Reducing, restoring, or enhancing autonomy with neuromodulation techniques

This chapter focuses on the question of how deep brain stimulation (DBS) and other new and emerging neuromodulation techniques such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and neurofeedback can influence our autonomy, that is, our capacity to govern ourselves. First, the concept of autonomy is clarified and related to concepts like authenticity or free will. Distinctions are made between autonomy as capacity and as condition, local and global autonomy, autonomous choice and executive autonomy. Next, a brief overview of the main existing and emerging neuromodulation techniques is given. It is then argued that neuromodulation techniques can impact on autonomy in various ways. Neurodmodulation can reduce autonomy by impeding the capacities needed for autonomous choice, or by affecting a person’s values and preferences. However, if the person endorsed these changes, his global autonomy can remain intact. Furthermore, it is argued, neuromodulation can also restore or even enhance capacities necessary for autonomy. Finally, it is argued that differences between techniques have consequences for their impact on autonomy. “Passive” techniques like DBS are more prone to abuse and to disrupting autonomy than techniques-like neurofeedback-that require active participation.

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