Emerging ethical issues in neuroscience

Neurorehabilitation of Offenders, Consent and Consequentialist Ethics

The new biotechnology raises expectations for modifying human behaviour through its use. This article focuses on the ethical analysis of the not so remote possibility of rehabilitating criminals by means of neurotechnological techniques. The analysis is carried out from a synthetic position of, on the one hand, the consequentialist conception of what is right and, on the other hand, the emphasis on individual liberties. As a result, firstly, the ethical appropriateness of adopting a general predisposition for allowing the neurorehabilitation of prisoners only if it is safe and if they give their consent will be defended. But, at the same time, reasons will be given for requiring, in certain circumstances, the exceptional use of neurotechnology to rehabilitate severely psychopathic prisoners, even against their will, from the same ethical perspective.

On Neurorights

In recent years, philosophical-legal studies on neuroscience (mainly in the fields of neuroethics and neurolaw) have given increasing prominence to a normative analysis of the ethical-legal challenges in the mind and brain sciences in terms of rights, freedoms, entitlements and associated obligations. This way of analyzing the ethical and legal implications of neuroscience has come to be known as “neurorights.” Neurorights can be defined as the ethical, legal, social, or natural principles of freedom or entitlement related to a person’s cerebral and mental domain; that is, the fundamental normative rules for the protection and preservation of the human brain and mind. Although reflections on neurorights have received ample coverage in the mainstream media and have rapidly become a mainstream topic in the public neuroethics discourse, the frequency of such reflections in the academic literature is still relatively scarce. While the prominence of the neurorights debate in public opinion is crucial to ensure public engagement and democratic participation in deliberative processes on this issue, its relatively sporadic presence in the academic literature poses a risk of semantic-normative ambiguity and conceptual confusion. This risk is exacerbated by the presence of multiple and not always reconcilable terminologies. Several meta-ethical, normative ethical, and legal-philosophical questions need to be solved in order to ensure that neurorights can be used as effective instruments of global neurotechnology governance and be adequately imported into international human rights law. To overcome the shortcomings above, this paper attempts to provide a comprehensive normative-ethical, historical and conceptual analysis of neurorights. In particular, it attempts to (i) reconstruct a history of neurorights and locate these rights in the broader history of idea, (ii) outline a systematic conceptual taxonomy of neurorights, (iii) summarize ongoing policy initiatives related to neurorights, (iv) proactively address some unresolved ethico-legal challenges, and (v) identify priority areas for further academic reflection and policy work in this domain.

[The predictable human : Possibilities and risks of AI-based prediction of cognitive abilities, personality traits and mental illnesses]

New approaches to the use of artificial intelligence (AI) to analyze data from neuroimaging but also passively collected data from so-called wearables, such as smartphones or smartwatches, as well as data that can be extracted from social media and other online activities, already make it possible to predict cognitive abilities, personality traits, and mental illnesses, as well as to reveal acute mental states. In this article, we explain the methodological concepts behind these current developments, illuminate the possibilities and limitations, and address ethical and social aspects arising from the use.

Placebo Brain Stimulation Affects Subjective but Not Neurocognitive Measures of Error Processing

The aim of this preregistered EEG study was to show how expectations about enhanced or impaired performance through transcranial stimulation affect feelings of agency and error processing. Using a single-blind experimental design, participants (N = 57) were attached to a transcranial direct current stimulation (tDCS) device, and in different blocks, they were verbally instructed to expect enhanced or impaired cognitive performance, or no effects of the brain stimulation. In all cases, but unbeknownst to the participants, we used an inert sham tDCS protocol. Subsequently, we measured their response to errors on a cognitive control task. Our expectancy manipulation was successful: participants reported improved subjective performance in the enhancement compared with the impairment condition—even though objective performance was kept at a constant level across conditions. Participants reported the highest feelings of agency over their task performance in the control condition, and lowest feelings of agency in the impairment condition. The expectancy manipulation did not affect the error-related negativity (ERN) in association with incorrect responses. During the induction phase, expecting impaired versus enhanced performance increased frontal theta power, potentially reflecting a process of increased cognitive control allocation. Our findings show that verbally induced manipulations can affect subjective performance on a cognitive control task, but that stronger manipulations (e.g., through conditioning) are necessary to induce top-down effects on neural error processing.

