Neurosurgery for Psychopaths? An Ethical Analysis

Abstract

Recent developments in neuroscience have inspired proposals to perform deep brain stimulation on psychopathic detainees. We contend that these proposals cannot meet important ethical re-quirements that hold for both medical research and therapy. After providing a rough overview of key aspects of psychopathy and the prospects of tackling this condition via deep brain stimula-tion, we proceed to an ethical assessment of such measures, referring closely to the distinctive features pf psychopathic personality, particularly the absence of subjective suffering and a lack of moral motivation. Scrutiny of these factors reveals that two essential bioethical criteria, individual medical benefit and voluntary informed consent, cannot be met in performing neurosurgical experiments or treatments on psychopathic inmates.

Some Ethical Considerations About the Use of Biomarkers for the Classification of Adult Antisocial Individuals

“…In general, assessing whether the application of bioprediction in many legal and social practices is premature involves addressing several issues. Firstly, there are relevant legal debates aimed at establishing when scientific predictive information, not necessarily of a biological kind, can be usefully used for initial sentencing, parole or rehabilitation monitoring (Douglas, Pugh, Singh, Savulescu, & Fazel, 2017;H€ ubner & White, 2016;Pugh & Douglas, 2016). Secondly, the ethical justification of application of bioprediction in particular might tolerate different reliability thresholds depending on the specific context and the balance of values at hand.…”

“…Nonetheless, regarding adults, bioprediction practices that would involve serious involuntary interference on personal freedom such as preventive incarceration, sentencing based on risk assessment, and mandatory treatments appear to be premature. In fact, arguably, these practices have and ought to have a very low tolerance for predictive error (Eastman & Campbell, 2006;H€ ubner & White, 2016). Without giving an exhaustive discussion, there are at least four sets of reasons indicating that presently most methods for predicting risky antisocial behavior, including bioprediction, do not satisfy such a requirement (see also Poldrack et al, 2018).…”

“…It should be acknowledged, however, that the latter might not apply to all forms of antisocial behavior. For instance, it is an open issue whether psychopathic individuals who, due to their lack of empathy, guiltlessness, grand sense of self and defiant attitudes, would be prone to actively engage in remedying their behavior through therapy (H€ ubner & White, 2016; for other challenges of this type, see Poldrack et al, 2018). In this regard, some authors and studies provide more optimistic results (Horstk€ otter et al, 2012).…”

Treating Psychopaths Fairly

“…Monique Wonderly, Princeton University Center for Human Values H€ ubner and White (2016) question the ethical justification of employing risky neurosurgical interventions to treat imprisoned psychopaths. They argue that (1) such interventions would confer no medical benefit on the psychopath as there is no "subjective suffering" involved in psychopathy and (2) psychopaths could not voluntarily consent to such procedures because they could have no "internal motivation" for doing so.…”

Forensic practitioners’ expectations and moral views regarding neurobiological interventions in offenders with mental disorders

“…These potential developments have stirred considerable ethical debate on the prospects, threats, and limitations of integrating neurobiological and behavioural genetic interventions in forensic psychiatric practices (Chhangur et al, 2015;Horstkö tter, 2015;Hü bner and White, 2016;Munthe and Radovic, 2015;Pustilnik, 2009;Rose, 2000;Rose and Abi-Rached, 2013).…”