Alzheimer’s and Suicide

There is a new blood test which can predict with 90% accuracy whether someone will develop Alzheimer’s disease in the near future, see biomarkers for alzheimers . In this posting I want to examine one of the consequences of cheap and accurate tests for degenerative mental diseases. Dena Davis has given a talk many times that highlights some of these consequences, see Hastings Centre Bioethics Forum . She asks her audience to imagine two individuals, Manny and Sue. Manny was a little frail and died at 85. He was living independently until his death and mentally “all there.” Sue lived until she was 99. From the age of 88 she began a slow cognitive decline eventually becoming incontinent and unable to walk, speak, or feed herself. Davis then asks her audience to imagine who they would rather be, Manny or Sue. The audience always preferred Manny and someone only rarely chose Sue.

An effective test for Alzheimer’s disease would enable someone with a positive test to plan for his future. For instance he might want to arrange his finances, make plans for his care and write a last directive if he wants. He might also choose to spend his savings on travel or the other things he enjoys whilst he is still capable. Such a test would also give him one further choice to make and it is this choice which is highlighted by Davis I want to focus on. He could choose to end his life like Manny or like Sue. A positive test means he has a rational reason to commit suicide. Committing suicide would not be an irrational choice.

It might be objected it is never rational to commit suicide. However for a spy facing prolonged torture to be rapidly followed by death, suicide seems a rational choice. The same reasoning might apply for someone suffering from a painful incurable disease when the pain is such that it cannot be controlled. I have also argued that sometimes it might be rational for someone who has committed some terrible crime to commit suicide. Let us accept in some circumstances it is rational to commit suicide. My objector might now object these circumstances are very rare. However according to Alzheimer’s Society there are currently 800,000 people in the UK suffering from dementia, see alzheimer's statistics . It follows if an accurate test could be introduced for Alzheimer’s disease became widely available the circumstances in which someone could make a rational decision to commit suicide might not be rare.

It might be objected whilst it might be rational to commit suicide that none the less it would be wrong. It might for instance be rational for a criminal to commit a crime which benefits him and would remain undetected. It would however be wrong to commit such a crime. One reason why it would be wrong is that crime harms others. It might then be argued that even if committing suicide is rational the fact that it harms others makes it wrong. I would certainly agree that a parent who commits suicide leaving her children behind does something wrong. However if someone commits suicide after committing a number of murders and rapes then does he do any additional harm to others by committing suicide, see prisoners serving life sentences . I would suggest he does not. It follows his suicide is not wrong and that it might even be wrong to stop him doing so. It follows that sometimes it might be both rational and not wrong based on harm to others for someone to commit suicide. My objector might now argue that committing suicide is wrong for reasons other than harm to others. I would reject such an argument. I believe in Mill’s dictum that “That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Moreover I believe any society that fails to accept the autonomous decisions of its members provided these decisions do not harm others is not a truly caring society. Such a society may care for its members; but someone may care for sheep. Caring about its members must of necessity involve respect and respect must involve accepting we are the sort of creatures who can determine our own future provided we don’t harm others.

I have argued that sometimes it might be both rational and not be wrong for someone to commit suicide. However in the case of Alzheimer’s disease my objector might argue even if it might be rational for someone to commit suicide it would still be wrong. I argued above there are some circumstances in which suicide is wrong. Indeed I would suggest suicide is wrong in most cases because of the harm it does to others. However if someone who will develop Alzheimer’s disease commits suicide is he really doing something wrong by harming others? Jennifer Hecht argues if someone commits suicide he harms the community he lives in because by committing suicide encourages others to do likewise (1). Firstly I would question whether someone who commits suicide because he has a terminal illness will develop Alzheimer’s disease would encourage suicide in general. This would mean Hecht objection would not apply to anyone who commits suicide because he is likely develop Alzheimer’s disease. Someone’s suicide in this situation may of course increase the suicide rate among those likely to suffer from similar conditions. Secondly should society make someone suffer because he might influence others? Should we for instance ban the sale of alcohol because its consumption might influence some people to drink unwisely? My objector might now argue someone who commits suicide because he will develop Alzheimer’s disease harms particular people, his family and friends, the people who love him. I accept his suicide will make those who love him sad. But he will make these people sad eventually anyway when he dies, his suicide merely brings this period of sadness forward. Does the fact he commits suicide increase this sadness? I can see no reason why it should. Does the fact he commits suicide mean his friends and family should feel rejected. Once again I can see no reason why this should be because as his disease takes hold his meaningful interactions with them will inevitably cease. In the light of the above I would suggest if someone commits suicide because he will develop Alzheimer’s disease does no wrong. I do however accept his timing is crucial as Davis does.

Let it be accepted that someone who will develop Alzheimer’s disease does no wrong if he commits suicide. I want to examine two consequences of accepting the above. Firstly would it be wrong to aid someone in this situation to commit suicide? Prima facie if someone engages in some enterprise which isn’t wrong how can it be wrong to aid him in his enterprise? I would suggest great care is needed in this situation. Care is needed because we must be sure any aid we offer is to help someone carry out his decision and does not influence him in making his decision. The two are easily confused. One option might be that before we aid someone in such a situation we should make sure he gives his informed consent. Adopting this option might mean only physician assisted suicide would seem to be possible. A better option might be only to provide the means for anyone in this condition to commit suicide once he has made a firm decision to do so. Secondly it might be objected that because of the sheer number of people who will develop Alzheimer’s disease that permitting such people the right to commit suicide would mean we would face an epidemic of suicides. I will only make two responses to the above. Firstly many people who will develop Alzheimer’s disease will not wish to commit suicide and I’m doubtful whether adopting such a policy would lead to an avalanche of suicides. Secondly even if such a policy leads to an epidemic of suicides the badness is in the disease not the wrongness of the suicides.

