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Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for prescriptively judging the ethical applications of neurotechnologies. Plentiful normative premises are available to ground such prescriptivity, however prescriptive neuroethics may remain fragmented by social conventions, cultural ideologies, and ethical theories. Herein we offer that an objectively principled neuroethics for international relevance requires a new meta-ethics: understanding how morality works, and how humans manage and improve morality, as objectively based on the brain and social sciences. This new meta-ethics will simultaneously equip neuroethics for evaluating and revising older cultural ideologies and ethical theories, and direct neuroethics towards scientifically valid views of encultured humans intelligently managing moralities. Bypassing absolutism, cultural essentialisms, and unrealistic ethical philosophies, neuroethics arrives at a small set of principles about proper human flourishing that are more culturally inclusive and cosmopolitan in spirit. This cosmopolitanism in turn suggests augmentations to traditional medical ethics in the form of four principled guidelines for international consideration: Self-creativity, Non-obsolescence, Empowerment, and Citizenship. neuroscience, prescriptive neuroethics, principled neuroethics, cultural pluralism, meta-ethics, cosmopolitanism, medical ethics.
E D I T O R I A L Open Access
A principled and cosmopolitan neuroethics:
considerations for international relevance
John R Shook
and James Giordano
Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for
prescriptively judging the ethical applications of neurotechnologies. Plentiful normative premises are available to
ground such prescriptivity, however prescriptive neuroethics may remain fragmented by social conventions, cultural
ideologies, and ethical theories. Herein we offer that an objectively principled neuroethics for international relevance
requires a new meta-ethics: understanding how morality works, and how humans manage and improve morality, as
objectively based on the brain and social sciences. This new meta-ethics will simultaneously equip neuroethics for
evaluating and revising older cultural ideologies and ethical theories, and direct neuroethics towards scientifically valid
views of encultured humans intelligently managing moralities. Bypassing absolutism, cultural essentialisms, and
unrealistic ethical philosophies, neuroethics arrives at a small set of principles about proper human flourishing that are
more culturally inclusive and cosmopolitan in spirit. This cosmopolitanism in turn suggests augmentations to traditional
medical ethics in the form of four principled guidelines for international consideration: empowerment, non-obsolescence,
self-creativity, and citizenship.
Keywords: Neuroscience, Prescriptive neuroethics, Principled neuroethics, Cultural pluralism, Meta-ethics,
Cosmopolitanism, Medical ethics
International neuroethics
The scientific foundations of neuroethics are structured
upon advances in the brain and behavioral sciences, and
in the novel technologies that allow access, evaluation,
and manipulation of the brain and its functions, inclu-
sive of the amalgam of conscious processes, cognitions,
and emotions that contribute to the mindand/or the
self. The ever-broadening use of neuroscience and neu-
rotechnology arouses scrutiny of longstanding common
senseand philosophical concepts of the relation of brain
to mind, and compels inquiry to the validity and value of
these ideas and their implications in the scientific,
medical and socio-cultural realms.
It is in this critical light that the philosophical founda-
tions for neuroethics are also gradually, yet steadily or-
ganizing. (Examples of broadly philosophical treatments
of neuroethics include Levy [1] and the work of Racine
[2]). These foundations are based in part upon extant
constructs of science, mind, self, and social relations, and
yet, we opine that there is an increased need for their re-
examination and perhaps reconstruction in light of new
information from the brain sciences, to update epistemo-
logical, anthropological, and ethical norms. Better under-
standing of how those normative sources have functioned
for humanity to date especially because they can now be
openly scrutinized can then be leveraged in formulating
concepts, constructs, and constraints regarding the ways
that neuroscientific research could and should be con-
ducted and applied in medicine to evoke effect(s) within
cultures and the social sphere. Clearly, neuroethics will be
an essential part of any such view [3-5]. Prescriptions for
what ought to be done about these implications soon fol-
low. Thus, neuroethics will be inescapably prescriptive, and
justifications for those prescriptions will rely on normative
premises. Normative premises are abundantly available: so-
cial, moral, and legal norms abound from all directions and
every culture. Neuroethics might remain prescriptively
splintered by such normative diversity and convention-
ality. Therefore, we ask if neuroethics as a philosophical
* Correspondence:
Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics,
Georgetown University Medical Center, 4000 Reservoir Road, Bldg D Rm 238,
Washington, DC 20057, USA
Human Science Center, Ludwig-Maximilians Universität, Munich, GER, Germany
Full list of author information is available at the end of the article
© 2014 Shook and Giordano; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public
Domain Dedication waiver ( applies to the data made available in this
article, unless otherwise stated.
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1
field can define and settle on core norms to take a uni-
fied principled stance? If it can, where will those nor-
mative premises be found, which ethical principles for
neuroethics would be wise, and what policy and legal reg-
ulations would follow from such ethical principles?
We assert that pondering a unified principled stance
for neuroethics is not an idle speculative venture. The field
of neuroethics is confronted with urgent international ques-
tions of how to deal with brain research and the uses of
novel neurotechnologies originating in many countries and
quickly crossing borders, whether from benevolent, com-
mercial, or even malevolent intent. Looking globally, neuro-
Western nations, as shifts in scientific, technological and
economic capabilities are evermore enabling non-Western
countries to become viably engaged in a growing inter-
national market of neuroscience (currently estimated at
greater than $150 billion annually). This shifting balance
will necessitate addressing ethical, legal, and social issues
incurred through the use of neuroscience and technology
not only in developed nations, but in those that are devel-
oping and under-developed, as well. The worldwide discus-
sion of neuroscience and neuroethics has swelled, and will
neuroethics relevant to upgrading international policies
and laws are mounting accordingly [8-11]. As a field
and set of practices, neuroethics should be involved in
these international deliberations, because its theoretical
resources allow direct examination and evaluation of the
human being, and human predicament (of disease, illness,
suffering and finitude) from a metaphysically and meth-
odologically naturalistic grounding and perspective that is
1) well comported with medicine, 2) conciliatory toward
human cultural diversity and 3) not incompatible with
theological views. Accordingly, we further urge that neu-
roethics should forge philosophical foundations and theor-
etical ethics that are universally and objectively valid as
science itself. To this end, we address the following core
issues. How might neuroscientific information about puta-
tive bases of moral cognitions and actions be engaged to
establish a basis for the development of ethical systems
and practices that are naturalistically grounded? Can such
neuroethical deliberations be guided by more than just
one cultures ethical ideals in order to guide the ways that
neuroscientific research is conducted and applied on the
world stage?
We affirmatively answer these questions in five stages.
First, the primary modes of prescriptive neuroethics are
outlined, showing how their argumentative forms admit-
tedly fit better with social conventionality than with ethical
theorizing. Second, a path for neuroethics to transcend in-
adequate ethical theorizing and outdated meta-ethics is
cleared, a new meta-ethics for neuroethics is revealed, and
hopes are posed that neuroethics can undertake ethical
theorizing. Third, neuroethics is shown to be compatible
with a modest type of cosmopolitan ethics that we believe
will be important to a broader, more naturalistic, and cul-
turally inclusive ethico-legal discourse. Fourth, in the spirit
of cosmopolitanism, (four) principled guidelines for a more
internationally capable neuroethics are proposed for consid-
eration: Empowerment, Non-obsolescence, Self-creativity,
and Citizenship. Finally, this philosophical path from syn-
apse to societyand on to a principled international neu-
roethics is defended against expected objections.
Prescriptive neuroethics
Pro Roskies [12], neuroethics has inherently (if not axi-
omatically) embraced two central matters: first, studying
neural function to understanding how our species and
others developed and manifest capacities for sociality
and morality; and second, undertaking ethical thinking
about researching and modifying neural structure and
functions of cognitions, emotions, and behaviors using
the techniques and technologies of neuroscience. The first
mode of neuroethics explores how new knowledge about
the functions of the brain may impact wider understand-
ings of self, social relations, and culture. The second mode
of neuroethics explores how such self- and socio-cultural
understandings should be applied to judging the implica-
tions and potential effects of neuroscientific research and
its employment in various domains of the social sphere.
