by Dana Alliance for Brain Initiatives

January, 2006

Photograph by Don Carstens / PictureQuest

The newly developing field of modern neuroethics encompasses both the ethics of neuroscience that has to with the conduct of research, especially in an age of ever-expanding methods and complexity, and the neuroscience of ethics, such as whether an ethical “center” exists in the brain or discoveries about the brain should compel changes in law. Neuroscientists first began grappling with the ethical, social, and public policy implications of neuroscience advances in 2002, by publishing papers in peer-reviewed journals and special journal volumes and by participating in the first formal conference on the subject, “Neuroethics: Mapping the Field.”1

The field has grown dramatically since then. The number of scientific papers published on the subject of neuroethics in 2005 was almost four times the number in 2002. Professional meetings on neuroethics proliferated as well, and the field is attracting thinkers from other branches of science, the law, and even religion. Several of these meetings and publications made important contributions to sharpening the issues and focus in this multifaceted field in 2005. 

New Publications Add Perspective

The first professional book and the first popular book on the subject of neuroethics were published in 2005, enabling readers to better engage in the issues that will ultimately call for their formal or informal attention.

In October and November, concurrent with the annual meetings of the American Society for Bioethics and Humanities and the 35,000-member meeting of the Society for Neuroscience, Oxford University Press released the professional text, Neuroethics: Defining the Issues in Theory, Practice and Policy, edited by Judy Illes of Stanford University, laying out the state of the art in neuroethics today and the foundation of knowledge needed for future generations of neuroethics research. For the book, Illes, whose studies include the ethical implications of neuroimaging, commissioned 21 leading thinkers to contribute a chapter each on a specific aspect of neuroethics, such as moral decision-making, creativity, neuroimaging, treatment of neurodegenerative diseases, the connection between genetics and brain science, social and political aspects of brain research, and the portrayal of the mind in popular culture.

In April, the general public received its first wide-ranging opportunity to consider ethical implications of neuroscience with the publication of The Ethical Brain, by Michael S. Gazzaniga of Dartmouth College, a leader in the field of exploring how the mind emerges from the brain. In the book—to be republished by HarperCollins in May 2006—Gazzaniga explores neuroethical issues over the lifespan, from fetal development through old age; how neuroscience is redefining what is understood about memory and how these findings might affect the basis of the legal system; and finally, the insights neuroscience is providing into the nature of moral reasoning—and what implications these will have for the understanding of what makes us human. 

Technological Advances Pose Tough Choices

As the field of neuroethics has grown, so too have the number and type of issues under consideration. In light of that profusion, in May an invitation-only, two-day scholarly conference took on the task of focusing the discussion.

“Hard Science, Hard Choices: Facts, Ethics and Policies Guiding Brain Science Today” convened at the Library of Congress in Washington, D.C.,2 sponsored by the Dana Foundation, the National Institute of Mental Health, Columbia University College of Physicians and Surgeons, and the Library of Congress. About 150 participants were on hand to discuss three key areas: neuroimaging, neurotechnology, and psychopharmacology.

Conference co-directors Gerald Fischbach, dean of the Columbia medical school, and Ruth Fischbach, director of Columbia’s Center for Bioethics, chose these areas because the science within them is advancing so quickly—faster, arguably, than in any other area of neurobiology—and bringing the advent of ethical dilemmas closer than the work in more exotic areas. 

The half-day devoted to neuroimaging addressed the power of brain imaging technology, now being used to study behaviors as diverse as religious experience, moral decision-making, racism, lying, and investing money.

The half-day devoted to neuroimaging addressed the power of brain imaging technology, now being used to study behaviors as diverse as religious experience, moral decision-making, racism, lying, and investing money. Of greatest import, the participants agreed, are the risks of this research being misused or misunderstood in ways both small and large. Possibilities range from attempts to manipulate consumer responses to the prospect that neuroimaging may lead people to recast the definitions that underlie common social principles, and not necessarily correctly or beneficially.

