo, Jon P., and Richard E. Lee. 2008. Urea Loading Enhances Freezing Survival and
Postfreeze Recovery in a Terrestrially Hibernating Frog. The Journal of Experimental Biology
211 (Pt 18): 2969–2975. https://doi.org/10.1242/jeb.019695.
194 References

Côté, A. 2000. Telling the Truth? Disclosure, Therapeutic Privilege and Intersexuality in Children.
Health Law Journal 8: 199–216.
Cox, Ashley, and Robert Zhong. 2005. Current Advances in Xenotransplantation. Hepatobiliary &
Pancreatic Diseases International 4 (4): 490–494.
D’Aquili, Eugene, and Andrew Newberg. 1999. The Mystical Mind: Probing the Biology of
Religious Experience. Minneapolis, MN: Fortress Press.
Das, Saibal, Preeti Barnwal, Anand Ramasamy, Sumalya Sen, and Somnath Mondal. 2016.
Lysergic Acid Diethylamide: A Drug of ‘Use’? Therapeutic Advances in Psychopharmacology
6 (3): 214–228. https://doi.org/10.1177/2045125316640440.
Davey, L.M. 2001. The Oath of Hippocrates: An Historical Review. Neurosurgery 49 (3): 554–
566.
De Boer, Sietse F., Doretta Caramaschi, Deepa Natarajan, and Jaap M. Koolhaas. 2009. The
Vicious Cycle Towards Violence: Focus on the Negative Feedback Mechanisms of Brain
Serotonin Neurotransmission. Frontiers in Behavioral Neuroscience 3 (November): 52. https://
doi.org/10.3389/neuro.08.052.2009.
De Grey, A.D. 1997. A Proposed Refinement of the Mitochondrial Free Radical Theory of Aging.
Bioessays: News and Reviews in Molecular, Cellular and Developmental Biology 19 (2): 161–
166. https://doi.org/10.1002/bies.950190211.
Debiec, Jacek. 2007. From Affiliative Behaviors to Romantic Feelings: A Role of Nanopeptides.
FEBS Letters 581 (14): 2580–2586. https://doi.org/10.1016/j.febslet.2007.03.095.
Deckel, A.W. 1996. Behavioral Changes in Anolis Carolinensis Following Injection with
Fluoxetine. Behavioural Brain Research 78 (2): 175–182.
Dees, Richard H. 2004. Slippery Slopes, Wonder Drugs, and Cosmetic Neurology: The
Neuroethics of Enhancement. Neurology 63 (6): 951–952.
DeGrazia, David. 2005. Enhancement Technologies and Human Identity. The Journal of Medicine
and Philosophy 30 (3): 261–283. https://doi.org/10.1080/03605310590960166.
De las Casas, Bartolomé. 1992. The Devastation of the Indies: A Brief Account. Baltimore: Johns
Hopkins University Press.
Delgado, J.M.R. 1969. Physical Control of the Mind: Toward a Psychocivilized Society. NY:
Harper & Row.
DeMarco, D. 2003. Peter Singer: Architect of the Culture of Death. Social Justice Review 94: 154–
157.
Derr, J.S., and M.A. Persinger. 1989. Geophysical Variables and Behavior: LIV. Zeitoun (Egypt)
Apparitions of the Virgin Mary as Tectonic Strain-induced Luminosities. Perceptual and
Motor Skills 68 (1): 123–128. https://doi.org/10.2466/pms.1989.68.1.123.
Devinsky, Orrin, and George Lai. 2008. Spirituality and Religion in Epilepsy. Epilepsy &
Behavior 12 (4): 636–643. https://doi.org/10.1016/j.yebeh.2007.11.011.
Diamant, J.C. 2002. The Revised Declaration of Helsinki—Is Justice Served? International
Journal of Clinical Pharmacology and Therapeutics 40 (2): 76–83.
Dickman, Steven. 1988. US Role Alleged in Cover-up of Researchers Guilty of War Crimes.
Nature 335 (6190): 481. https://doi.org/10.1038/335481a0.
Dodman, N.H., R. Donnelly, L. Shuster, P. Mertens, W. Rand, and K. Miczek. 1996. Use of
Fluoxetine to Treat Dominance Aggression in Dogs. Journal of the American Veterinary
Medical Association 209 (9): 1585–1587.
Doebeli, Michael, and Iaroslav Ispolatov. 2010. A Model for the Evolutionary Diversification of
Religions. Journal of Theoretical Biology 267 (4): 676–684. https://doi.org/10.1016/j.jtbi.
2010.09.013.
Doig, Christopher James, and Graeme Rocker. 2003. Retrieving Organs from Non-heart-beating
Organ Donors: A Review of Medical and Ethical Issues. Canadian Journal of Anaesthesia 50
(10): 1069–1076. https://doi.org/10.1007/BF03018376.
Donaldson, Zoe R., and Larry J. Young. 2008. Oxytocin, Vasopressin, and the Neurogenetics of
Sociality. Science 322 (5903): 900–904. https://doi.org/10.1126/science.1158668.
References 195

Doyle, D. 2007. Ergonomics, Patient Safety, and Engineering Ethics: A Case Study and
Cautionary Tale. Journal of Long-term Effects of Medical Implants 17 (1): 27–33.
Doyle, D.J., and A. Robichaud. 2004. Inconsistencies in the Ethical Declaration of Death.
Canadian Journal of Anaesthesia 51 (3): 280.
Drexler, E. 1986. The Engines of Creation. The Coming Age of Nanotechnology. NY: Doubleday.
Dreyfus, H. 1979. What Computers Can’t Do. Cambridge, MA: MIT Press.
Dreyfus, H. 1986. Mind over Machine: The Power of Human Intuition and Expertise in the Era of
the Computer. Oxford, UK: Blackwell.
Dreyfus, H. 1992. What Computers Still Can’t Do. Cambridge, MA: MIT Press.
Drucker, E. 1999. Drug Prohibition and Public Health: 25 Years of Evidence. Public Health
Reports (Washington, D.C. : 1974) 114 (1): 14–29.
Dudai, Yadin. 2004. The Neurobiology of Consolidations, or, How Stable Is the Engram? Annual
Review of Psychology 55: 51–86. https://doi.org/10.1146/annurev.psych.55.090902.142050.
Egonsson, Dan. 2009. Death and Irreversibility. Reviews in the Neurosciences 20 (3–4): 275–281.
Elder, L. 2000. Why Some Jehovah’s Witnesses Accept Blood and Conscientiously Reject Official
Watchtower Society Blood Policy. Journal of Medical Ethics 26 (5): 375–380.
Elliott, C. 1998. The Tyranny of Happiness: Ethics and Cosmetic Psychopharmacology. In
Enhancing Human Traits: Ethical and Social Implications, ed. E. Parens, 177–188.
Washington, D.C.: Georgetown University Press.
Elliott, C. 1998. The Tyranny of Happiness: Ethics and Cosmetic Psychopharmacology. In
Enhancing Human Traits: Ethical and Social Implications, ed. E. Parens, 177–188.
Washington, DC: Georgetown University Press.
Elliott, C. 2003. Better Than Well. American Medicine Meets the American Dream. NY: W.W.
Norton & Company.
Elliott, Richard. 2004. Bangkok 2004. Drug Control, Human Rights, and Harm Reduction in the
Age of AIDS. HIV/AIDS Policy & Law Review 9 (3): 86–90.
Ellis, Mark R. 2002. Challenges Posed by a Scientific Approach to Spiritual Issues. The Journal of
Family Practice 51 (3): 259–260.
Elwyn, Todd S., Michael D. Fetters, Hiroki Sasaki, and Tsukasa Tsuda. 2002. Responsibility and
Cancer Disclosure in Japan. Social Science & Medicine 54 (2): 281–293.
Epstein, Miran. 2007. The Ethics of Poverty and the Poverty of Ethics: The Case of Palestinian
Prisoners in Israel Seeking to Sell Their Kidneys in Order to Feed Their Children. Journal of
Medical Ethics 33 (8): 473–474. https://doi.org/10.1136/jme.2006.017855.
Erin, Charles A., and John Harris. 2003. An Ethical Market in Human Organs. Journal of Medical
Ethics 29 (3): 137–138.
Erler, Alexandre. 2011. Does Memory Modification Threaten Our Authenticity? Neuroethics 4 (3):
235–249. https://doi.org/10.1007/s12152-010-9090-4.
Etchells, E., G. Sharpe, M.M. Burgess, and P.A. Singer. 1996. Bioethics for Clinicians: 2.
Disclosure. Canadian Medical Association Journal 155 (4): 387–391.
Ettinger, R. 2005. The Prospect of Immortality. Palo Alto, CA: Ria University Press.
Ettinger, R. 2005. Man into Superman: The Startling Potential of Human Evolution – And How to
Be Part of It. Palo Alto, CA: Ria University Press.
Evans, Martin. 2005. Ethical Sourcing of Human Embryonic Stem Cells—Rational Solutions?
Nature Reviews. Molecular Cell Biology 6 (8): 663–667. https://doi.org/10.1038/nrm1698.
Fahy, Gregory M., and Brian Wowk. 2015. Principles of Cryopreservation by Vitrification.
Methods in Molecular Biology 1257: 21–82. https://doi.org/10.1007/978-1-4939-2193-5_2.
Fahy, Gregory M., Brian Wowk, Roberto Pagotan, Alice Chang, John Phan, Bruce Thomson, and
Laura Phan. 2009. Physical and Biological Aspects of Renal Vitrification. Organogenesis 5
(3): 167–175.
Farr, A.D. 1980. Early Opposition to Obstetric Anaesthesia. Anaesthesia 35 (9): 896–907.
Fehrenbacher, D.E. 1981. Slavery, Law, and Politics: The Dred Scott Case in Historical
Perspective. New York: Oxford University Press.
196 References

