Neuroethics – K.(-em-).K

Neuroscience and free will

Neuroethics also encompasses the ethical issues raised by neuroscience as it affects our understanding of the world and of ourselves in the world. For example, if everything we do is physically caused by our brains, which are in turn a product of our genes and our life experiences, how can we be held responsible for our actions? A crime in the United States requires a “guilty act” and a “guilty mind”.

As neuropsychiatry evaluations have become more commonly used in the criminal justice system and neuroimaging technologies have given us a more direct way of viewing brain injuries, scholars have cautioned that this could lead to the inability to hold anyone criminally responsible for their actions. In this way, neuroimaging evidence could suggest that there is no free will and each action a person makes is simply the product of past actions and biological impulses that are out of our control. The question of whether and how personal autonomy is compatible with neuroscience ethics and the responsibility of neuroscientists to society and the state is a central one for neuroethics.

Additionally, in late 2013 U.S. President Barack Obama made recommendations to the Presidential Commission for the Study of Bioethical Issues as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. This Spring discussion resumed in a recent interview and article sponsored by Agence France-Presse (AFP): “It is absolutely critical… to integrate ethics from the get-go into neuroscience research,” and not “for the first time after something has gone wrong,” said Amy Gutmann, Bioethics Commission Chair.” But no consensus has been reached.

Miguel Faria, a Professor of Neurosurgery and an Associate Editor in Chief of Surgical Neurology International, who was not involved in the Commission’s work said, “any ethics approach must be based upon respect for the individual, as doctors pledge according to the Hippocratic Oath which includes vows to be humble, respect privacy and doing no harm; and pursuing a path based on population-based ethics is just as dangerous as having no medical ethics at all.” Why the danger of population-based bioethics? Faria asserts, “it is centered on utilitarianism, monetary considerations, and the fiscal and political interests of the state, rather than committed to placing the interest of the individual patient or experimental subject above all other considerations.”

For her part, Gutmann believes the next step is “to examine more deeply the ethical implications of neuroscience research and its effects on society.”

Neurological treatments

Neuroscience has led to a deeper understanding of the chemical imbalances present in a disordered brain. In turn, this has resulted in the creation of new treatments and medications to treat these disorders. When these new treatments are first being tested, the experiments prompt ethical questions. First, because the treatment is affecting the brain, the side effects can be unique and sometimes severe. Many subjects have claimed to have experienced “personal identity” changes during neurological treatment tests. This is a difficult ethical dilemma. There are no clear and undisputed definitions of personality, self, and identity. Neurological treatments can result in patients losing parts of “themselves” such as memories or moods. Yet another ethical dispute in neurological treatment research is the choice of patients. From a perspective of justice, priority should be given to those who are most seriously impaired and who will benefit most from the intervention. However, in a test group, scientists must select patients to secure a favorable risk-benefit ratio. Setting priority becomes more difficult when a patient’s chance to benefit and the seriousness of their impairment do not go together. For example, many times an older patient will be excluded despite the seriousness of their disorder simply because they are not as strong or as likely to benefit from the treatment. The main ethical issue at the heart of neurological treatment research on human subjects is promoting high-quality scientific research in the interest of future patients, while at the same time respecting and guarding the rights and interests of the research subjects. This is particularly difficult in the field of neurology because damage to the brain is often permanent and will change a patient’s way of life forever.

Politics of neuromarketing

The politics of neuromarketing is this idea of using advertisements to convince the mind of a voter to vote for a certain party.

Is it possible to scan a voters brain to determine if a candidate’s political message is effective or not? Can you make a person vote in a particular manner using neuromarketing techniques? Though this might sound like science fiction, neuromarketing is already a part of the election campaigns within the United States.

In the 2006 reelection of Governor Arnold Schwarzenegger, Schwarzenegger was trailing his Democratic opponent in the polls. Schwarzenegger’s theme in this campaign was whether or not the voters would want to continue Schwarzenegger’s reforms or go back to the days of the recalled governor, Gray Davis.

In normal political marketing, voters would use detail, numbers, facts and figures to determine if they were better off under the incumbent governor. However, with neuromarketing, voters were shown powerful advertisement visuals. These visuals tried to influence voters’ emotions and to convince voters that Schwarzenegger was the better candidate.

The ethics of political neuromarketing is debatable. Some argue that political neuromarketing will cause voters to make rash decisions while others argue that these messages are beneficial because they depict what the politicians can do. Neuromarketing might make voters blind to the reality of things. Voters might be swayed by how powerful the advertisements seem to be while failing to understand the political ability or political agenda of the candiate.

Other people disagree with this idea. Darryl Howard, a Republican consultant, said he crafted “neuromarketing-based messages for TV, direct mail and speeches for Senate, Congressional and Gubernatorial clients in 2010.” Howard also said that the advertisements that were presented were honest. Neuromarketing techniques were only used to determine which political advertisements were most effective.

Pharmacological enhancement

Cosmetic neuro-pharmacology, the use of drugs to improve cognition in normal healthy individuals, is highly controversial. Some case reports with the antidepressant Prozac indicated that patients seemed “better than well,” and authors hypothesized that this effect might be observed in individuals not afflicted with psychiatric disorders. Following these case reports much controversy arose over the veracity and ethics of the cosmetic use of these antidepressants. Opponents of cosmetic pharmacology believe that such drug usage is unethical and that the concept of cosmetic pharmacology is a manifestation of naive consumerism. Proponents, such as philosopher Arthur Caplan, state that it is an individual’s (rather than government’s, or physician’s) right to determine whether to use a drug for cosmetic purposes. Anjan Chatterjee, a neurologist at the University of Pennsylvania, has argued that western medicine stands on the brink of a neuro-enhancement revolution in which people will be able to improve their memory and attention through pharmacological means. Jacob Appel, a Brown University bioethicist, has raised concerns about the possibility of employers mandating such enhancement for their workers.

