Brain science creates a need for neuroethics

by Gail Johnson on November 18th, 2009 at 10:49 AM

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Judy Illes has a dilemma. What happens when someone who has agreed to participate in a medical study undergoes a brain scan during which the researcher happens to discover an anomaly, a potential health risk?

It’s a hypothetical quandary, but an example of the type of question Illes grapples with every day as the head of the National Core for Neuroethics at UBC.

“Say this person wants to do good and participate in a research study of the brain,” Illes says on the line from Mon-treal, where she’s attending meetings. “They’ve enrolled, fulfilled all the criteria, and they’re under the scanner, and the researcher—who’s not a physician—finds something suspicious, what we’d call an incidental finding.

“The problems there are huge,” she says. “Should the researcher show it to the person? If so, what are the physical implications? What about the psychological implications, the anxiety that person would experience? What about the cost of undergoing further tests? This is a big issue, one that really touches people when I talk about it. The questions are huge, and as to the answers, there’s not a consensus. But this kind of issue must be managed upfront in medical research.”

The field of neuroethics is relatively new, less than a decade old. However, organizations like the National Core for Neuroethics at UBC, which was formed in 2007, are becoming increasingly common. Such research bodies are being established in response to recent and remarkable advances in scientific understanding of the brain. Along with progress in such areas as genomics, molecular medicine, and brain disorders like addiction, depression, and dementia, however, come ethical challenges.

“What do we do when genetics can predict diseases of the brain in people who are presently completely healthy but know they are going to be hit with something 10, 20, 30 years down the road when there is no cure in sight?” Illes asks. “Technology is moving so fast. Neuroscience goes to the deep, ethical implications of what’s going on; it goes way beyond the institutional rules to get a protocol approved.

“On one hand, there’s a whole philosophy that we can apply science and the implications of science in a reactive way,” she adds. “Maybe the law comes in when adverse events have occurred. Then there becomes a sudden halt to science. We are looking to partner ethics right alongside neuroscience”¦to propel neuroscience further. We think that’s empowering.”

Illes, Canada research chair in neuroethics and a professor of neurology at UBC, is also a founding fellow of the university’s Institute of Mental Health. She is a cofounder of the international Neuroethics Society, editor of the American Journal of Bioethics: Neuroscience, and chair of Women in World Neuroscience for the International Brain Research Organization.

She explains that neuroethics pushes beyond the reach of bioethics—which also explores issues such as predicting disease and dealing with unintended consequences of research—by probing concepts like free will, personal responsibility, and decision-making.

The National Core for Neuroethics, a division of UBC’s Brain Research Centre, is involved in several research projects, including the international Neuroethics of Enhancement initiative. Led here by the centre’s codirector, psychiatrist Peter Reiner, the project will assess cross-cultural attitudes of doctors when it comes to prescribing cognitive enhancers. The normal cognitive decline that accompanies aging, although not a disease or disorder, can be problematic in a society that judges people by their smarts. Clinical trials are currently testing drugs designed to enhance cognition in “normal” individuals. If and when the drugs become available, the bur-den of prescription will fall on doctors. The aim of this research, which will take place in Canada and Germany and, possibly, Japan, the United Kingdom, and the United States, is to assess the views of doctors on prescribing medications designed to treat “normalcy”.

There’s a cultural dimension to neuroethical considerations as well.

The disease model of dementia, for instance, isn’t accepted in all cultures. Some First Nations groups view dementia-related cognitive decline as a means of communication during the transition from one life to the next. Such beliefs can shape attitudes about when medical treatment should be sought. Illes says that by taking into account such culturally relevant aspects of aging, neuroethics can help lead to relevant and respectful health care.

Other areas of interest to neuroethicists include the protection of privacy in the information age, the use of medicine in children with new or poorly understood forms of attention and mood disorders, and the ability to “peer” into a person’s brain to assess guilt or innocence.

Although there are people who are skeptical of the field of neuroethics, Illes says the number of those is diminishing.

“People who are critical sometimes say we are scaremongering, that we are anticipating things might go wrong where they might never go wrong,” Illes explains. “We’re not looking for things to go wrong. We’re looking for what’s right and how to put what’s right upfront on everyone’s table.”

Comments

10 Comments

enno niemuss

Nov 23, 2009 at 5:54pm

When I first saw the headline "Brain science creates a need for neuroethics," I groaned. Will we soon have cardioethics? nephrolo-ethics? Why can't these M.D.s be ethical in the old fashioned Hippocratic way?

Considering, though, that neuroscience deals with the brain, the mind, and that this organ determines whether a person functions as an intelligent humane human being or as a dull stupid beastly animal, I realized that neuroethics might be of great importance in guiding medical practitioners along the correct path.

It's certainly reassuring that by "probing concepts like free will, personal responsibility, and decision making," neuroscientists will act ethically in their interactions with patients who are undergoing mind control and manipulation by means of drugs, hypnotism, surgery, implants, whatever.

