Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation
Tóm tắt
The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation (DBS) on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (1), I argue that the pattern theory of self (PTS) can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves.
Tài liệu tham khảo
Agid, Y., Schüpbach, M., Gargiulo, M., Mallet, L., Houeto, J. L., Behar, C., Maltête, D., Mesnage, V., & Welter, M. L. (2006). Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission Supplementum, 70, 409–414.
Baylis, F. (2013). “I am who I am”: On the perceived threats to personal identity from deep brain stimulation. Neuroethics, 6(3), 513–526. https://doi.org/10.1007/s12152-011-9137-1.
Berofsky, B. (1995, September). Liberation from self: A theory of personal autonomy. Cambridge Core; Cambridge University Press. https://doi.org/10.1017/CBO9780511527241.
Bhargava, P., & Doshi, P. (2008). Hypersexuality following subthalamic nucleus stimulation for Parkinson’s disease. Neurology India, 56(4), 474. https://doi.org/10.4103/0028-3886.44830.
Brown, T., Moore, P., Herron, J., Thompson, M., Bonaci, T., Chizeck, H., & Goering, S. (2016a). Personal responsibility in the age of user-controlled neuroprosthetics. In 2016 IEEE International Symposium on Ethics in Engineering, Science and Technology (ETHICS) (pp. 1–12). https://doi.org/10.1109/ETHICS.2016.7560039.
Brown, T., Thompson, M. C., Herron, J., Ko, A., Chizeck, H., & Goering, S. (2016b). Controlling our brains – A case study on the implications of brain-computer interface-triggered deep brain stimulation for essential tremor. Brain-Computer Interfaces, 3(4), 165–170. https://doi.org/10.1080/2326263X.2016.1207494.
Bublitz, C., & Merkel, R. (2013). Guilty minds in washed brains? Manipulation Cases and the Limits of Neuroscientific Excuses in Liberal Legal Orders. https://doi.org/10.1093/acprof:oso/9780199925605.003.0014.
Caruso, G. (2012). Free Will and Consciousness: A Determinist Account of the Illusion of Free Will. Lexington Books.
Caruso, G. (2018). Skepticism about moral responsibility. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy (spring 2018). Metaphysics Research Lab: Stanford University https://plato.stanford.edu/archives/spr2018/entries/skepticism-moral-responsibility/.
Christman, J. (2011). The politics of persons: Individual autonomy and socio-historical selves. Cambridge University Press.
Christman, J. (2013). Autonomy. In R. Crisp (Ed.), Southern Journal of Philosophy (p. 281, 293). Oxford University Press.
Christman, J. (2018). Autonomy in moral and political philosophy. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy (spring 2018). Metaphysics Research Lab: Stanford University https://plato.stanford.edu/archives/spr2018/entries/autonomy-moral/.
Clausen, J. (2009). Man, machine and in between. Nature, 457, 1080–1081. https://doi.org/10.1038/4571080a.
Clausen, J. (2010). Ethical brain stimulation - neuroethics of deep brain stimulation in research and clinical practice: Ethical brain stimulation. European Journal of Neuroscience, 32(7), 1152–1162. https://doi.org/10.1111/j.1460-9568.2010.07421.x.
Craig, J. N. (2016). Incarceration, direct brain intervention, and the right to mental integrity – A reply to Thomas Douglas. Neuroethics, 9(2), 107–118. https://doi.org/10.1007/s12152-016-9255-x.
Daly, A., & Gallagher, S. (2019). Towards a phenomenology of self-patterns in psychopathological diagnosis and therapy. Psychopathology, 52(1), 33–49. https://doi.org/10.1159/000499315.
de Bruin, L., Dings, R., & Gallagher, S. (2017). The multidimensionality and context dependency of selves. AJOB Neuroscience, 8(2), 112–114. https://doi.org/10.1080/21507740.2017.1320327.
de Haan, S. (2017). Missing oneself or becoming oneself? The difficulty of what “becoming a different person” means. AJOB Neuroscience, 8(2), 110–112. https://doi.org/10.1080/21507740.2017.1320330.
de Haan, S., Rietveld, E., Stokhof, M., & Denys, D. (2013). The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model. Frontiers in Human Neuroscience, 7, 7. https://doi.org/10.3389/fnhum.2013.00653.
de Haan, S., Rietveld, E., Stokhof, M., & Denys, D. (2015). Effects of deep brain stimulation on the lived experience of obsessive-compulsive disorder patients: In-depth interviews with 18 patients. PLoS One, 10(8), e0135524. https://doi.org/10.1371/journal.pone.0135524.
