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An increasingly blurred understanding of the moral significance of accurate and authentic memory reconsolidation for an adequate apprehension of self, other, and community suggests a critical need to explore the inter-relationships shared between autobiographical memory, emotional rationality, and narrative identity in light of the contemporary possibilities of neurocognitive memory manipulation, particularly as it bears on ethical decision making. Grounding its thesis in four evidential effects – namely, (i) neurocognitive memory manipulation disintegrates autobiographical memory, (ii) the disintegration of autobiographical memory degenerates emotional rationality, (iii) the degeneration of emotional rationality decays narrative identity, and (iv) the decay of narrative identity disables one to seek, identify, and act on the good – the dissertation argues that neurocognitive memory manipulation cannot be justified as a morally licit biomedical practice insofar as it disables one to seek, identify, and act on the good. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

This dissertation focuses on the concept of authenticity and its implications for our projects of self-creation, particularly those involving the use of "enhancement technologies" (such as stimulant drugs, "mood brighteners", or brain stimulation). After an introduction to the concept of authenticity and the enhancement debate in the first part of the thesis, part 2 considers the main analyses of authenticity in the contemporary philosophical literature. It begins with those emphasizing self-creation, and shows that, despite their merits, such views cannot adequately deal with certain types of cases, which require a third option, “true self” accounts, emphasizing self-discovery. However, it is argued that in their existing versions, accounts of this third sort are also unsatisfactory. Part 3 of the thesis proposes a new account of the "true self" sort, intended to improve upon existing ones. Common problematic assumptions about the concept of the true self are critiqued, after which a new analysis of that concept is presented, based on seven different conditions. Two specific definitions of authenticity, respectively emphasizing self-expression and the preservation of one's true self, are provided, and its relation to various associated notions, such as integrity or sincerity, are examined. Finally, part 4 looks at the implications of the previous parts for the enhancement debate. In particular, it discusses the prospect of technologically enhancing our personality and mood dispositions. Do such interventions always threaten our authenticity, as some worry? A negative answer is provided to that question. Various potential pitfalls hinted at by the inauthenticity worry are discussed and acknowledged. It is, however, argued that such enhancements could still in principle be used in a fully authentic manner, and that they have the potential to bring about genuine improvements in our mood but also to our moral capacities and our affective rationality more generally.

Dans son analyse de la démarche de socialisation des enfants, Émile Durkheim met en garde contre « toute action positive destinée à imprimer une orientation déterminée à l’esprit de la jeunesse ». Notre thèse explore les déclinaisons contemporaines de ces « actions positives » qui émanent de l’État et de différents éléments de la société, et qui, en modifiant le fonctionnement cérébral, entendent orienter le comportement d’enfants non malades vers davantage d’attention et moins d’impulsivité. Cette orientation recouvre un enjeu politique : la réduction des inégalités dans les capacités cérébrales, qui tendent à devenir des inégalités majeures dans la société de performance contemporaine. Notre objet de recherche est constitué par les nouveaux pouvoirs exercés par les adultes sur les enfants, au moyen de techniques biomédicales nouvelles, en particulier par des substances chimiques : les médicaments psychostimulants. Les moyens biomédicaux s’exercent directement sur le fonctionnement cérébral, de manière intrusive, sans la médiation du langage et de la communication, et posent de ce fait des nouvelles questions liées à leur puissance d’action. Ce travail se donne pour objectif de contribuer à une théorie de la justice cognitive pour les enfants. Les nouvelles significations des inégalités d’attention dans les apprentissages, les enjeux sociaux de ces inégalités dans une société de performance et les nouvelles possibilités d’intervention biomédicales sur le fonctionnement cérébral des enfants convergent vers de nouvelles formes dans l’économie psychique des enfants. Il semble possible d’interpréter ces nouvelles forces à l’œuvre comme s’inspirant d’un principe de justice. Le débat autour d’une justice cognitive reflète alors le caractère ressenti comme insupportable socialement des inégalités d’attention et le caractère ressenti comme inévitable de la réponse pharmacologique qui lui est associée. Le recours à la théorie d’une justice cognitive implique, pour l’analyse des pratiques de prescription massives de Ritaline, de se situer au-delà du paradigme habituel de contrôle social et de contrôle des comportements par la médicalisation de la société. / The analysis of children’s socialization process made by Emile Durkheim warns us against any actions intended to have an impact on the orientation of the young spirits. Our thesis explores the contemporary range of these positive actions issued from the state as well as from different parts of society. Those ones, by modifying the proper cerebral functioning, are guiding the behaviour of non-ill toward more attention and less impulsivness. This subject has a significant political concern: the reduction of cerebral inequal capacities which tend to become more and more important in our contemporary performance oriented society. Our research investigates new powers exerciced by adults on children, through the use of modern biomedical techniques, and particuly through psychostimulant pharmaceuticals. Biomedical tools directly reach the functioning brain, in an intrusive way, without the intermediate of either language or communication, which therefore arises new questions about their power of action. The aim of this study is to contribute to a theory of a cognitive justice for children. The new meanings of the inequalities of focus in learning, the social issues of these inequalities in a performance society and the new possibilities of biomedical intervention on the functioning brain converge towards new forms in psychic economy of children. It seems possible to interpret those new forces in action through a principle of justice. The debate around a cognitive justice reflects the unbearable social aspect of the disparities in attention capacity and the hypothetically unavoidable pharmacological answers associated to it. The solution of the theory of cognitive justice involves, for the pratical analysis of the massive instruction of Ritaline, to be situated beyond the usual paradigm of social control and behavioural control through society’s medicalization.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

