Moral Education and the Right to an Open Future

One often-cited reason why the possibilities of moral bioenhancement should be explored is the supposed lack of effectiveness of so-called traditional methods of moral enhancement, such as upbringing, socialization, and education. Another recurring argument is that there are little principled differences between employing traditional and potential biomedical methods of moral betterment in terms of their ethical acceptability. David DeGrazia, for example, argues that (many of the) arguments against biomedical means also apply to traditional, non-biomedical means: “one should not inculcate moral values that are wrong, so how can a parent be sure that she or he is justified in providing a particular type of moral instruction? Also facing this challenge are public school teachers who attempt to inculcate in students certain moral virtues such as civility, respect for differences and concern for the poor.”^{Footnote 11}

An example of a domain in which these same questions are explicitly discussed is the field of so-called “moral education.” What is the proper aim of (moral) education and what is the appropriate role of parents and educators in guiding the moral development of children? What particular moral codes and values do we want to nurture or even instil in our children, and how much pluralism are we willing to tolerate? What aspects of the family, social, and schooling environment impact on the development of prosocial and moral competencies of children?

The theoretical and empirical study of moral functioning—of moral cognition, moral emotions, moral behavior, moral motivation, moral character, and moral development—has attracted a lot of interest from a wide range of scientific disciplines in recent years.^{Footnote 12} At what Daniel Lapsley and Gustavo Carlo^{Footnote 13} have termed ‘the new crossroad’ of moral development research, questions arise about the relevance of these different lines of research for “addressing the pressing social issues of our times.”^{Footnote 14} They argue that in order to adequately address these issues, broad, integrative and multidisciplinary theoretical and methodological approaches are needed. One important similarity between discussions on moral education and those on moral bioenhancement is a search not only for a scientifically adequate model of human moral psychology, for linking “substantive philosophical issues with relevant (neuro)psychological data and in providing the empirical paradigm with which to do so,”^{Footnote 15} but also an explicit focus on the practical implications of this growing body of knowledge.

Traditionally, within the literature on moral education, two main dominant educational approaches to the moral formation of children can be distinguished: traditional character education—focusing on the inculcation of virtuous traits of character—and rational moral education—seeking to facilitate the development of autonomous moral judgment and the ability to resolve disputes and reach consensus.^{Footnote 16} The latter approach focuses on nurturing skills such as perspective taking and deliberation more than on direct instruction on what to value and how to act,^{Footnote 17} and has, therefore, been characterized as a more progressive approach to moral education. Traditional character education on the other hand focuses on internalizing values inherent in the tradition and culture of society.^{Footnote 18} Darcia Narvaez formulates a number of familiar strengths and weaknesses of both approaches:

More integrative and comprehensive perspectives on moral functioning and the implication for moral development and education are explicitly being sought, for example in a special issue of the Journal of Moral Education in 2008.^{Footnote 20} Dissatisfaction with “the near exclusive focus on verbal reasoning about justice in a large portion of the research in the field”^{Footnote 21} has inspired attempts to formulate unifying, integrative models that encompass “not only personality but, also, on the one hand, the brain and central nervous system, and on the other hand, interaction and culture”^{Footnote 22} and that acknowledge the importance of both reflective reasoning (in the Kantian or utilitarian traditions), moral emotions (based in the Humean tradition), and virtues and good practical judgement (following the Aristotelian tradition).^{Footnote 23} This literature could inform the moral enhancement debate.

Both in the debate on moral bioenhancement and within moral education, a central and much discussed topic of debate concerns the question what moral bioenhancement should focus on given the fact that ethical systems and theories differ considerably.^{Footnote 24} Given a plurality of moral values and outlooks, a question that has been asked in the philosophy of education is whether parents and educators are justified in raising and shaping children according to their own preferences: “Should our goal be to raise our children so that they will have, as adults, as many options as possible, to give them, insofar as we can, a maximally ‘open’ future? Or should our goal be more directive, to lead our children toward a more specifically shaped future that we ourselves endorse?”^{Footnote 25}

The “right to an open future” argument concerns the balancing of the liberty of parents to raise their children according to their own lights, and the “anticipatory autonomy rights” of children to leave important life choices open. Joel Feinberg who introduced the right in 1980, discusses adults’ rights to exercise their religious beliefs, a right that a child is not yet capable of exercising, but that still holds “prematurely” as a so-called “right-in-trust.”^{Footnote 26} The argument has become commonplace in applied ethics in debates on genetic reproductive technologies, through which disclosure of certain types of genetic information could infringe on childrens’ right to have future’s options kept open until they are capable of making their own decisions.^{Footnote 27}

In the context of education, a child’s right to have important life choices kept open includes “restrictions on what parents (and others) are allowed to do to children, and, on some interpretations,…what parents (and others) ought to provide children.”^{Footnote 28} Besides an argument for refraining from imposing important life choices, the right to an open future might also be interpreted as a “positive claim right” with a corresponding obligation for parents and educators to ensure that a child has a good starting position.^{Footnote 29} This right to an open future argument could therefore also be used within the context of moral enhancement: on the one hand, to argue for limitations on what parents or others may do to “morally enhance” children, and on the other to argue in favor of instilling capacities that would help them to become full moral subjects with their own moral autonomy.

