Ethics of Brain Imaging

This paper offers an overview of the prospects and ethics of using AI to achieve human enhancement, and more broadly what we call intellectual augmentation (IA). After explaining the central notions of human enhancement, IA, and AI, we discuss the state of the art in terms of the main technologies for IA, with or without brain-computer interfaces. Given this picture, we discuss potential ethical problems, namely inadequate performance, safety, coercion and manipulation, privacy, cognitive liberty, authenticity, and fairness in more detail. (...) We conclude that while there are very significant technical hurdles to real human enhancement through AI, and significant ethical problems, there are also significant benefits that may realistically be achieved in ways that are consonant with a rights-based ethics as well. We also highlight the specific concerns that apply particularly to applications of AI for "sheer" IA (more realistic in the near term), and to enhancement applications, respectively. (shrink)

What ethical questions does neuroscience raise and help to answer? Neuroethics blends philosophical analysis with modern brain science to address central questions within this growing field: · Is free will an illusion? · Does brain stimulation impair a patient's autonomy? · Does having a mental disorder excuse bad behavior? · Is addiction a brain disease? · Should we trust our gut feelings in ethics and politics? · Should we alter our brains to become better people? · Is human reasoning bound (...) to be biased by our values? · Can brain science be trusted to read the minds of criminals and consumers? This book provides an opinionated tour through captivating cases and a close examination of the philosophical issues and scientific evidence. Joshua May's lively and accessible writing style makes it an indispensable resource for students and scholars in both the sciences and humanities. (shrink)

It has been argued that a biomarker-informed classification system for antisocial individuals has the potential to overcome many obstacles in current conceptualizations of forensic and psychiatric constructs and promises better targeted treatments. However, some have expressed ethical worries about the social impact of the use of biological information for classification. Many have discussed the ethical and legal issues related to possibilities of using biomarkers for predicting antisocial behaviour. We argue that prediction should not raise the most pressing ethical worries. Instead, (...) issues connected with ‘biologisation’, such as stigmatization and negative effects on self-image, need more consideration. However, we conclude that also in this respect there are no principled ethical objections against the use of biomarkers to guide classification and treatment of adult antisocial individuals. (shrink)

Since its emergence in the early 2000s, neuroethics has become a recognized, institutionalized and professionalized field. A central strategy for its successful development has been the claim that it must be an autonomous discipline, distinct in particular from bioethics. Such claim has been justified by the conviction, sustained since the 1990s by the capabilities attributed to neuroimaging technologies, that somehow ‘the mind is the brain’, that the brain sciences can illuminate the full range of human experience and behavior, and that (...) neuroscientific knowledge will have dramatic implications for views of the human, and challenge supposedly established beliefs and practices in domains ranging from self and personhood to the political organization of society. This article examines how that conviction functions as neuroethics’ ideological condition of possibility. (shrink)

Gerben Meynen (2019) invites us to consider the potential ethical implications of what he refers to as “thought apprehension” technology for psychiatric practice, that is, technologies that involve recording brain activity, and using this to infer what people are thinking (or intending, desiring, feeling, etc.). His article is wide-ranging, covering several different ethical principles, various situations psychiatrists might encounter in therapeutic, legal and correctional contexts, and a range of potential incarnations of this technology, some more speculative than others. Although Meynen’s (...) article raises some highly relevant potential implications of some “thought apprehension”-based neurotechnologies, which are certainly worthy of further exploration, I suggest that Meynen’s analysis is beset by two problems. First, some of the technologies that form the focus of his discussion are too speculative, and second, due to the many issues under consideration, some problems are not adequately characterized, relevant ethical principles are misidentified, and valuable literature is not sufficiently engaged with. Consideration of these weaknesses might allow us to better see how to conduct a fruitful analysis of speculative neurotechnologies. (shrink)