1. Jennifer Hecht, 2014, Stay: A History of Suicide and the Philosophies Against It, Yale University Press.

Gratitude and the Emotions

Recent research has shown that wisdom and gratitude go hand in hand suggesting it makes sense to be grateful, see is it wise to be grateful? Research also shows that gratitude appears to increase someone’s happiness, see for instance how to increase positive emotions . In the light of the above it would appear we have reason to cultivate a disposition to be grateful. Unfortunately cultivating this disposition might not be easy. In previous postings I have argued it is beneficial to us to love. However if someone simply seeks to love, for the benefits love confers on him, then he isn’t really loving at all. A similar state of affairs would seem to pertain to gratitude. If someone attempts to be grateful in order to in order to boost his happiness he isn’t being grateful. For instance if he receives a present and expresses his thanks merely to boost his happiness or intelligence then he is not really being grateful he’s simply attempting to boost his happiness or intelligence. In this posting in the light of the above worry I want to examine if it is even possible in practice to increase our disposition to be grateful and in doing so examine our emotions in general.

Before I commence my examination I must make it clear what I mean by gratitude. Being grateful can have several meanings. Among these meanings it can for instance mean, acting virtuously, experiencing a certain kind of emotion or simply having good manners. Let us consider whether a well mannered person is a grateful person. Such a person is likely to be thankful for things that benefit him. He certainly expresses his gratitude but his expressions of gratitude do not mean he feels gratitude. He may have been taught his good manners from an early age and these have become purely automatic. When expressing his thanks for some benefit he may feel no positive emotion. Christine Korsgaard likens such a person to a good dog whose desires and inclinations have been trained to perfection (1). It seems clear that good manners or mere expressions of gratitude expressed in isolation are only a small part of gratitude; gratitude shorn of its essence. Intuitively to be grateful someone must feel grateful and this feeling must include some positive emotion.

However gratitude is not simply just some positive emotion. After all someone can feel a positive emotion contemplating the supper he’s cooked for himself. Gratitude is a positive emotion framed by a particular set of circumstances. Let us assume X feels grateful to Y and consider the circumstances which validate her positive emotion. Firstly Y must have done or given something to X which seems good to her. This something could be help in solving a problem, giving good advice or perhaps a present. Secondly Y must have sought to benefit X by giving her something. For instance even if Y passes on an unwanted gift as a present when this present benefits X and is intended to benefit X then this present might still possibly provide a reason for X to be grateful. Thirdly Y’s actions must have gone beyond the call of duty and self interest. Giving someone a gift simply because conventions demand it or the giving of a gift in hope of a return of the favour should not be a cause for gratitude. It follows the giving of an unwanted gift as a present when this present benefits X and is intended to benefit X merely to get rid of the gift would not be a reason for X to be grateful. Of course good manners may require the expression of gratitude but as I have suggested above this expression is only a small part of gratitude. Basically I would suggest that gratitude is connected to the recognition of the love of someone else and reaction to this love, provided we regard love as simply ‘caring about’.

Let us accept that an essential element of gratitude has to be the feeling of some positive emotion in the circumstances outlined above. Let us also accept that a grateful person is one who has a disposition to feel this emotion framed by the circumstances outlined above. The answer to the question as to whether someone can increase his disposition for gratitude seems dependent on the nature of emotion. Some philosophers such as Jesse Prinz (2) argue an emotion is simply a bodily sensation reliably caused by a set of circumstances. Fear for instance might be an unpleasant bodily sensation caused by the approach of a mugger. Gratitude might then be seen simply as a pleasant bodily sensation caused by someone benefiting us for beneficent reasons and these reasons go beyond the requirements of duty. If we accept such a definition of the nature of the emotions it is hard to see what someone could do to increase his disposition to feel any particular emotion including gratitude.

However I am attracted to a different concept of an emotion as developed by Michael Brady (2). I will very briefly outline Brady’s concept. Brady argues that emotions are somewhat analogous to fire alarms. Emotions draw our attention to the things that are important to us. This is done in two ways. Firstly emotions capture our attention and point it in a certain direction. This capture means the attention we pay to other things diminishes. For instance, if I hear a noise downstairs in the dark at night when I’m going to sleep this noise will make me anxious and capture my attention making my dreamy contemplation of a pleasant day vanish. Secondly emotions have some persistence or as Brady puts it consume our attention. For instance whilst I lie in bed listening for further noises I start thinking whether my anxiety is justified and what could explain the noise. In this case my anxiety might be increased or diminished by further thought or information. Perhaps my wife calls out she is home and my anxiety vanishes as I remember she was going out tonight. Perhaps I hear a breaking sound and this sound increases my fear and further focuses my attention. How might Brady’s ideas work when I experience a feeling of gratitude? If I feel the emotion of gratitude this emotion consumes my attention making me consider the reasons why I’m grateful. Accepting the above explains why very young children are not truly grateful, they have not yet fully acquired the abilities needed to consider the reasons for their gratitude. Accepting the above would also suggest that my initial worry that we cannot increase our disposition to be grateful is unfounded. For if Brady is correct and we give serious consideration to the reasons as to why we are grateful then we should be able to increase our disposition to be grateful. If when I feel the emotion connected to gratitude and I reflect on how someone has gone beyond the call of duty to benefit me then this reflection is likely to increase my disposition to reflect in a similar manner in a similar situation.

