The rapid advances of the neurosciences have drawn much attention from philosophic quarters. According to many, the neurosciences are providing insights into age-old questions about freewill, responsibility, personality, agency, emotion, rationality, and even the very nature of morality. Some would even say that the neurosciences are the 'new philosophy', providing scientific access to answers where previously only philosophical speculation was available. While this reviewer is sympathetic to the possibility of the neurosciences providing insight into many philosophical questions, when one looks closely at what the science is actually telling us about the brain and how it produces complex behaviors it turns out that what we know about the these neurological processes is quite limited. The neurosciences are only just beginning to understand some of the basic processes involved in complex behaviors, personality, reasoning, emotion, and agency. Predictions that neuroscience has answered or will shortly answer these philosophical questions are at best premature. In fact, many of the neuroscientific answers proposed are themselves full of assumptions and philosophical speculations about what these processes mean for understanding complex behavior. Advances in the neurosciences will undoubtedly clear up many philosophical issues, but they also raise many of the same types of questions.

The application of neuroscience in clinical, research, legal, and social contexts raises an additional set of philosophical issues that neuroscience is not likely to resolve by itself. 'Neuroethics' is the new label that identifies the area of interdisciplinary inquiry that examines these and other questions that result from advances in the neurosciences. However, neuroethics is only just emerging as a field unto itself. Thus, Walter Glannon's new book, Bioethics and the Brain (Oxford University Press, 2007), is a much needed and welcome survey of the burgeoning social and ethical issues that identify neuroethics as a serious area of scholarship.

The explicit aim of Bioethics and the Brain is to explore the philosophical and ethical aspects of the clinical neurosciences — including psychiatry, neurology, and neurosurgery — with particular focus on questions about benefit, harm, responsibility, freewill, personal identity, and the self. The unique contribution that Glannon provides to this field is not just a traditional bioethical assessment of issues related to autonomy, informed consent, nonmaleficence, and beneficence, but an explicit acknowledgement that these normative questions are intimately engaged with more fundamental metaphysical questions about the nature of the mind, persons, agency, and the self. One of the reasons that the neurosciences are so philosophically compelling is that the science deals with the biological system most intimately identified with who we are, the brain. "It is because intervening in the brain can affect us so directly and deeply that we should be debating the ethical issues generated by different practices in clinical neurosciences." (12)

Bioethics and the Brain is impressively comprehensive, providing a veritable encyclopedia of information about the neurosciences and the ethical questions raised by the advances in those fields. The material presented in Bioethics and the Brain is intrinsically interesting, presented with scholarly acumen and an eye to integrating details across topic areas. Although the prose is sometimes arid and repetitive in its framing of the issues, Glannon is at his best when discussing concrete cases and the questions they raise for current and future practice. The book is divided into six topic areas. Chapter 1 outlines the relevant advances in clinical neuroscience and provides a primer on the relevant ethical principles to be used in the rest of the book. Chapter 2 deals with what neuroscience has to tell us about our minds, freewill and responsibility. In this chapter Glannon defends a non-reductionistic account of the mind as a way of orienting certain ethical questions about neurological interventions. Chapter 3 focuses exclusively on the applications and implications of neuroimaging, with particular attention given to predictive uses of imaging for psychiatric conditions. Chapter 4 gives a lengthy treatment of psychopharmacological interventions and questions involved in assessing risk, benefit, and potential enhancement uses. Chapter 5 examines more invasive surgical interventions and neurostimulation techniques, including deep brain stimulation and computer-brain interfaces. Chapter 6 completes the book with a discussion of brain death and the complexities in determining harms and benefits for the type of entity we think we are.

The topic choices and themes are organized in an integrated fashion, with attention to details that include assessment of risk, benefit, and informed consent. There are two major strengths of Glannon's approach to neuroethics in this book. First, he combines an erudite presentation of the neuroscience involved with a mature philosophical savvy in his presentation. The reader is not left wanting for detail in either the science or the ethics. For an interdisciplinary field such as neuroethics this is a difficult but much needed combination of knowledge. Second, and perhaps most importantly for a survey of neuroethics, Glannon repeatedly recognizes that normative questions about the propriety of certain neurological interventions involve complex metaphysical questions as well: "moral claims about what can benefit or harm us rest on the metaphysical claim regarding the sort of entities we are." (156) This is significant if for no other reason than that the neurosciences — the very sciences that raise these normative questions — themselves provide us with challenges and insight regarding what or who we are. Although it is not entirely clear that Glannon's commitment to a non-reductive theory of the mind provides anything more than a reductivist account can provide in these discussions, the fact that he pays considerable attention to these issues is enlightening in itself. The combination of normative and metaphysical issues is never easy to disentangle, but Glannon draws attention where it is needed.

Glannon's discussion of the ethical and social dimensions of clinical neuroscience is tempered by the fact that we are often only guessing at what the brain does or how these interventions work. What we know about the brain is only just emerging. Glannon does an admirable job of trying to balance the traditional assessment of risk and benefit with less settling metaphysical and normative choices in light of the limited knowledge we have of the brain and how it produces complex behaviors. Neuroethics is an emerging field that addresses questions worthy of serious and sustained consideration. Bioethics and the Brain is a welcome addition to the field that promises to orient the serious and initiate the curious.

© 2007 Bryan Benham

Bryan Benham is assistant professor of philosophy at the University of Utah. His main research interests are in philosophy of psychology and research ethics.

Categories: Ethics, Philosophical