What makes neuroethics possible?

The virtues of vagueness

In the wake of the Mapping the Field conference, the late Robert Martensen (2004: 36) described neuroethics as ‘an extension of traditional bioethics into the neurocentric realm’. Already at the time, however, the field was gaining a more distinct professional identity. Writing in July 2002 in the journal Neuron about a ‘heightened interest in the intersection of ethics and neuroscience’, the philosopher Adina Roskies (2002: 21) advocated a ‘neuroethics for the new millennium’. She argued that ‘the justification for identifying and promoting neuroethics as a new important field’ (rather than ‘merely a subdivision of bioethics’) was to be found in the ‘intimate connection’ between brain and behavior, in the ‘peculiar relationship between our brains and our selves’, and in ‘the intuition that our ever increasing understanding of the brain mechanisms underlying diverse behaviors has unique and potentially dramatic implications for our perspective on ethics and social justice’. The message has since remained the same. Some examples in chronological order:

New ethical issues are arising as neuroscience gives us unprecedented ways to understand the human mind and to predict, influence, and even control it. (Farah, 2010: 2)

By shedding light on the brain, [neuroscience] illuminates our prized rationality, our creativity, our capacity to produce and appreciate art, even our capacity for awe and transcendence. (Clausen and Levy, 2015: v)

Neuroethics is…concerned with the ethical questions that attend the development and effects of novel neurotechnologies, as well as other ethical and philosophical issues that arise from our growing understanding of how brains give rise to the people that we are and the social structures that we inhabit and create. (Roskies, 2016: 3)

We find ourselves at a pivotal historical moment as neuroscientific research increasingly offers insights into aspects of human existence that have long shaped our view of our place in the world, our uniqueness within the animal kingdom, and the very core of what makes us distinctly human. (Johnson and Rommelfanger, 2017: xviii)

We are here concerned with another property of those statements: they show that the raison d’être of neuroethics lies in a potential attributed to neuroscience, and that this attribution does not require explicitly taking a position with regard to ontology or philosophy of mind. On the contrary, they work because key terms and ideas such as ‘intimate connection’, ‘peculiar relationship’, ‘give rise to’, ‘intuition’, ‘understanding’, ‘shedding light’, ‘underlying’, ‘implications’, ‘unprecedented’ or ‘illuminate’ are left vague. Their suggestive character sustains their function, which is to act as the performative basis of the neuroethical enterprise.

Obviously, an utterance that begins ‘New ethical issues are arising’ is not like ‘War is declared’, which launches a war by declaring it. In the terms J. L. Austin used when he pioneered the idea of the performative, it is a ‘constative’ statement, that is, it can be descriptively true or false. In contrast, performatives have no truth value, since they do not describe the world; as Austin (1962: 5) put it, ‘the uttering of the sentence is, or is part of, the doing of an action’. In ‘New ethical issues are arising’, it is clearly not by the utterance of the words that the act is performed. The utterance, however, turns out to have prescriptive and motivational value, and the act – the emergence of new ethical issues – does happen largely by way of the repeated assertion that it is actually happening. ‘Performativity’ as used here is therefore close to the way it has been elaborated in the social sciences, when statements are shown to enact the realities they describe while not creating them ex nihilo, independently of conceptual and sociotechnical contexts (see Callon, 2007, for economics as an example).

In short, the sentences quoted above are performative because they help produce the reality they allegedly describe. Given that ‘[n]euroethical issues are surely going to become ever more pertinent with new developments in imaging analysis technique’, it seems obvious that ‘neuroscientists need neuroethics teaching’ (Sahakian and Morein-Zamir, 2009). The form and contents of such teaching, like the discipline to be taught, hinges on considering that statements like the ones quoted above are true; leaving them vague reinforces the impression that they are indeed true; that impression inspires calls such as ‘Well-prepared neuroethicists…are needed more than ever’ (Fischbach and Mindes, 2011: 370); and the emergence of a professionalized autonomous neuroethics finally seems to vindicate the assumptions the field began with.

The neuroethicist Eric Racine (2010: 93) has observed that conflating statements such as the ones quoted ‘with strong forms of reductionism’ would be misguided, since ‘no one really considers neuroethics to be focusing solely on an organ’ (ibid.: 76). Misguided indeed, but for another reason, which is that the exact meaning of the statements counts less than their performative efficacy. The intellectual condition of possibility of neuroethics is not reductionism or any specific position in the philosophy of mind, but certain performatively operative claims on what the neurosciences in general and neuroimaging in particular say about the nature of the human. Typical of this is the opening of the Springer Handbook of Neuroethics when it states that, if ‘the neuro-essentialist notion that the brain defines who we are might seem a bit far-fetched…there is no doubt that the brain is the biological substrate of central human characteristics’ and that there ‘is no aspect of our lives that neuroscience cannot, in principle, help to illuminate’ (Clausen and Levy, 2015: v). Again, there are many ways of understanding our lives, how the brain is substrate and how, in principle, neuroscience illuminates. But, whatever their intention and exact meaning, such statements have a performative function, and this function – which is to motivate both the neuro and the ethics in neuroethics – relies precisely on their not being specified. Their generality also favors the pragmatic and empirical orientation of neuroethics as a whole.

