Neuroethics

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Human brain organoids (HBOs) are novel entities that may exhibit unique forms of cognitive potential. What moral status, if any, do they have? Several authors propose that consciousness may hold the answer to this question. Others identify various _kinds of_ consciousness as crucially important for moral consideration, while leaving open the challenge of determining whether HBOs have them. This paper aims to make progress on these questions in two ways. First, it proposes a framework for thinking about the moral status (...) of entities other than paradigmatic persons. This framework identifies four qualities that ground moral status: evaluative stance, self-directedness, agency, and other-directedness. Second, we speculate on ways in which these qualities are relevant to dimensions of conscious experience that have been, or could be, identified in nonhuman animals. We further explore how these approaches could be adapted for use in HBOs, and argue that such studies, or something similar to them, will have to be performed if we wish to have empirical indications that HBOs have consciousness of a morally significant kind. We end by proposing that in our current scientific and epistemic situation, it is too soon to attribute any moral status to HBOs, but that this might change in the future. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should those (...) close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

We explored the care experiences and needs of the home caregivers of patients with amyotrophic lateral sclerosis (ALS) to improve their quality of life. We interviewed home caregivers in-depth and analyzed the data using Colaizzi's descriptive phenomenological method. We interviewed 11 home caregivers of patients with ALS with a disease duration between 1.5 and 4 years. Primary caregivers were predominantly female and were the patients' spouses. Daily caregiving time averaged 4–14 h for 0.5–3.5 years. Interview themes included helplessness and adaptation (...) to life changes, hopelessness, compassion for the patient’s prognosis, and expectation for diverse support. The study sample size was limited, as all participants were from a single tertiary hospital, and all patients had severe functional impairment. Caregivers of patients with ALS experience a considerable burden. Patients and their caregivers can benefit from diversified support channels, and assistive communication systems can be applied to home care. Future research will focus on in-home public long-term care services in China. (shrink)

The ethical value—and to some scholars, necessity—of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the (...) nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of post-trial care. We provide an overview of some of the potential post-trial care provisions that may be appropriate in psychedelic clinical trials. Although the World Medical Association’s Declaration of Helsinki calls on researchers, sponsors, and governments to make provisions for post-trial access, such provision may feel impracticable or out-of-reach within psychedelic trials that are already constrained by a high resource demand and significant bureaucratic burden. We show how conceiving of post-trial provision as an integral site of the research process, and an appropriate destination for research funding, will serve to develop the infrastructure necessary for the post-legalisation psychedelic medicine ecosystem. (shrink)

Advances in neurotechnologies, artificial intelligence (AI) and Big Data analytics are allowing interpretation of patterns from brain data to identify and even predict and manipulate mental states. Furthermore, there are avenues through which brain data can move into the consumer sphere, be reidentified and brokered. In response to these developments, there have been a number of approaches proposed to strengthen protections of brain data. To better understand the landscape of brain data protection discussions, we conducted a scoping review to identify (...) the rationales for establishing brain data protections and the proposals for protecting brain data offered in the ethics and neuroscience literature. To draw comparisons, we also surveyed the rationales given in the literature for the protection of sensitive behavioral inferences drawn from other types of personal data and associated approaches to achieving protection. This systematic examination of the rationale behind heightened protection for brain data should be useful to clarify the functional and conceptual bases given for brain data protection and to provide a better grounding for evaluating how the different approaches to brain data protection address these concerns. (shrink)

