Executive Summary

A new report on neuroscience and ethics from The Presidential Commission for the Study of Bioethical Issues offers recommendations involving cognitive enhancement, consent capacity, and neuroscience and the legal system.

• Hyperbole, exaggeration, and misinformation can instill misplaced fears and mislead the public.

• Bioethicists can use the report as a tool to promote informed conversations.

• The Commission cautions against making assumptions that individuals with certain diagnoses always lack the capacity to consent.

 

There is no question that it’s a groundbreaking time for neuroscience, but some pressing ethical considerations are being raised in tandem with new technologies.

“We are right on the threshold of some really exciting technologies that will allow us to treat previously untreatable diseases,” says Thomas Cochrane, MD, MBA, senior ethics consultant and associate neurologist at Brigham and Women’s Hospital in Boston. Cochrane is also assistant professor of neurology and director of neuroethics at Harvard Medical School’s Center for Bioethics, also in Boston.

Cochrane is hopeful that in the course of his lifetime, neurodegenerative diseases such as Alzheimer’s will be treatable, and that people paralyzed by disease or trauma will be given the opportunity to move around, care for themselves, and control their environment.

“We’re starting to invent technologies that enhance the neurological capabilities of healthy people,” adds Cochrane. “It might be that in the coming decades we’ll have the ability to make ourselves faster, smarter thinkers, or to alter memories.” In addition, researchers are starting to understand the neurological causes of undesirable behaviors like addiction or violence, he says.

The Presidential Commission for the Study of Bioethical Issues recently released Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society, the second volume of its report requested by the president as part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.1

“The President’s Commission identified three main areas of concern, given all this change,” says Cochrane. These areas are:

• How should we use techniques for cognitive enhancement, and how do we ensure that enhancement technologies are distributed fairly?

• How can we safely and fairly conduct research on diseases that cause diminished capacity and ability to consent?

• When and how should neuroscientific technologies be incorporated into the legal system?1

“These are the major challenges we face at the intersection of neuroscience and medical ethics,” says Cochrane.

The Commission’s report offers 14 recommendations on cognitive enhancement, consent capacity, and neuroscience and the legal system. “Neuroscience is a rapidly growing field, and has captured the interest of scientists, scholars and the public,” says Michelle Groman, JD, the Commission’s associate director, who oversaw staff work on Gray Matters. “We have well-intentioned voices in the mix. But there is also hyperbole, exaggeration, and misinformation.”

This can instill misplaced fears and mislead the public, she warns. The Commission’s report encourages well-informed discourse to combat hype and support neuroscience in realizing its full potential in alleviating neurological disorders and psychiatric conditions that afflict millions of Americans. “Gray Matters is a tool to help inform these conversations, moving forward,” says Groman.

Regarding consent capacity, public comments received by the Commission indicated a pressing need to address this particular issue.

“There is a challenging tension between the need for rigorous research on neurological disease and psychiatric conditions on the one hand, and the need to protect research participants who may be vulnerable because of impaired consent capacity on the other hand,” says Groman.

While capacity is an issue for all scientific investigators conducting studies on human subjects, it’s more pronounced for neuroscience researchers who study many of the various conditions that cause impaired, diminished, or fluctuating consent capacity. “There aren’t necessarily ethical issues that are unique to neuroscience, but there are certainly issues that come out in heightened relief. This is one of these issues,” says Groman.

Issues around consent capacity arise in both the clinical and research setting. “Much of the Commission’s analysis and recommendations are relevant to the clinical setting,” says Groman. For example, the Commission cautions against making assumptions that individuals with certain diagnoses always lack the capacity to consent. “Those types of generalizations can have unintended stigmatizing effects,” explains Groman. “Capacity needs to be considered individually.”

Medical decisions and research decisions aren’t the same things, however, notes Groman. “This is important to keep in mind, especially if you are talking about surrogate or proxy decisionmakers in the case of someone with impaired consent capacity,” she says. Medical decisions are generally presumed to be compatible with the best medical interests of the individual while research enrollment can entail procedures done for reasons other than the individual’s medical interests.

“The general message throughout the report is to avoid hype, and use the science when it’s ready,” says Groman. “The Bioethics Commission is really promoting informed dialogue and informed conversation.”

Reference

  1. Presidential Commission for the Study of Bioethical Issues. Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society. March 2015, Washington, DC.

SOURCES

  • Thomas Cochrane, MD, MBA, Center for Bioethics, Harvard Medical School, Boston, MA. Phone: (617) 732-8046. Fax: (617) 730-2885. Email: tcochrane@partners.org.
  • Michelle Groman, JD, Associate Director, Presidential Commission for the Study of Bioethical Issues, Washington, DC. Phone: (202) 233-3960. Fax: (202) 233-3990.