Unfortunately the situation appears not to be as simple as I have painted it above. Let us accept that negative emotions do cause us to focus our attention more selectively. However this might not be true of positive emotions. Many positive emotions appear to give us a broad feel good factor with a broad focus of attention; see for instance positive affect increases the breadth of attentional selection . Gratitude is a positive emotion. It might then be argued because the feeling of gratitude is a positive emotion that any reflections caused by gratitude are unlikely to narrowly focus on our reasons to be grateful and hence are unlikely to increase someone’s disposition to feel gratitude. Brady suggests that the way in which attention is connected to emotion is complex. He further suggests that there is attention which is constitutive of the emotion involved and attention which focuses on the consequences of that emotion. He then goes on to suggest that the broad focus of positive emotions only involves consequential attention (4). If this is so then the attention that is constitutive of positive emotions need not differ from that of negative ones. I have some doubts about Brady’s suggestions for it seems to me evolution may well have evolved us to pay more attention to some emotions than others. For instance if one of our ancestors saw a lion approaching her this would grab her attention much more than any shame she felt at wandering off and not helping with childcare. In general it seems to me that primitive negative emotions are much more likely to capture and consume our attention than positive or social emotions. Moreover I am not sure we can constitutive attention and consequential attention. Nonetheless even if I am correct this does not mean we pay no attention to the reasons for positive or social emotions. We pay such attention, just a little less urgently. It follows we can still cultivate a disposition to feel gratitude. Tiberius suggests that if we wish to live well we should cultivate a disposition to change our reflective perspective from a broad one to narrow one (5). Such a disposition might aid us to become more attentive to the positive emotions such as gratitude.

1.  Christine Korsgaard, 2009, Self-Constitution, Oxford University Press, page 3.
2.  Jesse Prinz, 2007, THE EMOTIONAL CONSTRUCTION OF MORALS, Oxford University Press
3.  Michael Brady, 2013, Emotional Insight; The Epistemic Role of Emotional Experience, Oxford University Press.
4.  Brady, page 181.  
5. Valerie Tiberius, 2008, The Reflective Life, Oxford University Press, Chapter 4.

The Structure of Love and Anti-Love Drugs

Brian Earp wonders whether it might be right for someone in certain situations to take an anti-love drug, see should we take anti love drugs? For instance a battered woman in an abusive relationship might take such a drug to help her restore her autonomy and independence. Such an anti-love drug might be seen as an enhancement on a welfarist account of enhancement, see frontiers in neuroscience , because it enhances someone’s overall welfare. I have suggested any such interventions should be treated with the greatest caution as diminishing love involves great dangers. For instance in the above scenario the woman in question might have children and diminishing her love for her abusive partner might also diminish her love for her children. In this posting I will argue that prior to considering any artificial means of diminishing love we must first consider what love is. In particular I will suggest we should consider whether love has some sort of structure.

What does it mean to love? One way of examining what it means to love is to examine what we can love. Someone might love a building, a particular piece of countryside or being a scientist. A mother may love her children and her children love their parents and siblings. Someone may love his friends. Lastly someone may love her beloved in a romantic way. The question I want to pose is this, do we love all these things in much the same way or are there varieties of love and perhaps even completely different ways of loving? What is the nature of the lover’s concern in all the above? According to Harry Frankfurt it is connected to caring about,

“It is in the nature of a lover’s concern that he is invested in his beloved. That is, he is benefited when his beloved flourishes; and he suffers when it is harmed. Another way of putting it is that the lover identifies himself with what he loves. This consists of accepting the interests of his beloved as his own.” (1)

If we agree with Frankfurt then a lover’s concern is compatible with him loving all the above. Someone might be harmed mentally if a building he loves is burnt down. A mother may suffer if her child suffers. A romantic lover will experience pleasure at the success of her beloved. The above suggests that all forms of love have a common basis, the ability to care about and identify with something, and this common basis rules out completely different ways of loving.

Let us accept that all forms of love must include Frankfurt’s basic idea of caring about and identification. Let us also accept that our ancestors possessed the capacity for this basic form of love, they had the capacity to love themselves and their offspring. At this point someone might object that our ancient ancestors didn’t have the capacity to actively identify themselves with what they loved. She might then proceed to argue even today most people don’t actively identify themselves with what they love. In response Frankfurt might argue even if someone doesn’t actively identify himself with what he loves that nonetheless he demonstrates his identification by his satisfaction with what he loves (2). Bennett Helm would argue someone identifies with what he loves by taking pride in what he loves (3). Intuitively there are different forms of love. How might we account for this diversity? Firstly as our ancestors’ lives became more complex the domain of what they loved expanded. That is the basic form of love remained the same but they started to love more things. Perhaps as their increased brains expanded their cognitive powers they simply became aware of the need to love or care about more things. Nonetheless they loved these things in the same way. Secondly as their lives became more complex evolution added or grafted on additional ways of loving onto this basic form. Love acquired some form of structure.

It might be thought that whilst such considerations have considerable theoretical interest they have no practical implications. Such a thought would be wrong. Let us return to the taking of anti-love drugs to enhance an abused women’s life. Now if love has changed simply by expanding the domain of love by cognitive means then any such supposed enhancement would be likely to be counter productive. For as I have remarked above any such so called enhancement would lead her to love her children and things in general, including herself, less. In this context I would suggest that the use of anti-love drugs would be unacceptable.

Intuitively I do not love the place I live in the same way as I love my children. I can feel empathy towards my children but it would be nonsensical to say I can feel empathy for the place I live. Some forms of love might have a structure. This structure consists of the basic capacity to care about and identify with something or someone, plus the capacity to feel empathy. Earp considers love to be based on ancient neurochemical systems that evolved to serve our ancestors' reproductive needs. I have suggested that love has a wider basis. It follows these neurochemical systems served wider needs, the need to love those things that helped us to survive. Nonetheless let us accept that our basic capacity to love is based on a neurochemical system. Let us also accept that our love is defined by a basic capacity to love as I have suggested above plus the capacity to feel empathy. It is possible that the neurochemical system underlying our capacity to feel empathy is distinct from neurochemical system underlying our capacity for basic love. However even if this situation pertains, the use of anti-love drugs would remain unacceptable. Taking an anti-love drug that affects someone’s basic capacity to love would affect her capacity to act as a person. An abused woman taking an anti-love drug which affects her capacity for empathy would damage all her relationships.