Pondering how new neuroscientific information about the
processes of intentional volition may indicate modifica-
tions to criteria for criminal responsibility and just punish-
ment is an example of the first mode; pondering whether
convicted criminals should receive novel brain modifica-
tions to diminish their anti-social conduct is an example
of the second.
Both modes have factually descriptive components [2];
both are normatively prescriptive as well. The prevalence
of prescriptivity throughout neuroethics deserves more
attention. The dual-aspect nature of neuroethics is gen-
erally acknowledged, but the disadvantages of bifurcating
neuroethics into traditionssuch a neuroscience of ethics
contrasted with an ethics of neuroscienceshould also be
recognized [13-15]. Distinctions can inflate into dichoto-
mies, especially where the gravity of traditional dichoto-
mies exert philosophical pull. The is-oughtdivide can
particularly sway an ethics of neuroscience towards envel-
oping all of the prescriptive work. On the contrary, the way
that the neuroscience of ethics recommends adjust-
ments to our conceptions of self, morality, and society
necessarily involves sensitively important normative and
ethical issues [16]. A non-normative and purely descriptive
neuroethics only appears feasible where some common no-
tion of sociality or morality is appraised as unquestionably
correct and made the object of research. This purede-
scription of the way humans do thingshides its normative
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 2 of 13
prescriptivity behind a façade of unrecognized cultural con-
ventionality. As soon as this purely descriptiveneuroethics
is forced to notice how differing conceptions of sociality
and morality are available for selective research, its purity is
adulterated by normativity. Furthermore, any neuroethical
judgment that sociality or moral responsibility needs to be
re-conceived in light of fresh neuroscience exposes how this
descriptiveneuroethics is already on prescriptive territory,
since a specific norm of sociality or moral responsibility is
getting selected for scrutiny, and some alteration to that
norm is recommended for its better fitwith the current
recognized facts about brain function afforded by neurosci-
ence. Both modes of neuroethics are unavoidably prescrip-
tive.Furthermore,thedualmodes of neuroethics must be
intricately connected across both descriptive and prescrip-
tive dimensions, since novel self-conceptions must affect
methods of doing ethics, which in turn will change how
ethical norms are applied to proposed brain technologies
that can further modify (self)-conceptions of humanity.
To avoid chaotically changing everything at once, philo-
sophical reflection typically approaches matters piecemeal.
For both modes of doing neuroethics, even the most so-
phisticated arguments yielding prescriptions can exemplify
a basic form. For the first mode, some item of neuroscien-
tific knowledge is premised in order to justify modify-
ing certain socio-cultural views. Hold the science steadily
in view, and recommend socio-cultural change to keep a
good fit with the realities science affords. For the second
mode, some view of the human being and/or socio-
culture is premised in order to justify a verdict on the ap-
propriateness of employing a neuroscientific technique or
technology in research or practice. Here, hold the self-
socio-cultural view steadily in view, and use those norms
to evaluate neuroscientific change(s) to brain structure
and functions of cognition, emotion and/or behavior. Both
modes basically hold one side of the neuroscientific/self-
socio-cultural formula steady, and recommend what must
be done (or not done) to the other to maintain some sense
of balance or coherence.
At first glance, the philosophical quest for coherence
and stability sounds reasonable enough. However, abun-
dant resistance arises from all directions to obstruct
revisions to self-socio-cultural matters, or to prevent de-
ployment of novel technologies. Prevailing cultural tradi-
tions and ideologies (including folk psychologies, common
morals, religious traditions, economic and political sys-
tems, etc.) mount resistance to modifying conceptions of
the human being/society/culture, especially where those
conceptions have normative dimensions. Struggles over
brain science that might be relevant to sensitive matters
such as gender or sexuality, family bonds and roles, per-
sonhood status and autonomy (e.g., of the mentally ill or
criminals) supply just a few examples. Struggles just as eas-
ily erupt over opportunities to utilize novel technologies.
On most any issue, opposed positions tend to develop and
harden: one camp conservatively rejects using a new tech-
nology by appealing to stable tradition, while the other
camp progressively recommends a novel social structure
made possible by some new technology [17]. Both camps
appeal to anything useful at hand, such as moral intui-
tions, common social standards, cultural norms, and legal
rules. Indeed, so many of these are available for recruit-
ment by both sides that neither camp may prevail, result-
ing in deadlock.
Only where there is wide agreement on priorities would
we expect to see somewhat easier convergence on accept-
ing some change in views of the human being, society and
culture, and the use of new technologies. Specifically, a so-
ciety will more quickly and compliantly accept new life
technologies when that society is already highly commit-
ted to some important goals, such as lifespan extension,
mental health, or crime prevention. Where neuroethics is
concerned, public justifications for using neurotechnolo-
gies to modify physiological functions and behaviors will
largely take a socially conventionalform, as a society ap-
peals to what it considers as valid and binding norms and
goals. Without question, social-cultural norms can and do
afford a vast amount of practical work and public benefit.
In their more rigid form as legal statutes, such norms are
often quite proper, and arguably necessary for social order.
Prescriptive judgments coalesce into legal and policy regu-
lations as needed.
Neuroethics must pay due attention to cultural tradi-
tions, prevailing ideologies, and social conventions. Indeed,
much of neuroethics will remain beholden to those power-
ful sources of norms and ideals, making tacit or explicit
appeals to them in the course of urging prescriptive judg-
ments. Yet, however attractive and useful, these normative
sources do not supply universally accepted principles
people disagree within societies, societies disagree with
each other, and entire cultures gradually change over time.
Just because a large part of a society, or much of a culture,
happen(s) to prefer things a certain way does not automat-
ically make it right, good, and/or just. What can appear to
be the strongestethical arguments are really only locally
and modestly prescriptive, and permitting majority-based
social standards to speedily decide matters may actually
perpetuate deep ethical disagreements rather than resolve
them. If philosophical foundations of/for neuroethics
remain at this socio-cultural level, argumentative stale-
mates will be frequent, and even where broad norms
weigh in favor of one position, those norms will still be
only socio-culturally relative and such positions have no
wider objectivestatus. Prescriptive neuroethics at its
best may remain philosophically fragmented, with an ob-
jectively principled neuroethics remaining out of reach. Of
course, such a neuroethics would hardly be the only ap-
pliedethics to be so fragmented there is a growing
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 3 of 13
recognition of irreducibly pluralistic bioethics in general
Offers to rescue neuroethics (and bioethics) from this
fragmented situation have been offered from those claim-
ing that there are universally valid norms for all humanity.
Theologically inspired offers rarely comport well with the
scientific worldview, but even if that clash could be over-
come, religious traditions tend to disagree with each other
over ethics as much as cultures do. The naturalistically-
minded philosophers among the theological community
often appeal to preserving humanity,human nature,hu-
man virtues, and the like. Their naturalism, however, pre-
vents this strategy from rising above conventionality as
much as hoped. In this Darwinian age, such essentialist
appeals can only amount to aggregating nicer humans into
one set and pointing to what many of us happen to be
doing well [22-24]. For example, repudiations of futurist
plans of trans-humanist agendas and post-humanisms typ-
ically make claims that either amount to what humans
have been doing as morally right is a path from which no
one should stray,or matters should they remain as they
have been.(That is why the divergent values of some fu-
ture post-humansociety are typically disregarded by such
conservative arguments.) Promoters of trans-humanism
and post-humanism are quite capable of appealing to se-
lected universalnorms of humanity as well, but closer
examination of this strategy exposes how these norms tend
to be conveniently pre-selected from special phases of
civilization and then discernedwithin all humanity [25].
To be sure, philosophy has additional resources. Es-
tablished ethical theories, such as various deontologies,
utilitarianism, contractarianism, and virtue ethics, may be
ways to surmount conservative-progressive stand-offs, and
rise above socio-cultural conventionalism altogether. These
ethical theories lay claim to some higher objectivestatus,
but do they really tend to end controversy? Far from it; the
spectacle of argumentative standoffs among ethical theor-
ies lends applied ethics its characteristic adversarial tone.