Ferris, C.F. 1996. Serotonin Diminishes Aggression by Suppressing the Activity of the
Vasopressin System. Annals of the New York Academy of Sciences 794 (September): 98–103.
Fiore, Arlene M., Vaishali Naik, Dominick V. Spracklen, Allison Steiner, Nadine Unger, Michael
Prather, Dan Bergmann, et al. 2012. Global Air Quality and Climate. Chemical Society
Reviews 41 (19): 6663–6683. https://doi.org/10.1039/c2cs35095e.
Forsberg, Joanna Stjernschantz, Mats G. Hansson, and Stefan Eriksson. 2014. Why Participating
in (certain) Scientific Research Is a Moral Duty. Journal of Medical Ethics 40 (5): 325–328.
https://doi.org/10.1136/medethics-2012-100859.
Frankfurt, H.G. 1971. Freedom of the Will and the Concept of a Person. The Journal of
Philosophy 68: 5–7.
Frati, Paola, Chrystalla Kyriakou, Alessandro Del Rio, Enrico Marinelli, Gianluca Montanari
Vergallo, Simona Zaami, and Francesco P. Busardò. 2015. Smart Drugs and Synthetic
Androgens for Cognitive and Physical Enhancement: Revolving Doors of Cosmetic
Neurology. Current Neuropharmacology 13 (1): 5–11. https://doi.org/10.2174/
1570159X13666141210221750.
French, R.M. 2000. The Turing Test: The First 50 Years. Trends in Cognitive Sciences 4 (3): 115–
122.
Friedlander, W.J. 1982. Oaths Given by U.S. and Canadian Medical Schools, 1977: Profession of
Medical Values. Social Science & Medicine 16 (1): 115–120.
Friedlander, Walter J. 1995. The Evolution of Informed Consent in American Medicine.
Perspectives in Biology and Medicine 38 (3): 498–510.
Friedman, David, Bracha Rager-Zisman, Eitan Bibi, and Alex Keynan. 2010. The Bioterrorism
Threat and Dual-use Biotechnological Research: An Israeli Perspective. Science and
Engineering Ethics 16 (1): 85–97. https://doi.org/10.1007/s11948-008-9075-4.
Friedman, E.A., and A.L. Friedman. 2006. Payment for Donor Kidneys: Pros and Cons. Kidney
International 69 (6): 960–962. https://doi.org/10.1038/sj.ki.5000262.
Fukuyama, F. 2002. Our Posthuman Future. NY: Farrar, Straus and Giroux.
Fukuyama, F. 2004. Transhumanism. Foreign Policy (144): 42–43.
Fukuyama, Francis. 2002. Life, but Not as We Know It. New Scientist (1971) 174 (2339): 42–45.
Gallimore, Andrew R. 2015. Restructuring Consciousness—The Psychedelic State in Light of
Integrated Information Theory. Frontiers in Human Neuroscience 9 (June): 346. https://doi.
org/10.3389/fnhum.2015.00346.
Gampel, Eric. 2006. Does Professional Autonomy Protect Medical Futility Judgments? Bioethics
20 (2): 92–104.
Garcia-Santibanez, Rocio, and Harini Sarva. 2015. Isolated Hyperreligiosity in a Patient with
Temporal Lobe Epilepsy. Case Reports in Neurological Medicine 2015 (August): 235856.
https://doi.org/10.1155/2015/235856.
García-Velasco, J.A., and A. Pellicer. 2007. Cancer Treatment and Fertility: a Time to Reassess
Realistic Opportunities. Clinical & Translational Oncology 9 (11): 681–682.
Gardiner, P. 2003. A Virtue Ethics Approach to Moral Dilemmas in Medicine. Journal of Medical
Ethics 29 (5): 297–302. https://doi.org/10.1136/jme.29.5.297.
Garnett, Alex, Louise Whiteley, Heather Piwowar, Edie Rasmussen, and Judy Illes. 2011.
Neuroethics and fMRI: Mapping a Fledgling Relationship. Plos One 6 (4): e18537. https://doi.
org/10.1371/journal.pone.0018537.
Gensler, Harry J. 1985. A Kantian Argument Against Abortion. Philosophical Studies 48 (1): 57–
72.
Geschwind, N. 1979. Behavioural Changes in Temporal Lobe Epilepsy. Psychological Medicine 9
(2): 217–219.
Gibson, Daniel G., John I. Glass, Carole Lartigue, Vladimir N. Noskov, Ray-Yuan Chuang,
Mikkel A. Algire, Gwynedd A. Benders, et al. 2010. Creation of a Bacterial Cell Controlled by
a Chemically Synthesized Genome. Science 329 (5987): 52–56. https://doi.org/10.1126/
science.1190719.
References 197

Gibson, T.M. 2006. The Bioethics of Enhancing Human Performance for Spaceflight. Journal of
Medical Ethics 32 (3): 129–132. https://doi.org/10.1136/jme.2005.012534.
Gilbert, David M. 2004. The Future of Human Embryonic Stem Cell Research: Addressing Ethical
Conflict with Responsible Scientific Research. Medical Science Monitor 10 (5): RA99–103.
Giles, Jim. 2004. Nanotech Takes Small Step Towards Burying ‘Grey Goo’. Nature 429 (6992):
591. https://doi.org/10.1038/429591b.
Gillon, R. 1985. Utilitarianism. British Medical Journal (Clinical Research Ed.) 290 (6479):
1411–1413.
Gillon, R. 1996. Brain Transplantation, Personal Identity and Medical Ethics. Journal of Medical
Ethics 22 (3): 131–132.
Goldstein, L.B., and J.N. Davis. 1990. Influence of Lesion Size and Location on
Amphetamine-facilitated Recovery of Beam-walking in Rats. Behavioral Neuroscience 104
(2): 320–327.
Gouzoulis-Mayfrank, E., and J. Daumann. 2006. Neurotoxicity of Methylenedioxyamphetamines
(MDMA; Ecstasy) in Humans: How Strong Is the Evidence for Persistent Brain Damage?
Addiction 101 (3): 348–361. https://doi.org/10.1111/j.1360-0443.2006.01314.x.
Graber, M.A. 2006. Dred Scott and the Problem of Constitutional Evil. Cambridge Studies on the
American Constitution. New York: Cambridge University Press.
Granqvist, Pehr, Mats Fredrikson, Patrik Unge, Andrea Hagenfeldt, Sven Valind, Dan Larhammar,
and Marcus Larsson. 2005. Sensed Presence and Mystical Experiences Are Predicted by
Suggestibility, Not by the Application of Transcranial Weak Complex Magnetic Fields.
Neuroscience Letters 379 (1): 1–6.
Granqvist, Pehr, Mario Mikulincer, and Phillip R Shaver. 2010. “Religion as Attachment:
Normative Processes and Individual Differences.” Personality and Social Psychology Review :
An Official Journal of the Society for Personality and Social Psychology, Inc 14 (1): 49–59.
https://doi.org/10.1177/1088868309348618.
Greek, Ray, Annalea Pippus, and Lawrence A. Hansen. 2012. The Nuremberg Code Subverts
Human Health and Safety by Requiring Animal Modeling. BMC Medical Ethics 13 (July): 16.
https://doi.org/10.1186/1472-6939-13-16.
Griffiths, R.R., W.A. Richards, U. McCann, and R. Jesse. 2006. Psilocybin Can Occasion
Mystical-type Experiences Having Substantial and Sustained Personal Meaning and Spiritual
Significance. Psychopharmacology 187 (3): 268–83, discussion 284. https://doi.org/10.1007/
s00213-006-0457-5.
Gunderson, Martin. 2004. A Kantian View of Suicide and End-of-life Treatment. Journal of Social
Philosophy 35 (2): 277–287.
Gutierrez, Roberto, and Roger Giner-Sorolla. 2007. Anger, Disgust, and Presumption of Harm as
Reactions to Taboo-breaking Behaviors. Emotion 7 (4): 853–868. https://doi.org/10.1037/
1528-3542.7.4.853.
Guttinger, Stephan. 2017. Trust in Science: CRISPR-Cas9 and the Ban on Human Germline
Editing. Science and Engineering Ethics, June. https://doi.org/10.1007/s11948-017-9931-1.
Halevy, A., and B. Brody. 1993. Brain Death: Reconciling Definitions, Criteria, and Tests. Annals
of Internal Medicine 119 (6): 519–525.
Hall, Wayne, and Michael Lynskey. 2009. The Challenges in Developing a Rational Cannabis
Policy. Current Opinion in Psychiatry 22 (3): 258–262. https://doi.org/10.1097/YCO.
0b013e3283298f36.
Haller, József, and Menno R. Kruk. 2006. Normal and Abnormal Aggression: Human Disorders
and Novel Laboratory Models. Neuroscience and Biobehavioral Reviews 30 (3): 292–303.
https://doi.org/10.1016/j.neubiorev.2005.01.005.
Harnett, M.J., A.D. Miller, R.J. Hurley, and K. Bhavani-Shankar. 2000. Pregnancy, Labour and
Delivery in a Jehovah’s Witness with Esophageal Varices and Thrombocytopenia. Canadian
Journal of Anaesthesia 47 (12): 1253–1255. https://doi.org/10.1007/BF03019877.
Harold, F.M. 2001. The Way of the Cell: Molecules, Organisms and the Order of Life. Oxford,
UK: Oxford University Press.
198 References

Harris, J. 1998. Clones, Genes, and Immortality. Oxford, UK: Oxford University Press.
Harris, J. 2003. In Praise of Unprincipled Ethics. Journal of Medical Ethics 29 (5): 303–306.
Harris, J. 2004. On Cloning. New York: Routledge.
Harris, J. 2007. Enhancing Evolution. Princeton NJ: Princeton University Press.
Harris, John. 2005a. Scientific Research Is a Moral Duty. Journal of Medical Ethics 31 (4): 242–
248. https://doi.org/10.1136/jme.2005.011973.
Harris, John. 2005b. Sex Selection and Regulated Hatred. Journal of Medical Ethics 31 (5): 291–
294. https://doi.org/10.1136/jme.2003.007526.
Harris, John. 2005c. No Sex Selection Please, We’re British. Journal of Medical Ethics 31 (5):
286–288. https://doi.org/10.1136/jme.2004.008870.
Harris, John. 2009. Is It Acceptable for People to Take Methylphenidate to Enhance Performance?
Yes. BMJ (Clinical Research Ed.) 338 (June): b1955. https://doi.org/10.1136/bmj.b1955.
Harris, John. 2011. Moral Enhancement and Freedom. Bioethics 25 (2): 102–111. https://doi.org/
10.1111/j.1467-8519.2010.01854.x.
Harris, S. 1992. Japanese Biological Warfare Research on Humans: A Case Study of Microbiology
and Ethics. Annals of the New York Academy of Sciences 666 (December): 21–52.
Haupt, W.F., and J. Rudolf. 1999. European Brain Death Codes: A Comparison of National
Guidelines. Journal of Neurology 246 (6): 432–437.
Heinrichs, Markus, Bernadette von Dawans, and Gregor Domes. 2009. Oxytocin, Vasopressin,
and Human Social Behavior. Frontiers in Neuroendocrinology 30 (4): 548–557. https://doi.
org/10.1016/j.yfrne.2009.05.005.
Hershenov, David. 2003. The Problematic Role of ‘Irreversibility’ in the Definition of Death.
Bioethics 17 (1): 89–100.
Heubel, Friedrich, and Nikola Biller-Andorno. 2005. The Contribution of Kantian Moral Theory to
Contemporary Medical Ethics: A Critical Analysis. Medicine, Health Care, and Philosophy 8
(1): 5–18.
Howard, Joseph. 2005. The Moral Status of the Human Embryo According to Peter Singer:
Individuality, Humanity, and Personhood. The Linacre Quarterly 72 (3): 212–228.
Huband, Nick, Michael Ferriter, Rajan Nathan, and Hannah Jones. 2010. Antiepileptics for
Aggression and Associated Impulsivity. Cochrane Database of Systematic Reviews
(2) (February): CD003499. https://doi.org/10.1002/14651858.cd003499.pub3.
Huff, Wolfgang, Doris Lenartz, Michael Schormann, Sun-Hee Lee, Jens Kuhn, Anastosious
Koulousakis, Juergen Mai, et al. 2010. Unilateral Deep Brain Stimulation of the Nucleus
Accumbens in Patients with Treatment-resistant Obsessive-compulsive Disorder: Outcomes
after One Year. Clinical Neurology and Neurosurgery 112 (2): 137–143. https://doi.org/10.
1016/j.clineuro.2009.11.006.
Hug, Kristina. 2006. Therapeutic Perspectives of Human Embryonic Stem Cell Research Versus
the Moral Status of a Human Embryo—Does One Have to Be Compromised for the Other?
Medicina (Kaunas, Lithuania) 42 (2): 107–114.
Hughes, James. 2004. Citizen Cyborg: Why Democratic Societies Must Respond to the Redesigned
Human of the Future. Cambridge, MA: Westview Press.
Huh, Ryoong, In Bo Han, MoonYoung Chung, and Sangsup Chung. 2010. Comparison of
Treatment Results Between Selective Peripheral Denervation and Deep Brain Stimulation in
Patients with Cervical Dystonia. Stereotactic and Functional Neurosurgery 88 (4): 234–238.
https://doi.org/10.1159/000314359.
Huxley, A. 1954. The Doors of Perception. London: Chatto & Windus.
Ikemoto, S., and J. Panksepp. 1999. The Role of Nucleus Accumbens Dopamine in Motivated
Behavior: A Unifying Interpretation with Special Reference to Reward-seeking. Brain
Research Reviews 31 (1): 6–41. https://doi.org/10.1016/S0165-0173(99)00023-5.
Iltis, Ana Smith, and Mark J. Cherry. 2010. Death Revisited: Rethinking Death and the Dead
Donor Rule. The Journal of Medicine and Philosophy 35 (3): 223–241. https://doi.org/10.
1093/jmp/jhq017.
References 199