If only neuroethics had been invented in time to subvert the infamous LSD experiments orchestrated by the CIA at Montreal's Allen Memorial Institute in the 1960s!! If only the principles of neuroethics might today have influence with the medical and psychological professionals who guide the torturers' hands!

But you can see that Dr. Illes and her cohorts have their work cut out for them and a lot of ethical ground to reclaim when you consider the following quote by an eminent neuroscientist:

"We need a program of psychosurgery for political control of our
society. The purpose is physical control of the mind. Everyone
who deviates from the given norm can be surgically mutilated.

"The individual may think that the most important reality is
his own existence, but this is only his personal point of view.
This lacks historical perspective.

"Man does not have the right to develop his own mind. This kind
of liberal orientation has great appeal. We must electrically
control the brain. Some day armies and generals will be
controlled by electric stimulation of the brain."

-- Dr. Jose Delgado
Director of Neuropsychiatry
Yale University Medical School
Congressional Record, No. 26, Vol. 118
February 24, 1974

Hitcliff Thompson

Mar 26, 2010 at 7:25am

The power to examine and manipulate the brain offers the potential to change lives in profound and personal ways. As this potential becomes an ever-present reality, how will we make wise decisions about its use? I concluded after reading lots of works and listening to the news found by <a href=http://www.mp3hunting.com> mp3 search </a> that most authors presuppose that neuroethics is almost exclusively focused on new neurotechnology—that neuroethics is somehow addressing only ethical issues associated with technological developments. This certainly represents some of the aims encompassed by the umbrella term of neuroethics, but the broader scheme is more complex and includes many other goals. For example, the lack of attention that bioethicists have paid to the advances in neuroscience is one of the reasons why a slightly distinct community has emerged to approach the ethics of neuroscience. If bioethics had been as attentive to neuroscience as it was to genetics, perhaps the story would be different. For others, interventions in the central nervous system create challenges that must be addressed in their own right, and some see yet another goal for neuroethics: the potential renewal of bioethics' commitment to public dialogue about biomedical science. As a pragmatist, my own personal view is that the single most important integrative goal underlying neuroethics is a practical one: the need to improve patient care for specific patient populations. Hence, technological advances should always be discussed in the light of their potential contribution to the good of the patients and the public. In fact, some of the first occurrences of the term were associated with the concerns of clinicians that we had to pay more attention to the needs of neurological and psychiatric patients, and, in particular, the need to protect them from potentially harmful new interventions.

r4 ds

Apr 24, 2010 at 3:40am

If bioethics had been as attentive to neuroscience as it was to genetics, perhaps the story would be different. For others, interventions in the central nervous system create challenges that must be addressed in their own right, and some see yet another goal for neuroethics: the potential renewal of bioethics' commitment to public dialogue about biomedical science. As a pragmatist, my own personal view is that the single most important integrative goal underlying neuroethics is a practical one: the need to improve patient care for specific patient populations. Hence, technological advances should always be discussed in the light of their potential contribution to the good of the patients and the public. In fact, some of the first occurrences of the term were associated with the concerns of clinicians that we had to pay more attention to the needs of neurological and psychiatric patients, and, in r4 dsparticular, the need to protect them from potentially harmful new interventions.

nono

Apr 26, 2010 at 2:39am

The power to examine and manipulate the brain offers the potential to change lives in profound and personal ways. As this potential becomes an ever-present reality, labatterie how will we make wise decisions about its use?

Joshua Miller

Jul 15, 2010 at 7:46am

So the typical neuroethics reactant questions are The differences between what neurological treatment of diseases of man and simply strengthening the human brain? Another one of such a question: whether this is true with regard to The rich, having the access to things different than the poor do... The problems could or would supplement ??????? thical issues in the field <a style="color: black; text-decoration: none;" rel="dofollow" href="http://www.essayontime.com/services/essay.html">essay</a> ethics and moral...

Minnesota Attorney

Aug 13, 2010 at 12:07am

There are a lot of general issues related to research in the nervous system that are contained within bioethics informed consent and people with cognitive impairments are traditional kinds of bioethical issues.
But if instead you want to ask about the essence of personal responsibility and how we should think about personal responsibility in light of neuroscience, and in light of our criminal justice system, that is something that is well beyond bioethics. It involves neuroscience, philosophy and the law.
Minnesota Attorney

Custom Essays

Nov 10, 2010 at 2:25am

Well science has been researching about many objects since centuries. I think that science has achieved a lot of discoveries around this world. The disease model of dementia, for instance, isn’t accepted in all cultures. Some First Nations groups view dementia-related cognitive decline as a means of communication during the transition from one life to the next.

Vedavyas

Nov 14, 2010 at 10:44am

The energy to look at and manipulate the mind provides the possible to alter lives in profound and private methods. Because this possible turns into an ever-present actuality, labatterie the way we make smart choices about its use?

Rene

Apr 15, 2011 at 1:17pm

It’s a hypothetical quandary, but an example of the type of question Illes <a href="http://www.gefickt.me/">bordell</a> grapples with every day as the head of the National Core for Neuroethics at UBC.