ESTUDANTES E O DOPING INTELECTUAL: VALE TUDO NA BUSCA DO SUCESSO NO VESTIBULAR?

RESUMO Este artigo apresenta os resultados de uma pesquisa que buscou caracterizar a percepção de estudantes do 3º ano do ensino médio de escolas públicas, privadas e profissionalizantes e de cursinhos públicos e privados sobre o uso de medicamentos para aprimoramento cognitivo. A pesquisa contou com 534 estudantes das cidades de Juazeiro do Norte (CE), Fortaleza (CE) e São Paulo (SP), e utilizou um questionário voltado à percepção desses estudantes sobre o uso de medicamentos que prometiam melhorar o aproveitamento nos estudos, se já tinham ouvido falar deles, se conheciam usuários e se fariam uso deles. A maioria considerou positivo o uso desses medicamentos, mostrou curiosidade em relação à substância e afirmou que faria uso, caso tivesse acesso, para garantir energia e concentração nas atividades. Os resultados deste estudo ressaltam a importância de se compreender a percepção dos jovens sobre este tema para que se possa orientar futuras intervenções.

Neuroimaging-based prediction of mental traits: Road to utopia or Orwell?

Predicting individual mental traits and behavioral dispositions from brain imaging data through machine-learning approaches is becoming a rapidly evolving field in neuroscience. Beyond scientific and clinical applications, such approaches also hold the potential to gain substantial influence in fields such as human resource management, education, or criminal law. Although several challenges render real-life applications of such tools difficult, future conflicts of individual, economic, and public interests are preprogrammed, given the prospect of improved personalized predictions across many domains. In this Perspective paper, we thus argue for the need to engage in a discussion on the ethical, legal, and societal implications of the emergent possibilities for brain-based predictions and outline some of the aspects for this discourse.

Pragmatic Neuroethics: Lived Experiences as a Source of Moral Knowledge

In this article, we present a pragmatic approach to neuroethics, referring back to John Dewey and his articulation of the "common good" and its discovery through systematic methods. Pragmatic neuroethics bridges philosophy and social sciences and, at a very basic level, considers that ethics is not dissociable from lived experiences and everyday moral choices. We reflect on the integration between empirical methods and normative questions, using as our platform recent bioethical and neuropsychological research into moral cognition, action, and experience. Finally, we present the protocol of a study concerning teenagers' morality in everyday life, discussing our epistemological choices as an example of a pragmatic approach in empirical ethics. We hope that this article conveys that even though the scope of neuroethics is broad, it is important not to move too far from the real life encounters that give rise to moral questions in the first place.

Did I Do That? Expectancy Effects of Brain Stimulation on Error-related Negativity and Sense of Agency

This study examines the effects of expected transcranial stimulation on the error(-related) negativity (Ne or ERN) and the sense of agency in participants who perform a cognitive control task. Placebo transcranial direct current stimulation was used to elicit expectations of transcranially induced cognitive improvement or impairment. The improvement/impairment manipulation affected both the Ne/ERN and the sense of agency (i.e., whether participants attributed errors to oneself or the brain stimulation device): Expected improvement increased the ERN in response to errors compared with both impairment and control conditions. Expected impairment made participants falsely attribute errors to the transcranial stimulation. This decrease in sense of agency was correlated with a reduced ERN amplitude. These results show that expectations about transcranial stimulation impact users' neural response to self-generated errors and the attribution of responsibility-especially when actions lead to negative outcomes. We discuss our findings in relation to predictive processing theory according to which the effect of prior expectations on the ERN reflects the brain's attempt to generate predictive models of incoming information. By demonstrating that induced expectations about transcranial stimulation can have effects at a neural level, that is, beyond mere demand characteristics, our findings highlight the potential for placebo brain stimulation as a promising tool for research.