Insel, T.R. 1997. A Neurobiological Basis of Social Attachment. The American Journal of
Psychiatry 154 (6): 726–735. https://doi.org/10.1176/ajp.154.6.726.
Insel, Thomas R. 2010. The Challenge of Translation in Social Neuroscience: A Review of
Oxytocin, Vasopressin, and Affiliative Behavior. Neuron 65 (6): 768–779. https://doi.org/10.
1016/j.neuron.2010.03.005.
Institute of Medicine (US). 2000. Committee on Quality of Health Care in America. InTo Err is
Human: Building a Safer Health System, Eds. Kohn LT, Corrigan JM, Donaldson MS.
Washington (DC): National Academies Press (US). (PubMed PMID: 25077248).
Inzlicht, Michael, Ian McGregor, Jacob B. Hirsh, and Kyle Nash. 2009. Neural Markers of
Religious Conviction. Psychological Science 20 (3): 385–392. https://doi.org/10.1111/j.1467-
9280.2009.02305.x.
James, Laura P., Philip R. Mayeux, and Jack A. Hinson. 2003. Acetaminophen-induced
Hepatotoxicity. Drug Metabolism and Disposition: The Biological Fate of Chemicals 31 (12):
1499–1506. https://doi.org/10.1124/dmd.31.12.1499.
Jamieson, D. 1999. Singer and His Critics. Malden, MA: Blackwell.
Johnson, Jane. 2013. Vulnerable Subjects? The Case of Nonhuman Animals in Experimentation.
Journal of Bioethical Inquiry 10 (4): 497–504. https://doi.org/10.1007/s11673-013-9473-4.
Jones, G.E. 1984. Fetal Brain Waves and Personhood. Journal of Medical Ethics 10 (4): 216–217.
Jonsen, Albert R. 1995. Casuistry: An Alternative or Complement to Principles? Kennedy Institute
of Ethics Journal 5 (3): 237–251.
Kaempffert, W. 1943. Process of Dying. New York Times, April 10.
Kahane, Philippe, and Antoine Depaulis. 2010. Deep Brain Stimulation in Epilepsy: What Is
Next? Current Opinion in Neurology 23 (2): 177–182. https://doi.org/10.1097/WCO.
0b013e3283374a39.
Kamm, Frances M. 2005. Ethical Issues in Using and Not Using Embryonic Stem Cells. Stem Cell
Reviews 1 (4): 325–330. https://doi.org/10.1385/SCR:1:4:325.
Kanai, Ryota, Tom Feilden, Colin Firth, and Geraint Rees. 2011. Political Orientations Are
Correlated with Brain Structure in Young Adults. Current Biology 21 (8): 677–680. https://doi.
org/10.1016/j.cub.2011.03.017.
Kao, Audiey C., and Kayhan P. Parsi. 2004. Content Analyses of Oaths Administered at U.S.
Medical Schools in 2000. Academic Medicine 79 (9): 882–887.
Kapogiannis, Dimitrios, Aron K. Barbey, Su Michael, Giovanna Zamboni, Frank Krueger, and
Jordan Grafman. 2009. Cognitive and Neural Foundations of Religious Belief. Proceedings of
the National Academy of Sciences of the United States of America 106 (12): 4876–4881.
https://doi.org/10.1073/pnas.0811717106.
Kass, L.R. 1997. The Wisdom of Repugnance. The New Republic (216): 17–26.
Kattera, Suresh, and Christopher Chen. 2006. Cryopreservation of Embryos by Vitrification:
Current Development. International Surgery 91 (5 Suppl): S55–S62.
Katz, J. 1996. The Nuremberg Code and the Nuremberg Trial. A Reappraisal. The Journal of the
American Medical Association 276 (20): 1662–1666.
Katz, Ralph V., B. Lee Green, Nancy R. Kressin, S. Stephen Kegeles, Min Qi Wang, Sherman A.
James, Stefanie L. Russell, Cristina Claudio, and Jan M. McCallum. 2008. The Legacy of the
Tuskegee Syphilis Study: Assessing Its Impact on Willingness to Participate in Biomedical
Studies. Journal of Health Care for the Poor and Underserved 19 (4): 1168–1180. https://doi.
org/10.1353/hpu.0.0067.
Katz, Ralph V., S. Stephen Kegeles, Nancy R. Kressin, B. Lee Green, Sherman A. James, Min Qi
Wang, Stefanie L. Russell, and Cristina Claudio. 2008. Awareness of the Tuskegee Syphilis
Study and the US Presidential Apology and Their Influence on Minority Participation in
Biomedical Research. American Journal of Public Health 98 (6): 1137–1142. https://doi.org/
10.2105/AJPH.2006.100131.
Keller, Charles F. 2003. Global Warming: The Balance of Evidence and Its Policy Implications.
A Review of the Current State-of-the-controversy. The Scientific World Journal 3 (May): 357–
411. https://doi.org/10.1100/tsw.2003.26.
200 References

Keller, Charles F. 2007. Global Warming 2007. An Update to Global Warming: The Balance of
Evidence and Its Policy Implications. The Scientific World Journal 7 (March): 381–399.
https://doi.org/10.1100/tsw.2007.91.
Kenagy, David N., Christopher T. Bird, Christopher M. Webber, and Joseph R. Fischer. 2004.
Dextroamphetamine Use During B-2 Combat Missions. Aviation, Space, and Environmental
Medicine 75 (5): 381–386.
Kevles, D.J. 1985. In the Name of Eugenics. Genetics and the Uses of Human Heredity. Berkeley,
CA: University of California Press.
Kim, C-Yoon, Hanseul Oh, Xiaoping Ren, and Sergio Canavero. 2017. Immunohistochemical
Evidence of Axonal Regrowth Across Polyethylene Glycol-fused Cervical Cords in Mice.
Neural Regeneration Research 12 (1): 149–150. https://doi.org/10.4103/1673-5374.199014.
Kimberly, Michael. 2002. Reevaluating Repugnance: a Critical Analysis of Leon Kass’ Writings
on Genetic Reproductive Technologies. Princeton Journal of Bioethics 5: 8–24.
King, B.J. 2007. Evolving God. New York, NY: Doubleday.
Kious, B.M. 2001. The Nuremberg Code: Its History and Implications. Princeton Journal of
Bioethics 4: 7–19.
Kirkpatrick, Lee A. 2004. Attachment, Evolution, and the Psychology of Religion. New York:
Guilford Press.
Knutson, B., O.M. Wolkowitz, S.W. Cole, T. Chan, E.A. Moore, R.C. Johnson, J. Terpstra, R.A.
Turner, and V.I. Reus. 1998. Selective Alteration of Personality and Social Behavior by
Serotonergic Intervention. The American Journal of Psychiatry 155 (3): 373–379. https://doi.
org/10.1176/ajp.155.3.373.
Koberda, J.L., W.M. Clark, H. Lutsep, and G. Nesbit. 1997. Successful Clinical Recovery and
Reversal Ofmid-basilar Occlusion in Clinically Brain Dead Patient with Intra-arterialurokinase.
Neurology 48 (suppl): A154.
Kohlberg, L. 1971. Stages in Moral Development as a Basis for Moral Education. In Moral
Education: Interdisciplinary Approaches, ed. C.M. Beck, B.S. Crittenden, and E.V. Sullivan.
Toronto: Toronto University Press.
Kolber, Adam. 2011. Neuroethics: Give Memory-altering Drugs a Chance. Nature 476 (7360):
275–276. https://doi.org/10.1038/476275a.
Kolibianakis, Efstratios M., Christos A. Venetis, and Basil C. Tarlatzis. 2009. Cryopreservation of
Human Embryos by Vitrification or Slow Freezing: Which One Is Better? Current Opinion in
Obstetrics & Gynecology 21 (3): 270–274. https://doi.org/10.1097/GCO.0b013e3283297dd6.
Kosko, B. 1993. Fuzzy Thinking. New York: Hyperion.
Kraemer, Felicitas. 2011. Authenticity Anyone? The Enhancement of Emotions via
Neuro-Psychopharmacology. Neuroethics 4 (1): 51–64. https://doi.org/10.1007/s12152-010-
9075-3.
Kramer, P.D. 1993. Listening to Prozac. NY: Viking Press.
Krasnova, Irina N., Zuzana Justinova, Bruce Ladenheim, Subramaniam Jayanthi, Michael T.
McCoy, Chanel Barnes, John E. Warner, Steven R. Goldberg, and Jean Lud Cadet. 2010.
Methamphetamine Self-administration Is Associated with Persistent Biochemical Alterations in
Striatal and Cortical Dopaminergic Terminals in the Rat. Plos One 5 (1): e8790. https://doi.org/
10.1371/journal.pone.0008790.
Kuchta, J., A. Koulousakis, and V. Sturm. 2007. Neurosurgical Pain Therapy with Epidural Spinal
Cord Stimulation (SCS). Acta Neurochirurgica. Supplement 97 (Pt 1): 65–70.
Lai, C.S., S.E. Fisher, J.A. Hurst, F. Vargha-Khadem, and A.P. Monaco. 2001.
A Forkhead-domain Gene Is Mutated in a Severe Speech and Language Disorder. Nature
413 (6855): 519–523. https://doi.org/10.1038/35097076.
Landsborough, D. 1987. St. Paul and Temporal Lobe Epilepsy. Journal of Neurology,
Neurosurgery, and Psychiatry 50 (6): 659–664.
Lanni, Cristina, Silvia C. Lenzken, Alessia Pascale, Igor Del Vecchio, Marco Racchi, Francesca
Pistoia, and Stefano Govoni. 2008. Cognition Enhancers Between Treating and Doping the
Mind. Pharmacological Research 57 (3): 196–213. https://doi.org/10.1016/j.phrs.2008.02.004.
References 201