Any agreeable convergence among rival ethical theories
seems more like a matter of chance than design. Even
those ethical theories proud of a basis in reasondo not
precisely agree on how to best be rational.
Does prescriptive neuroethics have any further options
beyond settling for socio-cultural fragmentation, seeking
humanitysgenuinevalues and virtues, or following the
lead of one or another established ethical theory? As a
field, neuroethics has an opportunity to transcend these
alternatives. By taking the social, behavioral, and brain
sciences most seriously, the first mode of neuroethics
has access to knowledge about how humans cognize the
world, undertake their conduct, engage in relationships,
and structure and manage social and moral responsibil-
ities. The second mode of neuroethics has the capacity
to apply such knowledge for evaluating the methods used
for ethically judging proposed modifications to ourselves
and our societies. In short, we opine that there is nothing
about how we can do morality, make ethical judgments,
change moral habits or social roles, or re-design societies
that is theoretically off-limits or beyond the purview of
neuroethics. This burdens neuroethics with the require-
ment of being consistent with several sciences (bringing
attendant concerns discussed in the next section), but
it simultaneously loosens neuroethics from complete de-
pendence on folk psychologies, social conventions, cul-
tural standards, obsolete epistemologies and theories of
mind, traditional philosophical and religious ethics, and
outdated meta-ethics.
Has neuroethics fully realized the extent of a proper
domain, and the potential capaciousness of its power? If
not, neuroethics will remain weakly prescriptive, but it will
obtain its value premises on loan from outside sources.
Neuroethics can make appeals to intuitions, social con-
ventions, legal statutes, and ethical theories too; indeed,
these inherited argumentative habits from older versions
of applied ethics (such as medical ethics) nearly exhaust
the neuroethics literature to date. But we believe that a
much wider field of action awaits neuroethics: the poten-
tial to be served by and serve as anewmeta-ethics.
A new meta-ethics for neuroethics
Meta-ethics involves clarification of any linguistic, epi-
stemic, psychological, or even metaphysical presupposi-
tions and commitments involved with moral thinking and
practice. Ethical theories tend to append some meta-ethics
to their systems since each theory relies on a characteristic
view of what morality is and how morality works, views
contested by rival ethical theories. Before the advent of
the behavioral and brain sciences, such meta-ethical pre-
suppositions were just that: sheer assumptions. Philoso-
phers and theologians foundthem grounded in all sorts
of places, such as folk intuitions, grammars, linguistic defi-
nitions, common sensemorals, socio-cultural norms, and
legal regulations, along with whatever the bestsciences
or theologies of the day said about free will, human na-
ture, natural law, speculative metaphysics, or divine com-
mands. Over the centuries, typical pronouncements of
meta-ethical principles have really amounted to little more
than personality traits, linguistic habits, folk psychology
concepts, comfortable moral intuitions, race/class/gender
prejudices, theological dogmas, armchair speculations, and
so forth.
Ethical theories and meta-ethics have long mapped out
morality and moral concepts in the absence of adequate
biological, sociological, and psychological knowledge about
origins of human sociality, the human capacity for doing
morality, and the ability to modify moral and social norms.
We posit that a new scientific meta-ethics can gain inde-
pendence from inherited intuitions, social conventions,
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 4 of 13
and older ethical theorizing. Neuroethics will engage
the social, behavioral, and brain sciences to erect the
foundations of a new meta-ethics. Neuroethics need not
be another applied ethicsbeholden to outdated meta-
ethics or ethical theories; nor will neuroethics be imperi-
ously told (by any postmodernist meta-ethics, for example)
that bioethics cannot attain any measure of objectivity, or
be cowed by an analytic meta-ethics into abandoning em-
pirical ethics as a fallaciously naturalistic project [26]. For
neuroethics, neuroscientific understandings of the subject
matter, namely actual human sociality and moral cognition,
take priority. In a similar manner, the behavioral and
cognitive sciences are supplying much-needed tests and
correctives to epistemologies, theories of learning, and
metaphysical notions of the body-brain-mind relation-
ship [27,28].
Neuroethics could exemplify how to fruitfully apply a
new scientific meta-ethics because it addresses and treats
three matters that are crucial to any meaningful and au-
thentic exploration of human life: namely, moral capacity,
moral practice, and moral principle. What does morality
mean to neuroethics? Roughly, the naturalistic understand-
ing of human morality takes it to be a socially sustained
practice, found in all (or nearly all) cultures, in which indi-
viduals voluntarily and habitually conduct themselves in
accord with understood norms promoting personal fitness
for social interactions and regulating public conduct of
wide social concern. People participate in a morality not
only by regulating their own behavior in social relation-
ships, but also by assisting in the needed enforcements of
moral norms, and by teaching moral norms and the means
of enforcement to those who need moral education. The
universality of this social technology of morality indicates
its significant and longstanding utility for social groups
small and large (especially when supplemented by the far
older norms of kinship and the much younger norms of
law) [13,29].
Let us sketch neuroethicsapproach to moral capacity,
moral practice, and moral principle in that order. First,
utilizing knowledge from the biological, cognitive and so-
cial sciences, neuroethics applies understandings of neural
substrates and mechanisms of cognition to investigate how
humans have the capacity to be social and moral [3,13].
Any theories involving mistaken presumptions about how
sociality works, how we must think about morality, and
the cognitive resources available for managing society or
being moral, will be disproven and then suitably revised or
speedily eliminated. Ideologies and philosophies having a
concern for actual human morality means they can be held
accountable by scientific information about human cog-
nition and sociality. Theoretical recommendations about
people being moral and becoming more moral must make
at least four kinds of presumptions about (1) how people
are already doing morality, in some specified sense of what
it means to be moral; (2) the cognitive/emotive processes
that people undertake when trying to be moral; (3) how
certain changes to these processes are possible; and (4)
how some of these changes can result in a personscon-
duct becoming more moral. Theories making these pre-
sumptions can hence be discredited in any of four ways:
(1*) a theorysspecifiedsenseof moralitymay not resem-
ble how humans generally do morality; (2*) a theorysview
of the cognitive/emotive processes involved with doing
morality may be inaccurate or entirely mistaken; (3*) a the-
ory may be proposing modifications to processes of doing
morality that are not in fact possible; or (4*) a theorysview
that possible modifications to moral processes are effective
for doing morality better cannot in fact be that effective. So-
cial ideologies and ethical philosophies are not immune
from evaluation and criticism from the behavioral and brain
sciences. Ethical theories that can be adapted in light of sci-
entific knowledge will enjoy a deserved advantage [30].
Second, from this sound(er) basis in reliable theorizing
about sociality and morality, neuroethics can expand its
inquiry into any and all social and moral practices, carefully
evaluating them for their consistency with brain realities,
and recommending modifications where indicated. Expec-
tations that people should be doing things a certain way
should align with the ways that (their) brains can actually
function. Neuroethics (like the brain and behavioral sci-
ences generally) will be perpetually confronted by cultural
ideologies, legal and political philosophies, ethical theories,
meta-ethical systems, and the like, each protesting that fac-
tual brain science is largely irrelevant to the normative task
of making people into who they ought to be. While neuro-
science does not and/or cannot purport to prescribe
and proscribe actions or establish ideals, it and neu-
roethics can infer and inform what, why and how neural
functions, and effects can enable embodied organisms (like
humans) to sense, perceive, emote, decide and act, and this
is important to the establishment of norms and ethics
about the ways we relate. Furthermore, guiding peoples
lives implies shaping minds, so ignorance of the brain is
no excuse. Any movement of social reform, for example,
should partner with neuroethics in order to determine how
modifications to brain structure and function (by whatever
means, from inter-socially pedagogical to neurologically
pharmaceutical) can affect our personal capacities, inter-
personal relationships, and moral practices. More gener-
ally, neuroethics is usefully central to inquiries into the
potential wider impacts of modified mind/brain capacities
and practices on all other moral, social, economic, legal,
political, cultural, (etc.) realms of life [3,5,13,31].