What, then, makes neuroethics possible? We could say, ‘exaggerating how much scientific research can tell us about who we are’ and ‘the fantasy of one all-encompassing explanation for complex human traits’ (Parens and Johnson, 2007: 562). A more precise answer would be: the postulate that ‘brains give rise to the people that we are and the social structures that we inhabit and create’ (Roskies, 2016: 3), that ‘our brains make us the kinds of creatures we are, with our values and goals’ (Levy, 2007a: 8). The extent to which this postulate is accepted or contested depends on its exact meaning, but neuroethics does not depend on its meaning – only on its aura of factuality and the resulting performativity.

Neuroethics and the future

After the Stanford conference of 2002, neuroethics required only a few years to professionalize and develop networks, platforms, societies, academic centers, teaching and research programs, and printed and online journals (Neuroethics, AJOB Neuroscience, and the Journal of Cognition and Neuroethics were launched respectively in 2008, 2010 and 2013). Internet forums for current research and debates have proliferated (e.g. www.theneuroethicsblog.com), and so have opportunities for professional training. Although there are few graduate programs dedicated exclusively to the field, by 2014 there were 33 centers, groups, teams and networks of different sorts and sizes focused on issues labeled ‘neuroethical’, mostly in North America but also in Asia, Australia, South America, the UK, and the European Union (Buniak, Darragh and Giordano, 2014).

Furthermore, neuroethics publications amount to hundreds of articles as well as single-authored books, multi-authored volumes, handbooks, anthologies, and collections of original essays (Buniak, Darragh and Giordano, 2014). ⁴ When considered in the context of the several ‘hyphen ethics’ that have emerged since the 1980s (environmental-, media-, computer-, animal-, gen-, nano-), its growth has been remarkable: it took neuroethics 8 years to reach the annual number of publications that environmental ethics, the previously most successful specialty, took 30 years to attain (Hoyer, 2010: 82-3). Future growth will be nurtured by initiatives such as Springer’s Advances in Neuroethics book series, established in 2016 (www.springer.com/series/14360). Favored with gifted and prolific leaders whose names recur in editorial boards and academic and public events, neuroethics is nonetheless diverse, ranging from empirical research on concrete cases to philosophical reflection.

The future of neuroethics seems therefore ‘bright’ (Dubljević, Saigle and Racine, 2016) and, as for much else, it apparently lies in globalization. Although predominantly North American, the discipline is international. In addition to translations and publications in English coming out from non-anglophone, although mainly European, countries it is well represented in, at least, French, German, Italian, and Spanish. ⁵ The production outside the English-speaking domain constitutes a rich and diverse scholarly corpus; although it does not entirely mimic the dominant Anglo-North-American mainstream, all the books that constitute it include extensive meta-neuroethical developments that do reproduce the foundational claims about the impact of the brain sciences.

Neuroethics, then, is international; however, the distribution of publications, actors and institutions shows that it is not yet global (Leefmann, Levallois and Hildt, 2016; Lombera and Illes, 2009). Advocates of globalization justify it by ‘the far-reaching impact of brain science in our lives’ (Chen and Quirion, 2011: 825; see also Lanzilao et al., 2013; Shook and Giordano, 2014). The growing Global Mental Health (GMH) movement may contribute to such development. Significant voices in both fields have described intersections between them and called for ‘mutual engagement’ and ‘converging perspectives’ (Stein and Giordano, 2015); the debates that, mainly in the post-colonial mode, have already affected GMH are also beginning to touch on their ‘potential synergies’ (Stein et al., 2015, followed by a comment by Carey (2015) and authors’ response).

Given that neuroscientific findings circulate quickly and worldwide, it is safe to say that no country eludes the ethical issues they may raise and the application of global ethical guidelines. However, if the science and the research ethics are (ideally) universal, those issues are sometimes profoundly shaped by local social and cultural factors. In Argentina, the traditional weight of psychoanalysis contributes to mold attitudes to neuroscience, and therefore to neuroethics (Salles, 2014, 2017); in Japan, understandings of the impact and ethics of neuroscience are likely influenced by distinctive concepts and vocabularies for mind-heart-spirit (Fukushi et al., 2017; on East Asia more generally, see Sakura, 2012). Moreover, how much or little neuroethics institutionalizes is largely dependent on the structure of research funding and academic organizations (see Gaillard, 2018 for the Japanese case).

Beyond these differences, the spread of neuroethics outside Western, Educated, Industrialized, Rich, and Democratic societies (WEIRD) (Henrich, Heine and Norenzayan, 2010), has been an export–import process, intellectually driven by the usual predictive assumptions – for example, neuroscientific advances may shed light on philosophical questions and concepts of the self, or neurotechnologies may enable better psychiatric diagnosis and treatment (Stein and Giordano, 2015: 2, 4). This process is well illustrated by the Japanese and Taiwanese cases, which are among the few to have been documented. Aside from some light speculations, informed by cultural neuroscience, about a possible ‘Confucian neuroethic’, it offers nothing specifically non-WEIRD (Chien-Chang Wu and Fukushi, 2012; Fukushi, Sakura and Koizumi, 2007). The same applies to proposals for the ‘global dissemination’ of neuroethics via e-learning, which would rely entirely on WEIRD resources (Tairyan and Frank, 2011). Promoting globalization seems justified by the belief that neuroscientific knowledge will have momentous consequences for the self and society worldwide. The prevalent view in this respect is that, as the brain sciences generate ‘novel ways of thinking about the human condition’, neuroethics will develop ‘a canon that seeks to (a) identify the humanistic importance of neuroscience…and (b) provide reflective direction to the pace and trajectory of technological progress’ (Giordano, 2010: xxviii). The push toward globalization is well under way, and actively recruiting (Larrivee, 2018).

