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This article examines the emerging possibility of “brain-state transitioning,” in which one brain state is prompted through manipulating the dynamics of the active brain. The technique, still in its infancy, is intended to provide the basis for novel treatments for brain-based disorders. Although a detailed literature exists covering topics around brain-machine interfaces, where targets of brain-based activity include artificial limbs, hardware, and software, there is less concentration on the brain itself as a target for instrumental intervention. This article examines some of the science behind brain-state transitioning, before extending beyond current possibilities in order to explore philosophical and ethical questions about how transitions could be seen to impact on assessment of responsibility and personal identity. It concludes with some thoughts on how best to pursue this nascent approach while accounting for the philosophical and ethical issues.
Someone once told me that the average number of readers of a philosophy article is about six. That is a particularly depressing thought when one takes into account the huge influence of certain articles. When I think of, say, Gettier’s article on knowledge, or Quine’s ‘Two Dogmas’, I begin to wonder whether anyone is ever likely to read anything I write. Usually the arguments of these very influential articles have been subjected to widespread analysis and interpretation. The case of Elizabeth Anscombe’s ‘Modern Moral Philosophy’, published in 1958, is something of an exception.1 That article has played a significant part in the development of so-called ‘virtue ethics’, which has burgeoned over the last three decades in particular. But there has been less close attention to its arguments than one might have expected.2
South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.
Because my time and competence are limited, I shall avoid exegetical discussion of Kant and restrict myself to discussion of some of the apparent implications of the views attributed to Kant by van Ackeren and Sticker (AS) in their insightful and suggestive article.
After this our next task is presumably to discuss pleasure, because pleasure seems to be especially closely associated with beings like us. This is why people educate the young by steering them in the right direction with pleasure and pain. Also, enjoying and hating the right things seem the most important factors in virtue of character, because pleasure and pain run through the whole of life; and they have weighty significance for virtue and the happy life, since people rationally choose what is pleasant, and avoid what is painful. It would seem, then, that these are the last things that should be ignored, especially since there is much dispute about them: some say that pleasure is the good, while others say on the contrary that it is thoroughly bad.
Some of those who say it is bad presumably say this because they are convinced that this is how things are. Others, however, say it because they believe that it is better with a view to how we live to represent pleasure as a bad thing, even if it is not. For they think that the masses are inclined towards it and are slaves to their pleasures, and that we ought therefore to lead them in the opposite direction, since in this way they might arrive at the mean point. But surely this view is incorrect. For in matters to do with feelings and actions, arguments are less reliable than the facts; so when they conflict with the facts of perception, they are scorned, and undermine the truth as well. For if a person who criticizes pleasure is once seen aiming at it, the reason for his inclining towards it is thought to be that he regards all pleasure as worth pursuing, because it is not characteristic of the masses to draw distinctions. True arguments, then, seem to be the most useful, not only in the acquisition of knowledge, but in how we live. For since they are in harmony with the facts, they are believed, and for that reason they spur those who understand them to live in accordance with them.
We must consider justice and injustice – what sort of actions they are concerned with, what kind of mean justice is, and what are the extremes5 between which the just is a mean. Let our inquiry be conducted in the same way as our preceding discussions.
We see that everyone means by justice the same kind of state, namely, that which disposes people to do just actions, act justly, and wish for what is just. In the same way, by injustice they mean the state that makes people act unjustly and wish for what is unjust. So let us too begin with these assumptions as a rough basis for our discussion.
What is true of sciences and capacities is not true of states, since it seems that contraries can both be the concern of the same capacity or science, while a state does not produce results contrary to itself. For example, as a result of health, we do not do actions contrary to health, but only those that are healthy; we say that we are walking healthily when we walk as a healthy person would.
In all friendships between dissimilar people, as we have said, it is proportion that produces equality and preserves the friendship; for example, in political friendship the shoemaker receives in return for his shoes what they are worth, and so do the weaver and the rest. In these cases, a common measure is provided in the form of money, and so everything is referred to this and measured by it.
But in erotic friendship the lover sometimes complains that his profound love is not requited (perhaps because he has no quality worthy of love), while the beloved often complains that the lover formerly promised him everything and now does nothing.
Things like this happen when the lover loves the beloved for pleasure, while the beloved loves the lover for utility, and these objects are no longer obtained by both of them. For if these are the reasons for the friendship, it is dissolved when they do not get what they were aiming at in their love; each was fond not of the other himself, but of his qualities, and since these do not last, such friendships do not last either. But friendship of character, since it exists for its own sake, does last, as we have said.
