ABOUT THE INTERNATIONAL NEUROETHICS SOCIETY
The International Neuroethics Society (INS) recently commented on the ethical considerations
of neuroscience research and the application of neuroscience research findings for
the Presidential Commission for the Study of Bioethical Issues, published in the Federal
Register Jan. 31, 2014.
An interdisciplinary group of scholars, neuroscientists, clinicians involved in the
treatment of brain disorders, ethicists, philosophers, lawyers, CEOs and other professionals
formed the INS in 2006. The INS doubled its growth in a few short years and has become
an international organization with over 375 members.
The INS established as its mission ‘to promote the development and responsible application
of neuroscience through interdisciplinary and international research, education, outreach
and public engagement for the benefit of people of all nations, ethnicities, and cultures’.
For details about the INS Executive Board and Governing Board and further information
about the society, see the website www.neuroethicssociety.org.
The former President, who completed his term of office in Feb. 2014, is Dr Steven
E. Hyman, Director of the Stanley Center for Psychiatric Research, Broad Institute
of MIT and Harvard, and President-Elect of The Society for Neuroscience (http://www.sfn.org/).
The current President is Professor Barbara J. Sahakian, Professor of Clinical Neuropsychology
at the Department of Psychiatry and the Medical Research Council/Wellcome Trust Behavioural
and Clinical Neuroscience Institute, University of Cambridge. She has recently presented
at the World Economic Forum 2014 in Davos on achieving better outcomes globally for
individuals with mental health disorders and on the effects of poverty on the brain
ON THE ETHICAL CONSIDERATIONS OF NEUROSCIENCE RESEARCH AND THE APPLICATION OF NEUROSCIENCE
For the Presidential Commission for the Study of Bioethical Issues, the INS lists
the top 12 areas of importance for consideration and discusses the top five in detail.
These five are chosen due to their rapid advancement and the immediate need for more
government and public consideration of the ethical impact on society.
There has been an explosion of important and innovative neuroscientific technologies
over the recent years which have driven discoveries of greater visualization and understanding
of the brain in health and disease. These techniques can be applied to understanding
and promoting brain health and to novel, more effective treatments for brain disorders
and brain injury. Some of these new techniques, such as induced pluripotent stem cells,
new-generation antibodies, designer receptors exclusively activated by designer drugs,
and optogenetics, will be game changing in terms of understanding neurotransmitters
and neural circuits in healthy brains, and to producing new drug and other treatments
for neuropsychiatric disorders, such as depression and dementia. There are also new
advances in innovative areas, such as computing, bioinformatics, machine learning,
brain–machine interface, games industry, mobile and tablet industries, nanotechnology
and neuroimaging. These tools can be used to assist in understanding the neurobiological
basis and to mitigate the effects of poverty on the brain, as well as other impacts
on brain health. Similar to any novel advances in technology and innovation, techniques
can be used to benefit society, but there are also concerns in regard to harms, which
need careful consideration and evaluation in order to ensure that the benefits to
society greatly outweigh the risks.
The members of the INS would welcome the opportunity to assist as required by the
Presidential Commission for the Study of Bioethical Issues.
COMMENTS BY THE INTERNATIONAL NEUROETHICS SOCIETY (INS) ON THE ETHICAL CONSIDERATIONS
OF NEUROSCIENCE RESEARCH AND THE APPLICATION OF NEUROSCIENCE RESEARCH FINDINGS FOR
THE PRESIDENTIAL COMMISSION FOR THE STUDY OF BIOETHICAL ISSUES
The International Neuroethics Society has listed the top 12 areas of importance for
consideration by the Presidential Commission for the Study of Bioethical Issues. We
have picked out the top five which need to be addressed now due to the fact that these
areas are rapidly advancing and require more public consideration of the ethical impact
HUMAN BRAIN PROJECTS (USA AND EU)
These expensive and long-term projects have just recently got underway, and due to
the use of taxpayers’ money and the intense interest by the media and general public,
it is important that the main neuroethical issues for each platform are appropriately
addressed. While these two Human Brain Projects have made some provision for oversight
of neuroethics within the projects, it is extremely important that the key areas are
addressed outright. These include: issues of transparency; issues of consent; safety
of neuroimaging techniques; use of large databases; security of personal databases
(containing e.g. disease or genetic information); obsolescence of data in a rapidly
developing field where technology and methodology are updated frequently; secondary
findings of potential clinical significance and return of results.
There is an increasing lifestyle use of cognitive enhancing or ‘smart drugs’ by healthy
people. These include amphetamine salts (Adderall), methylphenidate (Ritalin) and
modafinil (Provigil). It is important to take the lead in determining the long-term
safety and efficacy of these drugs in healthy people in order to avoid harms. Another
concern is the purchase of these drugs via the Internet when the long-term safety
is unknown, when the quality of the product is questionable, and when individuals
do not take advice from a medical practitioner as to whether these drugs are counter-indicated
in their particular case. The impact of the widespread use of these drugs on society,
including social and distributive justice, should also be evaluated.
Other means of enhancement, such as transcranial direct current stimulation (tDCS)
are currently being marketed and may be used after purchase on healthy children or
adolescents whose brains are still in development.