Should offenders with psychopathy or those exhibiting extreme forms of antisocial behav- iour be considered criminally responsible? The current debate seems to have reached a stalemate. Several scholars have argued that neuropsychologi- cal data on individuals with psychopathy might be relevant for determining their criminal responsibil- ity. However, relying on such data has not produced a consensus among legal scholars and philosophers on whether individuals with psychopathy should be excused from responsibility. We offer a diagnosis about why this debate has (...) reached a standoff. We argue that part of the problem is that psychopathy, being a syndrome-based category, is too heterogeneous and thus offers low prospects for being integrated with neuropsychological data that might support significant conclusions about the criminal responsibility of individuals with psychopathy. Moreover, the construct of psychopathy was not originally devised to discriminate criminally accountable from unac- countable antisocial individuals. To overcome these difficulties and advance the debate, we extend a currently less discussed theoretical framework for bridging biopsychology and the law that focuses on neuropsychological constructs, domains, and processes that directly measure capacities of offenders that are relevant for criminal responsibility, without necessarily relying on mediating syndrome-based constructs. The novelty of our contribution is that the biopsy- chological bases of exculpation can be further devel- oped and used for determining more fine-grained cat- egorisations of antisocial personality types. We show how this framework provides guidelines for inter- disciplinary research that can significantly advance our understanding of the preconditions for criminal responsibility and help the legal practice of ascribing or withholding it. (shrink)

Wexler and Sullivan (2023) recommend integration as a guiding principle for translational neuroethics. We agree that collaboration between neuroethicists and other professionals can advance the fie...

The momentum for global neuroscience that is geopolitically-free has never been greater, and neuroethics holds a unique place in this context both in its translational and transnational forms.In th...

Today, nearly two years after Wexler and Sullivan’s (2023) article was first published, the crucial questions discussed therein are all the more pertinent and troubling. The advent of novel interve...

Wexler and Specker Sullivan (2023) note that, “unbridled speculation can imperil the credibility of neuroethics, generate unrealistic expectations amongst different stakeholders, take up time that...

Wexler and Specker (2023) offer a review of criticisms directed against what they describe as the relatively new field of neuroethics and offer as solution the development of a more “integrated, in...

Anna Wexler and Laura Specker Sullivan (2023) draw on their positionality as Global North early career neuroethics scholars to initiate a meaningful and timely conversation on Translational Neuroet...

Wexler and Specker Sullivan (2023) reflect on the field of neuroethics by highlighting criticisms from both scholars within and outside the field. Among these criticisms, are claims that neuroethic...

In their valuable call-for-action article, Wexler and Specker Sullivan (2023) propose an integration–inclusion–impact axis for “translational neuroethics,” to face the challenges and criticisms tha...

As early-career neuroethicists, we come to the field of neuroethics at a unique moment: we are well-situated to consider nearly two decades of neuroethics scholarship and identify challenges that have persisted across time. But we are also looking squarely ahead, embarking on the next generation of exciting and productive neuroethics scholarship. In this article, we both reflect backwards and turn our gaze forward. First, we highlight criticisms of neuroethics, both from scholars within the field and outside it, that have focused (...) on speculation and lack of skepticism; the dearth of consideration of broader social issues such as justice and equality, both with regard to who speaks for neuroethics as a field and who benefits from its recommendations and findings; and the insufficient focus on the practical impact of our ethical work. Second, we embrace the concept of “translational neuroethics” to outline a vision for neuroethics that is integrated, inclusive, and impactful. Integration can help us identify more pertinent, real-world issues, and move away from speculation; inclusivity can help ensure that the questions we attend to are not merely relevant to a single subgroup but aim toward just distribution of benefits; and impact can help us think beyond guidelines and recommendations to focus on implementation. Our goal is for this call to action to help shape neuroethics into a discipline that develops rigorous research agendas through relationships with interdisciplinary partners, that is broadly inclusive and attends to issues beyond novel neurotechnologies, and that is devoted to the translation of scholarship into practice. (shrink)

Interventions designed to promote perspective taking are increasingly prevalent in educational settings, and are also being considered for applications in other domains. Thus far, these perspective-taking interventions (PTIs) have largely escaped philosophical attention, however they are sometimes prima facie morally problematic in at least two respects: they are neither transparent nor easy to resist. Nontransparent or hard-to-resist PTIs call for a moral defense and our primary aim in this paper is to provide such a defense. We offer two arguments for (...) the view that an exemplar PTI is morally permissible even though it is plausibly neither transparent nor easy to resist. The first argument appeals to an analogy between PTIs and permissible deceptive research practices. The second appeals to the way in which PTIs draw participants’ attention to their reasons for action. We also respond to the objection that, by imposing a particular conception of the good, PTIs violate liberal neutrality. (shrink)