Third, proceeding from some sense of human moral
cognition and action, and how adjustments to ourselves
and our social practices may have wider implications,
neuroethics can help formulate principled judgments about
whether and how modifications to existing moral and
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 5 of 13
wider social practices ought to be made. Having partici-
pated in the comprehension of moral capacities and the
reformulation of sound ethical theorizing, neuroethics can
proceed to an articulation and application of improved eth-
ics to concrete problems arising in and from brain research
and new neurotechnologies that are coming fast to the
global stage. Again, established ethical systems will claim
priority here, offering to stock neuroethics with their princi-
ples, but such principles can be freely accepted or declined
as appropriate. Unlike philosophies that prefer to isolate
objective morality and its supposedly rational basis from
conventional ethics in its cultural settings, we reserve for
neuroethics a meta-ethical stance that takes the cognitive
and social sciences seriously in their investigations of the
embodied human being embedded within socio-cultural
environments [3,4,31]. This opportunity might first appear
like a return to the option of socio-cultural conventionality,
but, starting from science in fact opens the possibility for a
far more objective foundation for neuroethics than the ob-
jectivitypromised by older ethical theories.
Neuroethics and moral naturalism
Neuroethics is contributing to the project of moral nat-
uralism that aims at scientifically understanding how
humans practice sociality and morality in their cultures.
Moral naturalism must not be confused with moral real-
ism when a moral naturalist proposes to study human
morality, there is no specific code of morality intended
and no commitment is made about whether one or an-
other morality is true. Moral naturalism is hospitable to
deep moral pluralism, although it is inhospitable to views
of morality that contradict sound science [32-34]. This
meta-ethical grounding for and of neuroethics in the brain
and behavioral sciences arouses philosophical suspicions,
too many to entirely forestall in this paper. Rather, we can
only make a few statements about such concerns here. In
our view, while neuroethics has no choice but to be natur-
alistic in its approach to studying sociality and morality,
neuroethics is not automatically beholden to ethical natur-
alism, since neuroethics need not agree that all moral
meanings and values, and any ethical principles adjudicat-
ing among them, entirely reduce to the status of objective
facts about the natural world. Nor must neuroethics take
a strictly eliminativist stance against freedom, agency, and
responsibility, but need only consider scientifically accept-
able versions that find responsible autonomy in learned
capacities for managing individual conduct and social
relations, rather than in some mythical free willignor-
ing natural laws or non-existent self-conscious decisions
always instantaneously controlling actions (compatibilist
theories grounded on social neuroscience are better scien-
tific candidates, for example [2,35-37]). Neuroethics need
not necessarily heed extant ethical theoriescriteria for
possessing freedom or autonomy (such as the capacity
for purely rational thinkingand the like); nor need neu-
roethics be premised on any neuro-essentialismpositing
that a conception of the human being cannot exceed our
neurobiology [3,13,38].
Neuroethics is not reducible to any specific amount of
science, yet science is crucial for meta-ethics and neu-
roethics. By ensuring scientific continuities between actual
moral conduct in the natural world, inquiries into the
conditions permitting such conduct, and prescriptions for
modifying how people morally conduct themselves, neu-
roethics remains fully committed to the scientific world-
view without reducing ethical philosophy to the sciences
themselves. On this meta-ethical view, (neuro)scientific
knowledge about human (or any other species)morality
is not incompatible with all ethical philosophizing. While
ethical theorizing that relies on entirely disproven notions
must be eliminated, claims that evolutionary psychology,
sociology, or the cognitive sciences will eliminate morality
itself (and obviate all ethics) are hasty and overblown [39].
The scientifically-based meta-ethics of neuroethics will
find plenty of genuinely natural morality among humans
to research, and this meta-ethics will leave room for neu-
roethics to engage ethical philosophy.
Some, but not all, ethical philosophies are refuted by the
fact(s) that: many people are not fulfilling moralitysaltru-
istic expectations; peoplesmoral intuitions have emotional
roles set by evolution instead of cognitive ways to track
moral realities; peoplesintuitive notions of how morality
works are quite mistaken; and ordinary language about
morality is replete with confusions and errors. Ethical phil-
osophies do not all agree about the cognitive or motiv-
ational capacities of ordinary morality, and they dontall
share the same degree of reliance upon what people hap-
pen to think or say about morality. Ethical philosophers
typically focus on thoughtfully guiding people toward im-
proving one or another system of morality and the
shortcomings obtained therein. For example, the discovery
that people typically fulfill only minimal expectations of
morality, and are sentimentally partial and partisan to-
wards those like themselves who live in proximity, is not
exactly a stunning revelation for much of philosophical
ethics (or for religious ethics) that some brain scientists
may have made it seem [39]. Similarly, when one or an-
other ethical theory or meta-ethics has defined morality
or moral knowledgein terms later discovered to be inad-
equate by the brain or behavioral sciences, philosophers
should refrain from announcing that morality does not
exist,and instead focus on discrediting (sources of) poor
definitions of morality [40-42].
Despite centuries of misguided and mistaken ethical
theorizing about the origins and foundations of morality,
it has been and remains a robust part of human social
life. Neuroethics can be an equally robust and perhaps
better philosophical ethics. In general, philosophical ethics
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 6 of 13
can handle less than ideally moral people and can avoid
defining morality in entirely fictitious terms, but ethical
theories cannot keep supposing that their preferred modes
of ethical reasoning are immune to discoveries about ac-
tual human cognition. A scientifically based meta-ethics,
and its focus starting from an understanding of moral cog-
nition, emotion and behaviors in the human world means
that ethical philosophizing can be held accountable by
neuroethics, not the other way around. No philosophical
ethics, not even utilitarianism or deontology, can enjoy
presumptive ethical status anymore.
Neurosciences liberation from reliance upon notions of
morality established by antiquated ethical theories, (that are
absent knowledge about cognition), is only half-heartedly
recognized at present. For example, the relative immaturity
of neuroethics as a discipline and practice is manifested by
the curious way that some neuroscientists are attempting
to map correspondences between specialized cognitive/af-
fective functions and the modes of reasoning inherent to
traditional ethical theories (for overview, see [1,43]). Why
just those ethical theories, rather than others? Are we for-
ever wedded to utilitarianism and deontology (or any other
lineup of extant theories that one would care to list)? Im-
agine if epistemological inquiries were conducted in this
manner. That some brains are capable of thinking deonto-
logicallyand others in a utilitarianmanner when con-
fronted with an artificial situation having only two possible
outcomes only indicates that brains are indeed trainable in
those two ways (which we knew well before brain imaging).
But no amount of brain imaging would infer that those
are the only two ways of moral thinking. The far more
interesting kinds of information from neuroscience do not
involve what we already know about what brains can do,
but rather what brains could potentially do differently
and perhaps better. What will brain images look like from
people who transcend the artificial utilitarian-deontological
option when dealing with messier real-world situations?
We should be looking at a neuroscience of the morally
possible, not just the ethically necessary.
To be sure, while we are pointing a way towards develop-
ing a scientifically adequate meta-ethics, this essay does not
offer a correctethical philosophy grounded in that meta-
ethics. Even the lengthy process of weeding out disproven
ethical theories (not attempted here) leaves no obvious sin-
gle winner in its place the negotiation between the brain
and behavioral sciences and adequate ethical theorizing will
be an on-going process for as long as new things are
learned about cognition. Instead, we here propose under-
taking three modest meta-ethical goals: First, grounding a
new meta-ethics for neuroethics on empirical knowledge
about actual people in their societies; second, questioning
whether a prescriptive neuroethics must remain beholden
to such things as socio-cultural norms or traditional ethical
theories; and third, suggesting how a new neuroethical
framework with objectively principled outcomes could
be erected. This path from real people to normative
prescriptions, and then on to neuroethics principles, is
neither obvious nor easy, especially because outdated meta-
ethical presumptions crowd the philosophical landscape.
