Emerging ethical issues in neuroscience

Neuroscience and the law: philosophical differences and practical constraints

Controversies surrounding the value of neuroscience as forensic evidence are explored from the perspective of the philosophy of mind, as well as from a practical analysis of the state of the scientific research literature. At a fundamental philosophical level there are profound differences in how law and neuroscience view the issue of criminal responsibility along the continuum from free will to determinism. At a more practical level, significant limitations in the current state of neuroimaging research constrain its ability to inform legal decision-making. Scientifically supported and unsupported forensic applications for brain imaging are discussed, and recommendations for forensic report writing are offered.

Ethical issues in psychopharmacology of children and adolescents

PURPOSE OF REVIEW

This summary of the literature published over recent years focuses on the ethical aspects of interventions with psychotropic medication in child and adolescent psychiatry. Ethical issues of pharmacotherapy concern aspects of research, safety, indicated use, enhancement, information and evidence-based practice.

RECENT FINDINGS

The literature on pharmacological interventions suggests changes in prescribing patterns for some substance classes owing to regulatory authorities' warnings. For most of the commonly used medications in children and adolescents no sound database about efficacy and safety is available and knowledge about adverse events and long-term safety remains poor. This is due to a general lack of clinical trials in this population. Legislative efforts have tried to improve safety and labelling of medicines for children. Ethical issues of enhancement in minors have been increasingly discussed over recent years.

SUMMARY

The ethical aspects of psychopharmacotherapy in minors are still rarely discussed in the literature. Practical questions of research and treatment ethics such as a need for information for children and parents are pointed out; conflicts of evocation and access to care for special populations in need are identified in a field lacking adequate ethical and clinical research.

[Autonomy in medicine. Self-determination, self-design and shaping one's own life]

Autonomy is a central and multifaceted concept of ethical reflection with many nuances of meaning. Central to the concept are the ability and opportunity to self-determine and self-design, as well as the potential to shape the course of one's own life significantly. However, there is generally a narrow understanding of the concept in the debate on patient autonomy and informed consent in a medico-therapeutic context, to which the possibility to a free decision-making process based on concrete treatment scenarios is central. In contrast, the present article discusses the diversity of autonomy-related aspects in non-therapeutic areas of medicine, while underlining the need to further develop and differentiate the concept of autonomy.

A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States

Background

Rule violations among elite-level sports competitors and tragedies among adolescents have largely defined the issue of non-medical anabolic-androgenic steroid (NMAAS) use for the public and policy makers. However, the predominant and oft-ignored segment of the NMAAS community exists in the general population that is neither participating in competitive sports nor adolescent. A clearer profile of NMAAS users within the general population is an initial step in developing a full understanding of NMAAS use and devising appropriate policy and interventions. This survey sought to provide a more comprehensive profile of NMAAS users by accessing a large sample of user respondents from around the United States.

Methods

U.S.-based male NMAAS users (n = 1955) were recruited from various Internet websites dedicated to resistance training activities and use of ergogenic substances, mass emails, and print media to participate in a 291-item web-based survey. The Internet was utilized to provide a large and geographically diverse sample with the greatest degree of anonymity to facilitate participation.

Results

The majority of respondents did not initiate AAS use during adolescence and their NMAAS use was not motivated by athletics. The typical user was a Caucasian, highly-educated, gainfully employed professional approximately 30 years of age, who was earning an above-average income, was not active in organized sports, and whose use was motivated by increases in skeletal muscle mass, strength, and physical attractiveness. These findings question commonly held views of the typical NMAAS user and the associated underlying motivations.

Conclusion

The focus on "cheating" athletes and at risk youth has led to ineffective policy as it relates to the predominant group of NMAAS users. Effective policy, prevention or intervention should address the target population(s) and their reasons for use while utilizing their desire for responsible use and education.

Illness related deception: social or psychiatric problem?

In this paper we question the validity of factitious disorder as a meaningful psychiatric diagnosis. When the diagnosis is used there is often the assumption that the person engaging in the 'deception' is not lying in the traditional sense of being deliberately misleading. Moreover, little is known about the aetiology or psychopathology underlying factitious disorder, and the legitimacy of deception as a mental disorder has been questioned. It is argued that while illness deception may be more common that hitherto assumed, factitious disorder as a distinct type of psychiatric disorder is conceptually flawed, diagnostically impractical and clinically unhelpful and should be dropped from existing nosologies.

