What neuroethics is and what it means are evolving
New ethics branch probes personality, soul
In its infancy, neuroethics was thought of as simply a small offshoot of the bigger field of bioethics. In the last five years, however, interest in and study of neuroethics has taken on a life of its own, spawning studies, conferences, and the establishment of a society to further the development of the field. The term "neuroethics" is believed to have been coined in the literature in the early 1990s.
While there's no doubt neuroethics is a booming new frontier in ethics, most people would be stymied if asked to pin down a definition of just what neuroethics is.
That's because, according to Judy Illes, PhD, senior research scholar at Stanford University's Center for Biomedical Ethics and a founding member of the Neuroethics Society founded in early 2006, neuroethics has the potential to touch so many different areas of medicine and behavior studies.
For example, who are neuroethicists?
"Neuroethicists can be medical ethicists, they can be philosophers, they can be brain and spinal cord [specialists], to be really inclusive," Illes says, offering examples. "They can be neuroscientists who have become interested in ethics. We all bring a different skill set to the table."
Two focus areas: What we do, and who we are
According to the University of Pennsylvania Center for Cognitive Neuroscience (CCN), which created and manages the on-line resource neuroethics.upenn.edu, neuroethics is concerned with the ways in which developments in basic and clinical neuroscience intersect with social and ethical issues.
"The field is so young that any attempt to define its scope and limits now will undoubtedly be proved wrong in the future, as neuroscience develops and its implications continue to be revealed," CCN suggests.
But neuroethicists relatively agree that there are two general categories of neuroethical issues — one relating to what humans can do (problems arising from neuroimaging, psychopharmacology, and physical manipulation of the brain), and one relating to what we know (philosophical advances and questions relating to behavior, consciousness, personality, and the soul).
Authors have written that neuroethics will be tasked with addressing concerns about the effects brain science and technology will have on other aspects of life — for example, the idea of personal responsibility.
"I really think that in health care a huge area of research — and, ultimately, controversy — is going to revolve around freedom of will," says John Banja, PhD, an ethicist at Emory University's Center for Ethics. "Neuroscientists are more and more going to uncover and discover really impressive evidence that will show, among other things, that certain people don't have as much free will as other people do."
For example, he asks whether people who abuse drugs and alcohol, or molest children, or become serial killers do so out of free will or because their brains are "wired differently."
"So, if they're doing this because their brains are actually structured differently or are wired differently, do you penalize them for that? It's an interesting question," Banja suggests.
Neuroethics Society's first issue: Imaging
Illes says the first issue the Neuroethics Society is addressing involves functional brain imaging.
"We have been trying to locate behavior in the brain since antiquity," she says. And now, if imaging can map the brain and tell us things about ourselves — should it?
"What are the dangers of scanning brains in children and adolescents? And what if we do find something wrong — if we can't intervene, should we look for it in the first place?" Illes asks. "What does it mean to predict certain abilities or limitations in the very young? Does the child become a self-fulfilling prophesy then?"
These questions bear close resemblance to an ethical dilemma clinicians have grappled with for years — whether or how to deliver inadvertently discovered, negative health news, particularly if there's nothing that can be done. Another example is how to use the knowledge that a patient carries the genetic markers for Parkinson's disease — is the burden of knowing you bear the risk of developing a degenerative, incurable disease worth knowing, when there is a possibility you'll never get sick?
Banja says this is the two-edged sword of neuroscience advances — the need to be careful what you ask for.
"I have a hunch that this is going to be deeply interesting, especially in predictive health and being able to look at our genome and see our disposal to this illness and that illness," he says. "But all that is predicated on people wanting that information."
All these questions are why Illes and colleagues interested in neuroethics, who had previously met and talked only informally at neuroscience conferences and other meetings, decided to launch the Neuroethics Society.
"We felt it would help draw new people into neuroethics, which is a critical step for continuing to make progress in the field," she says. The fact that there is as much debate as agreement over what neuroethics is and what it can and should do "is one of the things that make it so exciting and challenging."