After this, the next step would be a discussion of friendship, since it is a virtue or involves virtue, and is an absolute necessity in life. No one would choose to live without friends, even if he had all the other goods. Indeed, rich people and those who have attained high office and power seem to stand in special need of friends. For what use is such prosperity if there is no opportunity for beneficence, which is exercised mainly and in its most commendable form towards friends? Or how could their prosperity be watched over and kept safe without friends? The greater it is, the greater the danger it is in. In poverty, too, and in other misfortunes, people think friends are the only resort.
Friendship benefits the young by keeping them from making mistakes, and the old by caring for them and helping them to finish jobs they are unable to finish themselves because of their weakness. And it benefits those in their prime by helping them to do noble actions – ‘two going together’ – since with friends they are more capable of thinking and acting.
Next let us discuss generosity. It seems to be the mean in relation to wealth: the generous person is praised not in matters of war, nor in those that concern the temperate person, nor again in respect of his legal judgements, but rather with regard to the taking and giving of wealth, and more especially the giving. By wealth, I mean everything the value of which is measured in money.
Both wastefulness and stinginess are also excesses and deficiencies with regard to money. We always ascribe stinginess to people who take wealth more seriously than they should, but we sometimes use the term ‘wasteful’ with a wider connotation, calling wasteful those who are incontinent and spend their money on intemperate pursuits. These incontinent people are therefore thought to be the worst of characters, because they possess several vices at the same time. But this means they are not properly called wasteful, since ‘wasteful’ means a person with one vice, namely, that of wasting his property. This is because a wasteful person – one who is asōtos, ‘not saved’ – is a person who ruins himself, and the wasting of one’s property seems to be a kind of ruining of oneself, since living depends on it. This, then, is how we understand wastefulness.
This new edition of Aristotle's Nicomachean Ethics is an accurate, readable and accessible translation of one of the world's greatest ethical works. Based on lectures Aristotle gave in Athens in the fourth century BCE, Nicomachean Ethics is one of the most significant works in moral philosophy, and has profoundly influenced the whole course of subsequent philosophical endeavour. It offers seminal, practically oriented discussions of many central ethical issues, including the role of luck in human well-being, moral education, responsibility, courage, justice, moral weakness, friendship and pleasure, with an emphasis on the exercise of virtue as the key to human happiness. This second edition offers an updated editor's introduction and suggestions for further reading, and incorporates the line numbers as well as the page numbers of the Greek text. With its emphasis on accuracy and readability, it will enable readers without Greek to come as close as possible to Aristotle's work.
Since we have already stated that one should rationally choose the mean, not the excess or the deficiency, and that the mean is as correct reason prescribes, let us now analyse this prescription.
In all the states of character we have mentioned, and in the others as well, there is a sort of target, and it is with his eye on this that the person with reason tightens or loosens his string. There is also a sort of standard for the mean states, which, as we say, lie between excess and deficiency and are in accordance with correct reason.
But to say this, though true, is not at all clear. For in other practices of which there is a science it is true to say that one should exert oneself and relax neither too much nor too little, but to the extent of the mean that is prescribed by correct reason. But having grasped only this, someone would be none the wiser; for example, you would not know what sort of treatments to use on your body if someone were to say that you should employ those that medicine requires, and in the way that a medical practitioner employs them. With states of the soul as well, then, we must not only offer this truism, but also determine what correct reason is and what its standard is.
Since virtue is to do with feelings and actions, and since voluntary feelings and actions are praised and blamed, while the involuntary ones are pardoned and occasionally even pitied, presumably anyone considering virtue must determine the limits of the voluntary and the involuntary. It will be useful as well for legislators, in connection with honours and punishments.
Things that happen by force or through ignorance are thought to be involuntary. What is forced is what has an external first principle, such1110a that the agent or the person acted upon contributes nothing to it – if a wind, for example, or people with power over him carry him somewhere.
As for things done through fear of greater evils or for the sake of something noble – if a tyrant, for example, had one’s parents and children in his power and ordered one to do something shameful, on the condition that one’s doing it would save them, while one’s not doing it would result in their death – there is some dispute about whether they are involuntary or voluntary. The same sort of thing happens also in the case of people throwing cargo overboard in storms at sea. Without qualification, no one jettisons cargo voluntarily; but for his own safety and that of others any sensible person will do it.