Moving Beyond Concerns of Autonomy

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ACKNOWLEDGMENT

This commentary benefited from the editorial skills of Lora Nall and Christina Guajardo, as well as support from INTEGRIS Health, specifically Beth Pauchnik and IBMC's Neonatal Intensive Care Unit. Not only is their ethical leadership and ability to provide patients and families with compassionate care in the most difficult of clinical situations inspirational, but it has greatly influenced my work. ▪

Notes

1. Since the decision to use PBI involves a patient deliberately picking a second-order desire to control first-order urges, this suggests this patient will phenomenologically experience this decision as being strong. Moreover, that a patient's motivation for making the decision to use PBI is based on conflicting internal desires does not render his or her decision as unintentional or involuntary (Beauchamp and Childress 2012).

2. Assuming for the sake of argument that all intervention options meet conditions of biosafety, biotolerability, clinical efficacy, consent, authenticity, and necessity.

3. Brian Earp, Julian Savulescu, and Anders Sandberg (2012) have argued that in certain situations parents have obligations to use pharmaceutical neuromodulation to strengthen marital relationships in order to protect children from the harms of divorce.

4. It is an entirely different argument, beyond the scope of this commentary, as to whether this use of ADT is ethically appropriate.

5. I agree with the claim that, in principle, pharmaceutical interventions may also allow these criminals an opportunity to be able to engage in sustained decision making by suppressing these impulsive urges. However, because of the current side effects of ADT and concerns that, by virtue of human neurology, pharmaceutical interventions will always have side effects, pharmaceuticals to treat criminals with violent behavior or paraphilia and allow them to engage in sustained decision making by suppressing impulsive urges are not a live option (Terbeck and Chesterman 2014).