Lanphier, Edward, Fyodor Urnov, Sarah Ehlen Haecker, Michael Werner, and Joanna Smolenski.
2015. Don’t Edit the Human Germ Line. Nature 519 (7544): 410–411. https://doi.org/10.1038/
519410a.
Larson, Anne M. 2007. Acetaminophen Hepatotoxicity. Clinics in Liver Disease 11 (3): 525–48,
vi. https://doi.org/10.1016/j.cld.2007.06.006.
Larson, Paul Sloan. 2008. Deep Brain Stimulation for Psychiatric Disorders. Neurotherapeutics 5
(1): 50–58. https://doi.org/10.1016/j.nurt.2007.11.006.
Launis, Veikko. 2010. Cosmetic Neurology: Sliding down the Slippery Slope? Cambridge
Quarterly of Healthcare Ethics: CQ: The International Journal of Healthcare Ethics
Committees 19 (2): 218–229. https://doi.org/10.1017/S096318010999048X.
Lawlor, Rob. 2007. Moral Theories in Teaching Applied Ethics. Journal of Medical Ethics 33 (6):
370–372. https://doi.org/10.1136/jme.2006.018044.
Leask, Julie. 2015. Should We Do Battle with Antivaccination Activists? Public Health Research
& Practice 25 (2): e2521515. https://doi.org/10.17061/phrp2521515.
Lee, Tim W.R, and Kevin W. Southern. 2013. Topical Cystic Fibrosis Transmembrane
Conductance Regulator Gene Replacement for Cystic Fibrosis-related Lung Disease.
Cochrane Database of Systematic Reviews (11) (November): CD005599. https://doi.org/10.
1002/14651858.cd005599.pub4.
Lemaire, François. 2006. The Nuremberg Doctors’ Trial: The 60th Anniversary. Intensive Care
Medicine 32 (12): 2049–2052. https://doi.org/10.1007/s00134-006-0467-0.
Letsoalo, J.L. 1998. Law, Blood Transfusions and Jehovah’s Witnesses. Medicine and Law 17 (4):
633–638.
Levy, Neil. 2011. Neuroethics: A New Way of Doing Ethics. AJOB Neuroscience 2 (2): 3–9.
https://doi.org/10.1080/21507740.2011.557683.
Levy, Robert, Timothy R. Deer, and Jaimie Henderson. 2010. Intracranial Neurostimulation for
Pain Control: A Review. Pain Physician 13 (2): 157–165.
Li, Zhi, Wei Zhao, Wei Liu, Ye Zhou, Jingqiao Jia, and Lifeng Yang. 2014. Transplantation of
Placenta-derived Mesenchymal Stem Cell-induced Neural Stem Cells to Treat Spinal Cord
Injury. Neural Regeneration Research 9 (24): 2197–2204. https://doi.org/10.4103/1673-5374.
147953.
Li, Peng-Wei, Xin Zhao, Yun-Long Zhao, Bing-Jian Wang, Yang Song, Zi-Long Shen, Hong-Jun
Jiang, Hai Jin, Sergio Canavero, and Xiao-Ping Ren. 2017. A Cross-circulated Bicephalic
Model of Head Transplantation. CNS Neuroscience & Therapeutics 23 (6): 535–541. https://
doi.org/10.1111/cns.12700.
Lifshitz-Ben-Basat, Adi, and Nira Mashal. 2018. Improving Naming Abilities Among Healthy
Young-Old Adults Using Transcranial Direct Current Stimulation. Journal of Psycholinguistic
Research 47 (1): 113–124. https://doi.org/10.1007/s10936-017-9516-9.
Lifton, R.J. 1986. The Nazi Doctors, Medical Killing & the Psychology of Genocide. NY: Basic
Books.
Lin, L., K.J. Vicente, and D.J. Doyle. 2001. Patient Safety, Potential Adverse Drug Events, and
Medical Device Design: a Human Factors Engineering Approach. Journal of Biomedical
Informatics 34 (4): 274–284. https://doi.org/10.1006/jbin.2001.1028.
Loutradi, Kalliopi E., Efstratios M. Kolibianakis, Christos A. Venetis, Evangelos G. Papanikolaou,
George Pados, Ioannis Bontis, and Basil C. Tarlatzis. 2008. Cryopreservation of Human
Embryos by Vitrification or Slow Freezing: A Systematic Review and Meta-analysis. Fertility
and Sterility 90 (1): 186–193. https://doi.org/10.1016/j.fertnstert.2007.06.010.
Luce, J.M. 1995. Physicians Do Not Have a Responsibility to Provide Futile or Unreasonable Care
If a Patient or Family Insists. Critical Care Medicine 23 (4): 760–766.
Lynch, Gary, and Christine M. Gall. 2006. Ampakines and the Threefold Path to Cognitive
Enhancement. Trends in Neurosciences 29 (10): 554–562. https://doi.org/10.1016/j.tins.2006.
07.007.
Machado, C. 1994. Death on Neurological Grounds. Journal of Neurosurgical Sciences 38 (4):
209–222.
202 References

Machado, Calixto, and Gerry Leisman. 2009. Towards an Effective Definition of Death and
Disorders of Consciousness. Reviews in the Neurosciences 20 (3–4): 147–150.
Maleck, W.H., S.N. Piper, J. Triem, J. Boldt, and F.U. Zittel. 1998. Unexpected Return of
Spontaneous Circulation after Cessation of Resuscitation (Lazarus Phenomenon). Resuscitation
39 (1–2): 125–128.
Maltz, E.M. 2007. Dred Scott and the Politics of Slavey. Landmark Law Cases & American
Society. Lawrence, Kansas: University Press of Kansas.
Mammen, Biju, T. Ramakrishnan, Uma Sudhakar, and Vijayalakshmi. 2007. Principles of Gene
Therapy. Indian Journal of Dental Research : Official Publication of Indian Society for Dental
Research 18 (4): 196–200.
Mann, M.C., J. Votto, J. Kambe, and M.J. McNamee. 1992. Management of the Severely Anemic
Patient Who Refuses Transfusion: Lessons Learned During the Care of a Jehovah’s Witness.
Annals of Internal Medicine 117 (12): 1042–1048.
Mantione, Mariska, Wim van de Brink, P. Richard Schuurman, and Damiaan Denys. 2010.
Smoking Cessation and Weight Loss after Chronic Deep Brain Stimulation of the Nucleus
Accumbens: Therapeutic and Research Implications: Case Report. Neurosurgery 66 (1): E218;
discussion E218. https://doi.org/10.1227/01.neu.0000360570.40339.64.
Marazziti, D., H.S. Akiskal, A. Rossi, and G.B. Cassano. 1999. Alteration of the Platelet Serotonin
Transporter in Romantic Love. Psychological Medicine 29 (3): 741–745.
Marshall, Ernest. 1986. Does the Moral Philosophy of the Belmont Report Rest on a Mistake? IRB
8 (6): 5–6.
Marx, K., and F. Engels. 2002. On Religion. Netherlands: Fredonia Books.
McIntyre, Alison. 2004. The Double Life of Double Effect. Theoretical Medicine and Bioethics 25
(1): 61–74.
McNally, J. Dayre, Christopher M. Sturgeon, and Kenneth B. Storey. 2003. Freeze-induced
Expression of a Novel Gene, Fr47, in the Liver of the Freeze-tolerant Wood Frog, Rana
Sylvatica. Biochimica et Biophysica Acta 1625 (2): 183–191.
Melega, William P., Matthew J. Jorgensen, Goran Laćan, Baldwin M. Way, Jamie Pham, Grenvill
Morton, Arthur K. Cho, and Lynn A. Fairbanks. 2008. Long-term Methamphetamine
Administration in the Vervet Monkey Models Aspects of a Human Exposure: Brain
Neurotoxicity and Behavioral Profiles. Neuropsychopharmacology 33 (6): 1441–1452. https://
doi.org/10.1038/sj.npp.1301502.
Merkle, R.C. 1992. The Technical Feasibility of Cryonics. Medical Hypotheses 39 (1): 6–16.
Metzger, T. 1998. The Birth of Heroin & the Demonization of the Dope Fiend. Port Townsend,
WA: Loompanics Unlimited.
Meyerlindenberg, A. 2008. Impact of Prosocial Neuropeptides on Human Brain Function. In
Advances in Vasopressin and Oxytocin—From Genes to Behaviour to Disease, 463–470.
Elsevier. https://doi.org/10.1016/s0079-6123(08)00436-6.
Mickelsen, Ruth A., Daniel S. Bernstein, Mary Faith Marshall, and Steven H. Miles. 2013. The
Barnes Case: Taking Difficult Futility Cases Public. The Journal of Law, Medicine & Ethics : a
Journal of the American Society of Law, Medicine & Ethics 41 (1): 374–378. https://doi.org/10.
1111/jlme.12027.
Mikhail, John. 2007. Universal Moral Grammar: Theory, Evidence and the Future. Trends in
Cognitive Sciences 11 (4): 143–152. https://doi.org/10.1016/j.tics.2006.12.007.
Miller, R.B. 2002. How the Belmont Report Fails. Essays in Philosophy 4 (2): Article 6.
Mohandas, A., and S.N. Chou. 1971. Brain Death. A Clinical and Pathological Study. Journal of
Neurosurgery 35 (2): 211–218. https://doi.org/10.3171/jns.1971.35.2.0211.
Mohandas, E. 2008. Neurobiology of Spirituality. Mens Sana Monographs 6 (1): 63–80. https://
doi.org/10.4103/0973-1229.33001.
Mokwa, Wilfried. 2007. An Implantable Microsystem as a Vision Prosthesis. Medical Device
Technology 18 (6): 20.
References 203