Surmounting conventional prescriptivity still appears espe-
cially daunting.
How can neuroethics go about selecting and elevating
conventional prescriptions into objective principles? Since
the meta-ethics of neuroethics must follow the brain and
behavioral sciences in their view of morality as socio-
culturally embedded, doesnt that imply that all prescrip-
tive judgment is forever limited to relativistic status? And
if neuroethics would instead find its principles in some
other source besides actual human cultures, would that
search amount to a betrayal of its confessedly scientific
foundations? We hold that there is a meta-ethical way past
this dilemma. We resist a simplistic forced choice between
many diverse social conventions or a unitary trans-cultural
ethics for doing prescriptive neuroethics. Neuroethics
moral naturalism and its reliance on the brain and behav-
ioral sciences especially cultural anthropology, social
neuroscience, and cognitive neuroscience cannot en-
dorse that dichotomy.
Brains are certainly embodied, and people are thoroughly
socialized and encultured beings [3,13]. So philosophical
appeals to some mythical capacity for pure reason or de-
tachment from group identity cant work; people can do
far more than robotically express one culture. People are
not individuals with accidental cultural identities, nor are
their identities exhausted by the folkways of some culture
or another. At the same time, these encultured humans
possess intelligent capacities to cognitively reflect on cul-
tures [9]. Furthermore, most people can appreciate how
they stand with respect to cultures, they can enjoy some
emotional ability to empathize with others in different cul-
tures, and they can learn from other cultures. The very fact
that humans enjoy quite sophisticated cultures is the very
reason why we can defensibly assert that we are not forever
trapped within just one culture (or sub-culture, etc.) or an-
other. Indeed, ethnic and cultural identities could not be
constructed, deliberately managed, and carefully sustained
against hegemonic and assimilationist pressures unless
ethnic and cultural identity could be objects of reflective
evaluation and comparison [44,45].
Enculturation is most powerful when it is least visible,
but it can come into view in many ways. People can
realize how other cultures are different, yet at the same
time, not so different. People can re-evaluate their own
cultures habits and norms; people can revise their social
structures in light of novel goals and ideals; people can
combine cultural features or move to other cultures; people
can respect and value people of other cultures without ne-
cessarily valuing everything about those other cultures; and
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 7 of 13
people of different cultures can work on converging agree-
ment on shared principles (although perhaps for differing
reasons). In short, people can feel respectfully beholden to
their own cultures even while they perceive that social
norms can, or sometimes should, be modified. Humanity is
a species that re-designs its moralities, just as it designs and
modifies all social technologies. Modifying moralities
cannot be a path towards some trans-cultural position,
however, since at every stage of socio-technological devel-
opment, we are still talking about thoroughly encultured
humans [46-48]. But it is a path that permits recognition
of the locations and limitations of any given socio-cultural
convention. This human capacity helps to explain how cul-
tural evolution happens at all. Furthermore, it turns out to
be no paradox that we can travel across and partially tran-
scend socio-cultural boundaries through our capacities for
understanding the very existence and permeability of those
Summarizing, neuroethics should participate in forging a
new, objective meta-ethics based upon scientific research
into human societies and their moralities. This new meta-
ethics in turn grounds the needed neuroethical testing of
ethical theories for adequacy, which then permits neu-
roethics to suggest improvements to our understandings of
morality and to ethical theories, and explain why humans
have the cognitive resources to reflectively modify socio-
cultural inheritances. Modifying social structures such as
moralities is far from easy; in the short term, domestic ap-
peals to social convention get much practical and policy
work done. All the same, methods yielding short term,
local results dont necessarily work beyond their social
range of application, or their conventional premises.
Principled and cosmopolitan neuroethics
We now come to the question of whether the evident
capacity of neuroethics to be prescriptive on its own
philosophical terms provides for the further ability to be-
come objectively principled as well. Although neuroethics
can and should take advantage of a new meta-ethics
grounded in the brain and behavioral sciences to acquire
some degree of liberation from socio-cultural conventions,
cultural ideologies, and outdated ethical theories, this pro-
gress is insufficient to guarantee that neuroethics could
erect an objectively principled ethical position. Under-
standing which conventions, ideologies, and ethical theor-
ies to avoid is hardly the same thing as discovering the
one right ethical system. Neuroethics could still remain
forever fractured, prescriptive only for local situations and
social contexts, and valid only by being premised on group
or cultural norms. Within any actual society, of course,
prescriptive neuroethics can seem properly principled, as
it contributes to the reflective stability of norms for that
society. The larger question is whether a principled neu-
roethics can apply to far more than just local contexts in a
piece-meal fashion. Will the philosophy and practices of
neuroethics rise above social or cultural relativism? Can
neuroethics provide something of objective value to the
world at large?
Thus far, this essay has sought to arouse a creative ten-
sion between (A) the way that neuroethics respects how
human brains are embodied, socialized and encultured;
(B) the expectation that neuroethics can and will do its
prescriptive work with great sensitivity to socio-cultural-
historical contexts; and (C) the hope that neuroethics
could approach an inter-cultural level of principled philo-
sophical ethics. But we hold that the tension within and
between these points is resolvable by the fusion of their
concepts and tasks. Specifically, we think that a new meta-
ethics for neuroethics is already entailed within points A
and B: that is, respect for both the power of enculturali-
zation and the intellectual flexibility to modify cultures.
People are always encultured, yet they can be thoughtful
and creative individuals, who can contribute to cultural
comparison and change. We believe that this position
points the way toward fulfilling the hopes of point C.
As we view it, a new meta-ethics for neuroethics already
contains some principled treatments of sociality and encul-
turalization that bridge the transition from how humans
are successfully social, to ways they should continue to be
social. For example, humans are properly encultured to
permit opportunities for their flourishing, yet cultural es-
sentialism is unsound. So we should be suspicious of social
groups preventing individuals from changing their self-
identities, dictating the identities of its members, ag-
gressively assimilating new members, or denying their
membersefforts to learn and think about the ways of
their culture and those of other cultures. Ethnocen-
trism is similarly unsound, so we should be suspicious
of any society claiming to exemplify a correctway of life.
Along these lines, we can see why excessive cultural elit-
ism is unsound, since no society/culture is so elite or cor-
rect that it can reasonably classify the members of other
societies as sub-human or less worthy of respect or dig-
nity. Cultures still permit people to pass moral judgments
on others (thats the point of having a morality), but indi-
viduals in other cultures are still to be viewed as worthy
candidates for moral regard [49].
Following this train of thought, excessive nationalism
looks unsound as well. While citizenship can be a valu-
able status for people, no country should presume that a
persons identity or loyalty is primarily characterized by
ones current domicile or citizenship, and people should
not automatically prioritize their nations interests. Be-
cause the new meta-ethics of neuroethics will also remain
skeptical towards any ethical theorizing that lays claim to
trans-cultural or absolute status, this stance renders im-
plausible any political theory reliant upon those sorts of
foundations, such as certain kinds of political liberalism or
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 8 of 13
social contractarianism grounded on a vision of truehu-
man nature that fails to recognize and regard biology and
culture [50].
A new meta-ethics will not merely describe how humans
are social and moral within cultures, since it will also com-
prehend how ecologies are capable of providing conditions
for successful human understanding and improvement of
their cultures. Most relevantly, this neuroethical meta-
ethics will grasp the proper cultural conditions minimally
needed for people to intelligently manage, sustain and im-
prove their moralities. Inappropriate cultural conditions
are hence specifiable as well, and include: obstructing
knowledge about how sociality and morality works; pre-
venting people from intelligently questioning and cre-
atively modifying their social structures and moralities;
isolating people to keep them ignorant about other cul-
tures; promoting ideology that ones own culture must be
uniquely correct; encouraging people to demean and de-
monize those in other cultures; and generally stunting the
human capacity (such as it is) for empathy and cooper-
ation with others. Cultures that foster such inappropriate
conditions are not fulfilling their proper function, basically
by failing to enhance intelligent human flourishing, which
is the entire point of being encultured humans. The uni-
versality of the use of culture across humanity supplies the
key to locating cultural norms to encourage.