_The Routledge Handbook of Neuroethics_ offers the reader an informed view of how the brain sciences are being used to approach, understand, and reinvigorate traditional philosophical questions, as well as how those questions, with the grounding influence of neuroscience, are being revisited beyond clinical and research domains. It also examines how contemporary neuroscience research might ultimately impact our understanding of relationships, flourishing, and human nature. The _Handbook_ features easy-to-follow chapters that appear here for the first time in print and—written by (...) 61 key scholars and fresh voices—represent the wide range of viewpoints in neuroethics. The volume spotlights new technologies and historical articulations of key problems, issues, and concepts, and includes cross-referencing between chapters to highlight the complex interactions of concepts and ideas within neuroethics. These features enhance the _Handbook_’s utility by providing readers with a contextual map for different approaches to issues, and a guide to further avenues of interest. (shrink)

In this article we critically review the neural mechanisms of moral cognition that have recently been studied via electroencephalography (EEG). Such studies promise to shed new light on traditional moral questions by helping us to understand how effective moral cognition is embodied in the brain. It has been argued that conflicting normative ethical theories require different cognitive features and can, accordingly, in a broadly conceived naturalistic attempt, be associated with different brain processes that are rooted in different brain networks and (...) regions. This potentially morally relevant brain activity has been empirically investigated through EEG-based studies on moral cognition. From neuroscientific evidence gathered in these studies, a variety of normative conclusions have been drawn and bioethical applications have been suggested. We discuss methodological and theoretical merits and demerits of the attempt to use EEG techniques in a morally significant way, point to legal challenges and policy implications, indicate the potential to reveal biomarkers of psychopathological conditions, and consider issues that might inform future bioethical work. (shrink)

Neuroethics is an emerging interdisciplinary field with unsettled boundaries. Many of the ethical issues within the purview of neuroethics could be described as resulting from the clash between the scientific perspective on concepts such as free will, personal identity, consciousness, etc., and the putatively commonsense conceptions of those terms. The assumption that undergirds the framing of the conflict between these two approaches is that advances in neuroscience, psychiatry, and psychology can be used to explain phenomena covered by commonsense concepts and (...) in some cases undermine them entirely. This book is focused on the examination of the particular relationship between developments in neuroscience and commonsense moral concepts. Common sense, I argue, has been misinterpreted as a static, either foundational or degenerative, basis of our morality, when it is an ever shifting repository of theories from many domains. Within this discussion, I focus on the application of neuroscience to human beings, i.e., the ethics of neuroscience. But I also cover issues within the purview of the neuroscience of ethics, and attempt to address the infiltration of neuroscientific knowledge into everyday parlance and the impact of that on our commonsense morality and psychology. (shrink)

Several types of inferences are employed in the diagnosis and prognosis of patients with brain injuries and disorders of consciousness. These inferences introduce unavoidable uncertainty, and can be evaluated in light of inductive risk: the epistemic and nonepistemic risks of being wrong. This article considers several ethically significant inductive risks generated by and interacting with inferences about patients with disorders of consciousness, and argues for prescriptive measures to manage and mitigate inductive risk in the context of disorders of consciousness.

Ethical questions have traditionally been approached through conceptual analysis. Inspired by the rapid advance of modern brain imaging techniques, however, some ethical questions appear in a new light. For example, hotly debated trolley dilemmas have recently been studied by psychologists and neuroscientists alike, arguing that their findings can support or debunk moral intuitions that underlie those dilemmas. Resulting from the wedding of philosophy and neuroscience, neuroethics has emerged as a novel interdisciplinary field that aims at drawing conclusive relationships between neuroscientific (...) observations and normative ethics. A major goal of neuroethics is to derive normative ethical conclusions from the investigation of neural and psychological mechanisms underlying ethical theories, as well as moral judgments and intuitions. The focus of this article is to shed light on the structure and functioning of neuroethical arguments of this sort, and to reveal particular methodological challenges that lie concealed therein. We discuss the methodological problem of how one can—or, as the case may be, cannot—validly infer normative conclusions from neuroscientific observations. Moreover, we raise the issue of how preexisting normative ethical convictions threaten to invalidate the interpretation of neuroscientific data, and thus arrive at question-begging conclusions. Nonetheless, this is not to deny that current neuroethics rightly presumes that moral considerations about actual human lives demand empirically substantiated answers. Therefore, in conclusion, we offer some preliminary reflections on how the discussed methodological challenges can be met. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