However romantic love seems to differ from other forms of love. Most forms of love seem to have more persistence than romantic love. Romantic love might be different from other forms of love. If the above is accepted then some forms of love might have the following structure. Love might consist of the basic capacity to care about and identify with something or someone, plus the capacity to feel empathy, plus the capacity for romantic love. It might then be possible that the neurochemical system underlying our capacity to feel romantic love is distinct from neurochemical systems underlying our capacity for basic love and empathy. If love has this form then it might be possible for an abused woman to take an anti-love drug which affects her capacity for romantic love without damaging her other loving relationships. The above assumes an abused woman’s love for her abusive partner depends on romantic love. In practice many abused women suffer abuse for many years suggesting their love may not be wholly based on romantic love.

I have not been able to answer the specific question as to whether it would be permissible to take anti-love drugs in certain situations. The above however suggests that before we attempt to answer this question we need firstly to investigate whether love has a structure and secondly provided it does investigate whether the neurochemical systems underlying the different elements of this structure are distinct enough to permit the use of these drugs.

1.      Harry Frankfurt, 2006, Taking Ourselves Seriously, Stanford University Press, page 41.

2.      Frankfurt, 1999, Necessity, Volition, and Love. Cambridge University Press. Page 103

3.      Bennett Helm, 2010, Love, Friendship & the Self, Oxford.

Effectiveness Enhancement and Motivational Enhancement

Hannah Maslen asks the question as to whether there is an important difference between the enhancement of effectiveness and the enhancement of motivation; see marathon mice and the will to work . In this posting I will examine Maslen’s question and will conclude there is. I will further conclude even if the artificial enhancement of effectiveness is unacceptable that the artificial enhancement of motivation may be acceptable.

In order to examine this question we must first examine what is meant by motivation. Intuitively motivation simply means how much effort we put in to achieving our goals. The greater the effort we put in, the greater our motivation. What do we mean by our motivation? Is motivation something we possess in much the same way as we might possess such things as strength or intelligence? Let us accept there are some means of enhancing our strength and intelligence which are acceptable; after all athletes enhance their strength through training and scholars their intelligence through learning. Let us also accept motivation is something we possess in much the same way as we possess strength or intelligence. Prima facie it follows there are some ways of enhancing our motivation which should be perfectly acceptable.

The above is of course too simplistic. For the sake of argument let us now assume there are some means enhancing strength and intelligence which are unacceptable such as artificial means. If this is so we might agree with Leonard Kass,

“Yet in those areas of human life in which excellence has until now been achieved only by discipline and effort, the attainment of those achievements by means of drugs, genetic engineering, or implanted devices looks to be “cheating” or “cheap.” We believe – or until only yesterday believed – that people should work hard for their achievements. “Nothing good comes easily.” See Beyond therapy: Biotechnology and the Pursuit of Human Improvement .

Basically it seems to me that Kass’ argument might be summarised as follows. He argues that if we obtain certain goods without any real determination that in so doing we devalue determination in general. In addition, for his argument to work he must believe the damage this does to our determination is not offset by the value of any goods obtained. For the moment let us accept this argument. Let us also assume it is possible to artificially enhance our motivation. It follows there is an important difference between the enhancement of effectiveness and the enhancement of motivation. Enhancing our effectiveness devalues our motivation whilst it is hard to see how enhancing our motivation could devalue motivation. More generally if something is worth enhancing then it must have some value and enhancing this something can only enhance this value. Of course if such an enhancement devalues other goods this devaluation might supply us with a reason not to proceed with the proposed enhancement. For instance Kass believes it would be wrong to enhance our intelligence or strength by artificial means because these enhancements would devalue and eventually damage our motivation. Let us accept that increased determination is a good thing. It follows from the above that it would not be wrong to artificially enhance our determination and hence our motivation provided this enhancement does not damage some other goods. In the case of enhancing our motivation what sort of other goods might we damage? Our determination to be determined? It seems it would be possible for Kass to endorse artificially enhancing our motivations whilst at the same time maintaining it would be wrong to artificially enhance more general goods such as our strength or intelligence and still remain consistent. Personally I doubt that Kass would make such an endorsement.

What sort of objection to the above might an objector such as Kass raise? He might suggest that artificially enhancing someone’s motivations would damage her authenticity as a person. What does it mean to be authentic? Intuitively an authentic person is one who is true to her self. An authentic person is someone who is not easily swayed by short term emotions or the views of others. I have argued in previous posts that a person is defined by what she cares about, what she takes pride in. It follows that anyone who is a person must care about or love something. I would suggest how authentic a person is depends on how she acts with regard to what she cares about or takes pride in. Enhancing someone’s motivation, her determination, does not change what she cares about. Moreover enhancing someone’s motivation increases her disposition to act with regard to what she cares about. It follows enhancing someone’s determination does not damage her authenticity. Accepting the above means it might even be argued enhancing someone’s motivation does not damage her authenticity and might possibly enhance it.