Moll, Jorge, Ricardo de Oliveira-Souza, Fernanda Tovar Moll, Fátima Azevedo Ignácio, Ivanei E.
Bramati, Egas M. Caparelli-Dáquer, and Paul J. Eslinger. 2005. The Moral Affiliations of
Disgust: a Functional MRI Study. Cognitive and Behavioral Neurology: Official Journal of the
Society for Behavioral and Cognitive Neurology 18 (1): 68–78.
Mondello, Sarah E., Michael R. Kasten, Philip J. Horner, and Chet T. Moritz. 2014. Therapeutic
Intraspinal Stimulation to Generate Activity and Promote Long-term Recovery. Frontiers in
Neuroscience 8 (February): 21. https://doi.org/10.3389/fnins.2014.00021.
Morewedge, C. K. and M.I Norton. 2009. When dreaming is believing: The (motivated)
interpretation of dreams .JPers Soc Psychol. 96(2): 249–64.
Morison, RS. 1971. Death: Process or event? Science. 173 (3998): 694–698. (PubMed PMID:
5568501).
Morelli, M. 1999. Commerce in Organs: a Kantian Critique. Journal of Social Philosophy 30 (2):
315–324.
Morris, Kelly. 2008. Experts Urge Smart Thinking on Cognitive Enhancers. Lancet Neurology 7
(6): 476–477. https://doi.org/10.1016/S1474-4422(08)70101-7.
Mosher, J.F., and K.L. Yanagisako. 1991. Public Health, Not Social Warfare: A Public Health
Approach to Illegal Drug Policy. Journal of Public Health Policy 12 (3): 278–323.
Muir, Timothy J., Jon P. Costanzo, and Richard E. Lee. 2007. Osmotic and Metabolic Responses
to Dehydration and Urea-loading in a Dormant, Terrestrially Hibernating Frog. Journal of
Comparative Physiology. B, Biochemical, Systemic, and Environmental Physiology 177 (8):
917–926. https://doi.org/10.1007/s00360-007-0190-3.
Muramoto, O. 1998. Bioethics of the Refusal of Blood by Jehovah’s Witnesses: Part 1. Should
Bioethical Deliberation Consider Dissidents’ Views? Journal of Medical Ethics 24 (4): 223–
230.
Muramoto, O. 1998. Bioethics of the Refusal of Blood by Jehovah’s Witnesses: Part 2. A Novel
Approach Based on Rational Non-interventional Paternalism. Journal of Medical Ethics 24 (5):
295–301.
Muramoto, O. 1999. Bioethics of the Refusal of Blood by Jehovah’s Witnesses: Part 3. A Proposal
for a Don’t-ask-don’t-tell Policy. Journal of Medical Ethics 25 (6): 463–468.
Muramoto, Osamu. 2004. The Role of the Medial Prefrontal Cortex in Human Religious Activity.
Medical Hypotheses 62 (4): 479–485. https://doi.org/10.1016/j.mehy.2003.10.010.
Murray, Robin M., Alessandra Paparelli, Paul D. Morrison, Arianna Marconi, and Marta Di Forti.
2013. What Can We Learn About Schizophrenia from Studying the Human Model,
Drug-induced Psychosis? American Journal of Medical Genetics. Part B, Neuropsychiatric
Genetics 162B (7): 661–670. https://doi.org/10.1002/ajmg.b.32177.
Nencini, Paolo. 2002. The Shaman and the Rave Party: Social Pharmacology of Ecstasy.
Substance Use & Misuse 37 (8–10): 923–939.
Nencini, Paolo, and Kathleen A. Grant. 2010. Psychobiology of Drug-induced Religious
Experience: From the Brain ‘Locus of Religion’ to Cognitive Unbinding. Substance Use &
Misuse 45 (13): 2130–2151. https://doi.org/10.3109/10826081003713803.
Newberg, A., A. Alavi, M. Baime, M. Pourdehnad, J. Santanna, and E. d’Aquili. 2001. The
Measurement of Regional Cerebral Blood Flow During the Complex Cognitive Task of
Meditation: A Preliminary SPECT Study. Psychiatry Research 106 (2): 113–122.
Newberg, A.B., E.G. d’Aquili, and V. Rause. 2002. Why God Won’t Go Away: Brain Science and
the Biology of Belief. New York, NY: Ballantine Books.
Newberg, A.B., and M.R. Waldman. 2006. Why We Believe What We Believe: Our Biological
Need for Meaning, Spirituality, and Truth. New York, NY: Free Press.
Ng, Felicity. 2007. The Interface Between Religion and Psychosis. Australasian Psychiatry:
Bulletin of Royal Australian and New Zealand College of Psychiatrists 15 (1): 62–66. https://
doi.org/10.1080/10398560601083118.
Nichols, David E. 2016. Psychedelics. Pharmacological Reviews 68 (2): 264–355. https://doi.org/
10.1124/pr.115.011478.
204 References

Nie, Jing-Bao. 2006. The United States Cover-up of Japanese Wartime Medical Atrocities:
Complicity Committed in the National Interest and Two Proposals for Contemporary Action.
The American Journal of Bioethics 6 (3): W21–W33. https://doi.org/10.1080/
15265160600686356.
Normann, Claus, and Mathias Berger. 2008. Neuroenhancement: Status Quo and Perspectives.
European Archives of Psychiatry and Clinical Neuroscience 258 Suppl 5 (November): 110–
114. https://doi.org/10.1007/s00406-008-5022-2.
Nuzzo, Jennifer B. 2006. The Biological Threat to U.S. Water Supplies: Toward a National Water
Security Policy. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 4
(2): 147–159. https://doi.org/10.1089/bsp.2006.4.147.
O’Connell, Garret. 2011. Tracking the Impact of Neuroethics. Cortex 47 (10): 1259–1260. https://
doi.org/10.1016/j.cortex.2011.04.020.
Oliver, Joan D., and Randall S. Perry. 2006. Definitely Life but Not Definitively. Origins of Life
and Evolution of the Biosphere 36 (5–6): 515–521. https://doi.org/10.1007/s11084-006-9035-4
.
Olweus, D., A. Mattsson, D. Schalling, and H. Löw. 1988. Circulating Testosterone Levels and
Aggression in Adolescent Males: A Causal Analysis. Psychosomatic Medicine 50 (3): 261–
272.
Pagel, James F. 2012. What Physicians Need to Know About Dreams and Dreaming. Current
Opinion in Pulmonary Medicine 18 (6): 574–579. https://doi.org/10.1097/MCP.
0b013e328358bf42.
Pallis, C. 1980. Television and Brain Death. British Medical Journal 281 (6247): 1064.
Palmer, David C. 2006. On Chomsky’s Appraisal of Skinner’s Verbal Behavior: A Half Century
of Misunderstanding. The Behavior Analyst / MABA 29 (2): 253–267.
Papsin, Blake C., and Karen A. Gordon. 2007. Cochlear Implants for Children with
Severe-to-profound Hearing Loss. The New England Journal of Medicine 357 (23): 2380–
2387. https://doi.org/10.1056/NEJMct0706268.
Parasuraman, R., and R.A. McKinley. 2014. Using Noninvasive Brain Stimulation to Accelerate
Learning and Enhance Human Performance. Human Factors: The Journal of the Human
Factors and Ergonomics Society 56 (5): 816–824. https://doi.org/10.1177/0018720814538815.
Parnas, Josef, and Mads Gram Henriksen. 2016. Mysticism and Schizophrenia: A
Phenomenological Exploration of the Structure of Consciousness in the Schizophrenia
Spectrum Disorders. Consciousness and Cognition 43 (July): 75–88. https://doi.org/10.1016/j.
concog.2016.05.010.
Patterson, K.W., and A. McShane. 1991. Reflex Spinal Cord Activity as a Cause of a Delay in the
Diagnosis of Brain Death. Irish Medical Journal 84 (1): 27–28.
Pegg, David E. 2007. Principles of Cryopreservation. Methods in Molecular Biology 368: 39–57.
https://doi.org/10.1007/978-1-59745-362-2_3.
Pellegrino, E.D. 1995. Toward a Virtue-based Normative Ethics for the Health Professions.
Kennedy Institute of Ethics Journal 5 (3): 253–277.
Penrose, R. 1989. The Emperor’s New Mind: Concerning Computers, Minds, and the Laws of
Physics. Oxford, UK: Oxford University Press.
Penrose, R. 1996. Shadows of the Mind: A Search for the Missing Science of Consciousness.
Oxford, UK: Oxford University Press.
Peoples, Hervey C., and Frank W. Marlowe. 2012. Subsistence and the Evolution of Religion.
Human Nature (Hawthorne, N.Y.) 23 (3): 253–269. https://doi.org/10.1007/s12110-012-9148-
6.
Persinger, M.A. 1983. Religious and Mystical Experiences as Artifacts of Temporal Lobe
Function: a General Hypothesis. Perceptual and Motor Skills 57 (3 Pt 2): 1255–1262. https://
doi.org/10.2466/pms.1983.57.3f.1255.
References 205

Persinger, Michael A., and Faye Healey. 2002. Experimental Facilitation of the Sensed Presence:
Possible Intercalation Between the Hemispheres Induced by Complex Magnetic Fields. The
Journal of Nervous and Mental Disease 190 (8): 533–541. https://doi.org/10.1097/01.NMD.
0000026653.84018.B0.
Pham, J.V., and T. Puzantian. 2001. Ecstasy: Dangers and Controversies. Pharmacotherapy 21
(12): 1561–1565.
Pommer, R.W. 1993. Donaldson V. Van de Kamp: Cryonics, Assisted Suicide, and the Challenges
of Medical Science. The Journal of Contemporary Health Law and Policy 9: 589–603.
Porta, M., A. Brambilla, A.E. Cavanna, D. Servello, M. Sassi, H. Rickards, and M.M. Robertson.
2009. Thalamic Deep Brain Stimulation for Treatment-refractory Tourette Syndrome:
Two-year Outcome. Neurology 73 (17): 1375–1380. https://doi.org/10.1212/WNL.
0b013e3181bd809b.
President’s Commission for the Study of Ethical Problemsin Medicine and Biomedical and
Behavior Research. 1981. Defining Death: A Report on the Medical, Legal and Ethical Issues
in the Determination of Death. Washington, DC: US Government Printing Office.
Puri, K.S., K.R. Suresh, N.J. Gogtay, and U.M. Thatte. 2009. Declaration of Helsinki, 2008:
Implications for Stakeholders in Research. Journal of Postgraduate Medicine 55 (2): 131–134.
https://doi.org/10.4103/0022-3859.52846.
Rawls, J. 1971. A Theory of Justice. Cambridge, MA: Belknap Press.
Ren, Shuai, Ze-Han Liu, Wu Qiong, Fu Kuang, Wu Jun, Li-Ting Hou, Ming Li, et al. 2017.
Polyethylene Glycol-induced Motor Recovery after Total Spinal Transection in Rats. CNS
Neuroscience & Therapeutics 23 (8): 680–685. https://doi.org/10.1111/cns.12713.
Ren, Xiaoping, and Michael C. Laugel. 2013. The Next Frontier in Composite Tissue
Allotransplantation. CNS Neuroscience & Therapeutics 19 (1): 1–4. https://doi.org/10.1111/
cns.12029.
Ren, Xiao-Ping, Yang Song, Yi-Jie Ye, Peng-Wei Li, Ke-Cheng Han, Zi-Long Shen, Ji-Gang
Shan, Kristin Luther, and Bao-Feng Yang. 2014. Allogeneic Head and Body Reconstruction:
Mouse Model. CNS Neuroscience & Therapeutics 20 (12): 1056–1060. https://doi.org/10.
1111/cns.12341.
Richards, P.M., M.A. Persinger, and S.A. Koren. 1993. Modification of Activation and Evaluation
Properties of Narratives by Weak Complex Magnetic Field Patterns That Simulate Limbic
Burst Firing. The International Journal of Neuroscience 71 (1–4): 71–85.
Ridley, D.T. 1999. Jehovah’s Witnesses' Refusal of Blood: Obedience to Scripture and Religious
Conscience. Journal of Medical Ethics 25 (6): 469–472.
Romain, Tiffany. 2010. Extreme Life Extension: Investing in Cryonics for the Long, Long Term.
Medical Anthropology 29 (2): 194–215. https://doi.org/10.1080/01459741003715391.
Rose, Gregory M., Voon S. Ong, and Diana S. Woodruff-Pak. 2007. Efficacy of MEM 1003, a
Novel Calcium Channel Blocker, in Delay and Trace Eyeblink Conditioning in Older Rabbits.
Neurobiology of Aging 28 (5): 766–773. https://doi.org/10.1016/j.neurobiolaging.2006.03.006.
Ross, W.D. 1930. The Right and the Good. Oxford, UK: Clarendon Press.
Rothenberg, David M. 1990. The Approach to the Jehovah’s Witness Patient. Anesthesiology
Clinics of North America 8 (3): 589–607.
Rowiński, Wojciech. 2007. Future of Transplantation Medicine. Annals of Transplantation 12 (1):
5–10.
Ryan, C.J. 1998. Pulling up the Runaway: The Effect of New Evidence on Euthanasia’s Slippery
Slope. Journal of Medical Ethics 24 (5): 341–344.
Sagoff, Mark. 2007. A Transcendental Argument for the Concept of Personhood in Neuroscience.
The American Journal of Bioethics 7 (1): 72–3; discussion W1. https://doi.org/10.1080/
15265160601064355.
Saini, P. 1999. The Doctrine of Double Effect and the Law of Murder. The Medico-legal Journal
67 (Pt 3): 106–120. https://doi.org/10.1258/rsmmlj.67.3.106.
Sandel, M.J. 2007. The Case Against Perfection: Ethics in the Age of Genetic Engineering.
Cambridge, MA: Belknap Press.
206 References