Neuroscientists have long sought to study the dynamic activity of the human brain—what's happening in the brain, that is, while people are thinking, feeling, and acting. Ideally, an inside look at brain function would simultaneously and continuously measure the biochemical state of every cell in the central nervous system. While such a miraculous method is science fiction, a century of progress in neuroimaging technologies has made such simultaneous and continuous measurement a plausible fiction. Despite this progress, practitioners of modern neuroimaging (...) struggle with two kinds of limitations: those that attend the particular neuroimaging methods we have today and those that would limit any method of imaging neural activity, no matter how powerful.In this essay, I consider the liabilities and potential of techniques that measure human brain activity. I am concerned here only with methods that measure relevant physiologic states of the central nervous system and relate those measures to particular mental states. I will consider in particular the preeminent method of functional neuroimaging: BOLD fMRI. While there are several practical limits on the biological information that current technologies can measure, these limits—as important as they are—are minor in comparison to the fundamental logical restraints on the conclusions that can be drawn from brain imaging studies. (shrink)

The central debate in the field of neurolaw has focused on two claims. Joshua Greene and Jonathan Cohen argue that we do not have free will and that advances in neuroscience will eventually lead us to stop blaming people for their actions. Stephen Morse, by contrast, argues that we have free will and that the kind of advances Greene and Cohen envision will not and should not affect the law. I argue that neither side has persuasively made the case for (...) or against a revolution in the way the law treats responsibility. -/- There will, however, be a neurolaw revolution of a different sort. It will not necessarily arise from radical changes in our beliefs about criminal responsibility but from a wave of new brain technologies that will change society and the law in many ways, three of which I describe here: First, as new methods of brain imaging improve our ability to measure distress, the law will ease limitations on recoveries for emotional injuries. Second, as neuroimaging gives us better methods of inferring people’s thoughts, we will have more laws to protect thought privacy but less actual thought privacy. Finally, improvements in artificial intelligence will systematically change how law is written and interpreted. (shrink)

This entry has two general aims. The first is to profile the practices of neuromarketing (both current and hypothetical), and the second is to identify what is ethically troubling about these practices. It will be claimed that neuromarketing does not really present novel ethical challenges, and that marketers are simply continuing to do what they have always done, only now they have at their disposal the tools of neuroscience which they have duly recruited. What will be presupposed is a principle (...) of proportionality: marketing practices are morally objectionable commensurate with the degree to which they impugn the moral sovereignty of market actors. With this principle in mind, it is important to consider the literature which is sceptical about the potential for neuromarketing to be successful. If its claims are overblown, as will be suggested, then the ethical threat neuromarketing is said to pose, can be viewed also as overblown. An area that has worried many is that neuromarketing poses a threat to brain privacy, and so an analysis will be given of the nature of this threat, given the principle of proportionality. It will be argued that worries about brain privacy seem, prima facie, to be justified, but on closer analysis, fall away. However, a residual threat to privacy does remain: the collection over time, and aggregation of private brain information, where the target loses control over its ownership and distribution. (shrink)

Unresponsive wakefulness syndrome (UWS, previously known as vegetative state) occurs after patients survive a severe brain injury. Patients suffering from UWS have lost awareness of themselves and of the external environment and do not retain any trace of their subjective experience. Current data demonstrate that neuronal functions subtending consciousness are not completely reset in UWS; however, they are reduced below the threshold required to experience consciousness. The critical factor that determines whether patients will recover consciousness is the distance of their (...) neuronal functions from this threshold level. Recovery of consciousness occurs through functional and/or structural changes in the brain, i.e., through neuronal plasticity. Although some of these changes may occur spontaneously, a growing body of evidence indicates that rehabilitative interventions can improve functional outcome by promoting adaptive functional and structural plasticity in the brain, especially if a comprehensive neurophysiological theory of consciousness is followed. In this review we will focus on the pathophysiological mechanisms involved in UWS and on the plastic changes operating on the recovery of consciousness. (shrink)

