Ethical issues in moral and social enhancement

pharmacopeia
toolkit 
widens.
Brain stimulation is a more speculative mode of MB. In this work I will focus on 
deep brain stimulation (DBS) and not on non-invasive brain stimulation methods, 
because emotion modulation is more likely to involve stimulation of structures deep 
in the brain. If developments in technology allow non-invasive stimulation of those 
brain structures and circuits, this may change the balance of costs and benefits, yet 
the more general arguments presented in this thesis will also apply to those 
methods. The current deep brain stimulation technology is mostly used for 
movement disorders and Parkinson’s and the move towards application in 
neuropsychiatric disorders has met with considerable controversy (see: Pacholczyk, 
2015). However, the behavioural changes observed in treatment of other disorders 
as well as the research on stimulation-induced behaviour and mood change, indicate 
that attempts at MB are within reasonable reach. The application of brain 
stimulation for such purpose in the near future is likely to be slow, if any. This is 
partially due to high surgical and post-surgical risks related to the necessity for 
surgically implanting electrodes, partially due to the history of brain surgery and 
related professional and social resistance and partially due to high cost of the 
procedure and subsequent check-ups and maintenance of the stimulation device.

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Ablative procedures to decrease aggressive behaviour (procedures in which a part 
of the brain is destroyed) has been largely stopped by the 1980s due to social 
pressure and ethical concerns. However, rarely appearing single cases and small 
follow-up studies indicate that a small number of patients, predominantly those 
with mental retardation and for whom no pharmacological treatment was effective, 
receive such treatment in a mental health setting (See Jiminez-Ponce et al. 2011). 
This opens the door for using brain stimulation in similar cases – a technique more 
expensive and inconvenient but also more flexible in its effects. Moreover, brain 
stimulation offers to be more specific and flexible in the future than generally 
acting pharmacological neuromodulators. Adjustable and changeable settings and 
the ability target a specific brain region/circuit make this technique potentially 
promising biomedical method.
Although the use of pharmacology and brain stimulation for moral modification and 
modulating pro-sociality is to some extent speculative, biomedicine’s potential for 
emotion modulation has been shown in the treatments of mood disorders. However, 
using biomedical tools to change our moral and social functioning raises ethical 
questions and it is the aim of this thesis to examine some of them and to contribute 
to the current debate on this topic. 
The leading question of this thesis is ‘What ethical issues should I consider when 
deciding whether and how to use biomedical means of moral modification?’ The 
common tread throughout this work is the importance of engaging with moral 
reasons in choosing, guiding the application and assessing the effects of MB. 
Chapters 1-4 focus on the conceptual issues and the plausibility of MB. Chapters 5-
7 address objections and doubts about the ethical desirability of MB. Chapters 7 
and 8 focus on the arguments related to the potential impact of MB on freedom and 
moral agency.
In Chapter 1 I raise the question of possible meanings of the phrase ‘moral 
enhancement’ in order to outline the possible applications of moral modification. 
This discussion also allows distinguishing different levels and aspects of ethical 
assessment that a MB can be subject to. Moral enhancement’ is a potentially 
ambiguous term. Section 1.2 examines what ‘moral’ in the phrase ‘moral 
enhancement’ means and section 1.3 (especially section 1.3.3.) focuses on drawing 

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an interpretation what ‘enhancement’ amounts in order to show the range of 
potential uses MB can be put to and discuss what matters ethically with those 
different uses in mind. Further, section 1.3 briefly discusses the meaning of the 
term ‘enhancement’ in the context of the treatment and enhancement distinction 
(1.3.2) and propose the understanding of enhancement as improvement (s. 1.3.3) 
with an aim of drawing the scope of the current discussion. Understanding 
enhancement as improvement provides a frame for the scope of the discussion in 
the current work, and underlies the consideration of both therapeutic and non-
therapeutic uses of MB and emotion modulation in this work (see also Chapter 5).
Chapter 2 addresses doubts about the plausibility of MB. It considers whether 
specifically biomedical means of modifying the moral sphere are likely to be 
effective, asks what kinds of effects can be expected after MB and thus what goals 
are in this context reasonable. It also considers what should be taken into 
consideration when making ethical assessment of costs and benefits (see also 
Chapter 7). I argue that the goals for MB set out by some of the proponents are too 
ambitious and should be revisited. However, if we set similar expectations to the 
expectations we have of cognitive enhancement, meaningful moral or social 
enhancement is plausible. 
Chapter 3 focuses on the discussion of modification of pro-social emotions and 
attitudes proposed by some to be a target for MB focused on enhancing moral 
agency. It explores the conflation between the moral and the pro-social present in 
the literature as well as the discourse in which some, but not all, emotions as 
constructed as being themselves ‘moral’. The aim of the Chapter is to ask whether 
or not biomedically modulating pro-social emotions and attitudes such as empathy 
would likely better moral agency. I argue that empathy and anger might have both 
pro-social and anti-social consequences, and that even pro-social sentiments are not 
sufficient for morality. Instead I propose that engagement with moral reasons is 
necessary for biomedical modification of emotion to result in better moral agency. 
Chapter 4 raises the question of the extent to which the presence of moral 
disagreement affects the application of MB? Section 4.1 explores the limitation of 
the scope of the argument that MB may be implausible in the presence of moral 
disagreement. In section 4.3 I examine the implications of fundamental moral 

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disagreement for MB and argue that although moral disagreement may pose a 
challenge for evaluation of MB applications, there is no reason to favour the 
status 
quo 
in the outcome of this deliberation.
Chapter 5 asks whether using specifically biomedical means of moral modification 
gives rise to a strong ethical reason to forgo using MB. After examining arguments 
brought forward by critics of medicalization, I argue the process of medicalization 
is in itself neutral, and only acquires meaning on the basis of what medicalization 
allows us to do and what costs it brings with it.
Chapter 6 explores the concerns raised in relation to identity. I ask to what extent 
MB may threaten the narrative identity of the agent and whether such threats can 
give raise to strong moral reasons to forego the use of MB. After examining 
attempts at base strong ethical objections to the use of MB on Schechtman’s and 
Ricoeur’s accounts of narrative identity, I argue that narrative identity theories face 
serious problems in providing strong ethical action-guiding reasons. 
The last two chapters discuss the impact of MB on freedom and agency. Chapter 7 
asks to what extent issues raised in relation to freedom in the discussion of 
Savulescu and Persson’s (2012a) thought experiment called the God Machine call 
the desirability of MB into doubt. I argue that although the discussion of the God 
Machine allows for teasing out what we find important in agency (and I suggest 
that the God Machine would threaten moral agency by affecting the ability of the 
agent to engage with moral reasons in affected action thus undermining the creation 
of one’s own free will), the conclusions that can be applied from this discussion to 
real-world MB are limited.
Chapter 8 asks in what way could real-world agent-led MB endanger and facilitate 
moral agency. I critically examine Harris’ (2011) objection that MB would be 
beyond moral review. Further, I consider MB in the context of Aristotelian 
framework and limitations of self-control and argue that we should aim for virtue. 

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