De Marco, G. (2019). Brain interventions, moral responsibility, and control over One’s mental life. Neuroethics, 12(3), 221–229. https://doi.org/10.1007/s12152-019-09414-7.
Dennett, D. C. (2004). Freedom evolves. Penguin.
Dings, R. (2019). The dynamic and recursive interplay of embodiment and narrative identity. Philosophical Psychology, 32(2), 186–210. https://doi.org/10.1080/09515089.2018.1548698.
Dings, R., & de Bruin, L. (2016). Situating the self: Understanding the effects of deep brain stimulation. Phenomenology and the Cognitive Sciences, 15(2), 151–165. https://doi.org/10.1007/s11097-015-9421-3.
Douglas, T. (2014). Criminal rehabilitation through medical intervention: Moral liability and the right to bodily integrity. The Journal of Ethics, 18(2), 101–122. https://doi.org/10.1007/s10892-014-9161-6.
Dubljević, V. (2013). Autonomy in Neuroethics: Political and not metaphysical. AJOB Neuroscience, 4(4), 44–51. https://doi.org/10.1080/21507740.2013.819390.
Dworkin, G. (1976). Autonomy and behavior control. The Hastings Center Report, 6(1), 23–28.
Dworkin, G. (1988). The theory and practice of autonomy. Cambridge University Press.
Eich, S., Müller, O., & Schulze-Bonhage, A. (2019). Changes in self-perception in patients treated with neurostimulating devices. Epilepsy & Behavior, 90, 25–30. https://doi.org/10.1016/j.yebeh.2018.10.012.
Fischer, J. M. (1994). The metaphysics of free will: An essay on control. Blackwell.
Fitzgerald, P. B., & Segrave, R. A. (2015). Deep brain stimulation in mental health: Review of evidence for clinical efficacy. Australian & New Zealand Journal of Psychiatry, 49(11), 979–993. https://doi.org/10.1177/0004867415598011.
Frankfurt, H. (2006). Taking Ourselves Seriously & Getting it Right. Bibliovault OAI Repository, the University of Chicago Press.
Frankfurt, H. G. (1969). Alternate possibilities and moral responsibility. Journal of Philosophy, 66(23), 829.
Frankfurt, H. G. (1971). Freedom of the will and the concept of a person. The Journal of Philosophy, 68(1), 5–20. JSTOR. https://doi.org/10.2307/2024717.
Frankfurt, H. G. (1988). The importance of what we care about: Philosophical essays. Cambridge University Press.
Frankfurt, H. G. (1998, November). Necessity, volition, and love. Cambridge Core; Cambridge University Press. https://doi.org/10.1017/CBO9780511624643.
Friedman, M. F. (2003). Autonomy. Social Disruption, and Women. https://doi.org/10.1093/0195138503.003.0005.
Gallagher, S. (2013). A pattern theory of self. Frontiers in Human Neuroscience, 7. https://doi.org/10.3389/fnhum.2013.00443.
Gallagher, S. (2018). Deep brain stimulation. Self and Relational Autonomy. Neuroethics. https://doi.org/10.1007/s12152-018-9355-x.
Gallagher, S., & Daly, A. (2018). Dynamical relations in the self-pattern. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.00664.
Gallagher, S., & Janz, B. (2018). Solitude, self and autonomy (pp. 159–176). https://doi.org/10.2307/j.ctv8xnhwc.11.
Gilbert, F. (2015). A threat to autonomy? The intrusion of predictive brain implants. AJOB Neuroscience, 6(4), 4–11. https://doi.org/10.1080/21507740.2015.1076087.
Gilbert, F., Goddard, E., Viaña, J. N. M., Carter, A., & Horne, M. (2017). I miss being me: Phenomenological effects of deep brain stimulation. AJOB Neuroscience, 8(2), 96–109. https://doi.org/10.1080/21507740.2017.1320319.