Sanger, M.A. 1932. Plan for Peace” The Birth Control Review.
Saposnik, G., J.A. Bueri, J. Mauriño, R. Saizar, and N.S. Garretto. 2000. Spontaneous and Reflex
Movements in Brain Death. Neurology 54 (1): 221–223.
Saposnik, Gustavo, Vincenzo S. Basile, and G. Bryan Young. 2009. Movements in Brain Death: A
Systematic Review. The Canadian Journal of Neurological Sciences. Le Journal Canadien
Des Sciences Neurologiques 36 (2): 154–160. https://doi.org/10.1017/s031716710000651x.
Saver, J.L., and J. Rabin. 1997. The Neural Substrates of Religious Experience. The Journal of
Neuropsychiatry and Clinical Neurosciences 9 (3): 498–510. https://doi.org/10.1176/jnp.9.3.
498.
Savulescu, J. 1995. Rational Non-interventional Paternalism: Why Doctors Ought to Make
Judgments of What Is Best for Their Patients. Journal of Medical Ethics 21 (6): 327–331.
Savulescu, J. 1999. Should We Clone Human Beings? Cloning as a Source of Tissue for
Transplantation. Journal of Medical Ethics 25 (2): 87–95.
Savulescu, J. 1999. Sex Selection: The Case For. The Medical Journal of Australia 171 (7): 373–
375.
Savulescu, J. 2001. Why Genetic Testing for Genes for Criminality Is Morally Required.
Princeton Journal of Bioethics 4: 79–97.
Savulescu, J. 2001. Procreative Beneficence: Why We Should Select the Best Children. Bioethics
15 (5–6): 413–426. https://doi.org/10.1111/1467-8519.00251.
Savulescu, J., and E. Dahl. 2000. Sex Selection and Preimplantation Diagnosis: A Response to the
Ethics Committee of the American Society of Reproductive Medicine. Human Reproduction
15 (9): 1879–1880.
Savulescu, Julian. 2002. The Embryonic Stem Cell Lottery and the Cannibalization of Human
Beings. Bioethics 16 (6): 508–529.
Savulescu, Julian, and Nick Bostrom. 2008. Human Enhancement. Oxford: Oxford University
Press.
Sawyer, Robert J. 2007. Robot Ethics. Science 318 (5853): 1037. https://doi.org/10.1126/science.
1151606.
Schaich Borg, Jana, Debra Lieberman, and Kent A Kiehl. 2008. Infection, Incest, and Iniquity:
Investigating the Neural Correlates of Disgust and Morality. Journal of Cognitive
Neuroscience 20 (9): 1529–1546. https://doi.org/10.1162/jocn.2008.20109.
Schermer, M.H.N. 2007. Brave New World Versus Island—Utopian and Dystopian Views on
Psychopharmacology. Medicine, Health Care, and Philosophy 10 (2): 119–128. https://doi.
org/10.1007/s11019-007-9059-1.
Schieman, S. 2010. Socioeconomic Status and Beliefs About God’s Influence in Everyday Life.
Sociology of Religion 71 (1): 25–51. https://doi.org/10.1093/socrel/srq004.
Schmidt, C.F. 1965. Pharmacological Support for Man on Long Space Flights. Proceedings of the
National Academy of Sciences of the United States of America 53 (6): 1365–1369.
Schnall, Simone, Jonathan Haidt, Gerald L. Clore, and Alexander H. Jordan. 2008. Disgust as
Embodied Moral Judgment. Personality and Social Psychology Bulletin 34 (8): 1096–1109.
https://doi.org/10.1177/0146167208317771.
Schroeder, Joshua, Janina Kueper, Kaplan Leon, and Meir Liebergall. 2015. Stem Cells for Spine
Surgery. World Journal of Stem Cells 7 (1): 186–194. https://doi.org/10.4252/wjsc.v7.i1.186.
Schwerkoske, John P., Jason P. Caplan, and Dawn M. Benford. 2012. Self-mutilation and Biblical
Delusions: A Review. Psychosomatics 53 (4): 327–333. https://doi.org/10.1016/j.psym.2012.
01.007.
Scott, David J., Christian S. Stohler, Christine M. Egnatuk, Heng Wang, Robert A. Koeppe, and
Jon-Kar Zubieta. 2007. Individual Differences in Reward Responding Explain Placebo-induced
Expectations and Effects. Neuron 55 (2): 325–336. https://doi.org/10.1016/j.neuron.2007.06.
028.
Shander, A. 1999. Informed Consent and ‘Reform’ Jehovah’s Witness Patients. Anesthesiology 90
(6): 1787.
References 207

Shanks, Niall, Ray Greek, and Jean Greek. 2009. Are Animal Models Predictive for Humans?
Philosophy, Ethics, and Humanities in Medicine: PEHM 4 (January): 2. https://doi.org/10.
1186/1747-5341-4-2.
Shapiro, M. 2001. Plasticity, Hippocampal Place Cells, and Cognitive Maps. Archives of
Neurology 58 (6): 874–881.
Shapshay, Sandra, and Kenneth D. Pimple. 2007. Participation in Biomedical Research Is an
Imperfect Moral Duty: A Response to John Harris. Journal of Medical Ethics 33 (7): 414–417.
https://doi.org/10.1136/jme.2006.017384.
Shaw, David. 2009. Cryoethics: Seeking Life after Death. Bioethics 23 (9): 515–521. https://doi.
org/10.1111/j.1467-8519.2009.01760.x.
Shemie, S.D. 2006. Severe Brain Injury to Neurological Determination of Death: Canadian Forum
Recommendations. Canadian Medical Association Journal 174 (6): S1–S12. https://doi.org/
10.1503/cmaj.045142.
Shermer, M. 2001. Nano Nonsense and Cryonics. Scientific American 285 (3): 29.
Sherwin, S. 1992. No Longer Patient: Feminist Ethics and Health Care. Philadelphia, PA: Temple
University Press.
Shuster, E. 1997. Fifty Years Later: The Significance of the Nuremberg Code. The New England
Journal of Medicine 337 (20): 1436–1440. https://doi.org/10.1056/NEJM199711133372006.
Singer, P. 1995. How Are We to Live? Ethics in an Age of Self-interest. Mandarin: London.
Singer, P.A. 1975. Animal Liberation. NY: Harper Collins.
Singer, P.A. 1996. Rethinking Life and Death: The Collapse of Our Traditional Values. New
York: St. Martin’s Griffin.
Singer, P.A. 2009. The Life You Can Save: Acting Now to End World Poverty. NY: Random
House.
Singer, P.A. 2011. Practical Ethics, 2nd ed. Cambridge: Cambridge University Press.
Sinsheimer, Robert. 2004. Beyond Therapy …. PLoS Biology 2 (6): e181. https://doi.org/10.1371/
journal.pbio.0020181.
Smith, G.P. 1983. The Iceperson Cometh: Cryonics, Law and Medicine. Health Matrix 1 (2): 23–
35.
Smith, W.J. 2001. Revisiting the Belmont Report. The Hastings Center Report 31 (2): 5.
Sneiderman, Barney. 1991. The Shulman Case and the Right to Refuse Treatment. Humane
Medicine 7 (1): 15–21.
Soeling, Caspar, and Eckart Voland. 2002. Toward an Evolutionary Psychology of Religiosity.
Neuro Endocrinology Letters 23 Suppl 4 (December): 98–104.
Spiegel, Allen M. 2013. The Stem Cell Wars: A Dispatch from the Front. Transactions of the
American Clinical and Climatological Association 124: 94–110.
Sreenivasan, Gopal. 2003. Does Informed Consent to Research Require Comprehension? The
Lancet 362 (9400): 2016–2018. https://doi.org/10.1016/S0140-6736(03)15025-8.
Stagg, Charlotte J., and Michael A. Nitsche. 2011. Physiological Basis of Transcranial Direct
Current Stimulation. The Neuroscientist 17 (1): 37–53. https://doi.org/10.1177/
1073858410386614.
Starr, P.A., J.L. Vitek, and R.A. Bakay. 1998. Deep Brain Stimulation for Movement Disorders.
Neurosurgery Clinics of North America 9 (2): 381–402.
Steeds, Hannah, Robin L. Carhart-Harris, and James M. Stone. 2015. Drug Models of
Schizophrenia. Therapeutic Advances in Psychopharmacology 5 (1): 43–58. https://doi.org/
10.1177/2045125314557797.
Stelten, Bianca M.L., Lieke H.M. Noblesse, Linda Ackermans, Yasin Temel, and Veerle
Visser-Vandewalle. 2008. The Neurosurgical Treatment of Addiction. Neurosurgical Focus 25
(1): E5. https://doi.org/10.3171/FOC/2008/25/7/E5.
Stolberg, Sheryl Gay. 1999. The Biotech Death of Jesse Gelsinger. The New York Times
Magazine, November, 14.
208 References