Why Is 10 Past 10 the Default Setting for Clocks and Watches in Advertisements? A Psychological Experiment

Have you ever noticed that in watch advertisements the time is usually set at 10:10? The reasons and psychological effects of this default time setting are elusive. In Experiment 1, we hypothesized that watches showing a time setting resembling a smiling face (10:10) would enhance emotional valence and intention to buy compared to a neutral time setting (11:30), whereas a time setting resembling a sad face (8:20) would have the opposite effect. Moreover, we investigated a possible interaction effect with the gender of the participants. In Experiment 2, we directly tested the hypotheses that watches set at 10:10 resemble a smiling face, whereas watches set at 8:20 resemble a sad face. The data of the first experiment reveal that watches set at 10:10 showed a significant positive effect on the emotion of the observer and the intention to buy. However, watches set at 8:20 did not show any effect on the emotion or the intention to buy. Moreover, watches set at 10:10 induced in women significantly stronger ratings of pleasure than in men. The data of the second experiment show that participants consistently perceive high resemblance between watches set at 10:10 and a smiling face as well as high resemblance between watches set at 8:20 and a sad face. This study provides for the first time empirical evidence for the notion that using watches with a time setting resembling a smiling face (like 10:10) can positively affect the emotional response of the observers and their evaluation of a seen watch, even though they are not aware of the fact that the shown time setting is inducing this effect. Practical implications of the observed findings and alternative explanations are discussed.

Should violent offenders be forced to undergo neurotechnological treatment? A critical discussion of the 'freedom of thought' objection

In this paper we examine one reason for rejecting the view that violent offenders should be forced to undergo neurotechnological treatments (NTs) involving such therapies as psychoactive medication to curb violent behaviour. The reason is based on the concern that forced treatment violates the offender's right to freedom of thought. We argue that this objection can be challenged. First, we present some specifications of what a right to freedom of thought might mean. We focus on the recently published views of Jared Craig, and Jan Cristopher Bublitz and Reinhard Merkel. Second, we argue that forcing violent offenders to undergo certain kinds of NTs may not violate the offender's right to freedom of thought as that right is specified by Craig, and Bublitz and Merkel. Third, even if non-consensual NT is used in a way that does violate freedom of thought, such use can be difficult to abandon without inconsistency. For if one is not an abolitionist, and therefore accepts traditional state punishments for violent offenders like imprisonment-which, the evidence shows, often violate the offender's right to freedom of thought-then, it is argued, one will have reason to accept that violent offenders can legitimately be forced to undergo NT even if doing so denies them the right to freedom of thought.

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.

Justifications for Non-Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.

Neurocognitive enhancement or impairment? A systematic meta-analysis of prescription stimulant effects on processing speed, decision-making, planning, and cognitive perseveration

Increasing numbers of adults, particularly college students, are misusing prescription stimulants primarily for cognitive/academic enhancement, so it is critical to explore whether empirical findings support neurocognitive benefits of prescription stimulants. Previous meta-analytic studies have supported small benefits from prescription stimulants for the cognitive domains of inhibitory control and memory; however, no meta-analytic studies have examined the effects on processing speed or the potential impairment on other domains of cognition, including planning, decision-making, and cognitive perseveration. Therefore, the present study conducted a meta-analysis of the available literature examining the effects of prescription stimulants on specific measures of processing speed, planning, decision-making, and cognitive perseveration among healthy adult populations. The meta-analysis results indicated a positive influence of prescription stimulant medication on processing speed accuracy, with an overall mean effect size of g = 0.282 (95% CI [0.077, 0.488]; n = 345). Neither improvements nor impairments were revealed for planning time, planning accuracy, advantageous decision-making, or cognitive perseveration; however, findings are limited by the small number of studies examining these outcomes. Findings support that prescription stimulant medication may indeed act as a neurocognitive enhancer for accuracy measures of processing speed without impeding other areas of cognition. Considering that adults are already engaging in illegal use of prescription stimulants for academic enhancement, as well as the potential for stimulant misuse to have serious side effects, the establishment of public policies informed by interdisciplinary research surrounding this issue, whether restrictive or liberal, is of critical importance. (PsycINFO Database Record

Euthanasia for Detainees in Belgium

In 2011, Frank Van Den Bleeken became the first detainee to request euthanasia under Belgium's Euthanasia Act of 2002. This article investigates whether it would be lawful and morally permissible for a doctor to accede to this request. Though Van Den Bleeken has not been held accountable for the crimes he committed, he has been detained in an ordinary prison, without appropriate psychiatric care, for more than 30 years. It is first established that Van Den Bleeken's euthanasia request plausibly meets the relevant conditions of the Euthanasia Act and that, consequently, a doctor could lawfully fulfill it. Next, it is argued that autonomy-based reasons for euthanizing him outweigh complicity-based reasons against doing so, and that, therefore, it is also morally permissible for a doctor to carry out the euthanasia request.

