Ethical issues in moral and social enhancement

6.2.2.
 
Schechtman’s objection to biomedical modification 
 
In her paper about DBS and narrative identity, Schechtman (2009) 
considers the 
hypothetical case of a patient who experiences personality changes after DBS: 
‘Mr. Garrison, a 61-year-old American with PD who 
consents to DBS to treat his tremors and severe apathy. 
Following surgery, Mr. Garrison experiences significant 
improvement in his motor symptoms and dramatic changes 
in personality. Where once he was shy and introverted, he is 
now outgoing and gregarious. Where once he was a loyal 
Republican, he is now a Democrat. Where once he was 
enthusiastic about his work, he has now quit his job to 
promote various social, political and charitable causes.’ 
(case formulation as in: Baylis, 2013) 
This case is hypothetical and simplified but both imaginable and plausible – it is 
consistent with reports of actual cases of personality changes, changes in attitudes 
towards work and psychosocial adjustment challenges faced by some DBS patients 
(Agid et al. 2006, Schupach et al. 2006).
Personality changes that result from DBS, Schechtman argues, are at odds with the 
articulation constraint on identity-constituting narratives according to which ‘the 
narrator should be able to explain why he does what he does, believes what he 
believes, and feels what he feels’ (1996, p. 114). When the causes of actions can be 
traced back to the influence of DBS, patients may not be able to explain how their 
actions are rooted in their ‘plans, projects, intentions, beliefs, and desires’ – 
because they are not
. Schechtman argues that ‘his current passions and interests – 

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the things he takes as reasons – were caused by manipulation of his brain’ (2009, p. 
85). This requirement can be related to the importance of engaging with reasons for 
action when pursuing moral modification aimed at creating better moral agents. I 
have argued that moral enhancement understood as making moral better people 
necessitates deliberation in general and engagement with moral reasons specifically 
(see Chapter 1, 3, 7 and 8), and it would be a pyrrhic victory to use means that 
undermine the ability of an agent to act autonomously and act on the will of their 
own (see Chapter 7). Schechtman suggests that if Mr. Garrison were to suggest that 
his new passions and interests were the result of personal development and not 
DBS, then his narrative would not fulfil the reality constraint, according to which 
the self-narrative must cohere with basic observational facts about the world. 
Thus, 
what seems to be particularly problematic for Schechtman is the means by which 
personality changes occur – as a result of having electrodes implanted in the brain, 
not ‘natural personal development’ (2009, p. 85). 
Schechtman’s discussion of DBS is relevant for the discussion of MB for several 
reasons. Firstly, she describes personality change as relevant to moral action. 
Secondly, even if no morally relevant behaviour was mentioned, the narrative 
identity objection would apply to all biomedical enhancements that change traits 
that are important to narrative identity, including moral enhancement in the sense of 
a morally desirable enhancement of any sphere or function (see: Chapter 1, s. 1.2.1). 
Biomedical attempts at moral enhancement understood as modification in the moral 
sphere (Chapter 1 s. 1.2.3), are likely to change how the person functions in their 
social realm, thus being likely to be relevant to narrative identity as understood by 
Schechtman. In this discussion, it does not matter whether an intervention is an all-
things-considered moral enhancement or dis-enhancement in the sense of making 
better moral agents (see Chapter 1, s. 1.2.2). In this discussion we will focus on 
how modification of the moral sphere in general could affects narrative identity.
One could object and argue that the difference between Schechtman's case and MB 
lies in the intention to change and the desirability of given personality changes. The 
patient that underwent DBS for Parkinson’s disease desired the decrease of 
Parkinson’s symptoms, but not the personality and psychosocial changes. On the 
other hand, in the case of MB the changes are both desired and intended. But 
consider an analogical case: 

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Mr Morrison, a 61-year-old American who consents to 
DBS to increase his empathy. Following surgery, Mr. 
Morrison experiences significant increases in empathy on 
several measures and dramatic changes in personality. 
Where once he was shy and introverted, he is now 
outgoing and gregarious. Where once he was a loyal 
Republican, he is now a Democrat. Where once he was 
enthusiastic about his work, he has now quit his job to 
promote various social, political and charitable causes. 
It is not clear that this hypothetical case differs from Schechtman’s in any relevant 
way. Mr Morrison might have wanted a change in a narrow cognitive-emotional 
aspect, yet got much more than he bargained for. Alternatively, he might have 
anticipated and accepted a dramatic personality change. One way or another, that he 
has anticipated and accepted the outcomes does not change the fact that his identity-
narrative might have been disrupted.
The case would also be relevant to the ethical evaluation of attempts at biomedical 
enhancement via direct emotion modulation by psychopharmacological means. 
Consider the following hypothetical case: 
Mr Ferrison, a 61-year-old American who consents to 
pharmacological modulation of oxytocin to increase his 
empathy. Following treatment, Mr. Ferrison experiences 
significant increases in empathy on several measures and 
dramatic changes in personality. Where once he was shy 
and introverted, he is now outgoing and gregarious. Where 
once he was a loyal Republican, he is now a Democrat. 
Where once he was enthusiastic about his work, he has 
now quit his job to promote various social, political and 
charitable causes. 
This example is similar to Schechtman’s and is hypothetical yet plausible. Oxytocin 
might modulate some mechanisms that underpin empathy, but also affects a host of 
other abilities and functions. It might increase trust in situations judged as safe, 
result in increased envy, promote parent-child bonding, influence attachment, 

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increase out-group bias, etc. There also seems to be a link between oxytocin and the 
effects of stress. As a result, if the change in oxytocin levels results in observable 
changes in morally-relevant actions, it will likely result in observable changes in 
personality. Thus, Schechtman’s objection to DBS is also relevant to at least some 
proposed methods of MB, and especially to attempts at moral enhancement by 
direct emotion modulation.