Gilbert, F., O’Brien, T., & Cook, M. (2018a). The effects of closed-loop brain implants on autonomy and deliberation: What are the risks of being kept in the loop? Cambridge Quarterly of Healthcare Ethics, 27(02), 316–325. https://doi.org/10.1017/S0963180117000640.
Gilbert, F., & Viaña, J. N. M. (2018). A personal narrative on living and dealing with psychiatric symptoms after DBS surgery. Narrative Inquiry in Bioethics, 8(1), 67–77. https://doi.org/10.1353/nib.2018.0024.
Gilbert, F. (2018). Deep brain stimulation: Inducing self-estrangement. Neuroethics, 11(2), 157–165. https://doi.org/10.1007/s12152-017-9334-7.
Gilbert, F., Viaña, J. N. M., & Ineichen, C. (2018b). Deflating the “DBS causes personality changes” bubble. Neuroethics. https://doi.org/10.1007/s12152-018-9373-8.
Gisquet, E. (2008). Cerebral implants and Parkinson’s disease: A unique form of biographical disruption? Social Science & Medicine (1982), 67(11), 1847–1851. https://doi.org/10.1016/j.socscimed.2008.09.026.
Glannon, W. (2009). Stimulating brains, altering minds. Journal of Medical Ethics, 35(5), 289–292. https://doi.org/10.1136/jme.2008.027789.
Glannon, W. (2014a). Philosophical reflections on therapeutic brain stimulation. Frontiers in Computational Neuroscience, 8. https://doi.org/10.3389/fncom.2014.00054.
Glannon, W. (2014b). Neuromodulation, agency and autonomy. Brain Topography, 27(1), 46–54. https://doi.org/10.1007/s10548-012-0269-3.
Goddard, E. (2017). Deep brain stimulation through the “Lens of agency”: Clarifying threats to personal identity from neurological intervention. Neuroethics, 10(3), 325–335. https://doi.org/10.1007/s12152-016-9297-0.
Goering, S. (2015). Stimulating autonomy: DBS and the Prospect of choosing to control ourselves through stimulation. AJOB Neuroscience, 6(4), 1–3. https://doi.org/10.1080/21507740.2015.1106274.
Goering, S., Klein, E., Dougherty, D. D., & Widge, A. S. (2017). Staying in the loop: Relational agency and identity in next-generation DBS for psychiatry. AJOB Neuroscience, 8(2), 59–70. https://doi.org/10.1080/21507740.2017.1320320.
Goethals, I., Jacobs, F., Van der Linden, C., Caemaert, J., & Audenaert, K. (2008). Brain activation associated with deep brain stimulation causing dissociation in a patient with Tourette’s syndrome. Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 9(4), 543–549.
Haahr, A., Kirkevold, M., Hall, E. O. C., & Østergaard, K. (2013). ‘Being in it together’: Living with a partner receiving deep brain stimulation for advanced Parkinson’s disease - a hermeneutic phenomenological study: Being in it together. Journal of Advanced Nursing, 69(2), 338–347. https://doi.org/10.1111/j.1365-2648.2012.06012.x.
Hariz, G.-M., Limousin, P., Tisch, S., Jahanshahi, M., & Fjellman-Wiklund, A. (2011). Patients’ perceptions of life shift after deep brain stimulation for primary dystonia-a qualitative study. Movement Disorders, 26(11), 2101–2106. https://doi.org/10.1002/mds.23796.
Haworth, L. (1986). Autonomy: An essay in philosophical psychology and ethics. Yale University Press; JSTOR. https://doi.org/10.2307/j.ctt211qz2c.
Hemm, S., & Wårdell, K. (2010). Stereotactic implantation of deep brain stimulation electrodes: A review of technical systems, methods and emerging tools. Medical & Biological Engineering & Computing, 48(7), 611–624. https://doi.org/10.1007/s11517-010-0633-y.
Herrington, T. M., Cheng, J. J., & Eskandar, E. N. (2016). Mechanisms of deep brain stimulation. Journal of Neurophysiology, 20.
Hildt, E. (2006). Electrodes in the brain: Some anthropological and ethical aspects of deep brain stimulation. International Review of Information Ethics, 5(9), 33–39.
