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Minding Brain Science in Medicine: On the Need for Neuroethical Engagement for Guidance of Neuroscience in Clinical Contexts

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Abstract

The Presidential Commission for the Study of Bioethical Issues (PCSBI) released the second volume of its Gray Matters report in March 2015 to address neuroethical, legal, and social issues arising in and from efforts of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. In concert with recommendations made in the Gray Matters volumes, we herein offer what we believe to be four crucial—and actionable—goals for neuroethics: First, neuroethics should be dedicated to evaluating the validity and value of current and proposed approaches to assessing and altering the structure and functions of the brain. Second, neuroethical tools and methods must be developed to interpret, and enable sound use of neuroscientific information, techniques, and technologies in biomedical research and clinical practice. Third, neuroethics should use newly emerging neuroscientific findings to inform common conceptions and definitions of the normal structure and functions of the brain, and how the brain should be treated to recover or improve its functional capacities. Fourth, neuroethics should be prominently featured in the education and training of researchers and clinicians, so as to enable more pragmatic and ethically prudent capability in laboratory and clinical settings, as well as policy-and public-oriented fields, organizations, and agencies.
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Ethics in Biology, Engineering & Medicine - An International Journal, 6(1–2): 37–42 (2015)
Minding Brain Science in Medicine: On
the Need for Neuroethical Engagement
for Guidance of Neuroscience in Clinical
Contexts
James Giordano1,* & John R. Shook2
1Department of Neurology and Neuroethics Studies Program, Pellegrino Center for Clinical
Bioethics, Georgetown University Medical Center, Washington DC, USA; 2Department of
Philosophy, and Graduate School of Education, University at Buffalo, Buffalo New York, USA
*Address all correspondence to: Professor J. Giordano PhD; Dept. of Neurology and Neuroethics Studies Program,
Georgetown University Medical Center, 4000 Reservoir Rd, Bldg. D, Rm. 238, Washington DC, USA 20057; Phone:
202-687-1160; E-mail: james.giordano@georgetown.edu
ABSTRACT: The Presidential Commission for the Study of Bioethical Issues (PCSBI) released
the second volume of its Gray Matters report in March 2015 to address neuroethical, legal, and
social issues arising in and from efforts of the Brain Research through Advancing Innovative
Neurotechnologies (BRAIN) Initiative. In concert with recommendations made in the Gray
Matters volumes, we herein offer what we believe to be four crucial—and actionable—goals for
neuroethics: First, neuroethics should be dedicated to evaluating the validity and value of cur-
rent and proposed approaches to assessing and altering the structure and functions of the brain.
Second, neuroethical tools and methods must be developed to interpret, and enable sound use
of neuroscientic information, techniques, and technologies in biomedical research and clini-
cal practice. Third, neuroethics should use newly emerging neuroscientic ndings to inform
common conceptions and denitions of the normal structure and functions of the brain, and how
the brain should be treated to recover or improve its functional capacities. Fourth, neuroethics
should be prominently featured in the education and training of researchers and clinicians, so
as to enable more pragmatic and ethically prudent capability in laboratory and clinical settings,
as well as policy- and public-oriented elds, organizations, and agencies.
KEY WORDS: neuroethics; neuroscience; neurotechnology; medicine; guidelines; funding;
education
I. BACKGROUND
The Presidential Commission for the Study of Bioethical Issues (PCSBI) released the
second volume of its Gray Matters report in March 20151 in response to President
Obama’s 2013 request to directly address neuroethical, legal, and social issues aris-
ing in, and from efforts and developments of, the Brain Research through Advancing
Innovative Neurotechnologies (BRAIN) Initiative.2 This new report, subtitled Topics at
the Intersection of Neuroscience, Ethics, and Society,3 enlarges upon the emphasis of
the rst volume of Gray Matters call for “…integrating ethics explicitly and systemati-
cally into the relatively new eld of contemporary neuroscience…to…consider societal
Ethics in Biology, Engineering & Medicine - An International Journal
38 Giordano & Shook
implications of neuroscience research from the start.”4
Upholding ethical standards for evaluating biomedical advances has long been a
task of bioethics in general and medical ethics in particular. Accordingly, the Presidential
Commission provided fourteen recommendations embodying four ethical priorities for the
BRAIN initiative, namely: advancing public health and welfare, protecting the autonomy
and best interests of the vulnerable, promoting the justice of resource distribution and of the
legal system, and preventing harms from public ignorance about neuroscientic matters.
