A Scoping Review of Ethical and Legal Issues in Behavioural Variant Frontotemporal Dementia

Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists

Autonomie und Gerechtigkeit in der neuroethischen Auseinandersetzung um Kognitionsverbesserung

A great number of existing, emerging and hypothetical technologies offers the possibility of neuroenhancement of human beings, promising (or threatening) to drastically change the lives of citizens. Among them are so called „smart drugs” - psychopharmacological interventions that allegedly boost brain power, and „neuroprosthesis“ - electromagnetic interventions in the brain in the form of interface with computers or even artificial means of augmenting cognition, new brain stimulation technologies that combat pain and control mental focus, and even highly sophisticated neuroimplants with special sensory input or electro-mechanical output. The debate on enhancement in neuroethics, the field of applied ethics analyzing the social, legal and ethical challenges of these technologies, had been sidetracked to a metaphysical argument about human nature. Most arguments against enhancement tend to concentrate on the issue of authenticity or what it means to live according to human nature. The pro-enhancement arguments are broadly utilitarian, and furthered by the claim that human brains are no more than tools among other tools of cognition, and even that human beings are “natural born cyborgs”. The issue of distributive justice has been evoked on both sides, although without specific content to the conception of justice that should be applied. The questions of what implications does neuroenhancement have for individual and especially to political autonomy are so far rather left unanswered. This dissertation conducts an in-depth case by case analysis of existing and emerging cognitive neuroenhancement technologies while extending and applying Rawls' concept of autonomy and conception of distributive justice, in order to formulate a distinct approach in neuroethics that would be political and not metaphysical. The primary objective of this research is to contribute toward answering the question: What public policies would be legitimate and effective in the context of use of cognitive enhancement drugs and devices by healthy adults in a democratic society? More specifically, the dissertation extends and applies Rawls's principles of justice and autonomy by confronting their normative requirement with contemporary empirical findings that might challenge or even undermine them. Then, sufficiently updated Rawlsian notions of autonomy and justice are used in a case-by-case analysis of existing pharmaceutical (Modafinil, Methylphenidate and Amphetamines) cognitive enhancement technologies. In the case-by-case analysis, by drawing on empirical findings on safety and efficacy, long term effects and prevalence, arguments for and against the use of a given technology are discussed and a corresponding policy approaches and models analyzed. The appropriate approach (discourage use) and model (economic disincentives model) are specified and further analyzed in the context of existing legal regulation (including international treaties) of stimulant drugs. The principles, approach and model are then also applied in a case-by-case analysis of existing electro-magnetic (transcranial magnetic stimulation and transcranial direct current stimulation) cognitive enhancement technologies. The differences between the regulatory framework in stimulant drugs and devices are analyzed, along with currently available evidence on safety and efficacy and danger profiles, before tentative conclusions about policy are made. The analysis of particular cases is then tested against general objections to a Rawlsian framework, and more specific objections to the Rawsian idea of public reason. Finally, concrete objections to the policy proposals and conclusions in specific cases of existing pharmacological and electro-magnetic cognitive enhancement technologies are reviewed and refuted.Ein breites Spektrum bestehender, aufkommender und möglicher Neurotechnologien ermöglichen menschliches „Enhancement“. Sie versprechen (oder drohen) das Leben der Bürger drastisch zu verändern. Zu diesen Technologien gehören Medikamente zur Steigerung der Gehirnleistung, Neuroimplantate für Computerschnittstellen, künstliche Behelfsmittel zur Kognitionsverbesserung, neue Gehirnstimulationstechniken um Leiden zu mindern oder Stimmungen zu kontrollieren und Hochleistungsprothesen, um (einen) speziellen sensorischen Input bzw. mechanischen Output zu ermöglichen. Die Debatte um Enhancement wurde in der Neuroethik – der Bereich der angewandten Ethik, der gesellschaftliche, rechtliche und ethische Herausforderungen dieser Technologien analysiert – stark durch metaphysische Annahmen über die menschliche Natur beeinflusst. Die meisten Argumente gegen Enhancement konzentrieren sich auf Fragen nach Authentizität und einem der menschlichen Natur entsprechenden Leben. Die Argumente für Enhancement dagegen sind im Allgemeinen utilitaristisch und stützen sich auf die Annahme, dass das menschliche Gehirn nur eines von mehreren kognitiven Werkzeugen sei und Menschen im Grunde „natural born cyborgs“ wären. Zwar wurde dabei die distributive Gerechtigkeit von beiden Seiten thematisiert, jedoch nicht der spezifische Gehalt der Gerechtigkeitskonzeption, die hier angewandt werden sollte. Fragen nach den Wirkungen von Neuroenhancement auf die individuelle und politische Autonomie blieben bisher unbeantwortet. Im Rahmen dieser Dissertation ist eine eingehende Fall-zu-Fall-Analyse bestehender und aufkommender Neuroenhancement-Technologien verfolgt worden. Dabei wurde die Rawls’sche Theorie von Autonomie und Verteilungsgerechtigkeit angewendet, um einen neuroethischen Ansatz zu formulieren, der politisch und nicht metaphysisch ist. Das Ziel dieser Forschungsarbeit war es, einen Beitrag zur Beantwortung der Frage zu leisten: An welchen grundlegenden Moralprinzipien sollten sich Gesetzgeber und Bürger in einer demokratischen Gesellschaft in Bezug auf Neuro-Enhancement orientieren? Die Disseration hat dabei insbesondere die Rawls’schen Prinzipien der Gerechtigkeit und (dessen Konzept von) Autonomie analysiert und angewandt. Dabei wurde deren normativer Gehalt mit neuen empirischen Ergebnissen konfrontiert, welche diese nicht nur herausfordern sondern sogar untergraben könnte. Daraufhin wurden hinreichend überarbeitetet Rawls'sche Prinzipien der Autonomie und Gerechtigkeit in einer Einzelfallanalyse herangezogen und auf bestehende pharmazeutische (Modafinil, Methylphenidat und Amphetamine) Technologien zur kognitiven Verbesserung angewandt. In dieser Analyse wurde durch Bezugnahme auf empirische Ergebnisse zur Sicherheit und Wirksamkeit, sowie der langfristigen Wirkungen und Prävalenz, Argumente für und gegen den Einsatz der jeweiligen Technologie(n) diskutiert und entsprechende Möglichkeiten der Regulierung sowie Modelle thematisiert. Ein Ansatz zur Regulierung („dicourage use“) und ein angemessenes Modell („economic disincentives model“) wurden formuliert und vor dem Hintergrund bestehender gesetzlicher Regelungen (einschließlich internationale Verträge) von Stimulanzien analysiert. Prinzipien, Ansatz und Modell wurden in einer Einzelfallanalyse, namentlich der kognitiven Verbesserung mittels bestehender elektromagnetischer Technologien (transkranielle Magnetstimulation und die transkranielle Gleichstromstimulation) angewandt. Die Unterschiede zwischen der bestehenden gesetzlichen Regelungen von stimulierenden Medikamenten und Geräten werden gemeinsam mit verfügbaren Daten zur Sicherheit, Wirksamkeit und Gefahrenprofile analysiert und vorläufige Schlussfolgerungen zur Frage der Regulierung formuliert. Die Analyse von Einzelfällen wurde gegen grundlegende Einwände gegen die Rawls’sche Theorie geprüft, insbesondere gegen die Kritik an Rawls’ Idee des öffentlichen Vernunftgebrauchs. Schlussendlich wurden spezifische Einwände gegen die vorgebrachten politischen Vorschläge diskutiert und Schlussfolgerungen bezüglich bestehender Technologien zur pharmakologischen und elektromagnetischen kognitiven Verbesserung wurden gezogen