Such norms obtain: respect for individuals who value
their identities and are changing their self-identities; op-
portunities for people to acquire capacities for flourish-
ing; protection of individuals from cultural insulation,
isolation, and ignorance; denial that any society has ex-
clusively correct norms; disdaining efforts to cast some
peoples outside the circle of full humanity; and valuation
of people for themselves and not merely with regard for
their heritage, citizenship, or political status.
One tradition of ethical and political philosophy highly
prioritizes all of these recommendations: cosmopolitanism.
Humanist in its ethics, liberal in its attention to rights, and
open to secular as well as religious freedom but not op-
pression or aggression in its politics, cosmopolitanism
has long supported ethnic toleration, cultural pluralism,
equal rights, liberal democracy, global cooperation, and
international peace [51-55]. Cosmopolitanism cannot be
uncritically adopted, of course. Over the course of its his-
tory, some varieties of cosmopolitanism have harbored
hegemonic, essentialist, trans-cultural, or putatively abso-
lutist principles among their foundations. Cosmopolitan-
ism has occasionally included among its first principles
unrealistic expectations about such things as a human mo-
tivation to prioritize and follow reason; a human capacity
for deep empathy and equal concern for all; a willing sus-
pension of concern for local matters to tackle distant sit-
uations; an eager altruism for supplying strangers with
plentiful support at the cost of much personal wealth; an
excessive tolerance for moral and cultural pluralism; an
anti-pluralist hope for one hegemonic world culture; a de-
termination to view humanity only as one community; or
a drive to abolish countries in favor of a single world gov-
ernment. Varieties of cosmopolitanism can evidently be
not only idealistically hopeful about humanity, but as un-
realistic as any ethical or political philosophy could be. We
opine that the naturalistic meta-ethics for/of neuroethics
cannot support the aforementioned cosmopolitanisms that
are reliant on these sorts of expectations.
However, we assert that a modest cosmopolitanism,
compatible with typical moral performance, hospitable
to people enjoying ethnic diversity and democratic self-
determination, and workable with contemporary political
structures such as nations, international bodies, and global
accords, makes a good fit with the new meta-ethics as we
have formulated [56-59]. Despite prevalent caricatures of
cosmopolitanism as a way for privileged Westerners to dis-
cernagreeable moral rules ecumenically sharedby other
cultures, only to blunder into cultural misunderstandings
and perpetuate colonialist stereotypes, we venture to sup-
port a more philosophically sophisticated cosmopolitan
stance. We caution that neuroethics would be wise to ab-
stain from commitments about broader issues as wealth
egalitarianism, economic globalization, personal property
rights, or humanitys political solidarity [60,61]. Judging the
appropriate political frameworks for realizing cosmopolitan
visions, or deciding whether and when primary citizenship
could be transferred from a country to a world polis is
well beyond the purview of neuroethics alone. All the
same, a principled, cosmopolitan neuroethics can be in-
volved with offering recommendations for intercultural
deliberation about crucial issues such as guaranteeing
basic freedoms, protecting everyone from harms, pro-
moting material and cultural opportunities for all, and
preserving peoplescapacities for self-governance.
Four guidelines of a principled neuroethics
We have opened a reasoned path from the scientific
foundations for a novel objective meta-ethics towards a
principled cosmopolitan neuroethics. The next task of
translating the high ideals of this cosmopolitan neuroethics
into practical prescriptions about potential applications of
neuroscience and neurotechnologies is not any easier.
What are needed are mid-level principles to guide ethical
and policy deliberations in concrete situations. Fortunately,
neuroethics is hardly the first discipline to seek those sorts
of principles. The heritage of medical ethics is conspicu-
ously available in this regard.
If neuroethics is to transcend social conventionalism,
the relationships between neuroethics and medical ethics
are necessarily going to be complex. As a discipline, neu-
roethics is a sub-field of bioethics, which considers the
moral implications of the life-sciences, and since study of
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 9 of 13
neural systems is among the life sciences, neuroethics falls
under bioethics as an academic discipline [2]. Yet, while
engaging the inter-disciplinarily of bioethics, the method-
ology of neuroethics will need to be partially liberated from
bioethics and from medical ethics in particular [2,3,13,43].
Medical ethics to date has been dominated by problems
of Western medicine and ideals of Western philosophy,
which are premised on normative notions of the moral in-
dividual,whatcountsasstandard health, and concerns for
the autonomous patient(what we have coined as MIS-
HAP). Indeed, medical ethics has had a generally conser-
vative track-record, as befits a field trying to prevent
medico-moral mishaps in these domains [62,63].
By contrast, in practical application, neuroethics is both
more specific and broader than medical ethics, because
neuroethics must consider how and why individuals, non-
state organizations, and governments will be utilizing
brain/mind modifications for pursuing the widest imagin-
able variety of goals from pleasure to violence, both within
countries and across international borders [3,13,31,64]. As
for undertaking principled ethics, neuroethics will partially
transcend medical ethics, precisely because neuroethics
must regard modifications to the brain/mind made for
any reason within and across cultural or political boundar-
ies, including transitions to future iterations of humans,
cultures, and/or beings yet to emerge.
It must be acknowledged that medical ethics and its
application of principles such as beneficence, non-male
ficence, respect for autonomy and justice has been truly
useful for grappling with the impacts of scientific know-
ledge and technologies [65,66]. These mid-levelethical
principles have made much good sense in the scientific
context of medicine, and within the social contexts of
Western culture, but they are not without contention
[67], and in the light of neuroethical questions and di-
lemmas, we pose that they no longer entirely suffice. Novel
neuroscientific technologies will soon expose the inherent
limitations of all four principles as understood so far.
For example, respect for autonomy presumes that there
is an individual who has a stable personal identity over
time, but radical cognitive modifications will permit the
creation of new selves. Whose autonomy has been violated
when someone has re-written most of their own memor-
ies? Beneficence presumes that there are objectively identi-
fiable goods to be pursued by health care providers, but
radical modifications will be undertaken by individuals
who will decide for themselves what is valuable for their
own lives. Who is to judge the harms of radical cognitive
modifications when undertaken by people to gain com-
petitive advantages in the workplace? Non-maleficence
presumes that there are objectively identifiable harms for
health care providers to avoid, but radical modifications
will be chosen by individuals who will decide for them-
selves what harmsare acceptable. Where is the harm in
eliminating the need for sleep without side-effects? Justice
presumes that there are scarce medical resources to be
distributed by health care providers (or governments) in
some equitable manner, but some kinds of radical modifi-
cations will be selectively funded by communities, corpo-
rations, militaries, and countries to make people more
useful in assigned jobs. Where is the injustice in obtain-
ing a radical modification in order to stay employed in a
well-paying profession, or receiving radical adjustments to
courage and sensitivity levels to heighten performance as
The tradition of Western medical ethics and the four
principles mentioned here (and similar principles gone
unmentioned) [68,69] are not well-designed for such fu-
ture scenarios. To be perfectly fair, however, justifications
for principled medical ethics have frequently appealed to
the way that beneficence, autonomy, non-maleficence, and
justice are widely respected by many of the worldscivili-
zations, ethical systems, and wisdom traditions [70-72]. It
is not a coincidence that twentieth century medical ethics
has overlapped a great deal with modern cosmopolitan
ideals. Selected ideals of medical ethics could be revised
for fulfilling cosmopolitanism to a much higher degree.