The claim that neuroscience generates radical reconceptualizations of the human expresses both a desire and a normative view that do not correspond to real people’s self-conceptions or everyday experience (O’Connor and Joffe, 2013). That, however, does not abolish its performative efficacy. On the contrary, as sociologists Ilina Singh and Nikolas Rose (2006: 100) observed, ‘neuro-ethical anxieties have become part of the very problem they seek to address’ and foster ‘a culture of hype and hope, futurology and fear’. The mechanism is simple: neuroethics first predicts tensions that neuroscientific progress will generate, and then offers to manage them: ‘In the age of neuro-everything, as we enter novel and daring new territories, neuroethicists will be needed to formulate many essential questions, and provide much-needed guidance in addressing difficult and ethically challenging problems’ (Fischbach and Mindes, 2011: 370). This process embodies the organic alliance between neuroethics and neuroscience, and highlights the field’s affinity with the neuro disciplines that, from neuroanthropology to neurotheology, have prospered thanks to the availability of neuroimaging (Littlefield and Johnson, 2012; Vidal and Ortega, 2017). Pioneer neuroethicist Judy Illes (2010: 1294) highlighted such an alliance when she described neuroethics as a way of ‘empowering brain science’ by ‘moving age-old debates about mind and brain towards modern theoretical discussions about the understanding of human behaviour enabled by advances in neurosciences’. In short, as Leefman and Hildt (2017: 15) point out, even when some of its advocates explicitly reject reductionist ontologies (as illustrated below) or criticize neurohype, neurorealism and neuroessentialism (e.g. Lilienfeld et al., 2017), neuroethics as a field amplifies the ‘neuroscientific turn’, understood both as the widespread salience of neuroscience ‘as an interpretative framework for virtually every part of human life’, and more specifically as the application of neuroscientific concepts, methods and theories in the social sciences and the humanities. ⁶

In its focus on the future impact of neuroscience, neuroethics reproduces the ‘proleptic structure’ that has characterized the brain sciences since phrenology offered itself as a scientific means of managing the individual and society (Hagner and Borck, 2001, 508–9). Thanks to the neuroimaging technologies on which they depend for their existence (I return to this below), neuroethics and the neuro disciplines are able to advance the integrative universalism that has also distinguished the brain sciences since the 19th century: neuroscientific knowledge should frame concepts and practices ranging from individual self-improvement to the political organization of society; like Victorian neurologists, contemporary neuroscientists present themselves as the experts par excellence for demonstrating the universal brain-based system that will ultimately connect physiology and civilization (Casper, 2014). The proleptic structure of neuroscience helps define research topics, shape communication and public understanding, inspire expectations, and identify expertise. Neuroethics plays a central role in that process. After all, ‘[a] key pillar of the field is a naturalistic view that posits that advances in neuroscience may well shed light on philosophical issues’ (Stein and Giordano, 2015: 2).

Note the may. The use of an exclusively modal and conditional language, further illustrated below, shows that the discourse moves in the realm of speculative likelihood. The title of the recent edited volume entitled Neuroethics: Anticipating the Future (Illes, 2017) trumpets the dominant perspective. When embedded in major technology-driven, publicly financed multinational enterprises of enormous cost and symbolic and political value, like the European Human Brain Project (HBP) or the U.S. BRAIN Initiative, the prophesied eventualities acquire the consistency of the real. Both projects include ethics and society programs, and are a boon to neuroethics as a discipline. ⁷ Although future-oriented, that process demonstrates the need for neuroethics, and is at the heart of the discipline’s product positioning in the present.

For example, Oxford Handbook of Neuroethics devotes its foreword to arguing in favor of the ‘proactive approach’, underlines the significance of ‘emerging issues’ and of ‘potential pressure points for neuroscience-society tension’, claims that some neuroscientific insights ‘are likely to threaten core values and beliefs’, and asks, ‘How should the scientific community prepare for the likelihood that neuroscience advances will result in increasing tension with the rest of society?’ (Leshner, 2011: v, vii, xi, ix; emphasis mine). By definition, the proactive outlook evokes possible futures. Yet its most consequential effect is that it translates into research, which in turn drives the investigative and institutional policies and practices that consolidate its objects. In this case, foresight metamorphoses into self-fulfilling prophecy.

Let us consider a survey conducted among health providers and patients diagnosed with major depressive disorder, which found ‘high receptivity to brain scan for treatment tailoring and choice, for improving understanding of and coping with disease, and for mitigating the effects of stigma and self-blame’ (Illes et al., 2008: 107). Neither then nor now has neuroimaging helped in the ways posed by the survey (Ferrari and Villa, 2017; Vidal and Ortega, 2012; compare Lu, 2016, an optimistic review written entirely with modal verbs). In fact, despite decades of research and millions invested, ‘there are no biomarkers of any kind available to any of the psychiatric disorders’ (Martins-de Souza, 2013: 1). The survey authors recognized as much, admitting that there had been so far no translation of neuroimaging research to the depression clinic. That, however, did not prevent them from claiming that ‘rapid innovation’ was taking place along the ‘trajectory of discovery to implementation’, and to advocate ‘the development of responsible social and public policies in response to new diagnostic and prognostic capabilities for the benefit of patients and their families’ (Illes et al., 2008: 107). As the authors write in another article, which reports on interviews with adults diagnosed with bipolar or major depressive disorder, it cannot be assumed that ‘participants’ prospective attitudes will map directly onto how they would feel should these scenarios come to pass’ (Buchman et al., 2013: 77). However, as the interview responses illustrate, the outcome of prompting ‘attitudes to hypothetical clinical scenarios’ (ibid.: 68) is to inspire belief in them. This helps enforce the translational imperative that has come to dominate biomedicine (Harrington and Hauskeller, 2014).

