Authenticity and autonomy in deep-brain stimulation

Abstract

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation (DBS) to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy (interpreted as mental competence), and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions of autonomy such as authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general.

Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations

“…The relevance of authenticity in case of DBS treatment has been noted before [6, 7, 60, 61] and our findings confirm this relevance. Authenticity is, however, a very difficult issue, in general, and even more so in these special circumstances.…”

‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease

“…Furthermore, an autonomous agent reasons and acts on the basis of authentic desires, i.e. the attitudes of the agent that move her to act are identified as her own, being consistent with the agent's evaluation of her values [31]. According to this view, to act authentically and therefore responsibly is to do so in accordance with one's Btrue self^.…”

Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation

“…Contrary to what Kraemer claims, however, the dilemma above can be seen as wrong-headed, as many of the influential contemporary accounts of autonomy instead view authenticity as a prerequisite for autonomy, and as such, hold these two concepts as not excluding, but rather fundamentally depending on each other (Wardrope, 2014). As Christman (2018) states, "[p]ut most simply, to be autonomous is to be one's own person, to be directed by considerations, desires, conditions, and characteristics that are not simply imposed externally upon one, but are part of what can somehow be considered one's authentic self".…”