In this paper, we outline how one might conduct a comprehensive ethical evaluation of human brain organoid transplantation in animals. Thus far, ethical concerns regarding this type of research have been assumed to be similar to those associated with other transplants of human cells in animals, and have therefore not received significant attention. The focus has been only on the welfare, moral status, or mental capacities of the host animal. However, the transplantation of human brain organoids introduces several new ethical (...) issues. Many of these are related to uncertainty regarding whether or not brain organoids might be conscious. While these concerns might not be immediately relevant, they warrant closer scrutiny. We discuss how various ethical issues are relevant to different stages of human brain organoid transplantation and can guide the ethical evaluation of research. Our examination would broaden the horizons of the debate on the transplantation of brain organoids. (shrink)

This article investigates the challenges posed by the reliability of knowledge in neurophenomenology and its connection to reality. Neurophenomenological research seeks to understand the intricate relationship between human consciousness, cognition, and the underlying neural processes. However, the subjective nature of conscious experiences presents unique epistemic challenges in determining the reliability of the knowledge generated in this research. Personal factors such as beliefs, emotions, and cultural backgrounds influence subjective experiences, which vary from individual to individual. On the other hand, scientific knowledge (...) aims to uncover universal truths based on empirical observations and objective principles. Reconciling the subjective and objective realms presents a significant challenge in determining the reliability of knowledge generated through neurophenomenological research. This article aims to examine the inherent limitations and challenges of neurophenomenological research to shed light on the complexities involved in understanding the nature of knowledge itself. This article highlights that the ontological implications of the reliability of knowledge in neurophenomenology arise from the question of how subjective experiences relate to objective reality. Understanding the neural correlates and mechanisms behind subjective experiences can provide insight into the underlying ontological nature of consciousness. (shrink)

There is growing interest in the use of neurointerventions to reduce the risk that criminal offenders will reoffend. Commentators have raised several ethical concerns regarding this practice. One prominent concern is that, when imposed without the offender’s valid consent, neurointerventions might infringe offenders’ right to bodily integrity. While it is commonly held that we possess a moral right to bodily integrity, the extent to which this right would protect against such neurointerventions is as-yet unclear. In this paper, we will assess (...) whether, why, and how severely three forms of neurointervention might infringe the right to bodily integrity. We show that the severity of the infringement of the right to bodily integrity differs across different forms of neurointervention. Moreover, we argue that mental and behavioral effects of neurointerventions could in some cases be relevant to determining the severity of infringements of the right to bodily integrity. (shrink)

Brain age prediction is a relatively new tool in neuro-medicine and the neurosciences. In research and clinical practice, it finds multiple use as a marker for biological age, for general health status of the brain and as an indicator for several brain-based disorders. Its utility in all these tasks depends on detecting outliers and thus failing to correctly predict chronological age. The indicative value of brain age prediction is generated by the gap between a brain’s chronological age and the predicted (...) age, the brain age gap (BAG). This article shows how the clinical and research use of brain age prediction tacitly pathologizes the states that it is sensitive to. It will be argued that the tacit character of this transformation conceals the need for its explicit justification. (shrink)