Currently, the area of neurotechnology is advancing very rapidly. Issues of neural
implants, robotics in medicine, healthcare and teaching, and nanotechnology convergence
with the brain have a number of ethical concerns which need addressing immediately.
The safety of these new neurotechnologies has not been fully examined, for example,
in the case of nanoparticles which can pass the blood brain barrier there is the potential
of neurotoxicity. It is possible, given the dearth of caregivers for the elderly infirm
and especially those with dementia, that robots will become rapidly widely used. Indeed,
Robots for Interactive Body Assistance (RIBA) are currently being developed by the
RIKEN in Japan. Robots may be used in rehabilitation for traumatic brain injury patients.
There are also robots being developed for social interaction with elderly and demented
individuals, and for those with brain disorders, such as autism. New advances in this
area may be beneficial to society, creating greater wellbeing and entrepreneurial
opportunities. Nevertheless, we need to be cognisant of social and ethical issues
raised, ranging from increasing marginalization of vulnerable populations as members
of human society to the impact of increasingly ‘uncanny robots’ more broadly on human
social cognition and behavior.
RESPONSIBILITY, MORAL AGENCY AND THE LAW
Increasingly, neuroimaging is being used in courts for the purposes of providing supporting
evidence for the lack of intent or diminished responsibility (see e.g. http://ir.lawnet.fordham.edu/flr/vol80/iss1/9).
To what extent can the person be held accountable in the case of traumatic brain injury
or brain abnormalities, and brain disorders such as untreated attention deficit hyperactivity
disorder (ADHD) or addiction? For example, there is evidence to indicate that among
patients with ADHD, rates of criminality were lower during periods when they were
receiving ADHD medication. These findings raise the possibility that the use of medication
reduces the risk of criminality among patients with ADHD. To what extent are ADHD
criminals responsible for their crimes if they have not received diagnosis and treatment?
MENTAL HEALTH AND BRAIN DISORDERS
The effects of poverty on the brain are extremely important, particularly as we now
know from the impressive research conducted at the National Institute of Mental Health
that our brains are still in development through late adolescence into early young
adulthood. Therefore, the effects of poor nutrition on the brain may be difficult
to fully reverse in adulthood. (In the developing world, severe malnutrition including
inadequate calories has been clearly demonstrated to stunt not only physical stature,
but also intellectual ability as measured by IQ). Furthermore, the developing brain
appears particularly vulnerable to environmental influences during this time, ranging
from widely addictive substances such as nicotine and alcohol, and more speculatively,
to highly rewarding activities such as gaming and internet use. Finally, many American
states are beginning to undertake experiments (with other states as ‘controls’) on
broadened marijuana use. It is of the highest importance not to accept pre-existing
biases that tend to favour or disfavour recent medical marijuana or recreational marijuana
laws, but for the United States Government to fund good observational experiments
to determine the degree to which marijuana creates dependence in young people, whether
incident cases of schizophrenia increase, whether there are significant changes in
performance, and whether there are increases or decreases in incidence of anxiety
disorders and depression.
Good brain health needs to be considered every bit as important as good physical health.
Professor Barbara J Sahakian FMedSci
Professor Steven E Hyman MD
President of the International Neuroethics Society
Past-President of the International Neuroethics Society
On behalf of the International Neuroethics Society
THE INTERNATIONAL NEUROETHICS SOCIETY (INS) TOP 12 AREAS FOR THE PRESIDENTIAL COMMISSION
FOR THE STUDY OF BIOETHICAL ISSUES
Human Brain Projects (USA and EU)
Issues of transparency
Safety of novel neuroscience techniques
Use of large databases
Security of personal databases (containing e.g. disease or genetic information)
Secondary findings of potential clinical significance and return of results
Increasing lifestyle use of ‘smart drugs’ by healthy people (e.g. modafinil, methylphenidate)
Implicit and explicit coercion
Transcranial direct current stimulation (tDCS)
Cognitive training or ‘serious games’
Is there a human right to enhancement?
Non-invasive brain-computer interfaces (BCI)
Robots as social companions and caregivers
Robots as teachers
Nanotechnology and the blood brain barrier
Responsibility, moral agency and the law
Addiction to substances of abuse and to gambling
Traumatic brain injury
The use of neuroscientific arguments and neuroimaging in a legal context
Mental health and brain disorders
Effects of poverty on the brain
Issues of early detection
Lack of development of new treatments by the pharmaceutical industry
Rigour of evaluation of novel psychological treatments (e.g. mindfulness)
Effects of environmental toxins on brain health
Invasive techniques for treatment of brain disorders
Deep brain stimulation (DBS), especially for psychiatric disorders
Cell transplantation (e.g. in Parkinson's disease)
Decoding mental states and decision making
Issues in law and public policy
Special issues of children and adolescents
Brain development in children and adolescents
Issues of personhood
Brain development, level of understanding and intention, and the legal system
The Business of Neuroscience and the Neuroscience of Business
Addictive gaming, internet use etc.
Neuroscience, biologics and psychopharmacology in the context of the military
Issues of transparency
Issues of consent and coercion (direct or indirect)
Morality and Social Cognition
Neurobiology and legal issues (e.g. Autistic Spectrum Disorders, traumatic brain injury)
Effects of drugs
Brain injury and vegetative state, disorders of consciousness
End of life decisions