Storey, K.B., D.D. Mosser, D.N. Douglas, J.E. Grundy, and J.M. Storey. 1996. Biochemistry
Below 0 Degrees C: Nature’s Frozen Vertebrates. Brazilian Journal of Medical and Biological
Research 29 (3): 283–307.
Storey, Kenneth B. 2004. Strategies for Exploration of Freeze Responsive Gene Expression:
Advances in Vertebrate Freeze Tolerance. Cryobiology 48 (2): 134–145. https://doi.org/10.
1016/j.cryobiol.2003.10.008.
St-Pierre, L.S., and M.A. Persinger. 2006. Experimental Facilitation of the Sensed Presence Is
Predicted by the Specific Patterns of the Applied Magnetic Fields, Not by Suggestibility:
Re-analyses of 19 Experiments. The International Journal of Neuroscience 116 (9): 1079–
1096. https://doi.org/10.1080/00207450600808800.
Suckiel, Ellen. 2008. Human Embryonic Stem Cell Research: A Critical Survey of the Ethical
Issues. Advances in Pediatrics 55: 79–96.
Swanson, George A. 2005. The Religious Objections and Military Opposition to Anesthetics,
1846–1848. Bulletin of Anesthesia History 23 (2): 1, 4–5, 14.
Tabakow, Pawel, Geoffrey Raisman, Wojciech Fortuna, Marcin Czyz, Juliusz Huber, Daqing Li,
Pawel Szewczyk, et al. 2014. Functional Regeneration of Supraspinal Connections in a Patient
with Transected Spinal Cord Following Transplantation of Bulbar Olfactory Ensheathing Cells
with Peripheral Nerve Bridging. Cell Transplantation 23 (12): 1631–1655. https://doi.org/10.
3727/096368914X685131.
Takala, Tuija. 2007. Concepts of ‘Person’ and ‘Liberty’, and Their Implications to Our Fading
Notions of Autonomy. Journal of Medical Ethics 33 (4): 225–228. https://doi.org/10.1136/jme.
2006.016816.
Tandy, C. 2002. The Philosophy of Robert Ettinger. Palo Alto, CA: Ria University Press.
Taylor, C. 1985. Philosophical Papers: Volume 1, Human Agency and Language, vol. 1.
Cambridge, UK: Cambridge University Press.
Temme, Leonard A. 2003. Ethics in Human Experimentation: The Two Military Physicians Who
Helped Develop the Nuremberg Code. Aviation, Space, and Environmental Medicine 74 (12):
1297–1300.
Thair, Hayley, Amy L. Holloway, Roger Newport, and Alastair D. Smith. 2017. Transcranial
Direct Current Stimulation (tdcs): A Beginner’s Guide for Design and Implementation.
Frontiers in Neuroscience 11 (November): 641. https://doi.org/10.3389/fnins.2017.00641.
The American Academy of Neurology, Quality Standards Subcommittee. 1995. Quality Standards
Subcommittee of the American Academy of Neurology. Practice Parameters for Determining
Brain Death in Adults [summary Statement]. Neurology 45 (5): 1012–1014.
The President’s Council on Bioethics. 2003. Beyond Therapy: Biotechnology and the Pursuit of
Human Improvement. Washington, DC: US Government Printing Office.
Thomson, J.J. 1985. The Trolley Problem. The Yale Law Journal 94 (6): 1395–1415.
Treasure, T. 1998. Lessons from the Bristol Case. More Openness—On Risks and on Individual
Surgeons’ Performance. BMJ (Clinical Research Ed.) 316 (7146): 1685–1686.
Truog, R.D., and J.C. Fackler. 1992. Rethinking Brain Death. Critical Care Medicine 20 (12):
1705–1713.
Truog, Robert D., and Walter M. Robinson. 2003. Role of Brain Death and the Dead-donor Rule
in the Ethics of Organ Transplantation. Critical Care Medicine 31 (9): 2391–2396. https://doi.
org/10.1097/01.CCM.0000090869.19410.3C.
Tukmachev, Dmitry, Oleg Lunov, Vitalii Zablotskii, Alexandr Dejneka, Michal Babic, Eva
Syková, and Šárka Kubinová. 2015. An Effective Strategy of Magnetic Stem Cell Delivery for
Spinal Cord Injury Therapy. Nanoscale 7 (9): 3954–3958. https://doi.org/10.1039/c4nr05791k.
Tumpey, Terrence M., Christopher F. Basler, Patricia V. Aguilar, Hui Zeng, Alicia Solórzano,
David E. Swayne, Nancy J. Cox, et al. 2005. Characterization of the Reconstructed 1918
Spanish Influenza Pandemic Virus. Science 310 (5745): 77–80. https://doi.org/10.1126/
science.1119392.
Turing, A.M. 1950. Computing Machinery and Intelligence. Mind 59 (236): 433–460.
References 209

Turner, Leigh. 2003. Bioethics and Religions: Religious Traditions and Understandings of
Morality, Health, and Illness. Health Care Analysis: HCA: Journal of Health Philosophy and
Policy 11 (3): 181–197. https://doi.org/10.1023/B:HCAN.0000005491.88004.27.
Uppal, Talat, A. Pickering, K. Erasmus, J. Pardey, and Roy G. Beran. 2012. The Legal Status of
the Fetus in New South Wales. Journal of Law and Medicine 20 (1): 178–183.
Vajta, G., Z.P. Nagy, A. Cobo, J. Conceicao, and J. Yovich. 2009. Vitrification in Assisted
Reproduction: Myths, Mistakes, Disbeliefs and Confusion. Reproductive Biomedicine Online
19 (Suppl 3): 1–7.
Van den Belt, Henk. 2009. Playing God in Frankenstein’s Footsteps: Synthetic Biology and the
Meaning of Life. Nanoethics 3 (3): 257–268. https://doi.org/10.1007/s11569-009-0079-6.
Van Kuyck, K., L. Gabriëls, P. Cosyns, L. Arckens, V. Sturm, S. Rasmussen, and B. Nuttin. 2007.
Behavioural and Physiological Effects of Electrical Stimulation in the Nucleus Accumbens: A
Review. Acta Neurochirurgica. Supplement 97 (Pt 2): 375–391.
Van Norman, G.A. 1999. A matter of life and death: What every anesthesiologist should know
about the medical, legal,and ethical aspects of declaring brain death. Anesthesiology. 91 (1):
275–87. (PubMed PMID: 10422953).
Veenema, Alexa H., and Inga D. Neumann. 2008. Central Vasopressin and Oxytocin Release:
Regulation of Complex Social Behaviours. Progress in Brain Research 170: 261–276. https://
doi.org/10.1016/S0079-6123(08)00422-6.
Vernes, Sonja C., Jérôme Nicod, Fanny M. Elahi, Julie A. Coventry, Niamh Kenny, Anne-Marie
Coupe, Louise E. Bird, Kay E. Davies, and Simon E. Fisher. 2006. Functional Genetic
Analysis of Mutations Implicated in a Human Speech and Language Disorder. Human
Molecular Genetics 15 (21): 3154–3167. https://doi.org/10.1093/hmg/ddl392.
Veronelli, Laura, Sara J. Makaretz, Megan Quimby, Bradford C. Dickerson, and Jessica A.
Collins. 2017. Geschwind Syndrome in Frontotemporal Lobar Degeneration: Neuroanatomical
and Neuropsychological Features over 9 Years. Cortex 94 (June): 27–38. https://doi.org/10.
1016/j.cortex.2017.06.003.
Viamonte, Sarah M., Karlene K. Ball, and Meredith Kilgore. 2006. A Cost-benefit Analysis of
Risk-reduction Strategies Targeted at Older Drivers. Traffic Injury Prevention 7 (4): 352–359.
https://doi.org/10.1080/15389580600791362.
Vicente, Kim J., Karima Kada-Bekhaled, Gillian Hillel, Andrea Cassano, and Beverley A. Orser.
2003. Programming Errors Contribute to Death from Patient-controlled Analgesia: Case Report
and Estimate of Probability. Canadian Journal of Anaesthesia 50 (4): 328–332. https://doi.org/
10.1007/BF03021027.
Walker-Batson, D., S. Curtis, R. Natarajan, J. Ford, N. Dronkers, E. Salmeron, J. Lai, and D.H.
Unwin. 2001. A Double-blind, Placebo-controlled Study of the Use of Amphetamine in the
Treatment of Aphasia. Stroke 32 (9): 2093–2098.
Ward, Simon E., Benjamin D. Bax, and Mark Harries. 2010. Challenges for and Current Status of
Research into Positive Modulators of AMPA Receptors. British Journal of Pharmacology 160
(2): 181–190. https://doi.org/10.1111/j.1476-5381.2010.00726.x.
Watts, Jonathan. 2002. Victims of Japan’s Notorious Unit 731 Sue. The Lancet 360 (9333): 628.
Weber, M. 1933. The Sociology of Religion. Boston: Beacon Press.
Weijer, C. 2000. Bioethics: An Anthology. BMJ (Clinical Research Ed.) 320 (7243): 1215A.
Weijer, C., P.A. Singer, B.M. Dickens, and S. Workman. 1998. Bioethics for Clinicians: 16.
Dealing with Demands for Inappropriate Treatment. Canadian Medical Association Journal
159 (7): 817–821.
Wheatley, Thalia, and Jonathan Haidt. 2005. Hypnotic Disgust Makes Moral Judgments More
Severe. Psychological Science 16 (10): 780–784. https://doi.org/10.1111/j.1467-9280.2005.
01614.x.
Whetstine, Leslie, Stephen Streat, Mike Darwin, and David Crippen. 2005. Pro/con Ethics Debate:
When Is Dead Really Dead? Critical Care 9 (6): 538–542. https://doi.org/10.1186/cc3894.
White, R.J., M.S. Albin, and J. Verdura. 1963. Isolation of the Monkey Brain. In Vitro Preparation
and Maintenance. Science 141 (3585): 1060–1061.
210 References

