Bernat, James L. MD
Dr. Bernat is professor of neurology at Dartmouth Medical School and a former chair of the AAN Ethics, Law, and Humanities Committee. He is also the author of Ethical Issues in Neurology; the third edition is in press and is expected to be released next year.
Defining Right and Wrong in Brain Science: Essential Readings in Neuroethics • Edited by Walter Glannon • 405 pages • Dana Press 2007
The ethical issues raised by advances in neuroscience recently have been named neuroethics. Because ethical problems encountered in neurological practice also have been called neuroethics, the clearest terminology would be to call neuroscience research ethical issues research neuroethics to distinguish them from clinical neuroethics. But over the past five years, most scholars using the term neuroethics have restricted it to neuroscience research ethics; the intended use in this book.
The emerging field of neuroethics has been given a boost by the Dana Foundation of New York, one of whose three missions is to enhance public understanding of the brain and neuroscience.
The Dana Press publishes Cerebrum, a high-quality popular magazine in which sophisticated neuroscience issues are explained by experts to intelligent laymen; as well as series of excellent books with the same intent, such as Michael Gazzaniga's The Ethical Brain and Nancy Andreasen's The Creating Brain. Most notably, the Dana Foundation sponsored a conference in San Francisco in May 2002 to organize the nascent field of neuroethics. The Dana Press published the conference proceedings later that year as Neuroethics: Mapping the Field. This effort catalyzed the development of neuroethics as an academic discipline. (Disclosure: I am a member of the Dana Alliance for Brain Initiatives.)
Over the past five years, neuroethics has developed into an independent discipline with dedicated scholars, academic conferences, a professional society (the Neuroethics Society, www.neuroethicssociety.org/index.html), a journal (The American Journal of Bioethics — Neuroscience), scholarly Web sites (www.neuroethics.upenn.edu), and books. The neuroscience academic community has identified the ethical aspects of neuroscience as critical areas for investigation. The Society for Neuroscience, the premier scientific organization dedicated to neuroscience research, now includes the study of ethical issues in its mission statement — www.sfn.org/index.cfm?pagename=mission§ion=about_SfN.
Figure. Dr. James L....Image Tools
The philosopher Walter Glannon assembled the current anthology of previously published articles (most are from 2002–2006) to produce a primer on neuroethics. Approximately one-third of these articles were published originally by the Dana Press, one-third in ethics journals, and one-third in neuroscience journals. Glannon wrote helpful introductions to each section. The essays offer a reasonably complete introduction to the contemporary debates comprising the field of neuroethics. As is true in clinical neuroethics, legal questions closely parallel ethical ones in neuroscience research and this book includes essays analyzing the evolving legal challenges.
Glannon devotes a substantial section to discussions of the ethical issues in neuroimaging. One nagging question surrounds how researchers should handle unexpected abnormal findings on fMRI studies of volunteers. First, who determines whether the findings are abnormal given that most scans are read by researchers, not radiologists, and research MRI sequences are usually insufficient for a clinical examination? Should all scans be interpreted by radiologists? Who should tell the subjects about the purportedly abnormal findings and how? Who should arrange and provide clinical care for the subjects and who should pay for their care? Judy Illes and other scholars offer thoughtful discussions of these important questions. Most commentators agree that all of these questions should be addressed at the time the subject provides written consent to participate in the research project, thereby assuring adequate protection throughout the study.
Vexing ethical issues result from how functional neuroimaging data can invade privacy and confidentiality. For example, the information can be used for “mind reading” to detect personal behaviors or preferences, or can be used forensically to detect lying or to provide exculpatory evidence in criminal proceedings. “My brain made me do it” is Gazzaniga's clever phrase.
The ancient debates about free will, determinism, and moral responsibility have been given a fresh perspective now that regions of brain activation can be identified that correlate with various thoughts and behaviors. For example, fMRI studies of drug addicts who are shown videos of drug paraphernalia show amygdala activation similar to that evoked in people shown videos of explicit sexual acts.
The emerging business application called “neuromarketing” uses fMRI data from consumers to measure their preferences for commercial items. Patterns of fMRI activation have been shown to correlate with patients' anti-social and violent acts and may be used as evidence in the criminal justice system. Providing lie detection services using fMRI data is the business plan of at least one commercial company called “No Lie MRI.” The complex ethical and legal challenges raised by these phenomena are discussed in this volume.
Glannon provides a series of thoughtful essays on the enhancement debate: should advances in neuropharmacology and other neurotechnology be used to improve normal human function? Medical practice traditionally treats disease and disability with a goal of a cure or improving patients' functioning. The enhancement debate is controversial because it takes individuals who have normal functioning and asks if it is desirable or justified for physicians to use medical means to improve their functioning to levels above normal. Of course, for centuries people have used drugs such as alcohol, nicotine, and caffeine for this purpose. The ethical issue centers on whether providing requested enhancements for the healthy is a proper activity of the medical profession. Glannon offers a balanced series of essays written by advocates from both sides. The debate on this point between Arthur Caplan and Paul McHugh is particularly illuminating. Interestingly, the same fundamental ethical question pervades debates in both research and clinical neuroethics: “Should we do what we can do?”
The most fascinating and difficult neuroethical concepts are those involving neurophilosophy: morality, free will, personal identity, consciousness, and death. This is the least satisfying section of the book for readers. The insights offered by the authors are constrained by our limited knowledge of the relevant neurobiology and by our primitive conceptual frameworks. The philosophy of human consciousness and the definition of human death are good examples of incomplete conceptual systems. The neural basis of morality is being actively studied in several laboratories. Reproducible patterns of brain activation by fMRI have been found to underlie experimental models of moral deliberation and decisions.
To provide a needed caveat to the excitement generated by this research, I wish Glannon had included an essay emphasizing the limitations inherent in interpreting functional neuroimaging data. In a Dana Press article in 2006, the neurologist-neuroimaging expert Marcus Raichle warned prudently that contemporary cognitive scientists should not repeat the overgeneralization mistake made by 19th century phrenologists by simply correlating fMRI findings with mental faculties. Raichle suggested that neuroimaging scientists should continue to make correlations between cognitive tasks that have been performed and networks of brain activation that result. But he pointed out that the more challenging effort will be to “identify the elementary operations performed within such a network and relate these operations to the task of interest.”
The essays in this anthology define the boundaries of the new discipline of neuroethics and properly raise more questions than answers. The 21st century will be an exciting time to follow the fascinating developments that are inevitable in these areas. Neurologists can make an essential contribution as informed clinicians by studying both neuroscience and neuroethics.