However my objector might respond by pointing out I have been treating our motivation in a purely instrumental way. He might proceed to suggest our motivations form part of who we are. He might then maintain accepting the above means that artificially enhancing our motivations might still damage our authenticity as a person. I am inclined to accept our motivations are part of who we are. Our motivations might have both intrinsic and instrumental value to us. Personally I hope I am a reasonably determined person and take some pride in my determination. I would argue if someone is proud of some personal attribute then she must care about that attribute and as a result that attribute helps define her as a person. If someone fails to act in a determined way when she cares about something she will be ashamed of herself. Let us accept that our motivations are not purely instrumental but have some intrinsic value for us. Let us further accept that some people care about their motivations and that this means these motivations help to form them as persons. It follows our motivations can be part of our authentic self. Does this acceptance mean we shouldn’t artificially enhance our motivation? People seek to change themselves by enhancing themselves by training or learning. I can see of no reason why people changing themselves by these means will render themselves in-authentic. Perhaps, as suggested above, we shouldn’t do this by artificial means because doing so might damage our motivation. However I can see no reason why someone shouldn’t change herself by artificially enhancing her motivation because doing so might damage her authenticity. In practice I have some remaining doubts but perhaps these might be based on some unjustified arrogance on my part.

Meaning and Happiness

In a recent posting in practical ethics Hannah Maslen considers happiness meaning and well-being. Let us accept that happiness and meaning in life are both part of well-being. There is usually a positive correlation between happiness and meaning. Usually happy people have a more meaningful life and vice versa. However some research by Roy Baumeister, Kathleen Vohs, Jennifer Aaker and Emily Garbinsky shows this correlation is not always positive (1). Maslen wonders if when this occasional incompatibility occurs whether we must make a decision about which of these two goods to pursue. In what follows I will consider this question. I will however use a slightly different approach to what is meant by meaning in life.

Before examining Maslen’s question I must consider what is meant by meaning in life. Firstly I must make it clear I am not going to consider what a meaningful life is from some objective viewpoint. I am going to consider what living a meaningful life actually means to the person who lives that life. According to the researchers’ results meaningfulness involves doing things that express and reflect the self and in particular doing positive things for others. This involvement can increase someone’s stress, worries, and anxiety. Secondly meaningfulness involves being a giver more than a taker. Lastly meaningfulness integrates past, present, and future, and sometimes meaningfulness means feeling bad. I agree with Maslen that these results rule out a purely hedonistic life as a meaningful life. Moreover these results seem to be incompatible with a meaningful life being based on desire fulfilment. For as Maslen points out stress, worry and anxiety are associated with frustrated desire, rather than desire fulfilment. It might be thought that a meaningful life is one that includes a number of objective items, items such as friendship and good health. Personally I believe such items may well contribute to a meaningful life but that they do not define it.

I now want to return to a common thread of this blog. I want to suggest that in order for someone to have a meaningful life he must ‘care about’ or love something. Indeed I would go as far as to suggest that for someone, whose life is totally devoid of any ‘caring about’, he has a life totally devoid of any meaning and as a result is not really a person at all. He is simply a wanton, see (2). In what follows I will treat the terms ‘caring about’ and ‘loving’ as interchangeable in much the same way as Harry Frankfurt does. Someone who ‘cares about’ or loves something identifies himself with what he cares about and makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about flourishes or is harmed (3). The researchers’ results showed meaningfulness involved doing things that express and reflect the self. Caring about something means identifying with what is cared about. Identification involves doing things that express and reflect the self. Secondly the researchers’ results showed that meaningfulness can increase someone’s stress, worries and anxiety. Caring about something makes someone vulnerable and so can also increase his stress, worries and anxiety. Lastly these results show meaningfulness integrates past, present, and future. According to Frankfurt caring about involves consistency, steadiness of behaviour, and some degree of persistence (4). It follows caring about must integrates past, present, and future to some degree. In the light of the above it appears accepting that, meaning is imparted to someone’s life by what he cares about or loves concurs very well with the researchers’ results.

Let us accept that meaning in someone’s life is dependent on what he loves or cares about. If someone’s beloved flourishes then he is susceptible to the benefits of this flourishing. He is happy. It is important to be clear that someone’s beloved can refer to things as well as people. Someone’s beloved might for instance be a cause, his religion, or a place. If someone’s beloved is harmed then he is harmed. He is unhappy. At times caring about or meaning is incompatible with our ideas about being happy. Some positive psychologists such as Martin Seligman might disagree. Seligman would incorporate meaning into the meaning of happiness, see PERMA . In such cases happiness seems to mean well-being. Such a meaning seems at odds with our intuitive ideas of happiness and in what follows ‘happiness’ will refer to these intuitive ideas. Let us return to Maslen’s question, must we sometimes make a decision about whether we should pursue happiness or meaning? I will now argue the question is meaningless because if meaning depends on what we love or ‘care about’ we cannot make such a decision.

We cannot make such a decision because we cannot make a decision to love. Someone cannot simply decide to love someone or something. According to Frankfurt the will of a lover is not free. On the contrary he, because of the very nature of loving, is captivated by his beloved and his love. The will of the lover is rigorously constrained. Love is not a matter of choice (5). It follows if meaning depends on what we love that we cannot simply choose to have less meaning in our lives in order to be happier. This conclusion has important consequences for any pursuit of happiness. This pursuit is limited at least for our intuitive ideas of happiness. This limitation means that whilst we may of course seek to modify our life in order to be happier, that these modifications cannot be based on consciously altering or lessening the meaning in our lives. Of course I accept that what matters, what we love or what has meaning, may change over time but this change is not a matter of our own volition. I also accept even if we cannot simply will love we can nonetheless sometimes situate ourselves in situations in which love might grow.

1. Roy Baumeister, Kathleen Vohs, Jennifer Aaker & Emily Garbinsky, 2013, Some key differences between a happy life and a meaningful life, The Journal of Positive Psychology, 2013, volume 8(6)
2. Harry Frankfurt, 1999, Necessity, Volition, and Love. Cambridge University Press, page 114.
3. Harry Frankfurt, 1988, The Importance of What We Care About. Cambridge University Press, page 83.
4. Frankfurt, 1988, page 84.
5. Frankfurt, 1999, page 135.