The goal of surveys such as these ones is to integrate ‘the voices of stakeholders’ (mental health researchers and providers, patients and their families and caretakers) ‘upstream of clinical translation’ (Borgelt, Buchman and Illes, 2012). The vocabulary of democratic participation and upstream engagement has become fashionable (though its actual repercussion is limited) in science communication and governance since the 1990s (e.g. Hagendijk and Irwin, 2006). Neuroethicists have adopted it, and for a respectable motive: who would be against better social policy? But at the same time they take for granted that neuroimaging will ‘have a profound, expansive impact on the conceptualization of mental illness and provision of mental health care’ (Borgelt, Buchman and Illes, 2012), claim that future policy and practice must be informed by such an expectation, and establish neuroethics as the expert field par excellence to deal with the anticipated situations. This does not seem the best way to ‘maximize benefit’, ‘prevent false hope’, and ‘mitigate hype’ (Illes et al., 2008: 112).

By proclaiming that ‘fMRI promises significant benefit to the diagnostic process for major depression’ (Illes et al., 2008: 113) and presenting the accomplishment of that promise as virtually certain, neuroethicists neither lessen hype nor hinder false hope. Mainly, they bolster a ‘self-referential methodological structure’ where the foundations of their discipline include assumptions, expectations and results of scientific activities that neuroethics should (if the ethics part is to hold) critically examine (Hoyer, 2010: 38, 132). Such constitutive relationship between neuroscience and neuroethics prevents the latter from distancing itself from its objects; nevertheless, neuroethicists consider it an asset, and a basic ingredient of their field: ‘Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for prescriptively judging the ethical applications of neurotechnologies’ (Shook and Giordano, 2014, 1; see also Giordano, 2011; Roskies, 2016).

Could this be otherwise? Even when their immediate object is the present, ethical analysis and moral judgment are turned toward the future. Assessing a situation as it is today implies ideas about how it should be tomorrow. It is only natural that neuroethics be interested in the world to come, and that it devote part of its resources to the study of expectations and attitudes toward eventualities. But there is here something more specific than a general feature of ethical thinking. Given the role of imaging technologies in the expansion of the ‘neuro’ since the 1990s, as well as recent advances in other neurotechnologies, including neuroprostheses and brain–machine interfaces (Clausen et al., 2017; Müller and Rotter, 2017), neuroethics fully belongs in the larger development of ‘anticipatory ethics’, defined as ‘the consideration of ethical problems framed within technological scenarios which do not presently exist’ (O’Connell, 2006: 49).

Anticipatory ethics emerged as a way of thinking about accountability and responsibility with regard to rapidly evolving technologies (Brey (2012) speaks of anticipatory technology ethics). Seeking to influence their development and usages, it approaches science as a means to social ends, and, by integrating ethical thinking into technological development, proposes to merge science and ethics (Johnson, 2010, 2011); hence the label anticipatory ethics and governance (Hester et al., 2015). It comes as no surprise that neuroethics was from be beginning incorporated into the BRAIN Initiative and the Human Brain Project, which were promoted as technology initiatives, and whose funding of billions was officially justified in terms of the technological breakthroughs they are expected to accomplish. ⁸ As usual, discourses about technology are characterized by an ‘innovation-centric futurism’ (Edgerton, 2007: xvi) that masks continuities with familiar epistemological and metaphysical questions and commitments.

Although speculation and foresight do not have equal weight across the neuroethical field, their constitutive role has prompted some neuroethicists to respond to the depiction of their discipline as ‘a speculative philosophy’ (Fins, 2008: 38). Their epistemic status and their impact on expectations among scientists, funding institutions and the general public have given rise to calls for assessing them more carefully and acknowledging more systematically the assumptions that undergird them (see for example Racine et al., 2014 on cognitive enhancement); this has led to a newfound invitation to focus on ‘actual, current issues’ and leave behind the ‘moot’ question of neuroethic’s supposed uniqueness (Kushner and Giordano, 2017: 525).

To my knowledge, the most elaborate attempt at arguing for the discipline’s real-world relevance beyond speculation and foresight concerns privacy in connection with neuroimaging research on individual differences in personality and intelligence. It is based on 16 studies, and concludes ‘that the use of imaging to gather information about an individual’s psychological traits is already possible, but to an extremely limited extent’ (Farah et al., 2010: 119). The article’s first author, neuroethicist and cognitive psychologist Martha Farah, contends that neuroethics has moved from being a ‘predominantly anticipatory field’ to focusing on actual advances; she attributes that development to ‘the rapidly evolving state of neuroscience itself’, and connects neuroethics’ mission to the observation that ‘neuroscience is calling into question our age-old understanding of the human person’ (Farah, 2011: 761, 776). The point to be made here is not whether her examples actually substantiate her claims, but that what she offers as an empirically based justification for the existence of neuroethics is nothing other than the discipline’s foundational postulate.

