Ethical issues in moral and social enhancement

particularly reflective. Or they might suffer from a mental health issue that 
undermines their capacity to form complex narratives, to form and act on their 
endorsed preferences, or both. They also could be highly reflective, but in the 
Strawsonian way ‘episodic’, assigning little importance to a consistent narrative 
line, while, perhaps, focusing on current reflectively endorsed interests, desires and 
preferences. In a narrative view, the lives of the last group are less meaningful and 
incompatible with flourishing.
This brings us to the examination of the narrative ethical view. Similar to Vice 
(2003), I see no strong reason to think that the lives of the last group are necessarily 
less meaningful or incompatible with flourishing. There may be an aesthetic allure 
in the Ricoeurian view of fully flourishing life as life that is ‘complete’, but I doubt 
whether such an aesthetic preference translates into an epistemic or moral 
imperative to lead or even aim at such a life. T
he move from how 
we might 
construe ourselves through the process of creating an autobiographical identity 
narrative
 
to the conclusion that construing of such personal narrative is 
necessary 
for a meaningful or flourishing existence
 
is a strong thesis, and I have yet to 
encounter a strong argument in favour of this claim. It remains an open 
philosophical question whether only certain autobiographical narratives can be 
personal identity conferring, or whether identity can also be conveyed by non-
narrative items such as core beliefs, values, life plans, roles or relationships. And in 
medical practice, I see no strong reason to favour a narrative identity view (and 

---

131 
accept the potential objections to DBS coming with it) 
if
the patient does not 
endorse or care about it.
A related objection is rooted in the observation that 
not all identity narratives are 
good for you
. A narrative of ‘how I fail in most important aspects of life’ or ‘how 
my chronic pain determines what I do in life’ might fulfil the criteria for an 
identity-constituting narrative yet be hardly conducive to wellbeing (Morris 2012; 
Farkas 2013). Narrative scholars have long been comparing wellbeing- and 
autonomy-promoting narratives and harmful and autonomy-undermining narratives 
(Frank, 1997; Brody, 1994; Sontag, 1978), both in medicine and psychiatry. 
Psychotherapy viewed through narrative glasses can be seen as both a process of 
developing impoverished narratives or fixing fractured narratives through a process 
of re-writing harmful narratives into ones that are conducive to a flourishing life 
(Kirmayer, 2000; Adler et al. 2008; Angus and McLeod, 2004). Even if we were to 
accept the strong ethical narrative thesis that narrative is necessary for a flourishing 
life, recognizing the deleterious aspects of some narratives opens the door to the 
conclusion that one might be better off in a state of narrative-less existential 
puzzlement than to be stuck in the rut of a harmful narrative.