Early Identification of “Risky Children” and the Moral Pitfalls of Screening

It has been argued that “early childhood is probably the optimal starting point for moral enhancement,”^{Footnote 30} and that neuroscientific knowledge may inform traditional forms of moral education as well as enable early identification and prevention of antisocial behavior. Research is underway to determine which biomarkers—genetic, neurobiological, and physiological—give the most accurate risk predictions,^{Footnote 31} and to determine which preventive interventions would be effective.^{Footnote 32} “Biological information may provide useful information about which individuals may be at somewhat greater risk for antisocial behaviour, and thus may provide for the opportunity to intervene with programs designed to reduce this risk.”^{Footnote 33}

Early detection of children “at risk” for developing antisocial personality disorder or for becoming violent criminal offenders is ultimately aimed at prevention of antisocial behavior and violent crime.^{Footnote 34} Envisaged biomedical interventions aimed at prevention of such behavior can be understood as moral enhancements, in the sense of improving the moral capacities and/or behavior of these children. It aims to make them “morally better” persons than they would otherwise be. An (as yet largely hypothetical) comprehensive program for screening and early intervention to prevent antisocial behavior can, therefore, be understood as a program for moral enhancement. Some may oppose this framing, as consensus on the definition of moral enhancement is lacking.^{Footnote 35} However, even if such screening and prevention practices do not meet the criteria of one’s preferred definition of moral bioenhancement, the similarities are obvious. The emerging ethical discussion around early detection and prevention of antisocial behavior may therefore inform the moral enhancement debate and introduce new and important considerations and arguments.

First, in the moral enhancement debate so far, the idea that a suitable target population will need to be determined for any moral enhancement intervention that may be developed has not yet been considered. Targeting interventions at specific groups; for example, those who already exhibit immoral behavior, or those who are at risk of doing so, requires a way to distinguish those people from others. Some form of screening will be necessary to determine who is in need of moral enhancement, who will benefit most from a specific intervention, or who need to be targeted to optimize societal benefit. A first—moral—question is who the target population should be; a second, more practical, question is how these subjects can be identified.

When such a hypothetical screening program for children “at risk” for antisocial behavior is considered, a number of ethical issues come up that have so far hardly been addressed in the moral enhancement debate.^{Footnote 36} First of all, screening tests may give false negative or false positive outcomes, resulting in unjustified reassurance and failure to intervene, or in unjustified labeling and unnecessary interventions. Limitations to the predictive value of screening tests are, therefore, morally problematic. Of many identified risk predictors, it is unclear whether they are causally relevant factors^{Footnote 37} or mere correlates, making their exact meaning doubtful. Moreover, screening tests themselves or the follow-up interventions could have side effects or carry risks; therefore, issues of safety should be considered. Next, it has been argued that such a screening program may have unwanted social effects. It may lead to individualization of problem behavior and lead to neglect of social and environmental factors contributing to this behavior. It may also lead to stigmatization and discrimination of children who are labeled (correctly or falsely) as “at risk.” This may also have negative effects on their self-identity or even become a self-fulfilling prophecy: if one is looked on and treated as a potential violent offender, this may cause one to start behaving as such. One could even say that this threatens the child’s “open future.” At the same time, too strong a focus on antisocial behavior “might disadvantage those in greatest need of good youth care who are not also, for example, genetically at risk to translate early personal into later social problems.”^{Footnote 38} Finally, it has been brought forward that such screening programs could easily lead to oppression and exclusion of the identified individuals, especially in the absence of effective preventive or therapeutic interventions.^{Footnote 39}

All these considerations are highly relevant for understanding what it would mean to single out certain individuals or groups as suitable candidates for moral improvement, but they have so far been neglected in the debate on moral enhancement, because this debate has hardly concerned itself with potential “real world” practices.

A third lesson to be drawn from the discussion about early detection and prevention of criminal or antisocial behavior concerns the tension between the interests of the individual and those of society. This is mentioned as a very important issue by almost all commentators in the screening debate. Briefly stated: is the intended purpose helping the detected children, or is it protecting society? What if both aims cannot be served at the same time? Which one should take precedence? “At the core, perhaps, is the challenge of ethically balancing public protection and individual autonomy, privacy, and liberties.”^{Footnote 40} This issue will be taken up further in the next section.