Toward a Psychology of Human Agency

This article presents an agentic theory of human development, adaptation, and change. The evolutionary emergence of advanced symbolizing capacity enabled humans to transcend the dictates of their immediate environment and made them unique in their power to shape their life circumstances and the courses their lives take. In this conception, people are contributors to their life circumstances, not just products of them. Social cognitive theory rejects a duality between human agency and social structure. People create social systems, and these systems, in turn, organize and influence people's lives. This article discusses the core properties of human agency, the different forms it takes, its ontological and epistemological status, its development and role in causal structures, its growing primacy in the coevolution process, and its influential exercise at individual and collective levels across diverse spheres of life and cultural systems.

Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls

Estimating cognitive or affective state from neurophysiological signals and designing applications that make use of this information requires expertise in many disciplines such as neurophysiology, machine learning, experimental psychology, and human factors. This makes it difficult to perform research that is strong in all its aspects as well as to judge a study or application on its merits. On the occasion of the special topic "Using neurophysiological signals that reflect cognitive or affective state" we here summarize often occurring pitfalls and recommendations on how to avoid them, both for authors (researchers) and readers. They relate to defining the state of interest, the neurophysiological processes that are expected to be involved in the state of interest, confounding factors, inadvertently "cheating" with classification analyses, insight on what underlies successful state estimation, and finally, the added value of neurophysiological measures in the context of an application. We hope that this paper will support the community in producing high quality studies and well-validated, useful applications.

Neuroimaging: beginning to appreciate its complexities

For over a century, scientists have sought to see through the protective shield of the human skull and into the living brain. Today, an array of technologies allows researchers and clinicians to create astonishingly detailed images of our brain's structure as well as colorful depictions of the electrical and physiological changes that occur within it when we see, hear, think and feel. These technologies-and the images they generate-are an increasingly important tool in medicine and science. Given the role that neuroimaging technologies now play in biomedical research, both neuroscientists and nonexperts should aim to be as clear as possible about how neuroimages are made and what they can-and cannot-tell us. Add to this that neuroimages have begun to be used in courtrooms at both the determination of guilt and sentencing stages, that they are being employed by marketers to refine advertisements and develop new products, that they are being sold to consumers for the diagnosis of mental disorders and for the detection of lies, and that they are being employed in arguments about the nature (or absence) of powerful concepts like free will and personhood, and the need for citizens to have a basic understanding of how this technology works and what it can and cannot tell us becomes even more pressing.

When is diminishment a form of enhancement? Rethinking the enhancement debate in biomedical ethics

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the diminishment of a capacity or function, under the right set of circumstances, could plausibly contribute to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a welfarist conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing.

Brain-machine interfaces: an overview

Brain-machine interfaces (BMIs) hold promise to treat neurological disabilities by linking intact brain circuitry to assistive devices, such as limb prostheses, wheelchairs, artificial sensors, and computers. BMIs have experienced very rapid development in recent years, facilitated by advances in neural recordings, computer technologies and robots. BMIs are commonly classified into three types: sensory, motor and bidirectional, which subserve motor, sensory and sensorimotor functions, respectively. Additionally, cognitive BMIs have emerged in the domain of higher brain functions. BMIs are also classified as noninvasive or invasive according to the degree of their interference with the biological tissue. Although noninvasive BMIs are safe and easy to implement, their information bandwidth is limited. Invasive BMIs hold promise to improve the bandwidth by utilizing multichannel recordings from ensembles of brain neurons. BMIs have a broad range of clinical goals, as well as the goal to enhance normal brain functions.