Disorders of consciousness

Patients in coma, vegetative, or minimally conscious state pose ethical challenges. The patients are unable to respond, therefore the assessment of their needs can only be approached by adopting a third person perspective. They are unable to communicate their pain levels, quality of life, or end of life preferences. Neuroscience and brain imaging have allowed us to explore the brain activity of these patients more thoroughly. Recent findings from studies using functional magnetic resonance imaging have changed the way we view vegetative patients. The images have shown that aspects emotional processing, language comprehension and even conscious awareness might be retained in patients whose behavior suggests a vegetative state. If this is the case, it is unethical to allow a third party to dictate the life and future of the patient. For example, defining death is an issue that comes with patients with severe traumatic brain injuries. The decision to withdraw life-sustaining care from these patients can be based on uncertain assessments about the individual’s conscious awareness. Case reports have shown that these patients in a persistent vegetative state can recover unexpectedly. This raises the ethical question about the premature termination of care by physicians. The hope is that one day, neuroimaging technologies can help us to define these different states of consciousness and enable us to communicate with patients in vegetative states in a way that was never before possible. The clinical translation of these advanced technologies is of vital importance for the medical management of these challenging patients. In this situation, neuroscience has both revealed ethical issues and possible solutions.

Brain imaging

What is brain imaging?

Neuroimaging or brain imaging is the use of various techniques to either directly or indirectly image the structure, function, and pharmacology of the nervous system. It is a relatively new discipline within medicine, neuroscience, and psychology. Brain imaging has given scientists and researchers unprecedented insight into the inner function of the brain and the rapidly developing ability to correlate brain activation with psychological states and traits.

One of the most widely discussed new applications of imaging is based on correlations between brain activity and intentional deception. Intentional deception can be thought of in the context of a lie detector. This means that scientists use brain imaging to look at certain parts of the brain during moments when a person is being deceptive. A number of different research groups have identified fMRI correlates of intentional deception in laboratory tasks, and despite the skepticism of many experts, the technique has already been commercialized. A more feasible application of brain imaging is “neuromarketing“, whereby people’s conscious or unconscious reaction to certain products can purportedly be measured.

Researchers are also finding brain imaging correlates of myriad psychological traits, including personality, intelligence, mental health vulnerabilities, attitudes toward particular ethnic groups, and predilection for violent crime. Unconscious racial attitudes may be manifest in brain activation. These capabilities of brain imaging, actual and potential, raise a number of ethical issues. The most obvious concern involves privacy. For example, employers, marketers, and the government all have a strong interest in knowing the abilities, personality, truthfulness and other mental contents of certain people. This raises the question of whether, when, and how to ensure the privacy of our own minds.

Another ethical problem is that brain scans are often viewed as more accurate and objective than in fact they are. Many layers of signal processing, statistical analysis, and interpretation separate imaged brain activity from the psychological traits and states inferred from it. There is a danger that the public (including judges and juries, employers, insurers, etc.) will ignore these complexities and treat brain images as a kind of indisputable truth.

A related misconception is called neuro-realism: In its simplest form, this line of thought says that something is real because it can be measured with electronic equipment. A person who claims to have pain, or low libido, or unpleasant emotions is “really” sick if these symptoms are supported by a brain scan, and healthy or normal if correlates cannot be found in a brain scan. The phenomenon of phantom limbs demonstrates the inadequacy of this approach.

Brain interventions

Neuroimaging in red

“New findings in neuroscience have given us unprecedented knowledge about the workings of the brain. Innovative research—much of it based on neuroimaging results—suggests not only treatments for neural disorders but also the possibility of increasingly precise and effective ways to predict, modify, and control behavior.” – Robert H. Blank, Intervention in the Brain

Brain interventions

The ethics of neurocognitive enhancement, that is the use of drugs and other brain interventions to make normal people “better than well”, is an example of a neuroethical issue with both familiar and novel aspects. On the one hand, we can be informed by previous bioethical work on physical enhancements such as doping for strength in sports and the use of human growth hormone for normal boys of short stature. On the other hand, there are also some arguably novel ethical issues that arise in connection with brain enhancement, because these enhancements affect how people think and feel, thus raising the relatively new issues of “cognitive liberty”. The growing role of psychopharmacology in everyday life raises a number of ethical issues, for example, the influence of drug marketing on our conceptions of mental health and normalcy, and the increasingly malleable sense of personal identity that results from what Peter D. Kramer called “cosmetic psychopharmacology”.

Nonpharmacologic methods of altering brain function are currently enjoying a period of rapid development, with a resurgence of psychosurgery for the treatment of medication-refractory mental illnesses and promising new therapies for neurological and psychiatric illnesses based on deep brain stimulation as well as relatively noninvasive transcranial stimulation methods. Research on brain-machine interfaces is primarily in a preclinical phase but promises to enable thought-based control of computers and robots by paralyzed patients. As the tragic history of frontal lobotomy reminds us, permanent alteration of the brain cannot be undertaken lightly. Although nonpharmacologic brain interventions are exclusively aimed at therapeutic goals, the US military sponsors research in this general area that is presumably aimed at enhancing the capabilities of soldiers.