Pharmacological Moral Enhancement

Joao Fabiano asks us to imagine that in the future humanity makes a major breakthrough, see Practical Ethics. He imagines that society develops a pill which rids our morality of all its faults. Without any side-effects, it vastly increases our ability to cooperate and to think rationally on moral issues, while also enhancing our empathy and our compassion for the whole of humanity. Such a pill would morally enhance us. Fabiano argues the use of such a pill would present us with grave dangers. In this posting I will consider Fabiano’s worries about pharmacological moral enhancement but with some slight modifications my comments might be applied to germline editing using CRISPR.

The pill Fabiano asks us to imagine has two functions. Firstly it enhances our cognitive abilities. Secondly it enhances our capacity for empathy. For the sake of argument I consider two pills, firstly one which enhances our cognitive abilities and secondly one which enhances our capacity for empathy. This separation means it would be possible to gain one of these kinds of enhancement even if the other posed dangers. I will consider the implications of using of each of these pills in turn.

Prima facie it might be assumed that increasing our powers of reason would increase our capacity for morality. If reason allows us to see others as much the same as ourselves then the domain of morality expands. It might be argued this has happened over time. In ancient civilisations such as that of the Greeks moral concern for the most part focussed on citizens of that state. Over time this focus broadened to include women, slaves and even animals. This seems to be the position adopted by Steven Pinker (1). However this ability to see others as much the same as ourselves does not automatically expand the domain of morality. Persson and Savulescu point out that reason and self-interest could tell you to rob and kill an injured stranger in the wilderness rather than help him or to abstain from returning a favour to someone you will not ever see again rather than return it at some cost to yourself (2). Moreover it might seem that a cognitively enhanced sociopath could do much more harm than one who had been un-enhanced. It might be suggested that if a tyrant such as Hitler or Mao had been cognitively enhanced that he could have inflicted even greater suffering. In the light of the above it might be thought I am not in favour of cognitive enhancement for moral reasons.

In fact if a pill became available, which simply cognitively enhanced us without any adverse side effects, I would be in favour of us taking such a pill for moral reasons. Firstly reason as pointed out by Hume reason alone does not give us any reason to act. If reason alone gives us no reason to act then cognitive enhancement will not alter someone’s ends. At this point an objector might point out even if cognitive enhancement does not alter someone’s ends it might enable an evil person achieve his evil ends more effectively. I accept my objectors point but would also point out cognitive enhancement should equally make it easier for a good person to achieve his good ends. In addition I would suggest that because there are more good people rather than evil people we should favour cognitive enhancement. However my objector might now suggest that certain people, such as Hitler or Mao, could cause even greater suffering if they were cognitively enhanced and that this suffering outweighs the more modest good most cognitively enhanced people would be capable of. She might then argue that because of this increased suffering which might be caused by a small minority of cognitively enhanced people we should not favour cognitive enhancement. In response I would doubt whether people such as Hitler or Mao could cause greater suffering provided they were cognitively enhanced. Moral monsters cannot cause great suffering alone. Let us accept my suggestion that most people are good, even if only to some modest degree. It follows if most people were cognitively enhanced that they would be less likely to aid moral monsters such as Hitler or Mao further their ends. It further follows we should favour cognitive enhancement. My second reason for favouring cognitive enhancement is that it is inevitable. Even if it is impossible to cognitively enhance us by pharmacological means we will nonetheless be enhanced by education. We will experience an ever expanding knowledge basis even if the speed at which we process this basis remains constant. It follows if pharmacological means of cognitive enhancement are adopted we are merely speeding up an inevitable process.

Let us consider the implications of using the second pill solely to enhance our capacity for empathy. Fabiano worries whilst such an enhancement might lead to an increase in our individual tendency towards cooperation between individuals it might also lead to an increase in competition between groups, this worry is shared by Paul Bloom (3). He argues that what is important about enhancing morality is increasing cooperation between groups. I accept Fabiano’s argument and find his worry plausible. Evolution designed us to live in small groups and enhancing our empathy might only lead to more social cooperation with people we know. Enhancing our empathy might not lead us to have any more moral concern for those separated by distance and time. It might not lead those of us in the more affluent parts of the world to think more about those of the third world or future generations, see (4). Let us assume our increased capacity for empathy is only for people we know. This increase means we might see the wants and needs of people we know assuming greater importance to us. This increased importance might lead us to exploit those people we don’t know to benefit those we do. For instance enhancing our capacity for empathy for those we know, existing people, might lead us to disregard the needs of future generations to serve the needs of the present one. In the light of the above it appears Fabiano’s worries are justified and that we should not encourage empathic enhancement for moral reasons.

If we should not encourage empathic enhancement for moral reasons should we only encourage cognitive enhancement for these purposes? Someone might suggest we should enhance our toleration of others. Indeed I would suggest in more connected, multi-racial, multi faith world the capacity for toleration is among most important moral capacities we can possess. Unfortunately at the moment there appears to be no prospect of simply enhancing our toleration by pharmacological means. In the light of the above does this mean we should only attempt to enhance our morality cognitively unless some means is found to enhance our toleration? I will now argue it does not. However even if it is impossible to directly enhance our toleration I would suggest any other type of moral enhancement should be judged by its indirect effects on our toleration.