An ‘inevitable and omnipresent working hypothesis’

Most presentations of neuroethics follow Roskies (2002) in explaining that the term refers to the neuroscience of morality and the ethics of neuroscience. Some consider neuroethics as a ‘way of doing ethics’ that is ‘new’ because it uses ‘the neuroscience of ethics to illuminate the ethics of neuroscience’ (Levy, 2011: 8). Such a view belongs in the vast debate about the possibility and forms of a naturalized ethics; some of its advocates bring up that context and the challenges it implies (Wagner and Northoff, 2015). Making the neuroscience of ethics integral to ethics – including the ethics of neuroscience – is an instance of the already mentioned organic alliance between neuroscience and neuroethics. Nevertheless, in practice, neuroethics concerns above all the ethical, social, political and legal implications of brain science for the individual and society (and it has been argued, for example by Müller et al. (2018), that it should be understood only in that sense and, therefore, as not fundamentally different from other bioethical domains). Bibliometric analyses (Buniak, Darragh and Giordano, 2014; Leefmann, Levallois and Hildt, 2016) show that it encompasses a considerable range of topics and methods, falling in four large thematic areas: brain science and the self, brain science and social policy, ethics and practice of brain science, brain science and public discourse (Lombera and Illes, 2009). Now, since bioethics has long been an established profession and ethical, legal and social implications (ELSI) approaches apply to neuroscience as to other areas, why was it argued that neuroethics had to be a separate discipline?

The making of neuroethics, as of any other discipline, involves various sociological dimensions (Conrad and De Vries, 2011). Leaving aside institutional discipline-building, the crucial one concerns its relationship to neuroscience. It has been argued that neuroethicists became approved experts for mediating between neuroscience and the public sphere in the contexts of ‘biocapitalism’ and the global politics of science (Hoyer, 2010) by drawing ‘on expectational discourses’ about the future of brain research, and actively aligning themselves with neuroscience at the expense of their role as ‘ethical watchdog’ (Brosnan, 2011: 289). Early commentators noted the absence within neuroethics of voices from the humanities and social sciences – an absence connected to the dearth of discussion on socio-economic issues and to the structural ambivalence resulting from the discipline’s alliance with neuroscience (De Vries, 2007; Martensen, 2004; see also Hoyer and Slaby, 2014, for a discussion of the depoliticized nature of neuroethics in the enhancement debate).

How about the neuroscience of childhood poverty, in which some neuroethicists are actively interested? Poverty being a complex, multidimensional phenomenon, it would be reckless to deny the merit of showing how it impacts the developing brain (for recent overviews see Lipina and Evers, 2017; Noble, 2017). Documenting such impact in detail is scientifically significant, and because of the current authority of the neuro, it may become politically valuable if it prompts individuals and agencies to action. Nevertheless, demonstrating the neurodevelopmental effects of poverty does nothing to account for poverty, nor can directly help combat it. Perhaps it will in the future inspire measures for reversing injurious neurological effects, but implemented interventions, such as combining cognitive stimulation with nutritional supplements, rely on knowledge of psychology and physiology; and there is no evidence that neuroscience can in this domain valuably inform political, moral, or economic decisions. That is why the supposed ‘neuroethical implications’ of the neuroscience of childhood poverty contain virtually no neuro, and nothing recognizable as ethics.

Finally, as far as neuroscience in society is concerned, in spite of recent calls for paying more attention to the ‘biopolitical’ implications of brain science and for seeing neuroethics itself as a form of biopolitics (Jotterand and Ienca, 2017), the field gives precious little room to the rich body of research on the neuro that anthropologists, historians and sociologists of science and medicine have produced since the 1990s. The issue of ‘exceptionalism’ belongs in that framework. I shall here look into only one aspect of it, namely the field’s intellectual condition of possibility.

In 2005, Judy Illes and Eric Racine’s American Journal of Bioethics target article ‘Imaging or Imagining? A Neuroethics Challenge Informed by Genetics’ prompted a unique debate on exceptionalism. This debate shows that, contrary to what neuroethicists have affirmed, neuroscientific progress is not by itself the ultimate ground for advocating the autonomy of their discipline.

The article explains that the specific task of neuroethics is to deal ‘proactively’ and ‘responsibly’ with ‘the inevitable and omnipresent working hypothesis…that the mind is the brain’, and to interpret neuroimaging data so as ‘to untangle what we image from what we imagine’ (Illes and Racine, 2005: 10, 12). The potential attributed to functional neuroimaging is offered as ‘the principal reason that traditional bioethics analysis…will not suffice as a guide’ (ibid.: 7, 6). This justification reproduces the ‘technology story’ typical of self-presentations of bioethics (De Vries, 2007: S66): ‘advanced capabilities for understanding and monitoring human thought and behavior enabled by modern neurotechnologies have brought new ethical, social and legal issues to the forefront’ (Illes and Racine, 2005: 5). The article, like the field it announces, proclaims the onset of a ‘new era’ of ‘bold new findings and claims’ (ibid.: 15): fMRI ‘poses pivotal challenges to thought privacy’ (ibid.: 11), and neurotechnologies ‘will fundamentally alter the dynamic between personal identity, responsibility and free will in ways that genetics never has’, and ‘are challenging our sense of personhood and providing new tools to society for judging it’ (ibid.: 14). Behind the stated certainties about the future stands the notion that ‘the mind is the brain’. Though introduced as a working hypothesis, it operates as an empirical matter of fact, and it is as such that it justifies neuroethical exceptionalism. As mentioned, this function is facilitated by the indeterminacy of its exact meaning: the mind can be the brain in a variety of ways, which are left unspecified.