Cognitive Enhancement and Academic Misconduct: A Study Exploring Their Frequency and Relationship

We investigated the acceptability and use frequency of cognitive enhancement medication and three different types of academic misconduct (plagiarism, cheating, and falsifying/fabricating data). Data collected from a web-based survey of German university students were used in our analysis. Moral acceptability of cognitive enhancers was relatively low and moderate for academic misconduct. The correlation between these measures was moderately weak. The use frequency of cognitive enhancers was lower than for academic misconduct and was (very) lightly correlated with the occurrences of reported plagiarism and fabrication/falsification. A higher acceptability of each act was associated with a higher use frequency of each act

Deciphering moral intuition: How agents, deeds, and consequences influence moral judgment

Moral evaluations occur quickly following heuristic-like intuitive processes without effortful deliberation. There are several competing explanations for this. The ADC-model predicts that moral judgment consists in concurrent evaluations of three different intuitive components: the character of a person (Agent-component, A); their actions (Deed-component, D); and the consequences brought about in the situation (Consequences-component, C). Thereby, it explains the intuitive appeal of precepts from three dominant moral theories (virtue ethics, deontology, and consequentialism), and flexible yet stable nature of moral judgment. Insistence on single-component explanations has led to many centuries of debate as to which moral precepts and theories best describe (or should guide) moral evaluation. This study consists of two large-scale experiments and provides a first empirical investigation of predictions yielded by the ADC model. We use vignettes describing different moral situations in which all components of the model are varied simultaneously. Experiment 1 (within-subject design) shows that positive descriptions of the A-, D-, and C-components of moral intuition lead to more positive moral judgments in a situation with low-stakes. Also, interaction effects between the components were discovered. Experiment 2 further investigates these results in a between-subject design. We found that the effects of the A-, D-, and Ccomponents vary in strength in a high-stakes situation. Moreover, sex, age, education, and social status had no effects. However, preferences for precepts in certain moral theories (PPIMT) partially moderated the effects of the A- and C-component. Future research on moral intuitions should consider the simultaneous three-component constitution of moral judgment

Cognitive Enhancement in Germany : Prevalence, Attitudes, Moral Acceptability, Terms, Legal Status, and the Ethics Debate

Sattler S. Cognitive Enhancement in Germany : Prevalence, Attitudes, Moral Acceptability, Terms, Legal Status, and the Ethics Debate. In: Jotterand F, Dubljevic V, eds. Cognitive Enhancement. Ethical and Policy Implications in International Perspectives. Oxford University Press; 2016: 159-180

Toward a rational and ethical sociotechnical system of autonomous vehicles: A novel application of multi-criteria decision analysis

The expansion of artificial intelligence (AI) and autonomous systems has shown the potential to generate enormous social good while also raising serious ethical and safety concerns. AI technology is increasingly adopted in transportation. A survey of various in-vehicle technologies found that approximately 64% of the respondents used a smartphone application to assist with their travel. The top-used applications were navigation and real-time traffic information systems. Among those who used smartphones during their commutes, the top-used applications were navigation and entertainment. There is a pressing need to address relevant social concerns to allow for the development of systems of intelligent agents that are informed and cognizant of ethical standards. Doing so will facilitate the responsible integration of these systems in society. To this end, we have applied Multi-Criteria Decision Analysis (MCDA) to develop a formal Multi-Attribute Impact Assessment (MAIA) questionnaire for examining the social and ethical issues associated with the uptake of AI. We have focused on the domain of autonomous vehicles (AVs) because of their imminent expansion. However, AVs could serve as a stand-in for any domain where intelligent, autonomous agents interact with humans, either on an individual level (e.g., pedestrians, passengers) or a societal level