Let us return to considering enhancing empathy and Fabiano’s worry that enhancing our empathy might lead to more group competition. Basically it might lead to less toleration. I only share Fabiano’s worry provided we only enhance our empathy. However if we can enhance our empathy it seems probable we can also enhance our cognition. It follows that in much the same way doctors use a drug cocktail to treat some diseases such as cancer, we might use a pharmacological cocktail to address our moral shortcomings. It might appear that provided we use a pharmacological cocktail to enhance both our empathy and our cognition that Fabiano’s worry might be misplaced. Let us accept that enhancing our empathy should lead to more social cooperation with people we know. Now it seems to me whether Fabiano’s worry is justified or not depends on what is meant by ‘people we know’. It is certainly justified if we only mean family and friends. It’s also justified if ‘people we know’ means people who share our particular tastes, feelings and prejudices. However ‘people we know’ could just mean the broader recognition of these people simply as people. That is they are capable of love, being hurt and are the sort of creatures that can decide their own future. It might appear that enhancing our cognition might change what we mean by ‘people we know’ from friends and family or people who share our tastes to people in the broader sense outlined above. However the above appearance might be false. It is possible even if we enhance both cognition and empathy that our enhanced empathy simply overwhelms our ability to act rationally. Whether enhanced empathy might overwhelm someone’s cognitive abilities is an empirical question and it should possible to design an experiment to answer this question. Provided it can be shown that enhanced empathy doesn’t overwhelm someone’s cognitive abilities and we adopt dual enhancement we have reason to believe Fabiano’s worry is unwarranted.

In conclusion I want to consider the enhancement of our empathy in more detail. In order to do so we must be clear about what is meant by empathy. Being able to feel empathy roughly means one has the capacity to understand and share the feelings of another. I have suggested above that the ability to feel empathy must initially have a broad basis. We must see others as being capable of love, being hurt and being the sort of creatures who can decide their own future. It follows if I care about someone in a purely empathic way I must care about what she cares about, rather than what I think might be in her best interests. Understanding other people is not always easy. Sometimes we mistake the feelings of another and substitute, what we believe they feel or even what we think they should feel, for their true feelings. We may do this because we are lazy. We simply don’t ask people how they feel. Or we may do this because we simply assume others feel the same way do. We suffer from epistemic arrogance. This substitution means we move from empathic concern to sympathy. It also means we leave the initial broad basis for empathy behind, see caring and empathy. If a pharmacological means became available which enhanced our understanding of others without leaving this initial broad basis I see no reason why such a means should not be adopted. Provided we retain this basis of empathic concern then I see no reason why enhancing our empathy should lead to more group conflict as envisioned by Fabiano.

1. Steven Pinker, 2011, The Better Angels of Our Nature, Allen Lane, page 656.
2. Ingar Persson & Julian Savulescu, UNFIT FOR THE FUTURE, Oxford University Press, page 107.
3. Paul Bloom, 2016, Against Empathy, Ecco
4. Michael Slote, 2007, The Ethics of Care and Empathy, Routledge, page 2

What do we mean by true self?

In this posting I want to examine what we mean by true self, indeed even wether the concept is a meaningful one. Buddhists and David Hume would suggest that true self is an illusion. Perhaps anti-vaxxers suggest otherwise? Their decisions seem to be based on the need to identify as a certain sort of person rather than the facts In an interesting piece posted in peasoup Joshua Knobe wonders whether the notion of a 'true self' really is best cashed out in terms of certain distinctive features of an agent's psychology. He suggests that our notion of a true self is a value-laden one and that we partly determine what lies within an agent's true self by making value-judgments of our own. In this posting I will firstly wonder whether the idea of a true self is even a meaningful one. I will conclude it is. This conclusion will open up the idea of a true self that can be cashed out in certain distinctive features of an agent's psychology. I will suggest these distinctive features are the agent’s pride and shame.

Let us examine Knobe’s position. Knobe asks us to consider someone,

“who is addicted to heroin but who desperately wants to kick the habit. He has a craving for another hit, but when he reflects, he rejects this craving and wishes he could get rid of it. Now ask yourself: Which part of this person constitutes his true self -- his craving for another hit or his desire to quit?”

Knobe suggests that intuitively we would link his true self with his desire to quit. He then asks us to consider an evangelical Christian called Mark

“He believes that homosexuality is morally wrong. In fact, Mark now leads a seminar in which he coaches homosexuals about techniques they can use to resist their attraction to people of the same-sex. However, Mark himself is attracted to other men. He openly acknowledges this to other people and discusses it as part of his own personal struggle.”

Knobe suggests in this case our intuitions are not so clear. Perhaps if someone is a born again Christian his intuitions would link Mark’s true self to his belief that homosexuality is wrong. Whilst someone of a more liberal nature would link Mark’s true self to his underlying sexual desires. The above leads Knobe to suggest that our idea of someone else’s true self is dependent on our values.

My first reaction to Knobe’s suggestion is to question whether such a concept of a true self is a useful one. Perhaps we should simply say we have a self and leave David Hume would suggest  that the whole idea of a self is an illusion. I would not go as far as that because everyone is different. Moreover everyone remains different even when we disregard their physical attributes. People are different because they have differing dispositions, abilities and personalities. If we define someone’s self by a set of non physical attributes such as, his dispositions, abilities and personality then he has a self. Let us accept that someone’s self is a meaningful concept, but is the idea of someone’s will meaningful? Many experiments have demonstrated that our decisions are partly determined by the situations we find ourselves in. For instance in a classic experiment Alice Isen and Paula Levin showed being made to feel good greatly influenced someone’s subsequent actions. In this experiment Isen and Levin showed that someone who dropped papers outside a phone booth was much more likely to be helped to pick them up if the person in the booth had just found a dime in the slot (1). Such experiments do not show we don’t have a will. However in the light of them someone might suggest our will is irrelevant when it comes to decision making. In response I would simply point out that not everyone makes the same decision in the same situation and that this difference in decision making is best explained by our differing dispositions, abilities and personalities, our self. The way in which our decisions are affected by our self is our will. I accept of course that many of the decisions, we think we consciously make, are made unconsciously and that sometimes our consciousness merely endorses these decisions. It follows that in many ways our will is not always under our conscious control. Let us accept our self and our will are as defined above.