Addiction is a common condition affecting millions of people worldwide of which only a small proportion receives treatment. The development and use of healthcare services is influenced by how addiction is understood (e.g., a condition to treat, a shameful condition to stigmatize), notably with respect to how volition is impacted (e.g., addiction as a choice or a disease beyond one’s control). Through semi-structured qualitative interviews, we explore the implicit views and understandings of addiction and volition across three stakeholder groups: people (...) with lived experience of addiction, clinicians with experience treating addiction, and members of the public without lived experience of addiction. We notably examine whether three paradigms, i.e., three philosophical sets of understandings about the nature of reality and knowledge (realism, relativism, pragmatism) reflect how stakeholders envision addiction and volition in the context of addiction. The use of these paradigms allows for the characterization of different stances on addiction and volition and an assessment of the coherence of beliefs about these matters. Our findings demonstrate that few participants relied on a single epistemic paradigm when describing their views. Furthermore, there were notable differences in understandings of volition between the clinician group, who were more oriented toward pragmatism, and people with lived experience of addiction, who were less oriented toward realism. Despite its limitations, our study suggests that a greater appreciation for the complexity of views held by different stakeholders about addiction and volition could help critically assess the search for coherence expressed in academic and policy debates. (shrink)

Advances in research on human cerebral organoids (HCOs) call for a critical review of current research policies. A challenge for the evaluation of necessary research regulations lies in the severe uncertainty about future trajectories the currently very rudimentary stages of neural cell cultures might take as the technology progresses. To gain insights into organotypic cultures, ethicists, legal scholars, and neuroscientists rely on resemblances to the human brain. They refer to similarities in structural or functional terms that have been established in (...) scientific practice to validate organotypic cultures as models for brain research. In ethical discourse, however, such similarities are also used to justify assumptions about the potential risk to cause harm to HCOs. Ethicists assume that as the technology advances, organotypic cultures will increasingly resemble the human brain, raising more complex ethical issues. I argue that such reasoning is not justified given the heterogeneity of HCOs that have been modified to enable scientists to pursue their research goals. I then discuss the implications this line of thought has for advocates of the precautionary principle, focussing on those suggestions which propose adopting research regulations to the presence of bodily warning signs deemed worthy of protection. In doing so, I illustrate that the prevalent assumptions on similarity in ethical discourse ultimately risk disproportionately restricting research. I conclude that given the severe uncertainty about the technology’s future development, ethical discourse might benefit from narrowing the time frame for anticipation. (shrink)

In the article “The Socio-Political Roles of Neuroethics and the Case of Klotho,” we proposed a socio-political approach to neuroethics, inspired by John Rawls’s roles for political philosophy. In...

From epileptic seizures to depressive symptoms, predictive neurotechnologies are used for a large range of applications. In this article we focus on advisory devices; namely, predictive neurotechnology programmed to detect specific neural events (e.g., epileptic seizure) and advise users to take necessary steps to reduce or avoid the impact of the forecasted neuroevent. Receiving advise from a predictive device is not without ethical concerns. The problem with predictive neural devices, in particular advisory ones, is the risk of seeing one’s autonomous (...) choice supplanted by the predictions instead of being supplemented by it. For users, there is a potential shift from being assisted by the system to being over-dependent on the technology. In other terms, it introduces ethical issues associated with epistemic dependency. In this article, we examine the notion of epistemic authority in relation to predictive neurotechnologies. Section 1 of our article explores and defines the concept of epistemic authority. In section 2, we illustrate how predictive devices are best conceived of as epistemic authorities and we explore the subject-device epistemic relationship. In section 3, we spell out the risk of harms interconnected with epistemic deferral. We conclude by stressing a set of preliminary measures to prepare users for the authoritative nature of predictive devices. (shrink)

Crutchfield (Crutchfield in Bioethics 33:112–121, [4]) has argued that if moral bioenhancement (MBE) ought to be compulsory, then it ought to be covert. More precisely, they argue that MBE is a public health intervention, and for this reason should be governed by public health ethics. Taking from various public health frameworks, Crutchfield provides an array of values to consider, such as: utility, liberty, equality, transparency, social trust, and autonomy. Subsequently, they argue that a covert MBE programme does better than an (...) overt one, in preserving or promoting said values, and hence, that a covert MBE is preferable. In this paper, I will provide novel reasons to doubt that the relevant values are in fact better promoted or preserved by a covert MBE programme. Additionally, I will provide a novel autonomy-based consideration which counts in favour of the MBE programme being overt, rather than covert. Given that as things currently stand it is unclear which kind of MBE programme is preferable, the upshot of my criticism of Crutchfield will be to provide some recommendations as to how we might proceed in establishing whether a covert or overt MBE programme fares better. (shrink)