The second conference subject, neurotechnology, dealt with ethical dilemmas already looming as a result of techniques now coming into clinical practice. For example, deep brain stimulation is already being used clinically for Parkinson’s disease and is under investigation for chronic pain and mood disorders, among other maladies. While deep brain stimulation raises some issues in common with older bioethics, such as access to care, informed consent, and insurance coverage, this technology affects an entire brain circuit, bringing the risk of unforeseen consequences. Such effects could be either neurological or behavioral; neuroscience has not yet learned the full workings of even one complete circuit in the brain.

A different, equally potent concern, with not only deep brain stimulation but also other neurotechnologies such as neural prostheses, is the potential of desperate patients, overenthusiastic investigators, and the media combining to speed the applications of such research too quickly and risk public backlash.

The participants deemed psychopharmacology, the final conference subject, the hardest area in which to forge ethical agreement. While no one debates treating people who are truly ill, diagnoses of mental disorders usually come in shades of gray, not black and white. Moreover, drawing on previous work by Martha Farah, Alan Leshner, and others, 3,4 participants agreed that one point of dispute can only grow more contentious: the use of drugs to enhance mental performance rather than to treat an underlying disease. This concept raises many metaphysical questions, ranging from the nature of personal responsibility to the definition of the “self.”

Bridging the Worlds of Science and Religion

Neuroscientists have long and informally been aware that advances in neuroscience raise philosophical questions traditionally in the purview of religious studies. In another milestone for neuroethics, organizers of a conference in April undertook to bridge the two worlds with a dialogue among neuroethicists and representatives of diverse religious communities. “Our Brains and Us: Neuroethics, Responsibility and the Self,” held in Cambridge, Massachusetts, was sponsored by the American Academy for the Advancement of Science, the Massachusetts Institute of Technology, and the Boston Theological Institute.

In this scholarly meeting, the focus was the philosophical implications of medical and surgical advances in neuroscience that can alter the brain and behavior, raising fundamental questions about the nature of free will, moral choice, and the self. Topics ranged from the propriety of neural enhancement via pharmacological and technological means to recent studies that begin to outline the neuroanatomical basis of moral reasoning.

The goal of the conference was not to arrive at conclusions but rather to foster discussion among participants approaching these issues from different intellectual traditions. The theologians gained a deeper understanding of the kinds of advances in neuroscience that are evoking questions of an ethical nature, while the neuroscientists had an opportunity to reflect upon some of the deeper implications of their laboratory work.

Neuroethical Implications of the Schiavo Case

As reflected in numerous scientific articles and commentaries in 2005, the highly politicized and publicized case of Theresa Marie (Terri) Schiavo demonstrated what happens when dialogue between people of opposing viewpoints breaks down. Schiavo, who entered a persistent vegetative state after suffering severe brain damage in 1990, was the subject of years of anguished litigation and political controversy, until her husband won the legal right to remove her feeding tube and she died on March 31, 2005. Her case embodied the legal, medical, and ethical issues created by brain treatment advances that have extended survival and redefined death. Yet, although it fostered vast public concern about those important issues, it resolved none of them.

In an editorial in the May Journal of Clinical Investigation, Joy Hirsch of Columbia University wrote that the Schiavo case raised awareness of the similar plight faced by other families and patients.5 As many as 15,000 Americans are in a persistent vegetative state, a condition in which someone shows no signs of conscious behavior, while another 100,000 are in a minimally conscious state, 6 exhibiting intermittent periods of consciousness.

As many as 15,000 Americans are in a persistent vegetative state, a condition in which someone shows no signs of conscious behavior, while another 100,000 are in a minimally conscious state, exhibiting intermittent periods of consciousness.

In a functional magnetic resonance imaging study published in Neurology, Hirsch and colleagues sought to compare brain activation in patients in a minimally conscious state with activation in healthy controls.7 Their findings suggest that certain brain circuits in minimally conscious patients are able to handle information much as those in healthy patients do. The same cannot be said for patients in a persistent vegetative state. However, further research lies ahead to ascertain whether brain activation represents some kind of awareness and whether any form of recognition exists that brain scans cannot detect.