A review of EEG-based brain-computer interfaces as access pathways for individuals with severe disabilities

Electroencephalography (EEG) is a non-invasive method for measuring brain activity and is a strong candidate for brain-computer interface (BCI) development. While BCIs can be used as a means of communication for individuals with severe disabilities, the majority of existing studies have reported BCI evaluations by able-bodied individuals. Considering the many differences in body functions and usage scenarios between individuals with disabilities and able-bodied individuals, involvement of the target population in BCI evaluation is necessary. In this review, 39 studies reporting EEG-oriented BCI assessment by individuals with disabilities were identified in the past decade. With respect to participant populations, a need for assessing BCI performance for the pediatric population with severe disabilities was identified as an important future direction. Acquiring a reliable communication pathway during early stages of development is crucial in avoiding learned helplessness in pediatric-onset disabilities. With respect to evaluation, augmenting traditional measures of system performance with those relating to contextual factors was recommended for realizing user-centered designs appropriate for integration in real-life. Considering indicators of user state and developing more effective training paradigms are recommended for future studies of BCI involving individuals with disabilities.

Consumer nueroscience: a new area of study for biomedical engineers

In scientific literature, the most accepted definition of consumer neuroscience or neuromarketing is that it is a field of study concerning the application of neuroscience methods to analyze and understand human behavior related to markets and marketing exchanges. First, it might seem strange that marketers would be interested in using neuroscience to understand consumer's preferences. Yet in practice, the basic goal of marketers is to guide the design and presentation of products in such a way that they are highly compatible with consumer preferences. To understand consumers preferences, several standard research tools are commonly used by marketers, such as personal interviews with the consumers, scoring questionnaries gathered from consumers, and focus groups. The reason marketing researchers are interested in using brain imaging tools instead of simply asking people for their preferences in front of marketing stimuli, arises from the assumption that people cannot (or do not want to) fully explain their preference when explicitly asked. Researchers in the field hypothesize that neuroimaging tools can access information within the consumer's brain during the generation of a preference or the observation of a commercial advertisement. The question of will this information be useful in further promoting the product is still up for debate in marketing literature. From the marketing researchers point of view, there is a hope that this body of brain imaging techniques will provide an efficient tradeoff between costs and benefits of the research. Currently, neuroscience methodology includes powerful brain imaging tools based on the gathering of hemodynamic or electromagnetic signals related to the human brain activity during the performance of a relevant task for marketing objectives. These tools are briefly reviewed in this article.

Ethical issues in brain-computer interface research, development, and dissemination

The steadily growing field of brain-computer interfacing (BCI) may develop useful technologies, with a potential impact not only on individuals, but also on society as a whole. At the same time, the development of BCI presents significant ethical and legal challenges. In a workshop during the 4th International BCI meeting (Asilomar, California, 2010), six panel members from various BCI laboratories and companies set out to identify and disentangle ethical issues related to BCI use in four case scenarios, which were inspired by current experiences in BCI laboratories. Results of the discussion are reported in this article, touching on topics such as the representation of persons with communication impairments, dealing with technological complexity and moral responsibility in multidisciplinary teams, and managing expectations, ranging from an individual user to the general public. Furthermore, we illustrate that where treatment and research interests conflict, ethical concerns arise. On the basis of the four case scenarios, we discuss salient, practical ethical issues that may confront any member of a typical multidisciplinary BCI team. We encourage the BCI and rehabilitation communities to engage in a dialogue, and to further identify and address pressing ethical issues as they occur in the practice of BCI research and its commercial applications.

Personal Liability and Human Free Will in the Background of Emerging Neuroethical Issues

In this paper, the author analyses the issues connected to emerging neurotechnologies, in particular their effects on (legal) concepts like capacity, liability, testimony, and evidence, and also on fundamental constitutional rights and freedoms like the right to autonomy and the right not to be treated without consent (in the general framework of the principle of human dignity). Starting from preliminary remarks on the key-concepts of neuroethics/technoethics, neurolaw/technolaw, the author investigates how personal liability is changing in the framework of new scientific developments. The paper underlines that neurolaw challenges some of the traditional legal institutions in the field of law (e.g., criminal law). From the point of view of ethics, the paper concludes that neuroethics is not challenged by the data coming from the use of emerging neurotechnologies, but human self-perception is strongly affected by it.

Ethical considerations in clinical training, care and research in psychopharmacology

Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.

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.

