Neuroethics

1. Neuroethics Research and Presentation by Paul J. Kelly, BS

2. What is Neuroethics? • Neuroethics is a relatively new field with two different, but related, areas of research: 1) The Ethics of Neuroscience: - The branch of bioethics that seeks to develop an ethical framework for regulating the methodology and application of neuroscientific research. 2) The Neuroscience of Ethics: - The impact of neuroscientific knowledge upon our understanding of ethics itself. • This presentation will mainly be concerned with the first area.

3. Neuroethics vs. Bioethics Generally • Some of the issues addressed in neuroethics have precedents in classic bioethical issues (i.e. receiving informed consent, ethical medical experimentation, etc). • However, some issues are unique because they directly concern human consciousness (i.e. neurological enhancement, brain-scan privacy concerns, etc).

4. Why Study Neuroethics? • Neuroscience is on the frontier of modern medicine. • Also, many contemporary bioethical issues intersect directly with neuroscientific research. For example: • Using stem-cell research to help cure neurological diseases such as Alzheimer’s and Parkinson’s • Future technologies that enable us to manipulate mental traits such as intelligence and personality • Many arguments concerning abortion appeal to the development of brain function in the fetus • Drug industry marketing, regulation, and safety for neurological illnesses

5. Outline of Presentation 1) The Enhancement Debate • Treatment vs. Enhancement • Cosmetic Psychopharmacology • Cosmetic Neurology • Neuroprosthesis • Benefits of Enhancement • Dangers of Enhancement 2) Neuroimagingand Privacy • Benefits of Neuroimaging • Dangers of Neuroimaging

6. The Enhancement Debate • “The traditional focus of medical practice has been to treat disease and disability with a goal of cure or at least re-establishment of normal functioning. The enhancement debate is controversial because it takes individuals who have normal functioning and asks if it is desirable or justified to use medical means to improve their function to levels above normal… The ethical issue centers on whether providing requested enhancements for the healthy is a proper activity for the profession of medicine.” – James L. Bernat in “Ethical Issues in Neurology”

7. Treatment vs. Enhancement • The following issues force us to reconsider the fundamental objective of the medical profession. • Should medical professionals seek to treat disease and disability with the goal of improving deficient function to normal levels, or should they also seek to improve patient functionality over and above what is normal in an attempt to improve quality of life?

8. Cosmetic Psychopharmacology • Example #1: • Beth is a high school junior with a moderate learning disability that causes her to lose concentration and not remember things very easily. • Billy, Beth’s classmate, has no learning disabilities and an average concentration and memory. • While studying for a standardized test, Beth takes Ritalin, while Billy takes nothing. • Upon receiving their graded tests, Beth and Billy find out that they received the same score. • Did Beth do anything wrong? Why or why not?

9. Cosmetic Psychopharmacology • Example #2: • Both Beth and Billy have no learning disabilities and an average concentration and memory. • While studying for a standardized test, Beth takes Ritalin, while Billy takes nothing. • Upon receiving their graded tests, Beth and Billy find out Beth scored significantly higher than Billy. • Did Beth do anything wrong? Why or why not?

10. Cosmetic Psychopharmacology • The use of psychoactive medications by normal healthy individuals, for the purpose of enhancement rather than treatment of a disease or disorder.

11. Cosmetic Neurology • The use of neurological procedures by normal healthy individuals, for the purpose of mental enhancement rather than treatment of a disease or disorder.

12. Cosmetic Neurology • Neurologist AnjanChatterjee argues that, similar to cosmetic surgery’s goal of improving an individual’s physical appearance,cosmetic neurology will seek to improve an individual’s mental abilities. • Furthermore, he believes that while we can have an abstract ethical discussion about how such procedures and treatments should be limited, it won’t do much good. • He thinks that the public’s desire for personal enhancement is insatiable, and so neurologists should become comfortable with the idea of their healthy patients coming to them seeking “better brains.”

13. Neuroprosthesis • Artificial devices that are implanted inside an individual that can replace a motor, sensory, or cognitive modality. • The most common examples are cochlear implants and pacemakers, however the possibilities are immense.

14. Neuroprosthesis Video http://www.cbsnews.com/video/watch/?id=4564186n

15. Ray Kurzweil on Neuroprosthesis • Futurist and transhumanist Ray Kurzweil argues that neurological implants (while currently only being used by the severely disabled) will soon be used by healthy individuals seeking enhanced mental and physical abilities. • He goes so far as to predict a future in which machine implants gradually replace all biological functions until humans become completely artificial beings.

16. Main Positions on Enhancement • Conservative Position: Neurological modification is acceptable as long as it seeks to treat disease and disability with the goal of improving deficient function to normal levels. • Liberal Position: Neurological modification is acceptable, even when it attempts to improve patient functionality over and above what is normal. • Transhumanist Position: Neurological modification is accepted unconditionally in the hopes that humans will achieve enhanced intellect, eliminate suffering, increase physical strength, achieve freedom from disease, etc.

17. Benefits of Enhancement • Medical Benefits • Permitting neurological enhancements will potentially lead to: • An increase in overall quality of life • An increase in life expectancy • Increased mental abilities • Increased physical abilities • Etc.

18. Dangers of Enhancement • Undermines Societal Values • Happiness and abilities gained through artificial means are not authentic. • As a result, they cheapen improvements gained without such assistance and could potentially undermine society’s valuing of self-determination, hard word, and sacrifice.

19. Dangers of Enhancement 2) Will Increase Inequality • The richest 10% of adults own 85% of the world’s wealth. In contrast, the bottom half of the world adult population owns barely 1% of the global wealth. • New technological enhancements will be highly expensive, making them only available to the extremely wealthy. • If permitted, their use will exacerbate already existing inequalities between those who can afford such procedures and those who cannot.

20. Dangers of Enhancement 3) Safety Concerns • Some argue that we simply do not know enough about the brain to attempt to enhance it. • Author W. French Anderson writes: • “We may be like the young boy who loves to take things apart. He is bright enough to disassemble a watch, and maybe even bright enough to get it back together so that it works. But what if he tried to ‘improve’ it?... Attempts on his part to improve the watch will probably only harm it… I fear we, too, do not really understand what makes the minds we are tinkering with tick.” • Without a relatively good understanding of the effects of brain implants and psychopharmacological drugs on healthy patients we cannot ethically permit their use.

21. Neuroimaging and Privacy Video http://www.cbsnews.com/video/watch/?id=4697682n

22. Benefits of Neuroimaging • Medical Benefits • Permitting brain imaging could enable us to: • Communicate with patients with “locked-in syndrome” or those in a “minimally conscious state” • Predict if an individual has violent or criminal inclinations • Predict (and perhaps help cure) the development of neurodegenerative diseases, epilepsy, autism, schizophrenia, depression, etc.

23. Dangers of Neuroimaging • Privacy Concerns • What type of information will these scans reveal, and who will have access to the results? • The government? • My employer? • Health insurance companies? • Corporations? • My parents? • Is submitting to a brain scan in a legal case voluntary or mandatory?

24. Conclusion • As neuroscience progresses it will yield astonishing new medical advances, but also new ethical dilemmas we must carefully consider. • We should think critically about new procedures and technologies, and carefully weigh the potential benefits and possibility of abuse before embracing them.