Advances in technology are bringing greater insight into the mind, raising a host of privacy concerns. However, the basic psychological mechanisms underlying the perception of privacy violations are poorly understood. Here, we explore the relation between the perception of privacy violations and access to information related to one’s “self.” In two studies using demographically diverse samples, we find that privacy violations resulting from various monitoring technologies are mediated by the extent to which the monitoring is thought to provide access to (...) self-relevant information, and generally neuromonitoring did not rate among the more invasive monitoring types. However, brain monitoring was judged to be more of a privacy violation when described as providing access to self-relevant information than when no such access was possible, and control participants did not judge the invasiveness of neuromonitoring any differently than those told it provided no access to self-relevant information. (shrink)

In “Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness” (2013), Fischer and Truog argue that recent studies showing that some patients diagnosed as being in a vegetative state are in fact in a minimally conscious state raise various ethical questions for clinicians and family members. I argue that these findings raise a further ethical dilemma about how and whether to seek the involvement of the minimally conscious person herself in decisions about her care. There may be (...) a conflict between doing what is believed to accord with the patient’s prior stated wishes and/or her best interests, on the one hand, and respecting her own potential decision-making capacity and epistemic authority, on the other. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

There is ongoing ethical and legal debate about withdrawing life sup- port for patients with disorders of consciousness (DOCs). Frequently fu- eling the debate are implicit assumptions about the value of life in a state of impaired consciousness, and persistent uncertainty about the quality of life (QoL) of these persons. Yet there are no validated methods for assessing QoL in this population, and a significant obstacle to doing so is their inability to communicate. Recent neuroscientific discoveries might circumvent that problem (...) and help shed light on QoL in DOCs. There is an ethical imperative to prioritize QoL research in this patient population, to provide evidence to inform treatment, research, and end of life decisions. A minimalist and pragmatic model of QoL is proposed, targeting positive and negative affect as domains for which there is po- tential to reach across the communication gap, and restore to these voiceless persons some measure of control. (shrink)

Brain Computer Interface (BCI) technology offers potential for human augmentation in areas ranging from communication to home automation, leisure and gaming. This paper addresses ethical challenges associated with the wider scale deployment of BCI as an assistive technology by documenting issues associated with the development of non-invasive BCI technology. Laboratory testing is normally carried out with volunteers but further testing with subjects, who may be in vulnerable groups is often needed to improve system operation. BCI development is technically complex, sometimes (...) requiring lengthy recording sessions to achieve the necessary personalisation of the paradigms, and this can present ethical challenges that vary depending on the subject group. The paper contributes to the on-going ethical discussion surrounding the deployment BCI outside the specialist laboratory and suggests some tentative guidelines for BCI research teams, appropriate to those deploying the technology, derived from experience on a multisite project. Any tension between deployment and technical progress must be managed by a formal process within a multidisciplinary consortium. (shrink)

Neuroscience is advancing at a rapid pace, with new technologies and approaches that are creating ethical challenges not easily addressed by current ethical frameworks and guidelines. One fascinating technology is neuroimaging, especially functional Magnetic Resonance Imaging (fMRI). Although still in its infancy, fMRI is breaking new ground in neuroscience, potentially offering increased understanding of brain function. Different populations and faith traditions will likely have different reactions to these new technologies and the ethical challenges they bring with them. Muslims are approximately (...) one-fifth of world population and they have a specific and highly regulated ethical and moral code, which helps them deal with scientific advances and decision making processes in an Islamically ethical manner. From this ethical perspective, in light of the relevant tenets of Islam, neuroimaging poses various challenges. The privacy of spirituality and the thought process, the requirement to put community interest before individual interest, and emphasis on conscious confession in legal situations are Islamic concepts that can pose a challenge for the use of something intrusive such as an fMRI. Muslim moral concepts such as There shall be no harm inflicted or reciprocated in Islam and Necessities overrule prohibitions are some of the criteria that might appropriately be used to guide advancing neuroscience. Neuroscientists should be particularly prudent and well prepared in implementing neuroscience advances that are breaking new scientific and ethical ground. Neuroscientists should also be prepared to assist in setting the ethical frameworks in place in advance of what might be perceived as runaway applications of technology. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