Houeto, J. L. (2002). Behavioural disorders, Parkinson’s disease and subthalamic stimulation. Journal of Neurology, Neurosurgery & Psychiatry, 72(6), 701–707. https://doi.org/10.1136/jnnp.72.6.701.
Johansson, V., Garwicz, M., Kanje, M., Halldenius, L., & Schouenborg, J. (2014). Thinking ahead on deep brain stimulation: An analysis of the ethical implications of a developing technology. AJOB Neuroscience, 5(1), 24–33. https://doi.org/10.1080/21507740.2013.863243.
Johansson, V., Garwicz, M., Kanje, M., Schouenborg, J., Tingström, A., & Görman, U. (2011). Authenticity, depression, and deep brain stimulation. Frontiers in Integrative Neurosci., 5. https://doi.org/10.3389/fnint.2011.00021.
Kellmeyer, P., Cochrane, T., Müller, O., Mitchell, C., Ball, T., Fins, J. J., & Biller-Andorno, N. (2016). The effects of closed-loop medical devices on the autonomy and accountability of persons and systems. Cambridge Quarterly of Healthcare Ethics, 25(04), 623–633. https://doi.org/10.1017/S0963180116000359.
Klaming, L., & Haselager, P. (2013). Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics, 6(3), 527–539. https://doi.org/10.1007/s12152-010-9093-1.
Klein, E. (2015). Are brain-computer Interface (BCI) devices a form of internal coercion? AJOB Neuroscience, 6(4), 32–34. https://doi.org/10.1080/21507740.2015.1094546.
Kraemer, F. (2013a). Authenticity or autonomy? When deep brain stimulation causes a dilemma. Journal of Medical Ethics, 39(12), 757–760. https://doi.org/10.1136/medethics-2011-100427.
Kraemer, F. (2013b). Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics, 6(3), 483–497. https://doi.org/10.1007/s12152-011-9115-7.
Kyselo, M. (2014). The body social: An enactive approach to the self. Frontiers in Psychology, 5. https://doi.org/10.3389/fpsyg.2014.00986.
Leentjens, A. F. G., Visser-Vandewalle, V., Temel, Y., & Verhey, F. R. J. (2004). Manipulation of mental competence: An ethical problem in case of electrical stimulation of the subthalamic nucleus for severe Parkinson’s disease. Nederlands Tijdschrift voor Geneeskunde, 148(28), 1394–1398.
Levy, N. (2011). Hard luck: How luck undermines free will and moral responsibility. Oxford University Press.
Lewis, C. J., Maier, F., Horstkötter, N., Zywczok, A., Witt, K., Eggers, C., Meyer, T. D., Dembek, T. A., Maarouf, M., Moro, E., Zurowski, M., Woopen, C., Kuhn, J., & Timmermann, L. (2015). Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson’s disease. Psychological Medicine, 45(1), 73–85. https://doi.org/10.1017/S0033291714001081.
Liddle, J., Phillips, J., Gustafsson, L., & Silburn, P. (2018). Understanding the lived experiences of Parkinson’s disease and deep brain stimulation (DBS) through occupational changes. Australian Occupational Therapy Journal, 65(1), 45–53. https://doi.org/10.1111/1440-1630.12437.
Mackenzie, C., & Walker, M. (2015). Neurotechnologies, personal identity and the ethics of authenticity. In Springer handbook of Neuroethics (pp. 373–392). Dordrecht: Springer.
Mackenzie, R. (2014). Authenticity versus autonomy in choosing the new me: Beyond IEC and NIEC in DBS. AJOB Neuroscience, 5(1), 51–53. https://doi.org/10.1080/21507740.2014.873620.
Mantione, M., Figee, M., & Denys, D. (2014). A case of musical preference for Johnny cash following deep brain stimulation of the nucleus accumbens. Frontiers in Behavioral Neuroscience, 8. https://doi.org/10.3389/fnbeh.2014.00152.
Maslen, H., Pugh, J., & Savulescu, J. (2015). The ethics of deep brain stimulation for the treatment of anorexia nervosa. Neuroethics, 8(3), 215–230. https://doi.org/10.1007/s12152-015-9240-9.
