William Safire is credited with inventing the term “neuroethics.” He defines it as “the examination of what is right and wrong, good and bad about the treatment of, perfection of, or unwelcomed invasions of and worrisome manipulation of the human brain.”

Safire’s definition already shows us what is troubling about the field. Treatment of the brain when we lack full knowledge of what the brain is and does is problematic. When treatment becomes experimentation, ethics is already sidelined and suffocated. When there are procedures to perfect through invasion and manipulation; through technological interventions, the starting point is already ethically suspect.

Neuroethics: Anticipating the Future, edited by Judy Illes gathers together a distinguished group of theorists and researchers to explore the critical issues raised by the field of neuroscience. The book is divided into four main sections. These are: 1. Neurotechnology: Today and Tomorrow; 2. Neuroethics at the frontline of healthcare; 3 Social, Legal and Regulatory Frameworks; and 4. an Epilogue. It is obvious that given the controversies of treatment within the field of neuroscience that an understanding of ethics is a welcomed requirement. In the words of James Giordana, “No new neuroscience without neuroethics.”

Judy Illes in the Preface to the collection asks an important question, “How is neuroethics different from bioethics?” The answer given is “Neuroexceptionalism”. Illes continues, “Unlike the knee or the elbow or the liver…the brain connects each of us to who we are. In health and disease it links us to our identity, relations, autonomy, personality, capacity to make decisions and much more. Each is intricately intertwined with the other like the threads of a rope, embedded in the context in which we thrive, derive and survive.”

As I reflect on this important passage, I already had a sense that Illes and most of the other contributors reduce what the medieval Franciscan philosophers call haecceity or our unique and irreplaceable singularity to brain function alone.

 Yes, it is clear from a merely biological point of view that there is no thriving, deriving and surviving without a brain but it is this biological reduction of the human person to this three pound organ that I find troubling from an ethical perspective.

My claim here is that ethics, understood as what is just, has to be in place before any interpretative event takes place. Here I wonder how exactly ethical concerns are framed within the field of brain sciences. This is why Adina Roskies formula, “Ethics of neuroscience; neuroscience of ethics” is problematic and shows that Neuroethics has not begun to think what ethics is.

An ethics defined by the very science that studies a phenomena already takes place within a closed circuit that has discarded the troubling features that ethics raises. Such as ethics, comes after the fact and arrives late on the scene, unable to effect transformation. It confuses the dinner eaten with how the meal was made.

A number of interesting ideas are explored in Part 1. This section explains the issues raised by multimodal brain imaging. The findings are that a complete imaging of the brain can be used as a research tool and as a clinical diagnostic tool as well. But I find that such a view is the same old unethical and bureaucratic procedure of detecting, and classifying and reducing the complexity of persons to manageable pieces of data. 

Kreitmar and Cho in their essay, “The neuroethical future”, realize what is at stake. They write, “Many of the same ethical issues that arise with wearable mobile technology in general are exacerbated when technology enters the domain of neuroscience, neurology and mental health.” The issue is one of “privacy and confidentiality.”

Technology reduces us to our daily data. As if looking at the health date on our IPhone can give anyone a complete understanding of our intrinsic complexity. Here the authors raise the question of authenticity. Do “aspects of daily living that matter to us correspond neatly to quantifiable dimensions?” The complexity of persons cannot be reduced to “the Self as database.” This for me would be the first axiom of any neuroethics to come.

Erin Klein’s essay on “Neuromodulation ethics”, raises the issue of brain-computer interface medicine and asks important questions about the privacy of thought, the security of brain data and changes to identity. Brain and computer interface raises the question of what it means to be human once the machine as techne drives our bios.

Part 2 develops important ideas about the open future, identity and self-determination. Cheryl D. Lew’s essay in this section is key to understanding the scope and significance of neuroethics as both theory and practice so that we can live “flourishing and successful lives.” 

Sarah Welsh’s essay on “Neuroprognostication” asks key questions regarding, “frameworks for estimating neurological outcomes after severe brain injury.” How does one trust the so-called objectivity of image date so that a proper life death decision can be made? Are images and data now the drivers of our ethical decisions?

Sabine Muller’s essay, “Ethical Challenges of modern psychiatric neurosurgery” provides a number of important insights. Muller writes, “Modern psychiatric neurosurgery has the potential to become a further method for treating otherwise treatment-refactory severe psychiatric disorders. However, to be broadly accepted in both the medical community and society, it has to conform to rigors scientific and ethical standards.” 

Muller does not tell us what kind of ethical standards will be utilized. Will they be deontological, utilitarian, virtue based, altruistic, egoistic or haecceic? It seems to be that such a view needs to reconsider Ken Kesey’s insights from his 1964 novel, One Flew Over the Cuckoo’s Nest. 

As Ramos and Koroshetz write in their article, “Integrating Ethics into Neurotechnology Research”, the human brain contains 84 billion neurons collectively making trillions of connections.” Given this fact, isn’t it the case that any kind of neurosurgery practiced even today would be no better than Neanderthal trepanning? See here the detail from the painting “The Extraction of the Stone of Madness” by Hieronymus Bosch.

Part 2 also contains essays that raise important questions about Alzheimer’s, well-being, autonomy, brain death and the boundary between life and death and the use of life-support technology. 

Part 3 looks at social, legal and regulatory frameworks and raises questions about the ethics of human participation in research, especially the category of vulnerable populations. The concepts of assent, consent and dissent are explored.

Racine and Dubljevic’s essay on “Behavioral and Brain Based Research” explores the issue of the illusion of human freedom. Here “quirky metaphysics” is given a lesson by Pavlov and Skinner. Yet the author do not tell us how free they were while freely writing their paper on the illusion of freedom.

Part 3 also contains important work on cognitive enhancement, environmental influences on the brain, the influence of neurotoxic agents and addiction.

The Epilogue contains an essay by Joseph J. Fins that examines “Neuroethics and Neurotechnology”. Fins defines neuroethics “as an ethics of technology. Fins shows us that the mind is still a mystery. Fins writes, “While neuroscience is nurtured by the scientist’s curiosity, neuroethics should help ensure that the quest of discovery is more than a science project. The stakes are higher than that and the work has to be understood in a broader humanistic context…short of that neuroethics will be a hollow, self-justifying framework, one prone to misdirection, distraction and even abuse.”

Here Fins summarizes the strengths and weaknesses of the volume.

Overall while the collection of essays contain extensive bibliographies on neuroscience, it lacks a substantial philosophical analysis of actual ethics in relation to neuroscience. It is not enough to attach the word ethics to neuro and believe that the word “neuroethics” gives a sufficient understanding of the issue.

 

Marko Zlomislic, PhD, Conestogac College

Categories: Ethics

Keywords: neuroethics, ethics, neuroscience