Can We Cope with the Ethical Ramifications of New Knowledge of the Human Brain?

May, 2002

Arthur Caplan, Ph.D. is currently the Emanuel and Robert Hart Chair for Bioethics and the Director of the Center for Bioethics at the University of Pennsylvania. At Penn, Dr. Caplan is also a professor in the Department of Philosophy and in the Department of Psychiatry in the School of Medicine.

ARTHUR CAPLAN: I want to take the somewhat provocative position that even before we know how to do it, we should strive to try and improve our brains. I understand that we don’t know much, and (scientific) grants are always necessary, but I do understand, too, that a lot of information is coming through in the brain sciences—neuroscience being a part of that—but also in scanning technologies and radiology and psychiatry, and, behavioral genetics. And,  these areas are going to give us opportunities to think about how we might change, modify and design ourselves.

Arthur Caplan, Ph.D. - Thumbnail 
Arthur Caplan, Ph.D. Credit: Scott Lasky 
I  mean it’s all wonderful that we talk about the safeguards and the protections and what we know and how to proceed and what we would do (with new scientific advances). But are these rules the same as is true of some parts of  television? There’s a very distinct model of how you move for forward. Anyone in this room who doesn’t think that in 10 years—I’ll make a predictionæthere will be a show that’s called, “My Brain Made Me Do It.” Someone will lie in a CAT Scanner, it will work quickly, it will take a picture of your head, someone is going to say, “Did he do it/didn’t he do it?” Here’s a picture of his head. Some guy will come out and say, “I don’t know, his amygdala is kind of big. I think he did it.”

Is it not important soon to begin to talk about the formulation of standards for conducting basic imagery work? That is to say accuracy, that is to say who’s doing it, competency and so on. I don’t care whether the information is completely valid or not in terms of the state of the art, but whatever the state of the art is, it would be useful to say these are some standards that anybody has to meet in order to say they are doing imagery work of the human brain. If you’re going to have people stepping into court soon, it would also be useful to say what are the standards that we have in place for doing assessments by psychiatrists or neurologists, or persons who want to mount legal defense types of claims, or introduce information about their banged-about brains into a courtroom.

Are there any standards yet for privacy and confidentiality of neuroscience clinical information? Well, actually, no there aren’t, and that is not a good situation to be sitting in if we’re going to watch this revolution move forward. In fact, it is not—I will just tell you one case that has come up. A colleague and I have had, at our school, people come to us and say: “We’re trying to use different types of scanning technology on the human brain. We’re trying to establish patterns and characteristics that might identify someone as having a mental illness, but when we do, we also have in front of us their history, their patient chart, and it tells us whether they’ve been arrested, it tell us whether they’ve served time in jail. We see all kinds of correlations, particularly ethnic and racial, between these patterns that we observe of their brains, and patterns that we observe in their lifestyle.” I do  know that this information is flying all over the place and no one has said to any experimental subject, “Hey, by the way, when we’re taking a picture of your head, we also have your rap sheet.”

The Enhancement Issue

Should we try to use knowledge of the brain to improve ourselves? This has been hinted at a little bit this morning, and when it came up, I believe it was Professor Schacter who said, “I’m a little uncomfortable about moving past baseline here. I’ve looked a lot of memories and I understand something about these mechanisms and it’s one thing to repair  and treat; it’s perhaps a different thing to enhance and optimize.”

For my remarks I just want to throw caution to the wind, a very unusual stance for me, and say let’s go for enhancement. Let’s just not worry about where the boundary is, let’s just say I’ve got a real interest in learning French, I’ve got Dr. Schacter and his mind machine, he’s got a pill, he’s got a tiny implant, he’s got a bit of a brain of a Frenchman, and one how or another, he’s able to get this in me and I don’t have to spend the entire summer going to Berlitz or some other tutorial course. I’m going to have French in minutes, because I’ve got the kind of French mind meld opportunity, for those of you who remember old Star Trek opportunities.

So, why shouldn’t I? What’s bad about this? Why would I want to enhance, improve, invigorate, optimize my pathetic mind and try to wind up with something better than I’ve got? I don’t claim to have disability, I don’t claim to be anything outside the norms. I’m in the normal distribution, I just don’t like it there; I want to be at the high end.

Why do we recoil somewhat at the idea that if we had knowledge about the brain, even imperfect knowledge, we shouldn’t use it to try and make ourselves better? Let me give you some examples where people are doing it, then I’ll review the arguments very quickly with you and try to mount some responses, because I don’t think the arguments I’ve heard so far are particularly persuasive. The armed services. If you have an ability to scan a person’s visual field inside their brain and they’re going to fly a very expensive stealth bomber, you’re interested in knowing things about somebody’s reflexes and things about somebody’s peripheral vision. Brain scanning is believed to be able to tell you a little bit about that. It probably tells you, let’s say, liberally, a 20-percent chance that you’re able to detect someone who’s going to have more skill in terms of peripheral vision. If you go to the Defense Department and say is that  spmething you’re interested in at that poor level, they’ll say, “Given the fact that the plane cost two billion dollars, we’re real interested. Begin testing. We want the best pilots possible, and if we’re in error about this, okay, but if we’re a little better at it, great.”

These drugs that you’ve been reading about that allow people to stay up longer with few side effects: I ate breakfast this morning with the head of Charles Schwab, he wants it tomorrow. I said to him, “It could have side effects.” “Yeah, it could.” So, there he is. He wants to stay up longer and turn more income and hopefully some of his employees will follow this path. We all know that in other areas of the so–called lifestyle drugs, whether it’s Viagra or things to repair our wizened faced or our furrowed brows, we have people who are trying to improve appearance, trying to improve  performance.

This kind of argument about what we can do or not do to design ourselves, is set by people who use Insulin, wear  eyeglasses, have artificial hips, have sometimes had organ or tissue transplants, heart valves, ride on airplanes, talk on phones, sit under electric lights. What are we talking about? There’s certainly an argument about how far we might push to improve or change ourselves, whether we were comfortable.

I think the neurosciences need to be thinking hard about the kinds of tech transfer from lab to clinical application or commercial application that they want to set in place to help ensure safety. Obviously, just going out there and saying, you know, “my boss is making me—I’m a truck driver and I’ve got to take these pills and stay up even though I’m going to become demented eventually,” or something is not a situation that’s going to be good. He’s not choosing, he’s feeling coercion, so we do need to have those standards in place about what’s safe, what sort of things are going to be put on the market.