Moreover, although scientists have reached a working consensus on how to define and diagnose the minimally conscious state, 8 they are not yet ready to provide what is considered the “gold standard” in medicine: evidence-based guidelines for diagnosis, prognosis, and management that would provide a roadmap for physicians.

Similar concerns about the unsettled issues were raised by Joseph J. Fins of the Weill Medical College of Cornell University in the March–April issue of the Hastings Center Report.9 Fins noted the chilling example of Terry Wallis, who suddenly began to talk in 2003, nearly 20 years after suffering a severe brain injury. Fins believes that Wallis progressed from a vegetative state to a minimally conscious state within months of his injury, then remained incorrectly diagnosed for years.

But the larger issue, Fins argues, is that severe brain injuries force professionals and lay people alike to confront the nature of consciousness and overly simplistic notions of recovery. After severe brain injury, recovery often takes years, even decades, and may significantly alter the life not only of the injured individual but of the family.  

Ethical Challenges in Neuroimaging

As indicated by its selection as one of the topics for the conference at the Library of Congress, deciding how to handle multiple challenges created by neuroimaging is not merely a theoretical problem but a rapidly evolving necessity. These issues were discussed at several scientific meetings and in a number of journal articles.

On January 6 and 7, 2005, the National Institutes of Health and Stanford University co-sponsored a conference entitled “Detection and Disclosure of Incidental Findings in Neuroimaging Research.” The 50 participants included ethicists, radiologists, neurologists, and other relevant professionals, who sought to develop consensus recommendations about what to do when brain scans reveal variations from expected brain architecture, or brain tumors or other sorts of brain pathology. Such incidents are surprisingly common: researchers have found variations in the expected brain form or structure in as many as 20 percent of study participants, and clinically significant abnormalities in anywhere from 2 to 8 percent.10

Working to shape recommendations that would be adopted by laboratories, institutional review boards, journals, and research sponsors, the conferees reached consensus on many questions. Others remained unresolved, and their work continues.11,12 Their work also spawned special sessions on incidental findings in the brain at the National Institutes of Health, research funding devoted to incidental findings in body imaging and genetics, and similar interest abroad.

Meanwhile, the American Journal of Bioethics devoted most of its March–April 2005 issue to the subject of neuroimaging. In one article, Judy Illes and Eric Racine of Stanford University noted that neuroimaging raises some of the same concerns as genetics, including the ability to predict disease and risks to privacy.13 Yet neuroimaging, far more than a genetic profile, provides a window into aspects of personality previously thought to be unquantifiable—including such things as values, morality, and social attitudes. And just as geneticists worry that genetic testing might lead to discrimination, neuroethicists worry that employers, judges, and educators might use brain scans to screen potential employees, convict suspects of crimes, or choose which students to admit.

Such uses would be questionable, the authors point out, because no “norm” yet exists (or may ever exist) with which one person’s brain can be compared. Brain scans published in journals are not “pictures” in any traditional sense; they are computer composites averaging and consolidating findings from many individuals. What’s more, the field has not yet arrived at standards for how to produce particular images. In short, Illes and Racine argue, it is important not to read too much into neuroimaging scans for use outside the laboratory just yet.

Another prospective use for brain imaging, one that is particularly controversial, is thought to be lie detection. Paul Root Wolpe, Kenneth Foster, and Daniel Langleben, all of the University of Pennsylvania, argue in the same issue of the American Journal of Bioethics that it is premature to see brain imaging as promising a sort of mental polygraph, even though significant money is being invested in such technology for use in criminal and terrorist investigations.14

Because significant questions exist about the reliability of this technology, the authors warn that premature commercialization could undermine and squelch research aimed at improving it and even lead to the misuse of brain scans in criminal cases. They urge that research continue while at the same time scientific, legal, and civil forums begin examining the ethical problems before they arise.