Mathers, J., Rick, C., Jenkinson, C., Garside, R., Pall, H., Mitchell, R., Bayliss, S., & Jones, L. L. (2016). Patients’ experiences of deep brain stimulation for Parkinson’s disease: A qualitative systematic review and synthesis. BMJ Open, 6(6), e011525. https://doi.org/10.1136/bmjopen-2016-011525.
Mecacci, G., & Haselager, W. F. G. (Pim). (2014). Stimulating the self: The influence of conceptual frameworks on reactions to deep brain stimulation. AJOB Neuroscience, 5(4), 30–39. https://doi.org/10.1080/21507740.2014.951776.
Mele, A. R. (2001). Autonomous agents: From self-control to autonomy. Oxford University Press.
Mele, A. R. (2006). Free will and luck. USA: Oxford University Press.
Mele, A. R. (2008). Manipulation, Compatibilism, and moral responsibility. The Journal of Ethics, 12(3), 263–286. https://doi.org/10.1007/s10892-008-9035-x.
Mele, A. R. (2013). Manipulation, moral responsibility, and bullet biting. The Journal of Ethics, 17(3), 167–184. https://doi.org/10.1007/s10892-013-9147-9.
Merkel, R., Boer, G., Fegert, J., Galert, T., Hartmann, D., Nuttin, B., & Rosahl, S. (2007). Intervening in the brain: Changing psyche and society. Springer Science & Business Media.
Meyers, D. T. (2004). Being yourself: Essays on identity, action, and social life. Rowman & Littlefield Publishers.
Mosley, P. E., Hall, W., Forlini, C., & Carter, A. (2014). Alienation and authenticity in Parkinson’s disease and its treatment. AJOB Neuroscience, 5(4), 54–56. https://doi.org/10.1080/21507740.2014.951783.
Müller, S., & Walter, H. (2010). Reviewing autonomy: Implications of the neurosciences and the free will debate for the principle of respect for the Patient’s autonomy. Cambridge Quarterly of Healthcare Ethics, 19(02), 205–217. https://doi.org/10.1017/S0963180109990478.
Munhoz, R. P., Fabiani, G., Becker, N., & Teive, H. A. G. (2009). Increased frequency and range of sexual behavior in a patient with Parkinson’s disease after use of pramipexole: A case report. The Journal of Sexual Medicine, 6(4), 1177–1180. https://doi.org/10.1111/j.1743-6109.2008.00861.x.
Nyholm, S., & O’Neill, E. (2016). Deep brain stimulation, continuity over time, and the true self. Cambridge Quarterly of Healthcare Ethics, 25(04), 647–658. https://doi.org/10.1017/S0963180116000372.
Olson, E. T. (2019). Personal identity. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy (fall 2019). Metaphysics Research Lab: Stanford University https://plato.stanford.edu/archives/fall2019/entries/identity-personal/.
Pham, U., Solbakk, A.-K., Skogseid, I.-M., Toft, M., Pripp, A. H., Konglund, A. E., Andersson, S., Haraldsen, I. R., Aarsland, D., Dietrichs, E., & Malt, U. F. (2015). Personality changes after deep brain stimulation in Parkinson’s disease. Parkinson’s Disease, 2015, 490507–490507. https://doi.org/10.1155/2015/490507.
Pugh, J., Maslen, H., & Savulescu, J. (2017a). The need for further fine-grained distinctions in discussions of authenticity and deep brain stimulation. AJOB Neuroscience, 8(3), W1–W3. https://doi.org/10.1080/21507740.2017.1380727.
Pugh, J., Maslen, H., & Savulescu, J. (2017b). Deep brain stimulation, authenticity and value. Cambridge Quarterly of Healthcare Ethics, 26(4), 640–657. https://doi.org/10.1017/S0963180117000147.
Pugh, J., Pycroft, L., Sandberg, A., Aziz, T., & Savulescu, J. (2018). Brainjacking in deep brain stimulation and autonomy. Ethics and Information Technology, 20(3), 219–232. https://doi.org/10.1007/s10676-018-9466-4.
Quine, W. V. O. (1969). Ontological relativity and other essays. Columbia University Press.