 If we accept it makes sense to talk about someone’s self and his will does it also make sense to talk of his true self? I accept the idea of someone’s self can be cashed out in certain distinctive features of his psychology but are there any additional distinctive features of his psychology that mark out his true self? My initial reaction was that there are not. However on reflection it seems to me there might be. What then could be the distinctive features of someone’s psychology that mark out his true self? In what follows I will argue those distinctive features are his pride and shame. Prior to making my argument I must make it clear what I mean by pride and shame.

I will deal with shame first. David Velleman suggests shame is anxiety about social exclusion (2). I have argued that there are two types of shame . Type one is as suggested by Velleman. Type two shame is someone’s anxiety about harming the things he loves or values. I would further suggest that, with the exception of sociopaths, all people feel type two shame. When considering shame with regard to someone’s true self I am only interested in type two shame. Let us now consider pride. Pride might be very roughly defined as someone’s pleasure or satisfaction with his belief that he possesses some property which he values. Unlike shame I believe there is only one sort of pride. However there are deficient forms of pride as shown by Shakespeare’s Coriolanus, see damaging self love pride and shame. Firstly pride may be empty when someone’s pride is focussed on himself, rather than some of the attributes he possesses or values he holds. Secondly pride may be exclusive when a proud person is incapable of feeling any shame. I would class such forms of pride as deficient pride and when considering someone’s true self I only interested in non- deficient pride.

  will now suggest our true self is defined by a subset of our actions, those actions that cause us to feel pride or shame. It is sometimes suggested that someone’s true self is defined by the beliefs and values which he reflectively endorses. I accept someone’s true self is connected to his beliefs and values. However I do not believe someone’s beliefs and values are simply defined by his endorsement following some reflection. Someone might believe he will act in a certain way but when the time for action comes finds he cannot do so in that way. What he thought he believed or valued doesn’t give him reason to act. I would suggest that someone the beliefs and values which define his true self are determined by what he feels proud or ashamed of. Indeed someone might not be fully aware of his beliefs and values and can come to a better understanding of himself not by reflection, but by those of his actions of which he is proud or ashamed of. If the above is accepted then others can also make sense of his true self by those of his actions which he is proud or ashamed of. Additionally I would suggest that actions which make someone proud are actions he can defend even if sometimes his defence can sometimes only be mounted retrospectively. Similarly someone must be able to give some reason for his shame. An objector at this point might object that a retrospective defence is simply a justification. I will not pursue his point here.

 Let us return to Knobe’s two examples using the above definition. In the case of the heroin addict our intuitive ideas of someone’s true self and his true self coincide. Let us now consider Mark. Let us assume that even though Mark openly acknowledges he is attracted to other men, to other people and discusses it as part of his own personal struggle, he feels some shame about this fact. Let us also assume that Mark feels some pride about his coaching homosexuals in techniques they can use to resist their homosexual inclinations. Knobe suggests our intuitions about Mark’s true self depend upon whether we believe homosexuality is acceptable or not. I would suggest provided, we know what Mark is proud or ashamed of in his thoughts and actions concerning homosexuality, our intuitions about Mark’s true self do not depend on our beliefs about homosexuality. In order to see this let us consider someone who believes homosexuality is acceptable. Let us assume he accepts that Mark is ashamed about his feelings for other men and that he can account for his shame by referring to his beliefs and values. Let us further assume he also accepts that Mark is proud he coaches homosexuals in order to change their sexual inclinations and that he can defend this coaching by referring to his beliefs and values. I would suggest that such a person would find it difficult not to associate Mark’s true self with coaching of homosexuals rather than his desire for other men irrespective the person’s own values. It should also be possible to set up an experiment to test the validity of my suggestion.

I have argued the idea of someone’s true self is a meaningful concept. However not all meaningful concepts are useful ones. I will now use a real life example to tentatively suggest that someone’s true self might be a useful concept. I will use the example of MB, see General Medical Concuil's consent guidelines . MB was twenty-three years old and was thirty-three weeks pregnant. She visited her local health clinic twice and on each occasion was asked for a sample of blood. On both occasions she refused consent saying she was frightened of needles. At a later visit to the health clinic it was suspected that her baby was in a breech position and this was later confirmed by ultrasound.  Breech position carries the risk of prolapse. If prolapse occurs there is a risk that the baby’s umbilical cord might get entangled in the membranes after they have ruptured causing the baby’s blood supply to be obstructed during birth. This obstruction might cause death or brain damage to the baby due to lack of oxygen. The above was explained to MB and she was admitted to hospital where she consented to a caesarean section but she again refused to consent to a venepuncture to provide blood samples. However, when she was taken to operating theatre and the anaesthetist wished to insert a veneflon, MB refused consent and was returned to the ward. Later, when her GP visited her, she again consented to the caesarean section. However she again refused consent when taken to operating theatre. The Hospital trust applied to the courts and MB was found to be of unsound mind due to her ambivalence caused by her needle phobia and hence her refusal of consent was incompetent. In cases of ambivalence such as that of MB it makes sense to ask which decision represents the patient’s true self. If a patient can coherently defend his decision based on his beliefs and values then provided he has a true self his decision should be accepted. If however his ambivalence extends to his beliefs and values and these conflict it might be questioned if he really has a true self. In the case of MB her refusal of consent to a venepuncture was not a decision she could defend, it was not a decision that reflected her true self and as such was not a competent decision.

1. Alice Isen, Paula Levin, 1972, Effect of feeling good on helping: Cookies and kindness, Journal of Personality and Social Psychology, Vol 21(3), Mar, 384-388.
2. David Velleman, 2009, How We Get Along, Cambridge University Press, page 95.