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.”
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.
Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous system (and its subdivisions, the autonomic nervous system, and the somatic nervous system); including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, which is the scientific study of the nervous system.
A neurologist is a physician specializing in neurology and trained to investigate or diagnose and treat neurological disorders. Neurologists may also be involved in clinical research, clinical trials, and basic or translational research. While neurology is a non-surgical specialty, its corresponding surgical specialty is neurosurgery.
The emerging field of neurological enhancement highlights the potential of therapies to improve such things as workplace efficacy, attention in school, and overall happiness in personal lives. This field has also given rise to questions about neuroethics and the psychopharmacology of lifestyle drugs.
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.