The concept of mental integrity is currently a significant topic in discussions concerning the regulation of neurotechnologies. Technologies such as deep brain stimulation and brain-computer interfaces are believed to pose a unique threat to mental integrity, and some authors have advocated for a legal right to protect it. Despite this, there remains uncertainty about what mental integrity entails and why it is important. Various interpretations of the concept have been proposed, but the literature on the subject is inconclusive. Here we (...) consider a number of possible interpretations and argue that the most plausible one concerns neurotechnologies that bypass one’s reasoning capacities, and do so specifically in ways that reliably lead to alienation from one’s mental states. This narrows the scope of what constitutes a threat to mental integrity and offers a more precise role for the concept to play in the ethical evaluation of neurotechnologies. (shrink)

Objectives To characterize recruitment approaches to research on the brain and mind that involves Indigenous peoples. Methods We conducted a secondary analysis of a Harding et al. (2021) scoping review. Reviewers screened studies (_n_ = 66) for sampling methods, recruitment and engagement, positionality statements, and details on ethics approvals. Synthesis We identified twenty-nine (29) English-language articles relevant to the analysis. Of these, 52% (_n_ = 15/29) reported a mix of sampling methods; 45% (_n_ = 13/29) contained statements or information about (...) author positionalities. While, overall, 24% (_n_ = 7/29) of the studies were missing information about ethics protocols, we observe an improvement over time in the reporting of approvals and use of community-engaged participant recruitment methods. Current brain research studies demonstrate ways of collaborating with Indigenous communities that meet existing ethics guidelines. To be wholly responsive to the needs of Indigenous peoples, however, researchers may need to exceed existing ethical benchmarks.. Positionality statements successfully detailed the relationships of the research teams with the communities with which they work, and contextualized recruitment methods. Conclusion Improved quality and meaningfulness of brain research with Indigenous peoples and trust in the research process and public health will be enhanced when remaining gaps in protecting and reporting of participant recruitment methods are closed. (shrink)

In this article, we propose a philosophical exploration on the main problems involved in two neurorights that concern autonomous action, namely free will and cognitive liberty, and sketch a possible solution to these problems by resourcing to a holistic interpretation of human actions. First, we expose the main conceptual and practical issues arising from the neuroright to “free will,” which are far from minor: the term itself is denied by some trends participating in the neurorights debate, the related concept of (...) ultimate control is also disputed, the understanding of free will depends on cultural context, and the exercise of being free to act in several domains may be covered by other regulations. Second, we analyze the historical origin of cognitive liberty, its current status, and its relation with free will. Third, we criticize the concept of decision in mainstream action theory and propose to conceive action as a unified process constituted by three explanatory, non-sequential dimensions: intention, decision, and action realization. Fourth, we discuss two possible cases involving neurotechnologies and suggest ways to interpret them according to a unified framework in which free will and cognitive liberty fall under a single neuroright to personal autonomy. Finally, we outline a recommendation to introduce freedom of thought and personal autonomy as complementary neurorights to protect both the internal and external dimensions of thought and action. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