Practical continuity between principled neuroethics and
medical ethics has many advantages. We agree with Eric
Racines pragmatic view that neuroethics should trans-
formatively adapt useful bioethical work, rather than re-
invent or duplicate bioethics [2]. While a new scientific
meta-ethics may supersede outdated ideologies and phil-
osophies, such meta-ethics cannot directly derive specific
moral codes, so it would be impractical for a principled
neuroethics to attempt a blank-slate start [3,5,13,31]. Evo-
lutionary continuity reconciles this principlism with prag-
matism (a pragmatic heuristics unable to suggest guiding
principles is empty, after all), and the kind of principlism
suggested here should be understood as the ethical priori-
tization of important moral ideals, rather than the ration-
alistic imposition of moral axiomsfrom which applied
deductions must derive. This pragmatically flexible ap-
proach fully permits thoughtful balancing and adjudica-
tion among these ethical priorities when applying them to
specific cases, and it encourages their perpetual testing
and reconstruction in a manner consistent with the scien-
tific meta-ethics of neuroethics.
Summing up thus far, we have argued that progress to-
wards an objectively principled neuroethics can be made by
naturalistically reconstructing ideals of medical ethics and
augmenting them according to a modest cosmopolitanism.
To illustrate how this pragmatic ethical evolution may
proceed, we suggest four augmented guidelines for inter-
national consideration: empowerment, non-obsolescence,
self-creativity, and citizenship.
Augmenting beneficence yields empowerment.Theduty
to advance the welfare of others should be extended to the
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 10 of 13
duty to increase the capabilities of people to autonomously
live independent and fulfilling lives. A modification would
be considered to be unethical if it causes unreasonable
harms to a person, makes a person more dependent on
others (especially to the point of losing effective citizenship,
the fourth guideline), or reduces a persons capacity to pur-
sue ones own well-being.
Augmenting non-maleficence yields non-obsolescence:
The duty to avoid unreasonably harming people should
be extended to avoid the creation of obsolete people, es-
pecially single-usepeople that are so irreversibly spe-
cialized by radical body/brain modifications that career
and lifestyle options become too limited. A modification
is unethical if it unreasonably risks producing a person
with peculiar or radical enhancementsthat excessively
restrict future self-creativity, or if it reduces empower-
ment or citizenship.
Augmenting autonomy yields self-creativity: The right
of persons to autonomously direct their lives should be
extended to the right to re-create themselves for enrich-
ing their lives. Access to self-creative modifications, even
to the point of making new selves, should be protected,
so long as other guidelines are respected along the way.
Self-creativity must not be conflated with individuality
or peculiarity; people should also be allowed to re-create
themselves to more closely conform to desired group
standards (so long as those standards do not themselves
involve loss of autonomy or violations of the other three
guidelines). A modification is unethical if it contracts cre-
ativity; for example, by reducing responsible autonomy or
capacity for further creativity, reducing basic capabilities
for supporting ones self, or limiting potential competen-
cies to improve ones standard of living and well-being.
Augmenting justice yields citizenship. The duty to fairly
distribute scarce goods should be extended to the duty to
guarantee everyones ability to be a free, equal, law-abiding,
and participatory citizen. A modification would be uneth-
ical if it risks debilitating a persons capacity for fulfilling
the roles and responsibilities of engaged civic life, or enjoy-
ing the rights and obligations of citizenship.
While we are confident that a cosmopolitan neuroethics
(indeed, a cosmopolitan bioethics in general) would be wise
to include principled guidelines like these, we dontwishto
exaggerate the priority of just these four specific principles.
A different formulation of cosmopolitanism and a different
selection from traditions of medical ethics would result in
variant sets of guidelines. The process of finding the best
mutual adjustment among a new neuroscientific meta-
ethics, improved ethical theorizing, and inter-cultural prin-
ciples for global utility has only begun.
Cosmopolitan neuroethics
We have claimed that neuroethics can find its philosoph-
ical foundations in much the same way that its scientific
foundations are found in understanding the human brain.
The objectivity of the new meta-ethics for neuroethics
cannot exceed the degree of scientific objectivity involved,
but there is robust objectivity available nonetheless, and
that objectivity can infuse a cosmopolitan neuroethics as
well. We propose fairly objective cosmopolitan principles
for neuroethics out of a responsible sense of pragmatic
need in light of current world affairs and with a view to
recommending international protocols, conventions, and
treaties [73]. Our approach seeks ethical objectivity not in
trans-human rationality but in inter-human deliberations
[48]. Only inter-cultural principles are sought here, not
trans-cultural or absolutist norms.
We have not paradoxically acknowledged cultural and
moral pluralism only to heedlessly forge ahead with im-
posing a universalistic ethics or unitary vision of the
good life without regard to actual human experience.
We do not risk any self-contradiction by first protesting
against both the traps of conventionalism and the dreams
of absolutism, and then offering guidelines that should
sound persuasive to many if not most contemporary cul-
tures. Nor do we risk self-contradiction by dismissing
principles grounded on essentialist and eternal visions of
humanity and then resorting to an objective meta-ethics
grounded in how humans commonly attempt to live best
at present. Our proposal does not elevate one cultures
norms to universalist status over humanity, but rather it
seeks the universal norms inherent to cultures doing their
proper work for humanity. Objective ethical theorizing
need not be held hostage to self-destructive cultural ide-
ologies and outdated philosophies inconsistent with the
natural facts of human cognition, sociality, and moral cap-
acity. As we all are well aware, plenty of cultures instruct
fantastical notions about mental abilities, inculcate doc-
trines hostile to healthy social relationships, and perpetu-
ate power inequalities by reserving full moral autonomy
only to the few. Refusing to permit their veto over an ob-
jective global ethics is entirely consistent with the cosmo-
politan standpoint on proper cultural functioning and
promoting human flourishing.
The modest cosmopolitanism urged here lends serious
support to efforts to preserve cultural diversity and self-
determination in the face of assimilation and hegemony
(although it cannot aid cultural essentialism or isolation-
ism). Our four proposed principles can help address under-
standable worries that radical biomedical enhancement
could undermine human sociality and solidarity [74], and
they can preserve moral achievements made by civilizations
around the world to date, which are impressive enough
that even postmodern pluralists tacitly appeal to their val-
idity. While conservative in spirit from a certain perspec-
tive, these principles can also be viewed as liberal and
even liberating. If the advocates of the most daring trans-
humanist and post-humanist visions are able to admit that
Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 11 of 13
contemporary adherence to these cosmopolitan principles
would be fairly useful for heading towards their dreams
from where humanity is standing today, then we may
avoid accusations of having prejudiced ethical theory
against them.
Neuroethics cannot avoid its destined role for deep inves-
tigations of humanity and broad relevance to humanitys
problems and potentials. Neuroscience, neurotechnology,
and a host of other scientific and technological advance-
ments can and will change the human predicament, if not
the human being. Socio-cultural forces will both affect the
scope and conduct of neuroscience and technology and be
affected by them in turn. Neuroethics will remain valid,
viable, and of value by boldly participating in the science-
based evaluation of these interacting dynamics and by help-
pluralized world stage.
Competing interests
The authors declare that they have no competing interests.
Both authors contributed to the development and writing of this manuscript
and approve the final content.
JS is Research Associate in the Philosophy Department and Graduate School
of Education of the University at Buffalo, NY, USA; JG is Chief of the
Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics,
Georgetown University Medical Center, Washington, DC, 20057, USA and
Clark Faculty Fellow, Human Science Center of the Ludwig-Maximilians Uni-
versität, Munich, Germany.
JG is grateful to the J. W. Fulbright Foundation and the Humanwissenschaftliche
Zentrum (HWZ) of the Ludwig-Maximilians Universität for their support, and
acknowledges funding provided by William H. and Ruth Crane Schaefer
Endowment, and the Pellegrino Center for Clinical Bioethics, and Graduate
Liberal Studies Program of Georgetown University, Washington, DC, USA.
Author details
Philosophy Department and Graduate School of Education, University at
Buffalo, Buffalo, NY, USA.
Neuroethics Studies Program, Pellegrino Center for
Clinical Bioethics, Georgetown University Medical Center, 4000 Reservoir
Road, Bldg D Rm 238, Washington, DC 20057, USA.
Human Science Center,
Ludwig-Maximilians Universität, Munich, GER, Germany.