II. THE NEED FOR NEUROETHICS
The second volume of Gray Matters clearly identied the need to address these issues.
Since its titular inception some thirteen years ago, the eld of neuroethics has developed
to engage both the ethical concerns accompanying the progress of neuroscience, and
radical implications of neuroscience for conceptions of the self and our ability to be
moral beings.5 Neuroscience and neurotechnology are, and will increasingly be, den-
ing new capabilities to assess and affect the brain, and these are generating both exciting
opportunities—and provocative, if not somewhat controversial challenges—in neurol-
ogy, psychiatry, rehabilitation, and pain care in pediatric, adult, and geriatric settings.
The neuroethical questions, debates, and problems fostered by these developments
and their applications are real, here, and now, and will only expand and be amplied
given that this year’s BRAIN initiative funding is dedicated to advancing translational
programs at the National Institutes of Health (NIH), and sustains rst-year allocations in
support of ongoing medical translational projects [e.g., Systems-Based Neurotechnology
for Emerging Therapies (SUBNETS), and Restoring Active Memory (RAM)] undertaken
by the Defense Advanced Research Projects Agency (DARPA).2,6,7 Absent at least any
plan for what directions and stances guidelines and policy should assume, there is real
risk of playing a hobbled game of “catch-up” on the ethical, medical, legal, and economic
fronts upon which neuroscience and neurotechnology are employed and leveraged to
affect individuals, communities, and groups in, and as parts of, various publics in inter-
national contexts. This manuscript provides what we posit to be crucial roles and tasks
of neuroethics that will be necessary to engage as these federally funded projects gain
momentum and come to fruition.
III. TOWARD ACTIONABLE GOALS
We argue that neuroethics needs to be intrinsically engaged at those fronts, and not
merely an after-the-fact consideration. Toward this end there must be dedicated efforts
to enact neuroethical investigation, deliberation, and diligence in key groups of potential
effect- and change-agents. This will necessitate research, education (on a variety of lev-
els), training, and articulation, and each and all of these endeavors will require explicit
subsidy.
Accordingly, and in concert with the recommendations made in the Gray Matters vol-
umes, we offer what we believe to be four crucial—and actionable—goals for neuroethics:
Volume 6, Number 1–2, 2015
Minding Brain Science in Medicine 39
First, as a set of practices, neuroethics should be dedicated to evaluating the validity
and value of current and proposed approaches to assessing and altering the structure and
functions of the brain.
Second, neuroethical tools and methods must be developed to interpret, and enable
sound use of, any and all neuroscientic information, techniques, and technologies in
biomedical research and clinical practice.
Third, neuroethics as a discipline should promote and work to use newly emerging
neuroscientic ndings to both transform common conceptions and denitions of the
normal structure and functions of the brain, and moderate popular notions about how
the brain should be treated to recover or improve its functional capacities of cognition,
emotion, and/or behavior.
Fourth, neuroethics should be a prominent feature in the education and training of
the next generation of researchers and clinicians, so as to enable more neuroscientically
pragmatic and ethically prudent capability in laboratory and clinical settings, as well as
policy- and public-oriented elds, organizations, and agencies.