The neuroscientific investigation of sex differences has an unsavoury past, in which scientific claims reinforced and legitimated gender roles in ways that were not scientifically justified. Feminist critics have recently argued that the current use of functional neuroimaging technology in sex differences research largely follows that tradition. These charges of ‘neurosexism’ have been countered with arguments that the research being done is informative and valuable and that an over-emphasis on the perils, rather than the promise, of such research threatens to (...) hinder scientific progress. To investigate the validity of these contrasting concerns, recent functional magnetic resonance imaging (fMRI) investigations of sex differences and citation practices were systematically examined. In line with the notion of neurosexism, the research was found to support the influence of false-positive claims of sex differences in the brain, to enable the proliferation of untested, stereotype-consistent functional interpretations, and to pay insufficient attention to the potential plasticity of sex differences in both brain and mind. This, it is argued, creates a literature biased toward the presentation of sex differences in the brain as extensive, functionally significant, and fixed—and therefore implicitly supportive of a gender essentialist perspective. It is suggested that taking feminist criticisms into account would bring about substantial improvement in the quality of the science, as well as a reduction in socially harmful consequences. (shrink)

The default mode network (DMN) has been consistently activated across a wide variety of self-related tasks, leading to a proposal of the DMN’s role in self-related processing. Indeed, there is limited fMRI evidence that the functional connectivity within the DMN may underlie a phenomenon referred to as self-awareness. At the same time, none of the known studies have explicitly investigated neuronal functional interactions among brain areas that comprise the DMN as a function of self-consciousness loss. To fill this gap, EEG (...) operational synchrony analysis was performed in patients with severe brain injuries in vegetative and minimally conscious states to study the strength of DMN operational synchrony as a function of self-consciousness expression. We demonstrated that the strength of DMN EEG operational synchrony was smallest or even absent in patients in vegetative state, intermediate in patients in minimally conscious state and highest in healthy fully self-conscious subjects. At the same time the process of decoupling of operations performed by neuronal assemblies that comprise the DMN was highest in patients in vegetative state, intermediate in patients in minimally conscious state and minimal in healthy fully self-conscious subjects. The DMN’s frontal EEG operational module had the strongest decrease in operational synchrony strength as a function of selfconsciousness loss, when compared with the DMN’s posterior modules. Based on these results it is suggested that the strength of DMN functional connectivity could mediate the strength of self-consciousness expression. The observed alterations similarly occurred across EEG alpha, beta1 and beta2 frequency oscillations. Presented results suggest that the EEG operational synchrony within DMN may provide an objective and accurate measure for the assessment of signs of self-(un)consciousness in these challenging patient populations. This method therefore, may complement the current diagnostic procedures for patients with severe brain injuries and, hence, the planning of a rational rehabilitation intervention. (shrink)

Postmortem evidence of chronic traumatic encephalopathy (CTE) in the brains of American National Football League players who suffered concussions while playing have intensified concerns about the risks of concussion in sport.1 Concussions are frequently sustained by amateur and professional players of Australia’s three most popular football codes (Australian football, rugby league, and rugby union) and, to a lesser extent, other contact sports such as soccer. This raises major concerns about possible long-term neurological damage, cognitive impairment and mental health problems in (...) players of these sports. (shrink)

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents a (...) rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. (shrink)

Abstract When new methods of generating information about individuals leave the confined space of research application the possibility of morally dubious application arises. The current propagation of neuroscientific diagnostics leads to new possibilities of misuse and accordingly new needs for the protection of individual privacy emerge. While most current privacy discussion focuses on sensationalist applications which aim/claim to gather information about psychological traits or even the content of thoughts, the more sober but much more realistic endeavour to gather health data (...) from research or medical imaging studies is widely neglected. I will try to answer the question if and in how far data from neuroscientific imaging technologies require special protection. Two developments form the background of the ethical discussion: the increased diagnostic power of neuroimaging techniques and the wider distribution of this technology beyond specialized medical offices and clinics. The first development is likely to broaden the scope of data, which are considered relevant for health care and related decisions. The latter is likely to widen the scope of persons who might have access to diagnostic results without at the time taking the role of a doctor towards the person diagnosed. I will argue that neuroimaging data are currently primarily medical data and that the associated standards of consent and confidentiality are worth protecting. Even nonmedical applications of neuroimaging technology inherit too much of the diagnostic power for which they were originally invented, for it to be advisable to drop the accompanying consent and confidentiality requirements. (shrink)