La problématique de mes recherches porte sur le langage – plus particulièrement, la communication humaine dans la perspective interdisciplinaire. Ainsi mes recherches puisent dans la philosophie (la philosophie du langage, l’éthique), la sociologie (Goffman, Mead), la psychologie (Piaget, Kohlberg, Watzlawick), la sociolinguistique, la linguistique (Jakobson, Buhler), la communication (Craig, McQuail) la neuroéthique (Patricia Churchland, Martha J. Farah). Cette « mosaïque » disciplinaire a pour objectif d’étudier la complexité de la communication interpersonnelle sous plusieurs points de vue afin de bien déterminer ses éléments « techniquement » constitutifs. Ceci permettra d’établir un groupe des facteurs qui jouent un rôle important dans la constitution de l’éthique de la communication. / The problematic of my research concerns language - in particular, human communication in the interdisciplinary perspective. My research is based on philosophy (philosophy of language, ethics), sociology (Goffman, Mead), psychology (Piaget, Kohlberg, Watzlawick), sociolinguistics, linguistics (Jakobson, Buhler) Craig, McQuail) neuroethics (Patricia Churchland, Martha J. Farah). This disciplinary "mosaic" aims to study the complexity of interpersonal communication from several points of view in order to determine its "technically" constitutive elements. This will help establish a group of factors that play an important role in shaping the ethics of communication.

Essay I explores brain machine interface (BMI) technologies. These make direct communication between the brain and a machine possible by means of electrical stimuli. This essay reviews the existing and emerging technologies in this field and offers a systematic inquiry into the relevant ethical problems that are likely to emerge in the following decades. Essay II, co-written with professor Sven-Ove Hansson, presents a novel procedure to engage the public in ethical deliberations on the potential impacts of brain machine interface technology. We call this procedure a Convergence seminar, a form of scenario-based group discussion that is founded on the idea of hypothetical retrospection. The theoretical background of this procedure and the results of the five seminars are presented here. Essay III discusses moral enhancement, an instance of human enhancement that alters a person’s dispositions, emotions or behavior in order to make that person more moral. Moral enhancement could be carried out in three different ways. The first strategy is behavioral enhancement. The second strategy, favored by prominent defenders of moral enhancement, is emotional enhancement. The third strategy is the enhancement of moral dispositions, such as empathy and inequity aversion. I argue that we ought to implement a combination of the second and third strategies. / <p>QC 20121206</p>