This chapter reviews fundamental ethical controversy surrounding the ongoing effort to revise the Uniform Determination of Death Act in the United States. Instead of focusing on the process of the revision itself, the chapter explores the underlying ethical debate over brain death that has been ongoing for many decades and finally culminated in this revision. Three issues are focused: the requirement for consent and personal exemptions before applying brain death for the diagnosis of death; redefining the areas of the brain (...) that have ceased to function in the definition of brain death; and codifying the American Academy of Neurology as the authority to issue the standards of the diagnosis of brain death. The chapter concludes that allowing the personal choice of death determination gives a pragmatic compromise to the disputed definition and practice of diagnosing brain death. So long as all risks and imperfections of the diagnosis are accepted through the consenting process, there is nothing ethically objectionable to continuing the current practice of diagnosing brain death as a successful tool to facilitate heart-beating organ donation without violating the dead-donor rule. By contrast, precluding personal choice and imposing legal restrictions to consent and exemptions would further erode public trust. (shrink)

As neuroethics continues to grow as an established discipline, it has been charged with not being sufficiently sensitive to the way in which the identification, conceptualization, and management of the ethical issues raised by neuroscience and its applications are shaped by local systems of knowledge and structures. Recently there have been calls for explicit recognition of the role played by local cultural contexts and for the development of cross‐cultural methodologies that can facilitate meaningful cultural engagement. In this article, we attempt (...) to fill this perceived gap by providing a culturally situated analysis of the practice of electroconvulsive therapy (ECT) in Argentina. ECT was introduced as a psychiatric treatment in Argentina in the 1930s but it is largely underutilized. While the use of ECT remains low in several countries, what makes the Argentinian case interesting is that the executive branch of government has taken a stance regarding both the scientific and moral appropriateness of ECT, recommending its prohibition. Here, we begin with a recent controversy over the use of ECT in Argentina and explain the legal recommendation to ban its application. Next, we offer an overview of some of the salient aspect of the international and local discussions on ECT. We argue that the governmental recommendation to ban the procedure should be rethought. While acknowledging the role that contexts and local conditions play in shaping the identification and assessment of the relevant ethical issues, we caution against using contextual and cultural considerations to avoid a necessary ethical debate on controversial issues. (shrink)

Mild Cognitive Impairment (MCI) is a diagnostic category indicating cognitive impairment which does not meet diagnostic criteria for dementia such as Alzheimer’s disease. There are public health concerns about Alzheimer’s disease (AD) prompting intervention strategies to respond to predictions about the impacts of ageing populations and cognitive decline. This relationship between MCI and AD rests on three interrelated principles, namely, that a relationship exists between AD and MCI, that MCI progresses to AD, and that there is a reliable system of (...) classification of MCI. However, there are also several ethical issues and problems arising in the AD/MCI relationship. These include early diagnosis and interventions, the effects on people with MCI, and the newer neuroimaging and neuropharmacological approaches used in diagnosis and treatment. All these issues pose questions about the principles of MCI in relation to AD, with implications for how MCI is understood, diagnosed, treated, and experienced by patients. This article analyses four challenging areas for neuroethics: the definition and diagnosis of MCI; MCI in relation to AD; clinical implications of MCI for ethical disclosure, diagnosis, and treatment; and the research implications of MCI. The significant connections between these areas are often overlooked, together with uncertainties overall. Patients, healthcare systems and society are best served by informed clinicians, academics and researchers. After 35 years, the store of MCI knowledge is expanding and evolving. (shrink)

It is plausible that current generations owe something to future generations. One possibility is that we have a duty to not harm them. Another possibility is that we have a duty to protect them. In either case, however, to satisfy the duties to future generations from environmental or political degradation, we need to engage in widespread collective action. But, as we are, we have a limited ability to do so, in part because we lack the self-discipline necessary for successful collective (...) action. Given that having an obligation hinges on being able to satisfy it, the apparent duty to future generations is at odds with our apparent inability to satisfy it. Thus, we either need to rethink our duties to future generations or rethink the nature of our abilities. I argue in this chapter that we should rethink the nature of our abilities. Specifically, we should enhance our self-discipline, which is distinct from enhancements of motivation, judgment, or emotion. Even the most intelligent, motivated, and empathetic actor is likely to slip up, which encourages others to withdraw their cooperation. Without the necessary self-discipline to sustain our public cooperative behavior, collective action is likely to fail, leaving us with one alternative: to abandon our duties to future generations. (shrink)