Scientific developments take place in a socio-political context but scientists often ignore the ways their innovations will be both interpreted by the media and used by policy makers. In the rush to neuroscientific discovery important questions are overlooked, such as the ways: (1) the brain, environment and behavior are related; (2) biological changes are mediated by social organization; (3) institutional bias in the application of technical procedures ignores race, class and gender dimensions of society; (4) knowledge is used to the (...) advantage of the powerful; and (5) its applications may reinforce existing structures of power that pose ethical questions about distributive justice. The case of crime, deception and functional Magnetic Resonance Imaging (fMRI) shows the complexity, and the political and ethical challenges that confront those who seek to use neuroscience to explain the etiology of crime, and who base policy on its findings. An ethically grounded neuroscience needs to take account of existing structures of power and difference, and to develop a public neuropolitical consciousness that ensures that those subject to risk by the application of science and technology are participants in the decision-making processes involving the implementation of policies that affect them. (shrink)

Neuroscience has been proposed for use in the legal system for purposes of mind reading, assessment of responsibility, and prediction of misconduct. Each of these uses has both promises and perils, and each raises issues regarding the admissibility of neuroscientific evidence.

Neuroscience research examining sex/gender differences aims to explain behavioral differences between men and women in terms of differences in their brains. Historically, this research has used ad hoc methods and has been conducted explicitly in order to show that prevailing gender roles were dictated by biology. I examine contemporary fMRI research on sex/gender differences in emotion processing and argue that it, too, both uses problematic methods and, in doing so, reinforces gender stereotypes.

Producing and interpreting functional brain data is part of the negotiation we imagine our brain. To take a closer look at the idea of brain imaging as a form of visual knowledge, it is necessary to put the research of today into a historical context. In my article I will point to a specific approach of functional imaging which depends on historical shifts entangled with the visual aspect of producing pictures of the brain. I will bring out the interaction of (...) issues like techniques, models and historical assumptions of the brain and link them with the way the brain images are presented. The aesthetic dimensions (Rancière) in the pictures are also questions of ethics and normativity. (shrink)

Postmortem research on the brains of American tackle football players has revealed the presence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated head trauma. Repeated concussion is a risk factor for CTE, raising ethical concerns about the long-term effects of concussion on athletes at risk for football-related concussion. Of equal concern is that youth athletes are at increased risk for lasting neurocognitive and developmental deficits that can result in behavioral disturbances and diminished academic performance. In this (...) article, we consider evidence of the effects of concussion in youth athletes, and discuss ethical duties to youth athletes and how these duties might be satisfied, given the intrinsic risks of football. Finally, we evaluate potential strategies for reducing concussions in junior football, and recommend the optimal strategy for reducing brain injury to an acceptable level while still making available the benefits of football participation for youth athletes. (shrink)

It has become evident that neuroimaging raises new normative questions that cannot be addressed adequately within the (in this regard unspecific) frameworks of existing research ethics. Questions that are especially troubling are, among others, provoked by incidental findings. Two questions are particularly intricate in view of incidental findings: (1) How can the research subject’s right not to know be guaranteed? And (2) should a diagnostic check of scans by a neuroradiologist become an obligatory part of neuroscientific research protocols? The present (...) paper examines these question against the background of two recent recommendations. The differentiation between difference position and similarity position serves as an analytic tool to further investigate the issue and to develop a distinct proposal for answering the questions. (shrink)

Disorders of consciousness pose a substantial ethical challenge to clinical decision making, especially regarding the use of life-sustaining medical treatment. For these decisions it is paramount to know whether the patient is aware or not. Recent brain research has been striving to assess awareness by using mainly functional magnetic resonance imaging. We review the neuroscientific evidence and summarize the potential and problems of the different approaches to prove awareness. Finally, we formulate the crucial ethical questions and outline the different articles (...) in this special issue on disorders of consciousness. (shrink)

Discussions in neuroethics to date have ignored an ever-increasing neuroscientific lilterature on sex differences in brains. If, indeed, there are significant differences in the brains of men versus women and in the brains of boys versus girls, the ethical and social implications loom very large. I argue that recent neuroscientific findings on sex-based brain differences have significant implications for theories of morality and for our understandings of the neuroscience of moral cognition and behavior.

