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Section Introduction: Development and History of Neuroethics
Abstract
In this introduction to the section on the development and history of neuroethics, we describe several distinct visions of this area of inquiry and its evolution. Accordingly, the following four chapters provide contrasting accounts of neuroethics and its foundations, including in-depth discussions about the merits of its existence, and detailed accounts of the key issues that have driven its development.
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The eye may be window to the soul, but neuroscientists aim to get inside and measure the interior directly. There's also talk about moving some walls.
A survey of the emerging field of neuroethics that calls for a multidisciplinary, pragmatic approach for tackling key issues and improving patient care.
Today the measurable health burden of neurological and mental health disorders matches or even surpasses any other cluster of health conditions. At the same time, the clinical applications of recent advances in neuroscience are hardly straightforward. In Pragmatic Neuroethics, Eric Racine argues that the emerging field of neuroethics offers a way to integrate such specialties as neurology, psychiatry, and neurosurgery with the humanities and social sciences, neuroscience research, and related healthcare professions, with the goal of tackling key ethical challenges and improving patient care. Racine provides a survey of the often diverging perspectives within neuroethics, offers a theoretical framework supported by empirical data, and discusses the neuroethical implications of such issues as media coverage of neuroscience innovation and the importance of public concerns and lay opinion; nonmedical use of pharmaceuticals for performance enhancement; and the discord between intuitive notions about consciousness and behavior and the scientific understanding of them.
Racine proposes a pragmatic neuroethics that combines pluralistic approaches, bottom-up research perspectives, and a focus on practical issues (in contrast to other more theoretical and single-discipline approaches to the field). [He discusses ethical issues related to powerful neuroscience insights into the mechanisms underlying moral reasoning, cooperative behavior, and such emotional processes as empathy.] In addition, he outlines a pragmatic framework for neuroethics, based on the philosophy of emergentism, which identifies conditions for the meaningful contribution of neuroscience to ethics, and sketches new directions and strategies for meeting future challenges for neuroscience and society.
Basic Bioethics series
Written by an eminent authority from the American Academy of Neurology's Committee on Ethics, Law, and Humanities, this book is an excellent text for all clinicians interested in ethical decision-making. The book features outstanding presentations on dying and palliative care, physician-assisted suicide and voluntary active euthanasia, medical futility, and the relationship between ethics and the law. New chapters in this edition discuss how clinicians resolve ethical dilemmas in practice and explore ethical issues in neuroscience research. Other highlights include updated material on palliative sedation, advance directives, ICU withdrawal of life-sustaining therapy, gene therapy, the very-low-birth-weight premature infant, the developmentally disabled patient, informed consent, organizational ethics, brain death controversies, and fMRI and PET studies relating to persistent vegetative state. © 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business © 1994 by Butterworth-Heinemann
There is no subject at the interface of law, psychiatry and medical ethics which is more controversial than psychosurgery. The divergent views of the treatment begin with its definition. The World Health Organisation ¹ and others ² define psychosurgery as the selective surgical removal or destruction of nerve pathways or normal brain tissue with a view to influencing behaviour. However, proponents of psychosurgery demur on the basis that the `modern' treatment is concerned predominantly with emotional illness, without any specific effect upon behaviour. The alternative definition offered is `the surgical treatment of certain psychiatric illnesses by means of localised lesions placed in specific cerebral sites. ³
It is difficult entirely to accept this definition because, as examined below, scientific psychiatry is not yet in a position to directly treat psychiatric illness solely through surgical intervention. There is no reliable theoretical relationship between particular cerebral sites (which are normal and healthy) and an identifiable psychiatric illness or symptomatology. Given this state of psychiatric understanding, it is misleading to suggest fine distinctions between generalised alteration of behaviour or mood and treatment of an illness. Highly divergent practices and theories (relating to the multiplicity of conditions treated, surgical methods adopted and areas of the brain operated upon) further undermine exaggerated claims that psychosurgery can scientifically `treat' specific illness through precise surgical intervention. Nonetheless, contemporary psychosurgery does not contain quite the same `broadbrush' approach of its ancestors and it can lay some legitimate claim as an effective empirical treatment in narrowly limited circumstances. Major ethical problems still, however, arise and these will be discussed in this article.
It is commonly thought that the horrific medical abuses occurring during the era of the Third Reich were limited to fringe physicians acting in extreme locales such as the concentration camps. However, it is becoming increasingly apparent that there was a widespread perversion of medical practice and science that extended to mainstream academic physicians. Scientific thought, specifically the theories of racial hygiene, and the political conditions of a totalitarian dictatorship, acted symbiotically to devalue the intrinsic worth to society of those individuals with mental and physical disabilities. This devaluation served to foster the medical abuses which occurred. Neurosciences in the Third Reich serves as a backdrop to highlight what was the slippery slope of medical practice during that era. Points on this slippery slope included the "dejudification" of medicine, unethical experimentation in university clinics, systematic attempts to sterilize and euthanasize targeted populations, the academic use of specimens obtained through such programs and the experimental atrocities within the camps.
As with all newborns, picking a name is a difficult and contentious task. One of the most animated debates at the close of the NMTF conference was about the appropriateness of the label “Neuroethics.” Some claimed it was an unfortunate name for this fledgling field, because ethics is the purview of philosophers, while the field clearly needs the concerted interaction of policy makers, lawyers, journalists, and the public, as well as the philosophers and neuroscientists. Others suggested that “Neuroethics” was ill-chosen because ethics excluded nonethicist philosophers and other humanists. I disagree on both counts. “Neuroethics” is a name well-chosen for a number of reasons. First, it is concise, catchy, and evocative. Second, it is a sad misconception of all too many that ethics is merely an academic exercise of philosophers. Rather, our ability to think and act ethically is arguably one of the defining things of what it is to be human: it is an inclusive rather than an exclusive term. Part of what it is to be a scientist, a doctor, a lawyer, a politician, or a journalist is to execute one's office in accordance with the values of one's profession and the society at large. Witness the Hippocratic oath, the courtroom oath, the swearing in before taking office, and the injunction not to fabricate stories or data. Ethics should therefore not be a domain foreign to nonethicist professionals. Moreover, in the time of Plato and Aristotle, it was considered imperative for every citizen to have a moral education and to take part in the ethical deliberations of society. It is perhaps reflective of some of the ills in our society that ethics is thought to be a philosopher's concern and not the common man's. But this is not a misconception we should yield to—it is an invitation to reeducate the public that ethics is a forum that needs the participation of everyone. Rather than capitulate to a narrow view of what ethics is and who it concerns, we should embrace the dialectical model of the NMTF meeting and demonstrate that ethics is as broad and inclusive a category as any.We should not merely pay lip-service to this inclusiveness. Neuroethics has the potential to be an interdisciplinary field with wide-ranging effects. However, because it ultimately impinges on the well-being of the individual and our society, it is not a study that can or should be undertaken in the ivory tower. It is imperative that neuroethicists take part in a dialogue with the public. To make this possible, however, it is important in the short term to strive for “neuroliteracy” of the public and the media. We must make a concerted effort to make the subtleties of neuroscientific research accessible to the lay public via the media and refrain from the current practice of feeding it sound bites. For it is only with a nuanced understanding of the science, and a renewed trust in the goals of neuroscientists, that real progress will be made on these difficult issues. In the last few months, we have heard just the first noises of such a dialogue. As Dana Foundation executive director Francis Harper aptly noted at the close of NMTF, “You can call it what you want, but the neuroethics train has left the station.”
Neuroethics The encyclopedia of bioethics
- Pr Wolpe