In "Defining Right and Wrong in Brain Science: Essential Readings in Neuroethics," University of Calgary philosophy professor Walter Glannon has collected and shaped many of the seminal papers in the growing field of neuroethics into a logical, readable primer for the public and policymakers. It is the fifth volume in The Dana Foundation Series on Neuroethics.
Why did you make this book?
A number of articles in the burgeoning field of neuroethics have been published in the past five years. Most of these articles discuss the ethical implications of diagnostic and predictive neuroimaging, psychopharmacology to treat mental disorders or enhance normal cognitive capacities, and how to assess altered states of consciousness and determine brain death. I wanted to collect the most insightful and thought-provoking articles by prominent neuroscientists and social scientists in a thematically integrated book that would capture the breadth, depth and excitement of neuroethics.
Why should we care about these issues?
Neuroimaging that reveals the neurobiological underpinning of our decisions and actions may lead some people to question the conviction that we have free will and are morally responsible for our behavior. Psychotropic drugs that alter our brains and minds raise questions about personhood, personal identity through time, autonomy, authenticity and the self
It is because measuring, monitoring and manipulating the brain can affect us so directly and deeply that we should be debating the ethical issues generated by theoretical and practical aspects of basic and clinical neuroscience.
What are some examples of issues in neuroethics that affect people directly or indirectly?
The fairly recent diagnostic category of the minimally conscious state distinguishes brain-injured patients with the possibility of recovering some cognitive and physical functions from patients in a permanent vegetative state with no hope of recovery. This diagnostic distinction has ethical implications for decisions about whether initiating or withdrawing interventions in the brain or body can benefit or harm patients.
A permanently vegetative patient such as Terri Schiavo could not be harmed because she lacked the conscious capacity necessary for an interest in continued life. A minimally conscious patient might benefit from deep-brain stimulation of the thalamus, which has connections with the cerebral cortex. Stimulating the brain in this way might restore some cognitive and physical functions impaired through brain injury.
One of the contributors, Joseph Fins, recounts a time when a New York Times editor did not precisely distinguish between minimally conscious and vegetative states, causing the headline on a major story to be wrong and leading to continuing confusion among families trying to find good information to help them decide how to care for their brain-injured relative. Do you find certain forms of media more of a help or hindrance in ethical discussions?
Presenting information to the general public is especially challenging in an area as complex as neuroscience. Some journalists are better than others in this regard. The media generally need to be more careful in being adequately informed and in drawing critical distinctions. In particular, they should avoid exaggerated claims about brain science.
I have read articles claiming that brain imaging will lead to thought control because it can read people’s minds. The mind is not located in the brain or reducible to it but is an emergent product of interaction among the brain, the body, and the external environment. Responsible journalists present this and other aspects of brain science in an accurate and nuanced way.
Is there public debate about issues of neuroethics?
There has been debate about neuroethics, though it has been confined mainly to neuroscientists and social scientists. The President’s Council on Bioethics discussed the ethical implications of psychopharmacology a few years ago and published its conclusions in "Beyond Therapy: Biotechnology and the Pursuit of Happiness." The public at large has not been very involved in this debate, certainly not to the same extent as in pre-symptomatic genetic testing or organ donation and transplantation. The fact that neuroethics is a relatively new field probably explains this.
Psychopharmacology, neuroimaging, neurostimulation, and altered states of consciousness are being debated by scientists, clinicians, and ethicists, but not so much by policy makers. One exception to this is the use of brain science for military purposes. Jonathan Moreno has discussed this contentious issue in his book "Mind Wars: Brain Research and National Defense," and it has provoked considerable discussion. I expect more public participation in the neuroethics debate as more people become aware of the uses and potential abuses of applied neuroscience.
Is the number of papers on these topics growing?
Since 2002, the number of articles on neuroethics has grown exponentially. Science, Nature and other journals have run editorials with titles such as “Neuroethics Needed.” The Journal of Cognitive Neuroscience is now devoting issues to neuroethics, as is the American Journal of Bioethics. And Springer will begin publishing the new Journal of Neuroethics this year.
Interest in this field is growing among neuroscientists and social scientists, though surprisingly a comparatively small number of philosophers have been publishing on neuroethics. It is surprising because neuroethics involves such perennial philosophical questions as free will and the mind-body problem. I expect a greater contribution from philosophers in the near future.
What do you hope to see in this field? Some sort of statements or principles for researchers, something like what the genome researchers came up with?
Clinical trials testing the safety and efficacy of neuroimaging or deep-brain stimulation are like any other area of medical research in that they must pass ethics review to be conducted. Internal review boards are charged with the responsibility of ensuring that the trials are designed appropriately and that they do not expose research subjects to more than minimal risk. There also needs to be peer review when new techniques are being applied in an innovative or experimental setting.
The same ethical principles must apply to neuroscientific techniques as apply to other types of medical research. In a paper published in 2002, Judy Illes and colleagues formulated ethical principles that all researchers should follow when dealing with incidental findings in neuroimaging. Similar principles should be formulated for other areas of neuroscientific research.
One of the most ethically important issues in neuroscientific research and practice is protecting information about the brain. Individuals have a right to privacy and/or confidentiality of this information to be protected from harm resulting from misuse or abuse of this information. Legislation is needed to ensure this protection—something similar to the Genetic Information Non-Discrimination Act of 2003.
Do you think researchers do consider all the ethical implications of their work?
A. Like other medical researchers, most brain researchers consider many of the ethical implications of their work. But it’s impossible to know all of these implications, since the long-term physiological and especially psychological risks of measuring and intervening in the brain are not known.
Information about the brain may be ambiguous and may be difficult to interpret and explain to the public. This is important for the researcher’s duty to obtain informed consent and not to harm research subjects and patients. Ethicists can provide guidance to neuroscientists in helping them to carefully consider the potential outcomes of their research and thereby promote benefit and minimize harm.
What are you working on now? What will you write about next?
A. I’m writing a book on the ethical dimensions of organ donation and transplantation. I’m also working on the concept of mind as distributed among the brain, body and environment and its implications for psychiatry.