Scaratti, C., Zorzi, G., Guastafierro, E., Leonardi, M., Covelli, V., Toppo, C., & Nardocci, N. (2020). Long term perceptions of illness and self after deep brain stimulation in pediatric dystonia: A narrative research. European Journal of Paediatric Neurology, S1090379820300416, 61–67. https://doi.org/10.1016/j.ejpn.2020.02.010.
Schechtman, M. (1996). The constitution of selves. Cornell University Press.
Schechtman, M. (2010). Philosophical reflections on narrative and deep brain stimulation. The Journal of Clinical Ethics, 21(2), 133–139.
Schermer, M. (2011). Ethical issues in deep brain stimulation. Frontiers in Integrative Neuroscience, 5. https://doi.org/10.3389/fnint.2011.00017.
Schüpbach, M., Gargiulo, M., Welter, M. L., Mallet, L., Béhar, C., Houeto, J. L., Maltête, D., Mesnage, V., & Agid, Y. (2006). Neurosurgery in Parkinson disease: A distressed mind in a repaired body? Neurology, 66(12), 1811–1816. https://doi.org/10.1212/01.wnl.0000234880.51322.16.
Sharp, D., & Wasserman, D. (2013). Compatibilism and a political conception of autonomy. AJOB Neuroscience, 4(4), 55–56. https://doi.org/10.1080/21507740.2013.827757.
Sharp, D., & Wasserman, D. (2016). Deep brain stimulation, historicism, and moral responsibility. Neuroethics, 9(2), 173–185. https://doi.org/10.1007/s12152-016-9260-0.
Shaw, E. (2014). Direct brain interventions and responsibility enhancement. Criminal Law and Philosophy, 8(1), 1–20. https://doi.org/10.1007/s11572-012-9152-2.
Smeets, A. Y. J. M., Duits, A. A., Horstkötter, D., Verdellen, C., de Wert, G., Temel, Y., Ackermans, L., & Leentjens, A. F. G. (2018). Ethics of deep brain stimulation in adolescent patients with refractory Tourette syndrome: A systematic review and two case discussions. Neuroethics, 11(2), 143–155. https://doi.org/10.1007/s12152-018-9359-6.
Sripada, C. (2016). Self-expression: A deep self theory of moral responsibility. Philosophical Studies, 173(5), 1203–1232. https://doi.org/10.1007/s11098-015-0527-9.
Strawson, P. (1962). Freedom and resentment. In Proceedings of the British Academy, Volume 48: 1962 (pp. 1–25).
Synofzik, M., & Schlaepfer, T. E. (2008). Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal, 3(12), 1511–1520. https://doi.org/10.1002/biot.200800187.
Thomson, C. J., Segrave, R. A., & Carter, A. (2019). Changes in Personality Associated with Deep Brain Stimulation: A Qualitative Evaluation of Clinician Perspectives. Neuroethics. https://doi.org/10.1007/s12152-019-09419-2
Thomson, C. J., Segrave, R., Racine, E., Warren, N., Thyagarajan, D., & Carter, A. (2020). ‘He’s Back so I’m Not Alone’: The Impact of Deep Brain Stimulation on Personality, Self, and Relationships in Parkinson’s Disease. Qualitative Health Research. https://doi.org/10.1177/1049732320951144
Unterrainer, M., & Oduncu, F. S. (2015). The ethics of deep brain stimulation (DBS). Medicine, Health Care and Philosophy, 18(4), 475–485. https://doi.org/10.1007/s11019-015-9622-0.
Wardrope, A. (2014). Authenticity and autonomy in deep-brain stimulation. Journal of Medical Ethics, 40(8), 563–566. https://doi.org/10.1136/medethics-2013-101419.
Watson, G. (1975, August 1). Free agency. The Journal of Philosophy., 72, 205. https://doi.org/10.2307/2024703.
Witt, K., Kuhn, J., Timmermann, L., Zurowski, M., & Woopen, C. (2013). Deep brain stimulation and the search for identity. Neuroethics, 6(3), 499–511. https://doi.org/10.1007/s12152-011-9100-1.
Wolf, S. (1987). Sanity and the metaphysics of responsibility. In F. D. Schoeman (Ed.), Responsibility, Character, and the Emotions: New Essays in Moral Psychology (pp. 46–62). Cambridge University Press.
Wolf, S. (1990). Freedom within reason. Oup Usa.