Some of the commentaries to Illes and Racine hint at that situation. Doucet (2005: 30) notes that neuroethics should help neuroscientists ‘recognize the limits of their discipline and their natural inclination’. Wilfond and Ravitsky (2005: 21) get closer to the core problem when they observe that ‘treating certain topical areas as new and exceptional encourages the misguided impression that some information, such as genetic sequences or brain images, is inherently unique because it defines the essence of life and personal identity’. So does Evers (2005: 31) when she points to the ‘misleading connotations’ of Illes and Racine’s use of ‘brain maps’ as equivalent of ‘thought-maps’. Buford and Allhoff (2005: 34) believe in turn that ‘the neurosciences and neurotechnologies are unlikely to have any metaphysical implications robust enough’ to support the authors’ views about the ethical implications of neuroscientific knowledge. They thereby dispute both Illes and Racine, and the editorialist who introduces the debate by claiming that ‘the simple fact that the brain is the origin of the mind, and therefore in many ways the seat of our humanity, confers very special status on it as an organ’ (Leshner, 2005: 1). Crucial notions such as ‘origin’, ‘seat’, or ‘special status’ are left undefined, and their vagueness reinforces the performative plausibility of the alleged ‘simple fact’.

Uniquely neuroethical issues

Even though neuroethics has been justified through claims about the impact of neuroscience on notions and practices of the self and personhood, studying such impact is not the core of neuroethical investigation. As of 2009, 60% of publications in the field concerned the ethics and practice of brain science, with policy issues (21%), self and personhood (16%) and scientists-public discourse (3%) trailing way behind (Lombera and Illes, 2009: 61 and 62, Figure 2). The latest bibliometric analysis confirms that what its authors depict as ‘the mainstream of neuroethics research’ deals ‘with ethical questions within the established theoretical frameworks of bioethics’ (Leefmann, Levallois and Hildt, 2016: 12). The most frequent topics do not concern the transformative potential of neuroscientific research (e.g. cognitive enhancement or the modulation or erasure of memories), but medical and health-care issues related to psychiatric and neurodegenerative diseases (ibid.: 13; see also Racine and Illes, 2008).

For Leefmann, Levallois and Hildt (2016: 17), the fact that ‘almost all topics discussed within neuroethics today have been present in debates in medical ethics, pharmacology or philosophy of mind’ weakens ‘the potential of neuroethics to establish itself as a discipline of its own’. That potential, however, is actually not in question, since it has already been realized. The significant point is rather that the professionalization and expansion of neuroethics does not derive from its dealing with new ethical or conceptual problems, but from perpetuating the belief that we are our brains (whatever exact content that belief may have), and on thereby sanctioning the ever growing number of projects that depend on it ideologically. ‘Sanctioning’ does not imply an uncritical attitude; on the contrary, it means warning about excesses, alerting about hype, calling for prudence – not to undermine those projects, but to give them apparently stronger philosophical and methodological foundations.

As an example, let us examine what, to our knowledge, is the most systematic defense of neuroethical specificity. In a chapter of the Penn Center Guide to Bioethics, Martha Farah (2009) seeks to differentiate issues that are ‘familiar bioethical issues, which pertain to the brain as well as other organ systems’, from those ‘that arise in connection with the brain, because it is the organ of the mind’. These are ‘unique to neuroethics’ and include

the social and ethical implications of brain imaging, psychopharmacology, brain stimulation, and brain-machine interfaces, as well as the ways in which our advancing understanding of mind–brain relations calls into question basic assumptions about what it means to be a person. (Farah, 2009: 72)

There are, however, four categories of ‘uniquely neuroethical issues’ that ‘emerge primarily because of the very special status of the brain, compared with other organs, in human life:’ functional neuroimaging, psychopharmacology, brain stimulation and brain prostheses, and brains and persons, that is, the ‘challenges to our concepts of personhood posed by our growing understanding of the neural bases of behavior, personality, consciousness, and states of spiritual transcendence’ (Farah, 2009: 75). The issues related to psychopharmacology concern primarily the use of substances ‘to change or enhance normal people’s cognitive abilities and moods’ (ibid.: 77). The augmentation of attention and memory, the weakening of unwanted memories or the improvement of mood raise questions about safety, fairness and social equity, the commodification of mental functions, the impact of enhancement practices on values such as hard work, as well as on personal identity and authenticity. Similar issues are raised by brain stimulation and brain prostheses (ibid.: 79–80).

As regards brain imaging, the main specifically neuroethical issue is said to be ‘privacy of thought’. In Farah’s view, the ‘most obvious concern’ derives from actual and potential uses of imaging technologies to detect lying and unconscious motivation as well as to ‘brainotype’ mental and personality traits. Although the well-documented problem of considering brain scans ‘as more accurate and objective than in fact they are’ is mentioned (Farah, 2009: 76), the neuroethical treatment of brain imaging turns out to be part of that very problem. Within the neuroimaging community, some matters, such as overblown predictions (e.g. Whelan and Garavan, 2014) or inflated false-positive rates (e.g. Eklund, Nichols and Knutsson, 2016), are widely recognized as needing remedy; the ethical and legal implications of the field’s ‘methodological crisis’ have been well identified (Kellmeyer, 2017). While discussing some of these matters may fall within the purview of neuroethics, their existence has not changed the beliefs about brain scans on which the discipline is founded: the assumption that imaging the brain ‘provides’ or ‘reveals information about the mind’ (Farah, 2010: 4; 2009: 75), and that fMRI therefore constitutes the ‘primary methodology to investigate mental states neuroscientifically’ (Levy, 2008: 7).