While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the needs of patients, in contrast to modern (...) neuroethics, which is more speculative and distant from the lived reality of the clinic. Using recent developments in the diagnosis and treatment of disorders of consciousness, and the history of the vegetative and minimally conscious states, Fins asks why modern neuroethics has taken this turn and what can be done to restore clinical neuroethics to a more proportionate place in the field. (shrink)

Racial and ethnic disparities exist for many nervous system disorders that are intervention targets for neuromodulation investigators. Yet, to date, there has been both a lack of racial and ethnic diversity and a lack of emphasis on diversity in neuromodulation research. In this paper, we suggest three potential reasons for the lack of racial and ethnic diversity in neuromodulation research: 1) the lack of diversity in the neuromodulation workforce, 2) incompatibility between the technologies employed and phenotypic traits (e.g., hair texture) (...) commonly present in minoritized populations, and 3) minoritized populations’ reluctance to participate in clinical trials. We argue that increasing diversity in the neuromodulation workforce, in conjunction with mutual collaboration between current neuromodulation researchers and underrepresented communities in neuromodulation, can aid in removing barriers to diversity, equity, and inclusion in neuromodulation research. This is important, because greater diversity, equity, and inclusion in neuromodulation research brings with it the development of novel, yet safe and effective, treatment approaches for brain disorders and enhances the rigor and generalizability of discoveries in the field. (shrink)

Family members can provide crucial support to individuals participating in clinical trials. In research on the “newest frontier” of Deep Brain Stimulation (DBS)—the use of DBS for psychiatric conditions—family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their (...) family members as interview participants. Using dyadic thematic analysis—an approach that takes both the individuals and the relationship as units of analyses—this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. (shrink)

There is little debate regarding the acceptability of providing medical care to restore physical or mental health that has deteriorated below what is considered typical due to disease or disorder (i.e., providing “treatment”—for example, administering psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of enhancing their capacities (i.e., “enhancement”—for example, use of a psychostimulant as a “study drug”), people often express greater hesitation. (...) Building on prior research in moral philosophy and cognitive science, in this work, we ask why people draw a moral distinction between treatment and enhancement. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive or statistical normality (Experiment 1), and that gains in descriptive normality for such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, our findings suggest that the tendency to draw a moral distinction between treatment and enhancement is driven, in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could undermine people’s selective opposition toward enhancement, rendering it morally comparable to treatment. (shrink)

How many factors, i.e. departures from normality, are necessary to explain a delusion? Maher’s classic one-factor theory argues that the only factor is the patient’s anomalous experience, and a delusion arises as a normal explanation of this experience. The more recent two-factor theory, on the other hand, contends that a second factor is also needed, with reasoning abnormality being a potential candidate, and a delusion arises as an abnormal explanation of the anomalous experience. In the past few years, although there (...) has been an increasing number of scholars offering a variety of arguments in defence of Maher’s one-factor theory, these arguments have not been adequately addressed by two-factor theorists. This paper aims to address this gap by critically examining the arguments on three crucial issues: the intelligibility of delusions, the dissociation between anomalous experiences and delusions, and the empirical evidence of a second factor. I will argue that the Maherian notion of anomalous experience is not sufficient for explaining delusions and the two-factor theory is on the right track in its search for the missing factor in the aetiology of delusions. (shrink)