In the March 2003 issue of Nature Neuroscience (Nat Neurosci 2003;6:205), Illes writes that the study of neuroethics is one way to help identify and avoid how brain imaging can be exploited. For example, if imaging were to be able to identify people who are prone to aggression, but someone whose brain images revealed that marker had never been aggressive toward another person — should family and employers have that information? Or should a very young child who is determined to be prone to doing poorly at school be so categorized before he or she has even entered kindergarten?
As imaging technology becomes more advanced and able to tell us more about ourselves and what makes each brain unique, Illes says we need to consider how that knowledge and power will be used. Currently, she points out, some research studies into imaging don't have protocols directing researchers what to do if they uncover incidental findings about participants — even whether to tell the participants about incidental findings.
Manipulating vs. healing the brain
Another issue frequently mentioned in neuroethics discussions is treatment of the brain vs. enhancing or boosting the brain. A question arising from that discussion might be, where do you draw the line between treatment and enhancement?
Banja says this question is already being asked on college campuses where so-called ADHD drugs (those frequently prescribed for attention deficit disorders, such as Ritalin and Adderall) have become drugs of choice for students seeking an edge in attention and memorization powers.
"The question that science fiction folks never tire of asking has to do with the possibilities of cosmetic enhancement of the brain, and that's what we're already seeing on campuses, with [the ADHD drugs] becoming popular as a stay-awake-and-memorize drug," he explains. "It's preferable to caffeine because it doesn't give them the shakes. But other students, ones who aren't using the drugs, are complaining because those who do are at an advantage.
"It's just like the situation of professional athletes using performance-enhancing drugs to give them a physical edge over their opponents, only this gives you a mental edge. Should there be performance-enhancing drugs for mental performance?"
Illes says questions like these, touching on pediatric and learning issues, are of particular interest, because children's brains are so much different from adult brains.
"We tend to think of children's issues as adult issues in a little box, but they are really special issues, such as autism in terms of identifying and understanding of the disease, ADHD and the implications of additional forms of diagnosis," she points out. "And also with predicting behavior — this has tremendous implications for these kids, both in the educational strategies they'll need, and also, if we say they're 'bad,' does that make them bad?"
Implications for clinicians
The importance of neuroethics research to neuroscientists and researchers seems clear, but what about for those practicing clinical medicine?
Banja says there is much to suggest doctors "in the trenches" will benefit from neuroethics study, as well.
"Health care professionals tend to be very responsible, thoughtful, well-intentioned people, but a lot of times, some of them have trouble empathizing with people whose behaviors they can't understand," he says. "Neuroethics and neuroscience will show us that these patients act this way through no fault of their own. Health professionals will question their own attitudes about people whose behaviors they don't like. If you're angry or upset with someone who can't control their behaviors, what does that say about you?"
The struggle over disclosing inadvertent findings, such as a tendency toward developing an incurable condition, is another neuroethics issue that clinicians can expect to encounter, he adds.
Illes says neuroethics is being introduced in medical school curricula, often, as at Stanford, as a "vertical thread" element within another course, such as neuron biology.
"We are very early in this field, and already there is so much for medical students to learn," she points out. "What we are seeing is an embodiment of neuroethics into seminar series, new and existing lectures, into psychiatry coursework, and in neuron content."
(In future issues, Medical Ethics Advisor will examine specific neuroethics issues in detail.)
For more information, contact:
- John Banja, PhD, assistant director for health sciences and ethics, Center for Ethics, Emory University, Atlanta. Phone: (404) 712-4804. E-mail: email@example.com.
- Judy Illes, PhD, director of neuroethics, Center for Biomedical Ethics, Stanford University, Palo Alto, CA. Phone: (650) 723-5760.
- Neuroethics Society, on-line at www.neuroethicssociety.org, phone: (800) 670-5548.