Fins (2011: 896) remarks that neuroethics was made possible by technology and is to such an extent dependent on it that it can be considered ‘essentially an ethics of technology’. Such dependence is most radical with respect to neuroimaging, which has been the field’s technological condition of possibility (Vidal, 2015). As the quotations above illustrate, the relevance of neuroethics depends on assuming that brain imaging is a window into the mind and into the constitutive features of personhood; valuable as they are, neuroethics discussions of myths and misunderstandings about neuroimaging are constructed so as to strengthen that postulate, never to call it into question. I return below to this point.

Neuroethics’ claims about neuroimaging raise numerous philosophical and empirical issues, to begin with the confusion of ‘mental privacy’ and ‘brain privacy’ (Gilead, 2015). Our purpose is not to discuss them, but only to note that asserting that neuroimaging ‘reveals information about the mind’ is a petitio principii in the guise of a factual statement. Illustration of that is Farah’s (2014) thoughtful reply to criticisms of functional neuroimaging, which does not deal with the assumption in question – from which, however, everything else follows. De Vries (2007: S68) noted that the ‘uncritical way’ in which neuroethicists respond to neuroimaging research ‘is surprising to a social scientist’. It should not be, because it reflects neuroethics’ trust, which is vital for its own existence, in the capabilities of neuroimaging for studying mental states. This is in turn tied to the discipline’s approach to brains and persons, the fourth category of ‘uniquely neuroethical issues’.

Brains and persons is said to define a distinctly neuroethical concern because knowledge of brain function is ‘forcing us to reexamine our understanding of ourselves as moral agents and spiritual beings’ (Farah, 2009: 80). Some individuals indeed reconsider their self-understanding in the light of neuroscientific information – though, generally, only when they feel particularly concerned (i.e. after they themselves had a cerebrovascular accident; see for example Pickersgill, Martin and Cunningham-Burley, 2015). However, the ‘amoral deterministic viewpoint’ which, allegedly due to neuroscientific knowledge, ‘will probably gain a stronger hold on our intuitions’ (Farah, 2009: 80), has long existed independently of such knowledge, and does not logically follow from empirical information. According to Farah, our ‘intuitive understanding of persons’ comprises beliefs, such that persons ‘have an essence that persists over time, that they are categorically either alive or dead, and that they have a nonmaterial dimension such as a spirit or soul’. These beliefs, she notes, do not fit ‘with the idea that a person is his or her brain;’ thus, ‘as neuroscience reveals progressively more about the physical mechanisms of personality, character, and even sense of spirituality, there is little about a human being left to attribute to an immaterial soul’ (ibid.: 80–1).

All this sounds as if believing that persons are their brains were the only alternative to faith in an immaterial soul, and as if questioning that conviction implied accepting the existence of spiritual substances. Nothing could be more inaccurate. Let us consider the most relevant instance for the context of neuroethics: the Christian tradition, which certainly affirms the existence of the soul, but defines persons as intrinsically corporeal and has, at least since Thomas Aquinas, consistently asserted that disembodied souls are not persons (on this vast topic, see most recently Baschet, 2016). It assumes a duality, but nothing like ‘Cartesian dualism’ is among its fundamental doctrines. The depiction of ‘brains and persons’ as a uniquely neuroethical issue thus fuses the fact that we cannot be without our brains with the persuasion that we are (somehow, but essentially) our brains. Such a confusion is perhaps no more than the result of a perfunctory handling of the notions of soul and person, yet it does reflect the belief that neuroscience will definitively get rid of the former and radically transform the latter. In the neuro universe, substance dualism still works well as the straw man to be lambasted. ⁹

As mentioned above, neuroethics’ foundational belief is sustained by trust in the potential of neuroimaging. This trust is decidedly not naïve. On the contrary, it is informed by expert knowledge about the technicalities of brain imaging and a keen awareness of the criticism that has been addressed to it. Neuroethicists have offered detailed rejoinders. Roskies (2010), for example, has defended the subtraction method, and Farah (2014) has systematically reviewed critiques and provided replies. Yet the net result of these competent treatments is to bolster confidence in the potential of neuroimaging to illuminate ‘our understanding of ourselves’ and give ‘information about the mind’, including (as illustrated by fields like neuroaesthetics, neuroanthropology, neurohistory or neurotheology) the most complex processes of humans as cultural creatures. Questioning that potential has so far stayed outside the compass of neuroethics as we know it – though not of professional neuroscience (e.g. Fitzpatrick, 2012).

I say neuroethics as we know it because not every consideration of the ethical, legal and social implications of the brain sciences belongs therein. For example, debating neuroenhancement has become one of the discipline’s home industries, and even its more contextualized treatments (e.g. Shook, Galvagni and Giordano, 2014) imply that the discussion has substance. Boris Quednow (2010), a neuropharmacologist at the University of Zurich, has challenged the pharmacological and epidemiological presumptions that justify what he calls a ‘phantom debate’. Neuroethicists have occasionally cited him, but only for informational details, while silencing his main point (thus in Lucke et al., 2011, who nonetheless go in a similar direction, and in two chapters of Hildt and Franke, 2013; there is no mention of it in the major volume edited by Jotterand and Dubljević, 2016). Clearly, dealing with neuroenhancement in ways that undermine the neuroethical mainstream is not doing neuroethics.