IV. THE NECESSITY OF FUNDING—AND RELEVANCE
The eld of neuroethics is not prepared or equipped to undertake these goals in isola-
tion, and only well-funded, interdisciplinary investigations can depict how such goals
and objectives can and should be realistically attained.8–10 Thus, while President Obama
has dedicated signicant funding to the BRAIN initiative, and tasked the PCSBI with
studying and making recommendations about ethical issues spawned by this initiative,
we opine that broader funding and an expanded research portfolio in neuroethics are
required. It is indeed noteworthy that the federal agencies receiving BRAIN initiative
funding to date (i.e., DARPA, NIH) each consult intramural groups specically devoted
to addressing neuroethical issues.
Yet, we believe that one of the functions of these intramural groups should be to pose
key domains and dimensions of neuroethics that will be important to employing neurosci-
ence and neurotechnology in both medicine and society at large.11 These should serve as
the basis for requests for ideas and proposals (RFI/RFP) solicited from interdisciplinary
teams of scholars, researchers, and clinicians to address realistic questions and/or possible
solutions focal to guiding brain research and its potential applications.
To be relevant in translational medical contexts, these issues and approaches should
not remain academic, but should be grounded to the realities and needs of clinical care, and
should appreciate the contingencies of socio-cultural diversity, economics, and politics,
for neither neuroscience, neuroethics, nor medicine exist in a social vacuum. Neuroethics
can develop guidelines for monitoring and comprehending proposed and enacted brain
modulations and modications, and develop analytic tools and methodologies to integrate
interdisciplinary information about the signicance and impact of such alterations.
Ethics in Biology, Engineering & Medicine - An International Journal
40 Giordano & Shook
V. CONCLUSIONS
Neuroscientic discoveries and neurotechnological tools will become ever more impor-
tant to advancing many diagnostic and therapeutic capabilities of medicine. The ethical
challenges at the frontlines of brain-related medicine multiply as fast as the therapies
based upon neurotechnology, and difcult choices more frequently confront physicians,
patients, and families. These decision-points in turn radiate throughout health care insti-
tutions and systems as they attempt to fulll their missions. Arguably, the good of any
such developments can only be achieved by insuring the ethical probity of brain research
and its translation in clinical practice. Moreover, given that any ethical decision-making
begins from depiction and analyses of the facts and realities at hand, the need for a prag-
matic view of what cutting-edge neurotechnologies can do, and what neuroscientic
information actually means, will only increase.
We believe that as a discipline, neuroethics is well-poised to accomplish these tasks.
We have called for “no new neuroscience without neuroethics,”12 and unapologetically
restate that assertion again here. Ultimately, the medical profession’s receptivity to neu-
roethics, and support for the worthy aims of neuroethics, as outlined in this essay, will
be crucial for the reciprocal development and ultimate success of both neuroethics and
the sound use of neuroscientic techniques and technologies in medical care.
VI. ACKNOWLEDGMENTS
This work was supported in part by funding from the William H. and Ruth Crane
Schaefer Endowment (J.G.), Children’s Hospital and Clinics Foundation (J.G.), and an
unrestricted research and educational grant from Thync Biotechnologies (J.G.).
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Background As a discipline, neuroethics addresses a range of questions and issues generated by basic neuroscientific research (inclusive of studies of putative neurobiological processes involved in moral and ethical cognition and behavior), and its use and meanings in the clinical and social spheres. Here, we present Part 4 of a four-part bibliography of the neuroethics literature focusing on clinical and social applications of neuroscience, to include: the treatment-enhancement discourse; issues arising in neurology, psychiatry, and pain care; neuroethics education and training; neuroethics and the law; neuroethics and policy and political issues; international neuroethics; and discourses addressing "trans-" and "post-" humanity. Methods To complete a systematic survey of the literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine (NLM). A Python code was used to eliminate duplications in the final bibliography. Results When taken with Parts 1-3, this bibliography aims to provide a listing of international peerreviewed papers, books, and book chapters published from 2002 through 2016. While seeking to be as comprehensive as possible, it may be that some works were inadvertently and unintentionally not included. We therefore invite commentary from the field to afford completeness and contribute to this bibliography as a participatory work-in-progress.
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