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

Invasive neurotechnologies are a frequent subject of discussion in neuroethics. Technologies, like deep brain stimulation and implantable brain-computer interfaces, are thought to hold significant promise for human health and well-being, but they also raise important ethical questions about autonomy, safety, stigma, privacy, and agency, among others. The terms ‘invasive’ and ‘invasiveness’ are commonly applied to these and other neurotechnologies, yet the concept of invasiveness itself is rarely defined or delimited. Some have suggested that invasiveness may have multiple meanings – physical, (...) emotional, or lifestyle – and that confusion about how people use the terms may lead to harm, especially for users of invasive devices. It is uncertain if debates in neuroethics contribute to this confusion. To investigate this, we conducted a study of how the term ‘invasiveness’ is used in neuroethics. We found that neuroethicists almost always use ‘invasiveness’ to refer to the physical features of interventions, and rarely to refer to other senses of invasiveness. We also found that referencing invasiveness does not determine which ethical issues are prioritized for a given type of neurotechnology. Overall, this study affirms the importance of understanding the meaning and use of the concept of invasiveness in ethical discussion of neurotechnology while also suggesting the need for further work in the area and consideration for rethinking what forms of technology we consider to be invasive. (shrink)

A growing number of technologies are currently being developed to improve and distribute thinking and decision-making. Rapid progress in brain-to-brain interfacing and swarming technologies promises to transform how we think about collective and collaborative cognitive tasks across domains, ranging from research to entertainment, and from therapeutics to military applications. As these tools continue to improve, we are prompted to monitor how they may affect our society on a broader level, but also how they may reshape our fundamental understanding of agency, (...) responsibility, and other key concepts of our moral landscape.In this paper we take a closer look at this class of technologies – Technologies for Collective Minds – to see not only how their implementation may react with commonly held moral values, but also how they challenge our underlying concepts of what constitutes collective or individual agency. We argue that prominent contemporary frameworks for understanding collective agency and responsibility are insufficient in terms of accurately describing the relationships enabled by Technologies for Collective Minds, and that they therefore risk obstructing ethical analysis of the implementation of these technologies in society. We propose a more multidimensional approach to better understand this set of technologies, and to facilitate future research on the ethics of Technologies for Collective Minds. (shrink)

Neurotechnologies broadly understood are tools that have the capability to read, record and modify our mental activity by acting on its brain correlates. The emergence of increasingly powerful and sophisticated techniques has given rise to the proposal to introduce new rights specifically directed to protect mental privacy, freedom of thought, and mental integrity. These rights, also proposed as basic human rights, are conceived in direct relation to tools that threaten mental privacy, freedom of thought, mental integrity, and personal identity. In (...) this paper, our goal is to give a philosophical foundation to a specific right that we will call right to mental integrity. It encapsulates both the classical concepts of privacy and non-interference in our mind/brain. Such a philosophical foundation refers to certain features of the mind that hitherto could not be reached directly from the outside: intentionality, first-person perspective, personal autonomy in moral choices and in the construction of one's narrative, and relational identity. A variety of neurotechnologies or other tools, including artificial intelligence, alone or in combination can, by their very availability, threaten our mental integrity. Therefore, it is necessary to posit a specific right and provide it with a theoretical foundation and justification. It will be up to a subsequent treatment to define the moral and legal boundaries of such a right and its application. (shrink)

This paper argues that calls for neurorights propose an overcomplicated approach. It does this through analysis of ‘rights’ using the influential framework provided by Wesley Hohfeld, whose analytic jurisprudence is still well regarded in its clarificatory approach to discussions of rights. Having disentangled some unclarities in talk about rights, the paper proposes the idea of ‘novel human rights’ is not appropriate for what is deemed worth protecting in terms of mental integrity and cognitive liberty. That is best thought of in (...) terms of Hohfeld’s account of ‘right’ as privilege. It goes on to argue that as privileges, legal protections are not well suited to these cases. As such, they cannot be ‘novel human rights’. Instead, protections for mental integrity and cognitive liberty are best accounted for in terms of familiar and established rational and discursive norms. Mental integrity is best thought of as evaluable in terms of familiar rational norms, and cognitive freedom is constrained by appraisals of sense-making. Concerns about how neurotechnologies might pose particular challenges to mental integrity and cognitive liberty are best protected through careful use of existing legislation on data protection, not novel rights, as it is via data that risks to integrity and liberty are manifested. (shrink)