It then appears germane to ask if neuroethics – insofar as that term is to make conceptual sense – can forgo the idea that ‘brains give rise to the people that we are and the social structures that we inhabit and create’ (Roskies, 2016: 3), as well as ‘make us the kinds of creatures we are, with our values and goals’ (Levy, 2007a: 8). I have suggested that it cannot, that such statements generate an intellectual space that accommodates multiple positions, that they thereby leave the discipline’s ‘unsettled boundaries’ (Gligorov, 2016: 1) unsettled, and that such feature sustains its credibility and growth. Again, the idea in question does not necessarily imply neuroreductionism. Thus, in Bioethics and the Brain and Neuroethics with a Human Face, Walter Glannon considers the mind as an ‘emergent feature of the brain’ (2006: 28), and calls attention to the interactions ‘among the brain, body, and environment’ (2011, 12). Going beyond emergentism, Neil Levy (2007a: 29–63; 2007b) advocates the extended mind thesis (according to which mind includes elements external to the brain and body whose function, were they internal, could be recognized as mental), and remarks that it ‘dramatically expands the scope of neuroethics’ (2007b: 3). Of course, one can question the aptness of calling such extension mind; however, as Levy (2007a: 74) points out, it does not matter what we call it as long as ‘we acknowledge that it is the combination of our brains and the tools and props upon which we lean that makes us so smart’. But why would any of this be neuroethics if not because mind (or even us) is equated to brain?

Since the forms and contents of disciplines evolve, it is obviously unproductive to be dogmatic about their names or to become entangled in onomastics. Yet names that are not simply practical labels carry meanings and point in definite directions. Surely one could use ‘neuroethics’ just to tag contents or make publications easily identifiable. Nevertheless, if the term is to retain the consistency it was designed to possess, it must designate something that is reasonably true to its two components. Dealing with the ethics would require a different article. As for the prefix, in the same way that, in compound words, cardio must refer to the heart (and eventually the circulatory system), angio to blood vessels, hemato to the blood, and pneumo to the lungs, neuro must refer to the nervous system. In practice, it has referred to the brain; and what it conveys is the notion that, to quote again, our brains not only ‘make us the kinds of creatures we are’, but also give rise to ‘the social structures that we inhabit and create’ (Levy, 2007a: 8; Roskies, 2016: 3). All the rest, the social and natural environments as much as the tools and props, is (somehow) supervenient. If that were not the case, neuroethics would not have to be neuro.

There is another possibility, namely that neuro is no more than an opportunistic, but misplaced prefix. In Subjectivity and Being Somebody: Human Identity and Neuroethics, Grant Gillett (2008: vii) discovers that, ‘inadvertently’, he had been doing neuroethics for 35 years. ‘Inadvertently’, he writes, because his philosophical and bioethical inquiries have turned out to coincide with ‘what is now known as neuroethics’, and because the questions that inspired him, about identity, consciousness or moral responsibility, ‘were exactly those central in neuroethics’. Such coincidence, however, like acknowledging that memory, consciousness and intention have neurobiological bases, is not enough to justify the prefix. That is why Roger Scruton could conclude a review of Gillett wondering about the neuroethics that Subjectivity and Being Somebody is supposed to exemplify.

Is there a branch of ethics that specifically concerns matters of neurology, or a branch of neurology that raises questions that are not general questions of ethics? The problematic use of brain surgery to control epileptic seizures and the worst forms of depression has certainly raised moral questions of a novel kind…But the real questions here are more metaphysical than moral: does the person remain at the end of the operation, or have you effectively destroyed him? (Scruton, 2009: 631)

Meta-neuroethical statements do not specify the meaning of the profession of faith proclaiming that we are our brain, nor explain if and how it represents a methodological, an ontological or an epistemic stance. Its unceasing repetition helps consolidate belief in it. More importantly, inspiring general confidence in its correctness and validity requires leaving it general: more than its repetition alone, vagueness buttresses performative efficacy. As noted, statements like ‘the brain is the origin of the mind’ or ‘imaging the brain reveals information about the mind’ can correspond to many positions, from emergentism to eliminativism. Leaving them undefined makes them compatible with a range of interpretive options, and thereby contributes to their plausibility. That is why, as observed, since neuroethics displays a range of individual positions, it would be mistaken to describe it wholesale in terms of reductionistic neuroessentialism. For the main function of meta-neuroethical propositions, including those about mind–brain, is merely to sustain the neuroethical project.

This observation is not meant to deny that neuroethics deals with issues of relevance in the framework of the ‘hegemony of autonomy’ that characterizes the prevalent bioethical paradigm (Cooter, 2010; Snead and Mulder-Westrate, 2014), but to underline the discipline’s ideological condition of possibility and to help place it in a broader frame of reference. It also highlights the paradoxical power of self-referentiality: neuroethics depends for its existence on adhering to the fundamental values and beliefs of the scientific field that is, in principle, its own object of analysis; and while such dependence may inhibit its critical ability, it potentiates its capacity to advance those values and beliefs, and thus to become a player in the global biopolitical dynamics of the ‘new millennium’.