In-depth learning: one school's initiatives to foster integration of ethics, values, and the human dimensions of medicine

Today's medical student curriculum is a lock-step experience that provides a broad survey of medicine with little opportunity to pursue fully integrated, in-depth learning. To teach students about the human dimensions of health care, many schools simply have added courses that survey general areas such as ethics, values, and patient-doctor relationships. However, a superficial, broad-brush approach does not offer students sufficient opportunity to engage with these topics in substantive and meaningful ways. The authors propose that a theme-based, individualized, in-depth learning experience (in which students pursue a focused project comprehensively and in detail)--one that is an integral part of the curriculum--helps students learn to blend values and ethics with medicine in a way that cannot occur during rapid-paced topical survey courses. Furthermore, it is in the depths of a learning experience that one comes face to face with the realities of uncertainty: the realization that unanswerable questions outnumber answerable ones; the awareness of the difficulty in accumulating sufficient evidence to answer a question that is, in fact, answerable; the recognition that many patients' problems transcend available evidence and must be addressed by the art of medicine; the realization that a patient can have a condition that one cannot diagnose and that may even get better for reasons that one cannot understand. The authors describe three initiatives at the University of Pittsburgh School of Medicine, two of which have been offered for more than 10 years, that illustrate the value of in-depth learning experiences. These in-depth experiences blend situated learning, reflective exercises, faculty mentoring, critical reading of literature, and constructive feedback in a prescribed but individualized curriculum.

Bioethical Issues in Medicinal Chemistry and Drug Treatment

The use of drugs to treat human disease is a pursuit that extends back into our evolutionary ancestors. Drugs are powerful substances with a great capacity to cause harm if misused or overused. Even when used correctly, pharmaceuticals can elicit disputes about their relative harms and benefits in specific situations. The establishment of modern intermediaries – physicians or pharmacists – in the allocation of the most powerful drugs increases the potential for conflict between those who control the resource and those who desire access to it. The size and influence of the pharmaceutical–industrial complex places disproportionate power in those whose interests lie in promoting and expanding pharmaceutical use in society. The expense of certain drugs complicates equitable allocation, and the concentration of pharmaceutical power in Western, industrialized countries promotes research and drug discovery disproportionately for diseases that are prevalent in the wealthier nations. The increasing sophistication of drug action challenges the traditional model of using drugs as a means to treat pathological conditions and processes, and raises the specter of lifestyle and enhancement uses of pharmaceuticals. New means of drug discovery – such as the use of stem cells – have elicited debate about the relative values placed on the status of the embryo and the potential treatment for intractable conditions that could result from stem cell research. Finally, the overall emphasis on drugs as the first line defense against what ails us has provoked some societal soul-searching. In this chapter, we review some of the ethical issues attendant to drug production and distribution, including issues of safety, justice, economic inequality, and the changing demands for drugs that exceed therapeutic uses. Suggestions are made to make pharmaceutical companies more responsive to these issues and to make oversight bodies more responsible for their roles.

Decoding mental states from brain activity in humans

Recent advances in human neuroimaging have shown that it is possible to accurately decode a person's conscious experience based only on non-invasive measurements of their brain activity. Such 'brain reading' has mostly been studied in the domain of visual perception, where it helps reveal the way in which individual experiences are encoded in the human brain. The same approach can also be extended to other types of mental state, such as covert attitudes and lie detection. Such applications raise important ethical issues concerning the privacy of personal thought.

Neuroscientific challenges to free will and responsibility

Recent developments in neuroscience raise the worry that understanding how brains cause behavior will undermine our views about free will and, consequently, about moral responsibility. The potential ethical consequences of such a result are sweeping. I provide three reasons to think that these worries seemingly inspired by neuroscience are misplaced. First, problems for common-sense notions of freedom exist independently of neuroscientific advances. Second, neuroscience is not in a position to undermine our intuitive notions. Third, recent empirical studies suggest that even if people do misconstrue neuroscientific results as relevant to our notion of freedom, our judgments of moral responsibility will remain largely unaffected. These considerations suggest that neuroethical concerns about challenges to our conception of freedom are misguided.