Mandatory Treatment in (Forensic) Psychiatry and the Dual Role Dilemma

We can imagine examples of people who freely choose to morally enhance themselves using biomedical technologies, in which case an individual choice frame that emphasizes the freedom of the individual and related concepts such as autonomy and self-determination appears the most suitable ethical framework. Nonetheless, in the debate on moral bioenhancement so far, the theme of “mandatory moral bioenhancement” has been a central one. Examples that are frequently discussed range from preventing individuals from initiating “ultimate harm,” to preventing violence or violent crime in the population at large.^{Footnote 41} The argument is made that those who are most in need of moral enhancement are least likely to be inclined to use it, and that mandatory use is therefore required. Subsequently, there has been explicit and quite extensive discussion on whether or not (safe and effective) moral bioenhancement technologies should be mandated either for the general population or for specific target groups.^{Footnote 42}

This raises a number of questions with respect to who decides, implements, and monitors the mandatory intervention in terms of expected and appropriate contexts, patient rights, and professional roles and responsibilities. These questions are reminiscent of a number of central ethical dilemmas in psychiatry, and in forensic psychiatry in particular, surrounding involuntary or coercive treatment, domains that are arguably a likely setting for implementing potential moral bioenhancement interventions.

In general, the conditions under which coercive treatment is warranted in mental health now involve direct prevention of suicide or other forms of self-inflicted harm, or situations when an individual poses a direct risk to others. Generally speaking, within mental health settings “protection of the community is typically a side constraint, something that moderates the treatment of the client or patient,”^{Footnote 43} whereas “a fundamental obligation to the best interests of one’s patient” remains central.^{Footnote 44} However, when focusing on forensic contexts,^{Footnote 45} ethical issues become more complex and controversial,^{Footnote 46} as these contexts are much more motivated by non-offender considerations.^{Footnote 47}

The so-called “dual-role dilemma,” central in the ethics of forensic psychiatry, refers to possible tension between psychiatrists’ obligations of beneficence toward their patients, and conflicting obligations to the community or third parties.^{Footnote 48} This tension or dissonance is something an individual psychiatrist might experience when “attempting to adhere to the conflicting ethical requirements associated with client well-being and community protection.”^{Footnote 49} This tension might also be inextricably linked to the profession, as forensic psychiatry “involves an interaction between two distinct state institutions, the criminal justice and mental health systems”^{Footnote 50} that each carry varying sets of ethical norms that can conflict.

In a classic text from 1984, Alan Stone formulated fundamental criticism on the lack of clear ethical boundaries for the professional roles of forensic psychiatrists.^{Footnote 51} His main worry was that the role of evaluator moves the forensic psychiatrist away from the role of physician and the fundamental notion of nonmaleficence: “helping the patient, which is the ethical thesis of the practitioner, becomes the ethical temptation in the legal context.”^{Footnote 52} Paul Appelbaum on the other hand argued that beneficence and nonmaleficence are not central notions in forensic psychiatry, and that forensic psychiatry is instead guided by a distinct set of ethics. The ethics of the “forensicist” is directed toward the benefit of society, and, therefore, the central responsibility of the forensicist is to justice, not the patient.^{Footnote 53} A notable example is forensic risk assessment, where the welfare of the patient is not necessarily the immediate object of concern, but rather the immediate concern is about public safety.^{Footnote 54}

This distinction suggests three directions for mandatory moral bioenhancement interventions. Either moral bioenhancement will be situated firmly within a health context, in which the interests and well-being of the patient are central and the patient’s right to treatment and other forms of support is emphasized, and in which in principle medical doctors prescribe a potential moral bioenhancement intervention, and monitor and weigh potential risks. An alternative option is to position mandatory moral bioenhancement within correctional, criminal justice contexts, where non-offender considerations, such as community protection and risk assessment, are primary. Whereas the first option presupposes the primacy of medical ethical considerations, the latter would function within a more general ethical framework, in which respect for persons, justice, and human rights are important considerations. A third, hybrid model would explicitly acknowledge that “more than one ethical theory will be required to justify and guide offender treatment,”^{Footnote 55} and would seek a pragmatic, procedural solution to solve potential conflicts between the different sets of norms and values. The Dutch Entrustment Act for example represents a rather exceptional combination of punishment and treatment,^{Footnote 56} a system that is criticized for (possible infinite) preventive detention,^{Footnote 57} but that is also praised for the quality of the care provided to prisoners and the lower recidivism rates. However, the fact that “individuals may be unable to ethically justify their professional actions and could move somewhat erratically between different courses of action”^{Footnote 58} remains a concern, one that should also be addressed with respect to those who would implement potential moral bioenhancement interventions.