Mapping the Future of Neuroethics

May, 2002

AL JONSEN (Professor Emeritus of Ethics in Medicine, University of Washington, Visiting Ethics Professor, Stanford University): Some of you remember that—I believe it was Alfred North Whitehead said, “All philosophy is a footnote to Plato.” And yesterday, as I was listening to the enhancement discussion, I had an illumination to that effect. I just had the pleasure and the daunting task of actually teaching Plato’s Republic to a group of freshmen in college. It was quite a task. But having the opportunity to re-read The Republic, one idea  came to me yesterday that struck me very  strongly—that The Republic is perhaps the most eloquent and evocative picture of enhancement ever written. The founding myth of The Republic was that all human beings are born as having either a bronze nature, a silver nature, or a gold nature—which is obviously genetics in a nutshell. And the selection of gold people to become the guardians, to go through this arduous training, which will eventually lead them to the vision of the good, and then allow them to come back and be guardians of the people, to live in a ruling status over the republic, ruling not by power, but by wisdom.

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Albert Jonsen, Ph.D. Credit: Scott Lasky 
But there’s a feature of the guardians, when it’s described, that we often forget. Plato says when the guardians return back to the world after they have seen this vision of the good, they will inevitably be unhappy, because they’ll have to  rule in a world that is not up to their standards. And that will be inevitably the case. So it will be only out of duty that  they will continue to do that, because they will always yearn to return to contemplation.  And I thought, that’s a wonderful message for the enhancers. I wish Arthur Caplan were still here. I’d say, “Art, beware about enhancement,” because you never know whether the most enhanced may be the most unhappy. They’re going to have things to do that may be very difficult to do. And there may be other  aspects of their life—if they’ve got wisdom they may not have other aspects which would make them happy, joyful people. So I began to wonder, again— how many of the problems that we talk about today draw on this long, long tradition. Not just Plato, but this long, long tradition of concern about issues that obviously scientifically are very different, but in human terms may be very similar.

Ethics really begins with conversation, and it moves on from conversation as people see that there are disputes involved, and begin to find out why the disputes are of the sort that they are, whether it’s because of commitments to a deep geological kind of question, or whether it’s a matter of facts that need to be clarified. And I think that what has happened in this conference is a perfect example of that. The long discussion period where many people could enter in, was  extremely valuable and created a kind of a Socratic dialogue. So in general, I think we have begun something which may, I hope, turn into something rich and valuable. Thank you.

ZACH HALL (President and CEO, EnVivo Pharmaceuticals, past director of the National Institute of Neurological Disorders and Stroke): It is important to have neuroethics as a field of scholarship, it is important to have professional scientists and physicians concerned with neuroethics. But if it stops there, we will have failed. And that’s the point of the session this morning. Neuroethics is not simply a matter for the ethicists or the neuroprofessionals, but involves politicians, religious leaders, public policy experts—even columnists from leading newspapers. The issues are simply too important to be left to the experts, and we know the experts are often wrong, as we heard this morning.

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Zach Hall, Ph.D. Credit: Scott Lasky 
So the challenge, then, is to how to involve these groups in thinking about issues in a proactive way. What is needed, I think, is some mechanism to try to identify these issues before they arise, to try to have discussion about them  beforehand, and to have some thought and some marshalling of expertise around specific issues. And what those issues might be, I don’t know. We’ve heard several of them during the course of this conference. I think Bill Winslade pointed to an extremely important one in terms of the role of brain injury in legal matters, something that really hasn’t been addressed. I think another one that I think somebody mentioned, certainly very much on my mind, is one of the things I became very aware of when I was at the NIH is that surgical procedures do not fall under the FDA. And so, particularly as regards the brain, I think what is and is not permissible is an issue that really needs to be addressed by somebody, and thought about by somebody. And this is the kind of thing, it seems to me, that we should perhaps begin to think about. And of course the challenge in all of these is in the absence of an emergency, how do you get busy, overburdened people interested and willing to sit down and put in the time and energy to talk. And I just see that as one of the real problems.

So what can we do as neuroethicists? And I think maybe the first thing is to focus on identifying harm. The point is not to say you shouldn’t take a pill because you ought not to take the pill, because it’s somehow unnatural or it’s against evolution. I think the real point is, if there’s positive harm that comes from the pill, then that’s the clearest thing. And I think that looking at tobacco, for example, it seems to me that in the 1960s the Surgeon General’s report showing the ill effects of smoking was the first and key point in the whole matter, was to say, look, this is bad for you. And so I think we have a particular responsibility here because of longterm effects on the brain. And we’ve heard some discussion at this meeting about the fact that many of the agents that act on the brain most effectively do so by making long-term  alterations. And so those are things that we need to be careful of. So first, identify issues in which there’s harm. And then the other responsibility that we obviously have is the protection of the weak and disabled, of children, and the identification of situations in which vulnerable populations are exploited.

And I think I’d like to end, then, by saying that it seems to me that with all this, one of the dangers that we face are the dangers of half-knowledge, of thinking we know what’s best, of thinking we know what’s right. And I again think of the prefrontal lobotomies and the psychosurgeries. And I think that we have to look at all of this and look at what we think is right, and what we think is best, with a large dose of humility. And we need to engage with the larger society on these issues.