The ethics of mind maintenance : analysing trade-offs for emerging technologies aimed at preventing and treating age-related neural decline and disease

Lyreskog, David Magnus; Nagel, Saskia K. (Thesis advisor); Karlawish, Jason (Thesis advisor)

Aachen : RWTH Aachen University (2020, 2021)
Dissertation / PhD Thesis

Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2020


Age-related neural decline and disease is a growing global problem. To the challenge of suffering and death caused by such conditions, rise technologies to help detect, monitor, prevent, and treat the causes and symptoms of neurodegenerative disease: nano- and microfluidic on-chip labs, optogenetic brain stimulation, and bioprinting of tissue for neurotransplantation – these emerging medical technologies promise to provide better healthcare for people who in the future will suffer from age-related neurological diseases, or risk to suffer from them. However, there are ethical issues associated with each method and technology. These issues are rooted in the possible opportunities and threats against many commonly endorsed moral values, ranging from privacy, to wellbeing, to self-determination and autonomy, to personal identity. Ultimately, if we understand retention of the mind as a necessary criterium for our continued existence, the value of life itself stands to be at stake. In the pursuit of fighting the threats that are part of aging, we are faced with a turmoil of complex value conflicts. The choices that will have to be made in clinics and doctors’ offices around the world will at best be difficult to make – and possibly unmanageable, if ethical soundness is to be achieved in the process. And yet, those decisions will need to be made. In a not too distant future, many of us will sit in the office of our GP, a hospital room, in a specialist clinic, or perhaps by our kitchen table, facing the reality of those fundamental, philosophical questions: ‘What should I give, what should I sacrifice, in order to have a chance to fight the decline, retain my mental health, and prolong my existence?’. In some cases, we may also have to make such decisions for others, if they are less able to do so themselves. Regardless, the circle is made complete: from large, philosophical questions to everyday life dilemmas, we are forced to revisit those large questions to find solutions to our dilemmas. This dissertation is an attempt to reach over the gap between fundamental philosophical and ethical questions on the one side, and everyday medical decision-making on the other. The main objective is to provide a guiding structure for how we can navigate the oftentimes complex and opaque value conflicts that arise with emerging technological measures for age-related neural decline and disease.