White, R.J., M.S. Albin, and J. Verdura. 1964. Preservation of Viability in the Isolated Monkey
Brain Utilizing a Mechanical Extracorporeal Circulation. Nature 202 (June): 1082–1083.
White, R.J., M.S. Albin, J. Verdura, Y. Takaoka, L.C. Massopust, L.R. Wolin, G.E. Locke, N.
Taslitz, and D. Yashon. 1996. The Isolation and Transplantation of the Brain. An Historical
Perspective Emphasizing the Surgical Solutions to the Design of These Classical Models.
Neurological Research 18 (3): 194–203.
White, R.K., M.S. Albin, G.E. Locke, and E. Davidson. 1965. Brain Transplantation: Prolonged
Survival of Brain after Carotid-jugular Interposition. Science 150 (3697): 779–781.
White, Robert M. 2006. The Tuskegee Study of Untreated Syphilis Revisited. The Lancet
Infectious Diseases 6 (2): 62–63. https://doi.org/10.1016/S1473-3099(06)70357-7.
White, Robert M. 2006. Effects of Untreated Syphilis in the Negro Male, 1932 to 1972: A Closure
Comes to the Tuskegee Study, 2004. Urology 67 (3): 654. https://doi.org/10.1016/j.urology.
2005.08.025.
White, T.I. 2007. In Defense of Dolphins: The New Moral Frontier. Oxford, UK: Blackwell.
Whitehouse, Peter. 2011. Empowering Whom? Neuroethics at Its Limits. The Lancet 377 (9764):
468. https://doi.org/10.1016/S0140-6736(11)60161-X.
Wijdicks, E.F. 2001. The Diagnosis of Brain Death. The New England Journal of Medicine 344
(16): 1215–1221. https://doi.org/10.1056/NEJM200104193441606.
Wijdicks, Eelco F.M. 2002. Brain Death Worldwide: Accepted Fact but No Global Consensus in
Diagnostic Criteria. Neurology 58 (1): 20–25. https://doi.org/10.1212/WNL.58.1.20.
Williams, B. 1985. Ethics and the Limits of Philosophy. Cambridge, MA: Harvard University
Press.
Williams, B. 1993. Shame and Necessity. Oakland, CA: University of California Press.
Wood, Allen. 2005. Ethics and Embryonic Stem Cell Research. Stem Cell Reviews 1 (4): 317–324.
https://doi.org/10.1385/SCR:1:4:317.
Wood, Mary F., Fredrick N. Nguyen, Michael S. Okun, Ramone L. Rodriguez, Kelly D. Foote,
and Hubert H. Fernandez. 2010. The Effect of Deep Brain Stimulation Surgery on Repetitive
Behavior in Parkinson Patients: A Case Series. Neurocase: Case Studies in Neuropsychology,
Neuropsychiatry, and Behavioural Neurology 16 (1): 31–36. https://doi.org/10.1080/
13554790903193190.
Wooldridge, D.E. 1968. The Physical Basis of Intelligent Life. NY: McGraw Hill.
World Medical Association. 2002. World Medical Association Declaration of Helsinki: Ethical
Principles for Medical Research Involving Human Subjects. Journal of Postgraduate Medicine
48 (3): 206–208.
Wu, Fan, and Cheemeng Tan. 2014. The Engineering of Artificial Cellular Nanosystems Using
Synthetic Biology Approaches. Wiley Interdisciplinary Reviews. Nanomedicine and
Nanobiotechnology 6 (4): 369–383. https://doi.org/10.1002/wnan.1265.
Yesavage, J.A., M.S. Mumenthaler, J.L. Taylor, L. Friedman, R. O’Hara, J. Sheikh,
J. Tinklenberg, and P.J. Whitehouse. 2002. Donepezil and Flight Simulator Performance:
Effects on Retention of Complex Skills. Neurology 59 (1): 123–125.
Zehr, E. Paul. 2015. Future Think: Cautiously Optimistic About Brain Augmentation Using Tissue
Engineering and Machine Interface. Frontiers in Systems Neuroscience 9 (May): 72. https://
doi.org/10.3389/fnsys.2015.00072.
Zeki, S. 2007. The Neurobiology of Love. FEBS Letters 581 (14): 2575–2579. https://doi.org/10.
1016/j.febslet.2007.03.094.
Zhao, Yong, Hui Jiang, Xin-Wei Liu, Liang-Bi Xiang, Da-Peng Zhou, and Jian-Ting Chen. 2015.
MiR-124 Promotes Bone Marrow Mesenchymal Stem Cells Differentiation into Neurogenic
Cells for Accelerating Recovery in the Spinal Cord Injury. Tissue & Cell 47 (2): 140–146.
https://doi.org/10.1016/j.tice.2015.01.007.
Zubieta, Jon-Kar, and Christian S. Stohler. 2009. Neurobiological Mechanisms of Placebo
Responses. Annals of the New York Academy of Sciences 1156 (March): 198–210. https://doi.
org/10.1111/j.1749-6632.2009.04424.x.
Index

A D
Adderall, 80 Dawkins, 151, 153, 156
Androids, 53, 67 Death, 1, 6–8, 11, 12, 18, 27, 29, 35, 39,
Animal / human hybrids, 4, 6, 7, 18, 23, 28, 32, 41–43, 45, 46, 65, 87, 93–96, 98–102,
34, 45, 47–49, 51, 52, 54, 62–65, 108, 105, 106, 109–113, 118, 122–126, 128,
113, 114, 119, 121, 122, 136, 164, 180 129, 131, 144, 154, 161, 168, 169, 177,
Artificial beings, 47, 66, 67, 69, 71, 130, 131, 181
180 Delgado, 66, 84, 85
Artificial life, 3, 4, 96 Deontological ethics, 12, 13, 23, 24
Artificial persons, 67 Dimethyltryptamine (DMT), 161
Authenticity, 87–90 DNA, 1, 4, 62, 63, 65, 66, 111, 112, 116, 143,
Autonomy, 24–27, 38, 41, 42, 44, 58, 59, 167, 144
168 Doctrine of double effect, 41
Dreams, 117, 168–174
B Dred Scott case, 2
Beauvoir, 49, 52 Drexler, 111
Bioconservatives, 34, 135, 137, 139, 140, 142,
144, 146 E
Bostrom, 3, 59, 115, 133, 139, 147 Einstein, 141, 151–153
Brain death, 7, 13, 39, 40, 93, 96–108, 112, Electrical brain stimulation, 73, 84
113 Ethics, 11–14, 17, 18, 21–26, 30, 33, 35, 41,
Brain enhancement, 78, 84, 86 47, 48, 51, 59, 71, 72, 87, 113, 121, 134,
142, 143, 150
C Eugenics, 6, 55, 56, 139
Chimeras, 63, 64 Existential risks, 58, 145
Christianity, 90, 153, 164, 174–176
Consciousness, 5, 17, 28, 50–54, 64, 67–71, F
95, 105, 112, 130, 131, 160, 162, 174 Freud, 149, 151, 169, 171, 172
Consent, 11, 15, 18, 38, 41, 42, 44–46, 62, 86, Freudian dream analysis, 171
109 Frontal lobes, 9, 149, 154, 158, 164, 165
Consequentialism, 22, 26, 30, 59 Fukuyama, 3, 9, 89, 133, 134, 136–139, 147
Cosmetic neurology, 4, 75, 77
Cryonic suspension, 6, 106, 110, 112, 115, G
116, 118, 122, 125–129, 131, 181 Genes, 4, 6, 59, 60, 62, 63, 65, 112, 116, 146,
Cyborgs, 3, 53, 67 154, 173, 174

© Springer Nature Switzerland AG 2018 211

D. J. Doyle, What Does it Mean to be Human? Life, Death, Personhood
and the Transhumanist Movement, Anticipation Science3,
https://doi.org/10.1007/978-3-319-94950-5
212 Index

Genetic engineering, 3, 11, 42, 47, 48, 55, 57, Medical futility, 11, 39, 40
61, 63, 72, 87, 112, 116, 124, 139, 144, Moral standing, 1, 6, 46–49, 54, 55, 65, 66,
150, 173, 180, 181 69–72, 85, 112, 122, 131, 180
Genospiritual engineering, 150, 173 Muramoto hypothesis, 165
Geschwind syndrome, 158, 159
God gene hypothesis, 154, 155 N
God helmet, 159 Nanotechnology, 3, 7, 8, 47, 48, 57, 59, 61, 67,
93, 96, 110, 114, 180
H Nazi doctors, 17
Harris, 5, 21, 25, 59, 60, 62, 133, 151–153, Neomorts, 108, 109
161, 162 Neurobiology of spirituality, 82
Head transplantation, 120, 121 Neuroimaging, 154, 162, 163
Heidegger, 87 Neuropharmacology, 3, 4, 6, 57, 76, 81, 135,
Hippocratic oath, 14–16 177, 181
Hughes, 8, 52–54, 71, 105, 111, 133, 145 Newberg, 162, 163
Human / computer hybrids, 1–6, 9, 13, 15, 18, Nietzsche, 49, 50, 90, 170
23, 25, 27, 28, 32, 34–38, 41, 44, 46–68, Non-heart-beating organ donors, 96, 109
70–72, 75, 76, 81–84, 86–91, 93, 95, Nonhuman personhood, 54
96, 102, 105, 107, 108, 111, 113–116, Nucleus accumbens, 66, 85
119–121, 124, 126, 127, 130, 131, Nuremberg code, 15, 17–19, 121
133–139, 142–147, 152–155, 157, 160,
165, 167, 170, 171, 173, 175–177, O
179–181 Other minds problem, 69, 71
Huxley, 75, 82, 86, 88, 89
P
I Papal bull Sublimis Deus, 2
Isolated head, 119, 120 Pathological beliefs, 7, 77, 97, 149, 165
Personhood, 1, 2, 5, 6, 28, 35, 46, 47, 49–55,
J 69, 71, 84–86, 93, 104, 105, 112–114,
James, 40, 42, 82, 111, 133, 145, 150, 157, 124, 131, 180
160, 164, 174, 177 Pharmacologic enhancement, 4, 6, 61, 75, 90
Jehovah’s Witnesses, 45, 167 Playing God, 59, 137, 142, 143
Jungian Dream Analysis, 172 Pleasure center, 85
President’s Council on Bioethics, 136
K Principlism, 11, 24–26
Kantian ethics, 11, 23, 24
Kass, 9, 34–37, 60, 133–136, 140, 142, 143, R
147 Religion, 9, 45, 50, 54, 66, 81–83, 87, 90, 123,
Kierkegaard, 87 124, 129, 149–155, 157, 159, 164, 165,
167, 169, 170, 175
L Religious experience, 82, 149, 150, 155–161,
Liberal eugenics, 55–57 164, 170, 174, 177
Life, 1, 2, 4, 7, 8, 11, 12, 16, 17, 25, 27, 28, 31, Robot ethics, 3, 71
32, 34, 37, 38, 40, 44–46, 51, 53–56, 58,
60, 64, 66, 69, 75, 77, 78, 80–82, 86–90, S
93–96, 102, 105–107, 109, 112–114, Sandel, 9, 87, 133, 135, 139, 147
119, 120, 124–131, 134, 135, 139–143, Sartre, 87, 88
150–152, 157, 159, 164, 167, 168, 170, Savulescu, 59, 133, 167
171, 173, 174, 176, 181 Schrödinger, 94
Singer, 5, 12, 18, 22, 27–29, 32, 34–37, 49,
M 106, 107, 128, 180
Marx, 90, 149, 151, 166 Solipsism, 70, 119
Medical ethics, 11, 15, 16, 20, 21, 25, 59, 124, Spaceflight, 61
167, 168
Index 213

T U
Tandy, 61, 114, 131 Unit 731, 21
Therapeutic privilege, 11, 41, 42 Utilitarianism, 11, 22, 23, 26–30, 33–36
Transhumanism, 3, 8, 9, 11, 12, 47, 48, 57, 59,
113, 129, 133, 134, 136, 138, 139, 145, V
147, 149, 150, 174–176, 179–181 Virtue ethics, 11, 12, 26, 30, 31
Transhumanist declaration, 57, 58 Vitrification, 8, 114, 116, 123
Transplantation, 7, 8, 13, 28, 39, 59, 62, 64, 96,
104–108, 117, 120, 142, 144 W
Turing test, 69, 70 Weber, 151, 166
Tuskegee syphilis study, 20 Williams, 33, 34
Wisdom of repugnance, 34, 135, 142