Neuroethics: Implications of Advances in Neuroscience

Introduction

Introduction to Advances in Neuroscience and their Ethical Implications

Imagine a legal system where, if you are a testifying witness, you must have an fMRI scan of your brain to determine if you are lying or telling the truth.

Imagine taking a drug that can ease your painful memories, preventing the formation of post-traumatic stress.

Imagine stepping into a trans-cranial magnetic stimulation salon for fifteen minutes and leaving refreshed and rejuvenated, ready to face the hardened world once again.

Imagine your employer's routine genetic screening of your traits such, as intelligence, greed, and even criminal behavior.

Introduction

The scenarios we list may sound like futuristic science fiction, but advances in neurology and neuroscience are bringing these notions closer to possibilities, if not to probabilities. We believe that neuroscientists and neuroclinicians, as well as neuroethicists, can work together to celebrate advances while helping to protect people from what might be considered inappropriate applications of novel technologies. This does not happen automatically. We must engage in reasoned and informed discourse to decide what innovations and applications are safe and appropriate. These modules on Neuroethics, sponsored by generous support from the Dana Foundation, provide basic information on four fields where significant advances in brain science have generated profound ethical issues. We trust you will find the modules informative and stimulating.

At the first of two landmark conferences on the topic, both of which were sponsored by The Dana Foundation, neuroethics was defined as "the study of the ethical, legal, and social questions that arise when scientific findings about the brain are carried into medical practice, legal interpretations, and health and social policy."¹ Later, William Safire adroitly described neuroethics as "the examination of what is right and wrong, good and bad about the treatment of, perfection of, and welcome invasion or worrisome manipulation of the human brain."²

Using either definition, it is clear that in the face of rapidly emerging brain technology and scientific research, neuroethical issues urgently need to be addressed. Why are the consequences of brain research of such concern to the public? "When we deal with brain science, we are dealing with the organ that makes us unique individuals, that gives us our personality, memories, emotions, dreams, creative abilities, and at times our sinister selves."³ Many would say that while they support development of disease treatments, medical technology, and basic research to further our understanding of the human body, they are reluctant to probe too deeply into the working of the human brain. The brain holds a special status as the core of our selfhood and autonomy. Manipulating the function of the brain is fundamentally different from manipulating the function of other organs like the heart or the kidney, and raises a number of distinct ethical issues. Inevitably, with a deeper and more complex understanding of how the brain works, we will need to examine metaphysical questions of personhood, responsibility, and consciousness.

The goals of this distance learning course in Neuroethics include a brief exploration of the newest and emerging technologies in brain research, an examination of the ethical, social, economic, and legal implications of these technologies, and the concomitant implications for social policy. The four modules included in this neuroethics course address issues that confront us with significant immediacy and scope.

1. Neuroimaging: Visualizing Brain Structure and Function.Techniques like PET, CT, and fMRI are used to diagnose brain disorders and levels of consciousness. Research is progressing to see if and how these technologies can be used to analyze behavior or identify an individual. These technologies raise important questions about the privacy of the mind and how we make decisions.

• a. Coma to Brain Death: Recognizing Disorders of Consciousness. With new imaging techniques, we are learning that even patients who seem unaware can have brain activity that is now being revealed. Distinguishing coma from persistent vegetative state and from minimally conscious state requires a clinical diagnosis. Increasingly, imaging scans are used to raise appreciation and understanding of brain activity or lack of activity despite a patient's diagnosed state of consciousness. This is a field of rapidly increasing knowledge that may prevent other contentious and divisive cases such as that of Terri Schiavo.⁴

2. Neurogenetics: The Complexity of Individuality. Neurogenetics focuses on the genes involved in heritable neurological diseases, and is concerned with how genetics can contribute to cognition, behavior, and personality. Questions about eugenics, genetic determinism, genetic exceptionalism, genetic enhancement, and the privacy of genetic information are all of ethical concern.

3. Neuropharmacology and Chemical Neuroenhancement. Research has improved our ability to understand, diagnose, and treat personality, social, and behavioral disorders.⁵ The ability to manipulate a person's mood, memory, and perception with pharmaceuticals holds great promise for those afflicted, but also raises questions about the use of psychoactive drugs as elective enhancements for people who are otherwise well. Are we medicalizing ordinary behavior?

4. Neurotechnology: New Tools for Stimulating and for Responding to Brain Activity. Technological innovations such as brain implants, robotics, and deep brain stimulation can be used to treat neurological and psychiatric disorders.⁶ While these technologies treat diseases and injuries, many people are concerned with the potential for future misappropriation of these technologies for the purposes of enhancement and control.

Scientific and technological advancements are neither inherently good nor evil. Rather, it is how they are used and applied to society that can be assessed and valued. As a culture, we tend to promote the unfettered use of technology whenever it is developed, but the steady increase of hype and unsupported research findings surrounding the promise of brain research warrant some measure of caution. Protection of patients and research volunteers, especially those who are vulnerable, must be a primary concern.

Because brain research and technologies are fraught with implications about the human mind and the nature of humanity, as well as fears about autonomy and privacy in the face of government intervention, we need an open forum to discuss benefits and burdens and to establish appropriate safeguards as we move forward.⁷

The technological advances featured in this course are presented in four specific modules. While holding out great promise for the improvement in health, treatment of disease, and understanding of the brain, these advancing technologies raise compelling ethical, legal, and social concerns which we trust readers of this course will take time to consider. The technologies are increasingly available. It is up to all of us to use them responsibly.

¹ William Safire, Mapping the Field Conference, 2002. San Francisco, CA.

² William Safire, Mapping the Field Conference, 2002. San Francisco, CA.

³ Fischbach, Ruth L. in Ackerman, Sandra J, ed. Hard Science, Hard Choices. Dana Press, New York, (2006), p. xiii.

⁴ Gostin, Lawrence O. Ethics, the Constitution, and the Dying Process: the Case of Theresa Marie Schiavo. JAMA, May 18, 2005-Vol 293, No. 19, pp. 2403-2407.

⁵ Psychiatric, Behavioral, and Addictive Disorders. The 2007 Progress Report on Brain Research (2007) Dana Press, New York, pg 57

⁶ Foster, KR. Engineering the Brain. in Illes, Judy, ed. Neuroethics: Defining the Issues in Theory, Practice, and Policy. Oxford University Press: Great Britain. 2006. Pg 185-190

⁷ Foster, KR. Engineering the Brain. in Illes, Judy, ed. Neuroethics: Defining the Issues in Theory, Practice, and Policy. Oxford University Press: Great Britain. 2006. Pg 185-190

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