Neuroethics

Neuroimaging, psychosurgery, deep-brain stimulation, and psychopharmacology hold considerable promise for more accurate prediction and diagnosis and more effective treatment of neurological and psychiatric disorders. Some forms of psychopharmacology may even be able to enhance normal cognitive and affective capacities. But the brain remains the most complex and least understood of all the organs in the human body. Mapping the neural correlates of the mind through brain scans, and altering these correlates through surgery, stimulation, or pharmacological interventions can affect us in both positive and negative ways. We need to carefully weigh the potential benefit against the potential harm of such techniques. This paper examines some of these techniques and explores the emerging ethical issues in clinical neuroscience.

Neuroethics: the practical and the philosophical

In comparison with the ethical issues surrounding molecular genetics, there has been little public awareness of the ethical implications of neuroscience. Yet recent progress in cognitive neuroscience raises a host of ethical issues of at least comparable importance. Some are of a practical nature, concerning the applications of neurotechnology and their likely implications for individuals and society. Others are more philosophical, concerning the way we think about ourselves as persons, moral agents and spiritual beings. This article reviews key examples of each type of issue, including the relevant advances in science and technology and their accompanying social and philosophical problems.

Emotionale Dysfunktion, Psychopathie und kognitive Neurowissenschaft

This article provides a review of recent findings in the cognitive neurosciences on antisocial personality disorders. There is accumulating evidence that the subtype of psychopathy is characterized by emotional dysfunction not only on the behavioral level but also by structural and functional abnormalities of the brain. Although the findings are not yet conclusive, they are already being discussed controversially with respect to the question of accountability of persons with psychopathy. False conclusions dominating these considerations are discussed and corrected. The findings open a new discussion of the relevance of emotional function and dysfunction for accountability.

Judgments of the Fairness of Using Performance Enhancing Drugs

Undergraduates (total N=185) were asked about performance-affecting drugs. Some drugs supposedly affected athletic performance, others memory, and other attention. Some improved performance for anyone who took them, others for the top 10% of performers, others for the bottom 10%, and finally, yet other drugs worked only on the bottom 10% who also showed physical abnormalities. Participants were asked about the fairness of allowing the drug to be used, about banning it, and about whether predictions of future performance based on testing with or without the drug were better. The study found that participants appreciated the "interaction effect," that they felt it was less unfair to allow the drug if it affected the bottom 10% than if it affected everyone, and they were more eager to have the drug banned if it affected everyone. Participants were least tolerant of drugs that affected athletic performance and most tolerant of those that affected attention.

The brain, aggression, and public policy

Investigational, conceptual, and interventional advances in the neurosciences strain consensus in research ethics, clinical ethics, legal ethics, and jurisprudence and demand innovative adaptation in public policy. I review these advances, ask how they might change a range of policies, and conclude that their implications -- particularly relating to aggression -- are likely to have been underestimated.

Emerging neurotechnologies for lie-detection: promises and perils

Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin.

Cognition-enhancing drugs

New drugs that enhance cognition in cognitively healthy individuals present difficult public policy challenges. While their use is not inherently unethical, steps must be taken to ensure that they are safe, that they are widely available to promote equality of opportunity, and that individuals are free to decide whether or not to use them.

Cosmetic neurology

Advances in cognitive neuroscience and neuropharmacology are yielding exciting treatments for neurologic diseases. Many of these treatments are also likely to have uses for people without disease. Here, I review the ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems. These potential "quality of life" interventions raise ethical concerns, some related to the individual and others related to society. Despite these concerns, I argue that major restraints on the development of cosmetic neurology are not likely. Neurologists and other clinicians are likely to encounter patient-consumers who view physicians as gatekeepers in their own pursuit of happiness.