Neuroscience increasingly allows us to explain, predict, and even control aspects of human behavior. The ethical issues that arise from these developments extend beyond the boundaries of conventional bioethics into philosophy of mind, psychology, theology, public policy, and the law. This broader set of concerns is the subject matter of neuroethics. In this book, leading neuroscientist Martha Farah introduces the reader to the key issues of neuroethics, placing them in scientific and cultural context and presenting a carefully chosen set of (...) essays, articles, and excerpts from longer works that explore specific problems in neuroethics from the perspectives of a diverse set of authors. Included are writings by such leading scientists, philosophers, and legal scholars as Carl Elliot, Joshua Greene, Steven Hyman, Peter Kramer, and Elizabeth Phelps. Topics include the ethical dilemmas of cognitive enhancement; issues of personality, memory and identity; the ability of brain imaging to both persuade and reveal; the legal implications of neuroscience; and the many ways in which neuroscience challenges our conception of what it means to be a person. (shrink)

A pressing issue in neuroscience is the high rate of misdiagnosis of disorders of consciousness. As new research on patients with disorders of consciousness has revealed surprising and previously unknown cognitive capacities, the need to develop better and more reliable methods of diagnosing these disorders becomes more urgent. So too the need to expand our ethical and social frameworks for thinking about these patients, to accommodate new concerns that will accompany new revelations. A recent study on trace conditioning and learning (...) in vegetative and minimally conscious patients shows promise as a potential diagnostic and prognostic tool, both for differentiating between states of diminished consciousness, and for predicting patient outcomes, but it also generates fresh concerns about quality of life in patients previously thought to be completely unaware. Optimism about progress in diagnosing and treating disorders of consciousness must be tempered by the understanding that not all progress will necessarily be good for all patients. The prognosis for most patients remains bleak, and we must remain vigilant to acute questions and concerns about welfare and quality of life. (shrink)

Michael Pardo and Dennis Patterson have recently put forward several provocative and stimulating criticisms that strike at the heart of much work that has been done at the crossroads of neuroscience and the law. My goal in this essay is to argue that their criticisms of the nascent but growing field of neurolaw are ultimately based on questionable assumptions concerning the nature of the ever evolving relationship between scientific discovery and ordinary language. For while the marriage between ordinary language and (...) scientific discovery is admittedly not always a happy one, it is an awkward union that nevertheless seems to work itself out with the passage of time. In the following pages, I will try to show that Pardo and Patterson’s primary argumentative strategy ultimately depends on basic assumptions concerning the fixity of language that we should reject. (shrink)

I will argue that the fairly common assumption that brain imaging may compromise people’s privacy in an undesirable way only if moral crimes are committed is false. Sometimes persons’ privacy is compromised because of failures of privacy. A normal emotional reaction to failures of privacy is embarrassment and shame, not moral resentment like in the cases of violations of right to privacy. I will claim that if (1) neuroimaging will provide all kinds of information about persons’ inner life and not (...) only information that is intentionally searched for, and (2) there will be more and more application fields of fMRI and more and more people whose brains will be scanned (without any coercion), then, in the future, shame may be an unfortunately common feeling in our culture. This is because failures of privacy may dramatically increase. A person may feel shame strongly and long, especially if his failure is witnessed by people who he considers relatively important, but less than perfectly trustworthy. (shrink)

This is a report on the 3-day workshop “The Neuroscience of Responsibility” that was held in the Philosophy Department at Delft University of Technology in The Netherlands during February 11th–13th, 2010. The workshop had 25 participants from The Netherlands, Germany, Italy, UK, USA, Canada and Australia, with expertise in philosophy, neuroscience, psychology, psychiatry and law. Its aim was to identify current trends in neurolaw research related specifically to the topic of responsibility, and to foster international collaborative research on this topic. (...) The workshop agenda was constructed by the participants at the start of each day by surveying the topics of greatest interest and relevance to participants. In what follows, we summarize (1) the questions which participants identified as most important for future research in this field, (2) the most prominent themes that emerged from the discussions, and (3) the two main international collaborative research project plans that came out of this meeting. (shrink)

