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Neuroethics - The Issues

The Dana Review summarizes emergent issues in the area of neuroethics.
Neuroethics, a subject still in its formative years, gained momentum in 2004 with neuroscience professionals, measured by the attention it drew in San Diego. After emerging at the Society’s 2003 meeting in a lecture sponsored by the Dana Foundation, neuroethics approached buzzword status in 2004 with both a featured lecture, by Stephan L. Chorover of the Massachusetts Institute of Technology, and a symposium chaired by Martha J. Farah. In his lecture, Chorover took a philosophical approach, putting neuroethics in a historical context. After discussing people who have influenced bioethics and, thus, neuroethics— from Rene Descartes to Francis Crick—Chorover said that today the challenge is what he called ethical, political, and social insufficiencies. “Whither neuroethics?” Chorover asked, quoting the title of his lecture. “A lot depends on the answers to basic questions about who we are, where we have come from, and where we are headed.” Forty-eight hours later, speakers at the neuroethics symposium delved into those very questions. The panel chair, Farah, of the University of Pennsylvania, suggested two categories for organizing neuroethical questions: classic bioethics issues and novel concerns brought to light by new knowledge and capabilities. The latter category was the focus of the symposium, Farah said. Imaging was central to Marcus Raichle, of the Washington University Department of Radiology and Neurology. He talked about the sea change in imaging during the past century, noting the hundreds of references to functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) at SfN alone. “The true investment in this enterprise is, to me, staggering,” Raichle said. “One of the really interesting things is that people are starting to dig deeply” to explore the implications, from not only a neuroscience perspective but also a social sciences one. Steven Hyman, provost of Harvard University and former director of the National Institute of Mental Health, examined the ethical challenges of pediatric psychopharmacology. The major one, he said, is whether children who need treatment are actually receiving it. Access, a dearth of trained clinicians in disadvantaged regions, and disparities of outcome are among the problems. “We must be careful not to be Chicken Littles,” Hyman said. Despite concerns about entering children into clinical trials, unknown long-term effects of drugs, and enhancement among children who are not really ill, he later suggested that the real problem is too little Ritalin: the drug not reaching some children who truly need it. Even in mild childhood mental disorders, Hyman said, not treating them may carry risks such as underperformance in school, selecting peer groups that are not ideal, problems with parents and teachers, and cooccurring problems such as substance use, depression, and anxiety. Hyman questioned what, if anything, separates mental disorders from other problems. He questioned whether there is a moral difference between using drugs to lower cholesterol levels and using them to alter neurotransmitter levels. Henry Greely, a professor at the Stanford Law School, addressed legal issues raised by advancements in neuroscience. He focused on three topics: prediction, mind-reading, and enhancement. These topics have implications in the courts and with insurance companies, Greely said. He tackled prediction first, questioning the value of predictions based on technology such as brain imaging. “To what extent should we use predictions to limit a person’s freedom?” Greely asked. For example, what if scientists determine that a certain image predicts pedophilia? One question Greely raised is whether and how predictive information—or what is done with such information—should be controlled. Mind-reading, he said, has a more direct impact on the courtroom. For example, a test to see if someone is really feeling pain could affect a case in which a crash victim is suing for damages. The key questions here, Greely said, are accuracy and privacy. Enhancement, too, raises a host of questions, Greely said. Among them is whether everyone would have equal access—and, even if so, whether enhancement is inherently unfair. Coercion—by government, peers, or parents—also would be a concern, one that raises constitutional questions. “There is nothing about the lives we live that is unenhanced and is purely natural,” Greely said. But where would we draw the line? Greely encouraged those in attendance to play active roles in the controversies that are sure to arise in the years ahead. The opportunity to affect what happens in this exciting time, he said, amounts to an obligation. Raichle said that education should be a primary goal as neuroethics affects other disciplines such as economics. “We have in hand an incredibly powerful tool,” he said. “Many of the issues we’re talking about are being brought to the level of normal human experience.” Raichle drew an analogy to the Hubble telescope. “What about the ‘dark energy’ of the brain?” he said. “We need to have a genuine respect for what it is we have yet to learn.”
ethics, bioethics, neuroethics, imaging, neuroimaging, treatment, enhancement, brain, dana, foundation
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