Neuroscience research on the addictions: a prospectus for future ethical and policy analysis

The increasing evidence that many addictive phenomena have a genetic and neurobiological basis promises improvements in societal responses to addiction that raise important ethical and social policy issues. One of the major potential benefits of such research is improved treatment of drug addiction, but in order to do the research required to realize this promise, it will be necessary to address ethical doubts raised about the capacity of addicted persons to give free and informed consent to participate in studies that involve the administration of drugs of dependence. Neuroscience research on addiction promises to transform the long running debate between moral and medical models of addiction by providing a detailed causal explanation of addiction in terms of brain processes. We must avoid causal models of addiction being misinterpreted as supporting simple-minded social policies, e.g., that we identify the minority of the community that is genetically and biologically vulnerable to addiction and hence can neglect social policy options for reducing addiction, including drug control policies. Causal accounts of addiction supplied by neuroscience and genetic research may also be seen to warrant the use of pharmacotherapies and drug vaccines under legal coercion. Neuroscientists also need to anticipate the ethical issues that may arise if the knowledge that they produce delivers interventions that enhance human cognitive and other capacities. Advances in neuroimaging that enable us to identify "addicts" or predict future risk of addiction will raise concerns about invasion of privacy, third-party use of neuroimaging data, the powers of courts to coerce defendants to undergo such tests, and consumer protection against the overinterpretation of test results. Given the strong public and media interest in the results of their research, neuroscientists and geneticists have a moral obligation, and a professional interest, to minimize popular misunderstandings of their work in the media that may rebound to its detriment.

Neuroethical considerations: cognitive liberty and converging technologies for improving human cognition

Developers of NBIC (Nano-Bio-Info-Cogno) technologies face a multitude of obstacles, not the least of which is navigating the public ethics of their applied research. Biotechnologies have received widespread media attention and spawned heated interest in their perceived social implications. Now, in view of the rapidly expanding purview of neuroscience and the growing array of technologic developments capable of affecting or monitoring cognition, the emerging field of neuroethics calls for a consideration of the social and ethical implications of neuroscientific discoveries and trends. To negotiate the complex ethical issues at stake in new and emerging kinds of technologies for improving human cognition, we need to overcome political, disciplinary, and religious sectarianism. We need analytical models that protect values of personhood at the heart of a functional democracy-values that allow, as much as possible, for individual decision-making, despite transformations in our understanding and ability to manipulate cognitive processes. Addressing cognitive enhancement from the legal and ethical notion of "cognitive liberty" provides a powerful tool for assessing and encouraging NBIC developments.

[Philosophizing about the mysteries of the brain. Overview of neurophilosophy]

The article portrays the field of "neurophilosophy" as the transdisciplinary reflection on questions of the brain and consciousness. Its central issues and basic assumptions are reviewed which belong in particular to the fields of neuroontology, neuroepistemology, neuroanthropology, and neuroethics. The article outlines the opportunities and limitations of this research.

On building a bridge between brain and behavior

Cognitive neuroscience is motivated by the precept that a discoverable correspondence exists between mental states and brain states. This precept seems to be supported by remarkable observations and conclusions derived from event-related potentials and functional imaging with humans and neurophysiology with behaving monkeys. This review evaluates specific conceptual and technical limits of claims of correspondence between neural events, overt behavior, and hypothesized covert processes examined using data on the neural control of saccadic eye movements.

Brains, lies, and psychological explanations

This chapter addresses the following question: If we adopt the view that it is the brain that feels, thinks, and decides, then how do we accommodate commonsense explanations of human behavior and the notion that we are intentional rational agents capable of voluntary action? It argues that there are limits to the coexistence of folk psychology (and the notion that we are intentional rational agents) and neuroscience. It explores how neuroethics must accommodate both science and ethics and, drawing on contemporary studies of deception, lies, and others, urges an awareness of the limitations of neuroscience in determining thought and defining responsibility for actions.

From genome to brainome: charting the lessons learned

This chapter explores converging and diverging issues between genetic and neuroimaging science research and clinical applications. It shows how genetics is intensely communal and familial, while the study of the central nervous system is more focused on the individual. Nonetheless, we learn how the ‘therapeutic gap’ gene hype, and the risk of scientific over-promising from both can lead to advances that may make situations worse before they make them better.