According to many researchers, it is inevitable and obvious that psychiatric illnesses are biological in nature, and that this is the rationale behind the numerous neuroimaging studies of individuals diagnosed with mental disorders. Scholars looking at the history of psychiatry have pointed out that in the past, the origins and motivations behind the search for biological causes, correlates, and cures for mental disorders are thoroughly social and historically rooted, particularly when the diagnostic category in question is the subject of controversy (...) within psychiatry. This is obscured by neuroimaging studies that drive researchers to proclaim 'revolutions' in psychiatry, namely in the DSM. Providing neuroimaging evidence to support the contention that a condition is 'real' is likely to be extremely influential, as has been extensively discussed in the neuroethics literature. This type of evidence will also reinforce the pre-existing beliefs of those researchers or clinicians who are already expecting a biological description. The uncritical credence given to neuroimaging research is an ethical issue, not in its potential for contributing to misdiagnosis per se but because of the motivations that often drive this research. My claim is that this research should proceed with an awareness of presumptions and motivations underlying the field as a whole, in addition to an explicit focus on the past and potential future consequences of classification and diagnosis on the groups of individuals under study. (shrink)

Joshua Greene has argued that several lines of empirical research, including his own fMRI studies of brain activity during moral decision-making, comprise strong evidence against the legitimacy of deontology as a moral theory. This is because, Greene maintains, the empirical studies establish that “characteristically deontological” moral thinking is driven by prepotent emotional reactions which are not a sound basis for morality in the contemporary world, while “characteristically consequentialist” thinking is a more reliable moral guide because it is characterized by greater (...) cognitive command and control. In this essay, I argue that Greene does not succeed in drawing a strong statistical or causal connection between prepotent emotional reactions and deontological theory, and so does not undermine the legitimacy of deontological moral theories. The results that Greene relies on from neuroscience and social psychology do not establish his conclusion that consequentialism is superior to deontology. (shrink)

Purpose: Whereas ethical considerations on imaging techniques and interpretations of neuroimaging results flourish, there is not much work on their preconditions. In this paper, therefore, we discuss epistemological considerations on neuroimaging and their implications for neuroethics. Results: Neuroimaging uses indirect methods to generate data about surrogate parameters for mental processes, and there are many determinants influencing the results, including current hypotheses and the state of knowledge. This leads to an interdependence between hypotheses and data. Additionally, different levels of description are (...) involved, especially when experiments are designed to answer questions pertaining to broad concepts like the self, empathy or moral intentions. Interdisciplinary theoretical frameworks are needed to integrate findings from the life sciences and the humanities and to translate between them. While these epistemological issues are not specific for neuroimaging, there are some reasons why they are of special importance in this context: Due to their inferential proximity, 'neuro-images' seem to be self-evident, suggesting directness of observation and objectivity. This has to be critically discussed to prevent overinterpretation. Additionally, there is a high level of attention to neuroimaging, leading to a high frequency of presentation of neuroimaging data and making the critical examination of their epistemological properties even more pressing. Conclusions: Epistemological considerations are an important prerequisite for neuroethics. The presentation and communication of the results of neuroimaging studies, the potential generation of new phenomena and new 'dysfunctions' through neuroimaging, and the influence on central concepts at the foundations of ethics will be important future topics for this discipline. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

The article addresses the potential impact of functional brain imaging (functional magnetic resonance imaging and positron-emission tomography) on surrogate end-of-life decision-making in light of varying state-law definitions of consciousness, some of which define awareness behaviorally and others functionally. The article concludes that, in light of admonitions by neuroscientists that functional brain imaging cannot yet replace behavioral evaluation to determine the existence of consciousness, state legislatures, courts and drafters of written advance healthcare directives should consider treating behavior, not function, as the (...) touchstone for end-of-life decision-making. (shrink)

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology (...) about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice. (shrink)