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In response to the vigorous growth of basic and disease-related neuroscience, the field of neuroethics has evolved, concerned with the ethical, social, legal, and policy implications of the conduct and outcomes of modern research on the brain. Leaders within the neuroscientific community and beyond are actively discussing ethical issues in neuroscience to determine how to promote and conduct ongoing research in a responsible manner. The Dana Foundation has contributed greatly to these discussions and we trust that these modules have encouraged you to consider the implications of the amazing growth of brain science.

Neuroscience research, as we have seen in these modules, offers promises of new treatments, even cures, for many devastating neurodegenerative diseases such as Huntington's, Alzheimer's, and Parkinson's diseases. At the same time, such research raises ethical issues. Should patients with Alzheimer's disease serve as research subjects in clinical studies if they are so cognitively impaired they lack the autonomy to provide informed consent for themselves? What are the implications of using embryonic stem-cell transplants to treat Parkinson's disease and other neurological disorders or even the potential for transplanted brain stem cells to enhance our brains? How do we cope with advances in genetics and molecular biology that raise increasing concerns with discrimination and legal privacy protections? How far can we push boundaries in neural prostheses or deep brain implants that ablate or stimulate when we are just beginning to understand brain circuitry? How do we draw the line between normal behavior and behavior that requires neurological intervention?

Indeed, there are concerns that we are on the cusp of changing what it means to be human by enhancing healthy brains with mood-altering drugs, memory and cognition improving drugs, or stimulating implants. Modern brain imaging techniques, while increasing our ability to make diagnoses objectively of the nonconscious brain, may someday be able to predict human behavior and reveal aspects of personality such as a tendency to lie, be aggressive, use illicit drugs, or racially discriminate. As a consequence of advances in neuroscience, a new lexicon is developing with terms such as "brain enhancement abuse" and "Acosmetic psychopharmacology," all with challenging ethical implications.

Multidisciplinary experts are needed to develop and disseminate ethical guidelines about how such research findings are used, how they are communicated to the public, and how they are developed into available treatments. As the technology of brain imaging improves, we will have to decide who should have access to the information this technology will provide if brain imaging technology can reveal thoughts. Would it be appropriate for our law enforcement and national security officials to use such findings? Have fMRI techniques developed sufficiently to warrant using it in commercial neuromarketing? And what are the implications if we derive, through neuroimaging, the physiological basis for morality?

With the hype as well as the hope, we must at the same time be circumspect about emergent technologies. For many advances, there may be, indeed undoubtedly will be, unintended consequences to confront. "We are discovering insights into improving the disordered brain and at the same time advancing on how we can make good brains better. We should respect the technology for the benefits it offers, but limit its use when it tends to lead to harm."2 We may have to rein in the technological imperative that implies if the technology exists, use it, while recalling the bioethics mantra, "It is not what you can do, rather it is what you should do." To do nothing, in some cases, may be to do the right thing.

In this period of heady development, we need to consider whether there are boundaries across which we should not tread. We need to consider who decides, and on what basis, a high-risk procedure is justified for a given individual. With enhancement techniques come the need to confront questions of equity. We must be especially concerned about those in a vulnerable or compromised position.

With all that we are learning, the brain and the mind remain enigmas. The prospect of greater understanding is stimulating. We trust that reading the four modules of this short course in neuroethics has provided you with an appreciation of both the potential for neuroscience research and the perils if this research is misused or abused. We are grateful to the Dana Foundation for playing such a major role supporting and shaping the emergent field of neuroethics. Only by educating those with an interest and involvement in this promising field can we be sure that future innovations in brain science will be effective as well as ethical.

We recognize that in many cases, these modules raise more questions than they answer. That is the nature of ethics debates and discussions. The charge of bioethics is not to come up with definitive answers to ethical dilemmas, but to explore the range of problems and consider the possible solutions and implications. As the social, political, and scientific climates change and evolve, the answers to the ethical dilemmas will change and evolve as well. The process of asking questions and contemplating the answers constitutes a primary focus of bioethics work. We hope that these modules have inspired thoughtful consideration and deliberation about emerging difficult issues.

1 Hyman, SE. Neuroethics: At age 5. field continues to evolve. In The 2007 Progress Report on Brain Research. The Dana Alliance for Brain Initiatives. Dana Press. P.9. toparrow

2 Fischbach, Ruth L. in Ackerman, Sandra J, ed. Hard Science, Hard Choices. Dana Press, New York, (2006), p.xii. toparrow