Responding to requests from adult patients for neuroenhancements: guidance of the Ethics, Law and Humanities Committee

In the last decade, persons who have no diagnosed medical or mental health condition are increasingly seeking and utilizing, for the ostensible purpose of enhancing their memory or cognitive skills, prescription drugs that were originally developed to improve executive function or memory in persons diagnosed with disorders such as attention deficit hyperactivity disorder or Alzheimer disease. Evidence suggests that this practice, now known as neuroenhancement, is gathering momentum. As a result, neurologists may be encountering patients without a diagnosed illness asking for medications with the goal of improving their memory, cognitive focus, or attention span. Strong arguments have been made for and against this practice, often reflecting strongly held convictions concerning the appropriate practice of medicine. The purpose of this report is to provide neurologists with an overview of the ethical, legal, and social issues surrounding the use of pharmaceuticals prescribed to enhance or augment normal cognitive or affective functioning, as well as practical guidance for responding to an adult patient's request for neuroenhancement.

A new ethics of psychiatry: neuroethics, neuroscience, and technology

Neuroethics is a new subset of bioethics that addresses ethical issues pertaining to the brain, primarily in the fields of neuroscience, cognitive science, and neuroradiology. Research in brain science is progressing at a phenomenal rate and, as a result, the acquisition and application of knowledge and technology raises ethical questions of a practical and philosophical nature. While neuroethics is developing as a distinct field of study, one area that should be addressed in greater depth is the relevance and potential impact of neurotechnology in psychiatry. New knowledge in the mind-brain conundrum and increasingly sophisticated techniques for imaging and intervening in human cognition, emotion, and behavior pose ethical issues at the intersection of technology and psychiatry. This article presents a broad survey of the new directions in neuroethics, neuroscience, and technology and considers the implications of technological advances for the practice of psychiatry in the new millennium. (Journal of Psychiatric Practice 2009;15:391-401).

Beyond Neurobiological Reductionism

This paper examines the neurobiological explanatory trend in psychology, including the related and tacit roles of ontological materialism and reductionism. In addition, the role of Cartesian dualism in both psychology and cognitive neuroscience is explored. In both, the complex relationships between mind/brain and mind/body tend to be conceptualized through the framework of either ontic dualism or attribute dualism, both of which ultimately constrain notions of embodiment. Alternatively, this paper understands the body as the inseparable unity of being-in-the-world from which the Cartesian dichotomy of “mind” and “body” is abstracted. This alternative surpasses the constraints of dualism and reframes embodiment as intentionality incarnate and ultimately as “flesh.” The body, understood phenomenologically, emerges not as a “what” but as a “ what—how”—the manifestation in extension of our intentionality, the flesh of our projects in and of the world. We argue that this understanding is indispensable to a properly psychological perspective on embodiment.

[Neuroethics in clinical practice]

In recent years the ability of neuroscience to identify and intervene in mental functions has progressed immensely, which raises several anthropologic and ethical questions. Meanwhile neuroethics arose as a new interdisciplinary field for critical analysis of neuroscientific actions and ethical reflection on the increasing knowledge of the human brain, with regard to society and politics. This article provides a survey of neuroethical implications for clinical practice.

Philosophical and ethical issues at the forefront of neuroscience and genetics: an overview for psychiatrists

This review has touched upon some of the major ethical issues surrounding emerging technologies in neuroscience and genetics. Although at first glance these issues may seem somewhat peripheral to the clinical practice of psychiatry, we suggest that they may have unanticipated effects upon the care of patients with mental illness. Certainly, the philosophical issues surrounding free will are of tremendous consequence to persons who commit crimes while suffering severe symptoms of mental illness. In addition, the opening up of a lucrative new "enhancement" market for the sale of new therapies could divert commercial resources away from the development of therapies for mental illness, although it is also possible that some enhancements will have secondary benefits as treatments for disease. Social acceptance of enhancement therapies could have a beneficial, normalizing effect on public attitudes toward those who receive mental health treatment. On the other hand, a moral backlash against enhancements as "quick fixes" that deprive individuals of authenticity could have a secondary effect of increasing the stigma of mental health treatment. For all of these reasons, it has become increasingly important for psychiatrists to be informed about and active participants in the public conversation about neuroethics. Psychiatric patients appear to have much at stake in these ethical debates, and psychiatrists have valuable expertise to offer as professionals with intimate knowledge of the human mind, its limitations, and its potential.