Received: 22 December 2013 Accepted: 22 December 2013
Published: 3 January 2014
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Shook and Giordano Philosophy, Ethics, and Humanities in Medicine 2014, 9:1 Page 13 of 13
... Toward such ends, we propose a paradigm of "biosecurity-bydesign, " yoked to a cosmopolitan-communitarian neuroethicolegal approach to accurately assess, depict, and mitigate (if not prevent) probable and possible near-and intermediate term effects of DBS use in various contexts (Lanzilao et al., 2013;Shook and Giordano, 2014;DiEuliis and Giordano, 2021). ...
Full-text available
DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury.
... By examining the issue from a utilitarian perspective, it could contribute to improving the quality of life of a significant portion of the population by enhancing their employment and academic potential (Dunlop and Savulescu 2014). Another view is that the use of public funds should only be used for curative rather than improvement purposes, as well as emphasizing the importance that the use of CE should not be used to promote asymmetrical relationships between individuals and groups, namely, socioeconomic levels (Shook and Giordano 2014). ...
Full-text available
At the present time there is a boom in the use of pharmacological cognitive enhancers (PCEs) particularly within an academic and labor context. Numerous objections to the use of this medicines arise in the context of Neuroethics, being one of the most important, the principle of justice. Among the most prevalent arguments put forward it is noted the disturbance of distributive justice and competitive fairness. Succinctly it is established that hypothetical PCEs without adverse effects could promote the social fragmentation by favoring economically dominant classes. However, it has been experimentally observed that PCEs present benefits ruled by the inverted U phenomenon, where cognitive benefits given by these medicines are not dose-dependent and have dependence on the baseline performance. Producing bigger benefits in individuals that initially had a worst performance. In this way the use of PCEs, assuming a context of open-access, could contribute to social equity and distributive justice.
... The apparent ethical dilemma seems to be a theoretical one at the first glance. It directly affects the philosophical concepts of brain-mind relation [83,202,203]. From a neuroethical point of view, the exceptional ethical implications of pharmacological brain modulation by pNE have to be considered, in specific, the questioning of human subject quality and its authenticity [200]. Pharmacological neuroenhancement can change personality and human image. ...
Full-text available
Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.
... [15][16][17][18] This is of particular note, given that 90% of global neuropsychiatric research is performed in the 10% of the developed world's mental health population 19 and hence, a significant proportion of global developing populations and ecologies are inadequately represented. This limited representation of ethnodiversity constitutes an important knowledge gap with respect to specific cultural variables (ie, beliefs, values, needs, traditions, and perceptions) that could shape attitudes toward the use-or non-use-of neuroS/ T, 9,20,21 which could mislead both global translational safety and effectiveness, and neuroethico-legal and sociocultural frameworks that address and guide such issues in practice. To mitigate or prevent such inadequacies, we advocate a complementary and proactive integration of transnational and cross-cultural analysis to (1) identify local NELSCI and influences in and for neuromodulatory techniques; (2) improve global translational and transnational safety, viability, compatibility, and value, and (3) improve efforts to enhance global benefits of neuroS/T research and applications of emerging developments in practice. ...
... The fact is that despite being in what we can call a multicultural project, we are just now beginning to truly engage with an aspect highlighted in the BRAIN 2.0 Neuroethics Report and also identified as crucial by representatives of the different Brain initiatives (the HBP included): how to acknowledge, understand, and manage cultural considerations in brain research in itself and its implications (Rommelfanger et al. 2018). Awareness of the extent to which environmental and cultural interactions impact the brain's functional architecture, and recognition of the impact of cultural contexts in determining which aspects of neuroscience travel into public consciousness, and which have more resonance, have resulted in a few articles that have pointed to the need to expand the cultural and international reach of the discipline (Lombera and Illes 2009;Shook and Giordano 2014). But ultimately, there is currently little research on these two areas of concern, and even when a call for a global/international/cosmopolitan/culturally aware/culturally competent neuroethics is common, there is not enough reflection on what each of the terms used means thus risking confusion or just rhetorical use of the main notions. ...
Full-text available
The recently published BRAIN 2.0 Neuroethics Report offers a very helpful overview of the possible ethical, social, philosophical, and legal issues raised by neuroscience in the context of BRAIN’s research priorities thus contributing to the attempt to develop ethically sound neuroscience. In this article, we turn to a running theme of the document: the need for an ethical framework for the BRAIN Initiative and for further integration of neuroethics and neuroscience. We assess some of the issues raised and provide an explanation of how we have addressed them in the Human Brain Project. We offer our experience in the HBP as a potential contribution to the international debate about neuroethics in the big brain initiatives. Our hope is that among other things, the type of exchange proposed by this AJOB special issue will prove productive in further identifying and discussing the issues and in inspiring appropriate solutions.
... We have advocated the use of an operational risk assessment and mitigation paradigm to appraise the capabilities, limitations, consequences and contingencies of developing and employing new biomedical techniques and technologies (Giordano 2017); and herein advocate its potential merit in the biosecurity milieu. A component of this method entails insight and appropriated regard for cultural and circumstantial contexts of use, and in this light, we have endorsed a cosmopolitan ethical palette from which to obtain or develop precepts that could be broadly multi-nationally applicable, and from which more "locally contextual" sets of principles may be taken for use in specific (inter-)cultural engagements (Shook and Giordano 2014). To put these into practice, we suggest consideration of discursive approach, taken with some form of equilibrium and application of a mini-max/maxi-min valuation of variables. ...
A book to those who wish to learn about Neuroethics, a proposal on how to visualize the field and communicate one's work in it; miscellaneous topics from Scope A and B.
Neuroscience and neurotechnology (neuroS/T) are techniques and tools used to assess or affect the nervous system. Current and near-future developments are enabling an expanding palette of capabilities to understand and influence brain functions that can foster wellbeing and economic growth. This "neurobioeconomy" is rapidly growing, attributable in large part to the global dissemination of knowledge that fosters and contributes to scientific innovation, invention, and commercialization. As a result, several countries have initiated programs in brain research and innovation. Not all brain sciences engender security concerns, but a predominance in global biomedical, bioengineering, wellness/lifestyle, and defense markets enables considerable power. Such power can be leveraged in nonkinetic or kinetic domains, and several countries have identified neuroS/T as viable and of growing value for use in warfare, intelligence, and national security operations. In addition to the current focus on biotechnology, the United States and its allies must acknowledge the significance of brain science and its projected impact on the economy, national security, and lifestyles. In this article, we examine growth of the neuroS/T market, discuss how the neurobioeconomy poses distinct ethical and security issues for the broader bioeconomy, provide examples of such issues that arise from specific nation-state activity and technological commercialization, and propose a risk assessment and mitigation approach that can be engaged by the economic, scientific, and security communities.
What is morality? Where does it come from? And why do most of us heed its call most of the time? In Braintrust, neurophilosophy pioneer Patricia Churchland argues that morality originates in the biology of the brain. She describes the "neurobiological platform of bonding" that, modified by evolutionary pressures and cultural values, has led to human styles of moral behavior. The result is a provocative genealogy of morals that asks us to reevaluate the priority given to religion, absolute rules, and pure reason in accounting for the basis of morality. Moral values, Churchland argues, are rooted in a behavior common to all mammals--the caring for offspring. The evolved structure, processes, and chemistry of the brain incline humans to strive not only for self-preservation but for the well-being of allied selves--first offspring, then mates, kin, and so on, in wider and wider "caring" circles. Separation and exclusion cause pain, and the company of loved ones causes pleasure; responding to feelings of social pain and pleasure, brains adjust their circuitry to local customs. In this way, caring is apportioned, conscience molded, and moral intuitions instilled. A key part of the story is oxytocin, an ancient body-and-brain molecule that, by decreasing the stress response, allows humans to develop the trust in one another necessary for the development of close-knit ties, social institutions, and morality. A major new account of what really makes us moral, Braintrust challenges us to reconsider the origins of some of our most cherished values.
The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The book reconceptualises the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi 'medical ethics', and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names.