Sunday, November 16, 2008

Review of Bioethics and the Brain by Walter Glannon

This review appeared in Philosophy in Review, Volume 28, Number 3 (2008), pages 197-199.

Walter Glannon. Bioethics and the Brain. New York: Oxford University Press 2007. PP viii+235 pages. ISBN13: 9780195307788
ISBN10: 019530778X. $45.00

Glannon addresses a number of issues relating to neuroscience and medical ethics. After his short introduction, his chapters examine the relation between self and brain, neuroimaging, pharmacological and psychological methods of changing people, direct interventions in the brain, and brain death. Glannon does not identify himself with well-known ethical theories, but rather examines issues on their own terms. His philosophy of mind tends more towards materialism than substance dualism, but he does not provide a label for his view. In his epilogue, he sums up his view of the relation between mind and body by saying "the mind emerges from the brain when it reaches a certain level of complexity, and ... the brain and mind are influenced by the ways in which a human organism interacts with the environment" (179). So Bioethics and the Brain does not set out a central philosophical thesis and systematically defend it. Rather, it examines the staked out views in its selected topics and comments on them. Aside from being about bioethics and the brain, there is not much to connect the different chapters.

The great strength of Glannon's examination lies in his knowledge of neuroscience and related technological developments. He manages to summarize large portions of technical knowledge in terms accessible to lay readers. He avoids jargon and minimizes scientific terminology, and explains it when he has to use it. So he is an excellent guide to neuroscience for readers who have not taken courses in the subject. However, the question arises, who is this book aimed at? Neuroscientists will already be familiar with the science that he summarizes. Yet Glannon also writes about philosophy in an introductory way. He introduces philosophers to the reader as if they may not have heard of them before: for example, he refers to "the seventeenth-century philosopher John Locke." Furthermore, it is enormously difficult to pin down Glannon's central philosophical claims. The book is full of discussions and explorations of ideas, but it is hard to know what he actually believes. For example, he says he adopts "the second, richer, concept of the self" (32). This is confusing because he has not contrasted two concepts of the self before this, but rather has said that self is a richer and more complex notion than mere conscious awareness of one's persistence through time. He seems to endorse V.S. Ramachandran's definition of the self as involving first-person conscious awareness of persistence through time, of internal coherence, of embodiment, and of agency. He also says that he would add to this account a fifth component: "the ability to perceive and respond appropriately to the external world" (33). Glannon explains that he will give an account how the capacities that constitute our selves correlate with brain processes.

Philosophers of mind will wonder what work Glannon's concept of self is doing here, and how we might assess its accuracy. He says neuropsychiatric disorders can "disturb, disrupt, or shatter the self" (32) but this sounds more like a metaphor than a literal truth. Glannon does not seem to be aiming to provide any necessary and sufficient conditions for having a self and he does not provide any clear criteria for what counts as disturbance or shattering of the self. Rather, his discussion rushes through Capgras syndrome, Asperger's syndrome, schizophrenia, near-death experiences, and a fictional character in a novel who has religious experiences. This all occurs in the space of a few pages. So philosophers of mind will not recognize this as scholarly work within their field, but conclude it is setting out some basic ideas for later discussion.

Glannon's discussion of neuroimaging first explains the basic science and techniques, and then proceeds to explore some of the philosophical issues it raises. He addresses some arguments that knowledge of the brain processes behind our actions may lead people to deny that we have free will, and he counters these views with some familiar arguments. He says that he defends a capacity-theoretic conception of free will and responsibility, and spends a paragraph explaining what he means, and then moves on. He proceeds to discuss some legal cases of the relevance of brain science to holding people responsible for their actions, and comes to the sensible conclusion that brain imaging should play a limited supplementary role in our current practices. In the process he has kicked up a great deal of dust, and it is far from clear what his central argument is, and what items in his discussion were peripheral.

In the chapter on pharmacological and psychological interventions, Glannon again does a good job of summarizing recent scientific developments. He surveys therapeutic psychopharmacology, placebos, forced behavior control, and cognitive and affective enhancement. He outlines some of the ethical concerns that arise concerning these issues and again makes sensible suggestions, urging caution and emphasizing the dangers of over enthusiasm for new medications and technology. Yet these issues have been discussed previously, at length, and Glannon's overview rushes by, passing from one issue to another without ever examining any of them in great detail. Similar remarks apply to the subsequent chapter on brain surgery and neurostimulation.

By far the most coherent chapter in the book is the last, in which Glannon argues that people are characterized essentially by their higher cognitive faculties, and so we should reject whole-brain death as our definition of death and adopt a higher-brain definition, or what he calls a "narrow neurological criterion" (149). Here his philosophical argument is more sophisticated and better integrated into the science and the particular recent and classic cases he discusses. His discussion of false neurological assumptions made by defenders of the whole-brain definition is particularly interesting. Philosophically, Glannon's argument is very familiar, but he does a good job at relating it to current neuroscience.

As a whole, Bioethics and the Brain will be informative to both neuroscientists and philosophers about areas outside their areas of expertise, but will not advance their knowledge within their areas of expertise. The book would work well as a text in an upper level interdisciplinary undergraduate course, and it should be helpful in interdisciplinary studies such as medical ethics and neuroethics.

Christian Perring, Dowling College

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