Conference Focuses on Ethics of Treating Brain Disorders
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A little more than 10 years ago, in 1990, the federal government launched the Decade of the Brain initiative, a focused effort to encourage research into the diseases of the brain and potential of the human mind. The result has been stunning progress in the field of neuroscience, researchers and ethicists say. But now more effort must be made to understand the social and ethical implications these advances will have on our society.
"I think we are starting to be able to ask questions about individuals that we were not ever able to ask or probe before," says Judith Illes, PhD, senior research scholar in the department of radiology at Stanford University in Palo Alto, CA. "We need to look at how we do that responsibly and what are the ethical implications of doing that."
For example, Illes notes, new neuroimaging technology is allowing researchers to examine not only traditional concepts such as memory and language, but also allowing them to examine how changes in a person’s brain activity may indicate other things—whether the person is angry or upset, aroused, or being untruthful, for example.
"That really brings to the foreground new issues: How do we use that data in a research environment? How do we communicate that data to the public? How might such information get used—in the courtroom, for instance—not just in the medical field," she says.
To begin looking at these issues, Stanford and the University of California at San Francisco held a conference May 13-14 in San Francisco to map this new field of study, which many are calling neuroethics.
At the conference, neuroscience researchers, bioethicists, and public policy experts came together to determine what initial questions needed to be asked about the impact new knowledge about the brain will have on society, says conference chair Zach Hall, MD, former director of the National Institute for Neurologic Diseases and Stroke (NINDS), now president and CEO of EnVivo Pharmaceuticals Inc. in Redwood City, CA.
"It is more to map a new terrain than to come up with any answers right now," Hall says. "We are not going to solve the question of when is the use of stem cells appropriate or when should you use electrical stimulation of the brain in two days. But, [we wanted to] simply question and think and start the discourse—that was the goal of the conference." Attendees had plenty to discuss, he adds.
Use of Stem Cells on the Horizon
One of the key topics discussed at the conference was the use of embryonic stem-cell transplants to treat neurologic diseases, notes Barbara Koenig, PhD, associate professor of medicine and the executive director of the Stanford University Center for Biomedical Ethics.
Although stem cells are thought to have the potential to treat numerous diseases of the body, neuroscientists already are discovering practical applications to treat problems of the brain and the impact that these treatments may have needs to be studied now, she says.
"We are probably likely to see more of an immediate impact," she explains. "It will be a long time before you can take a bunch of stem cells and grow a heart. But it might not be long before you can say, Here are two nerves that are no longer connected. Here are some growth factors that will get them to reconnect.’ Those kinds of experiments are already going on."
It’s important that the ethical implications of such technology are examined now, adds Illes. "One of the things we want to do is promote proactive bioethics. Very often, ethics comes into play once the research has been done and somebody says, Uh oh.’ The results get reported in Newsweek, and the public is calling."
What if You Can Predict Aberrant Behavior?
As the field of neurology advances, scientists increasingly also are finding biological bases for or factors that affect human behavior. For example, advanced magnetic resonance imaging may be used in research to examine different sites of brain activation for people who abuse drugs, for children who have attention-deficit disorder, or people who are lying, says Hall.
This research has significant implications for people who experience substance addiction or exhibit antisocial or criminal behavior, explains Koenig. "We might have the potential for predicting different kinds of behavior. And if we can, should we do this? What effect will that have on different parts of our society?" A new understanding of biological factors related to human behavior may drastically alter the criminal justice system, for example, she says. If there is some basis for criminal behavior in biology, how much responsibility should one bear?
"We are not just studying how many numbers people can remember anymore," says Illes. "We are now actually looking into their brain and seeing if some brain centers light up to fear-evoking stimuli or not, or sadness, for example." Another area that needs more discussion is the use of enhancements to improve brain function, says Illes.
Researchers already are examining how electrical stimulation of certain centers of the brain can be used to treat degenerative neurologic disorders and chronic pain. But healthy people could also potentially use this technology. "We need to look at patterns of the use of mental enhancers, from traditional things like use of amphetamines—which some people have used to stay up all night to study for exams—to new technology like transcranial magnetic stimulation, a single pulse to the brain, to boost your energy with your morning coffee."
Such questions have already come up with the increased use of mood-altering drugs such as Prozac and the increased use of Ritalin in children, say Hall and Koenig.
"How much should we allow? Should we allow it? Maybe we shouldn’t [use] any kind of manipulation that could change people’s personal characteristics," Hall says. "If we have a pill that makes you feel better, should everyone have access to it? Who will pay for that? What if we have a pill that will make you less shy at a party or better able to concentrate while working?"
Enhancements have the potential to alter our concept of a normal personality, says Koenig, and that will have implications for people who may be denied access to the enhancements. "We have drugs that may improve cognitive function in patients with Alzheimer’s," she says. "But if we do develop drugs to enhance memory, will there be justice issues about who gets them? Will there then be a new version of normal memory? There are a lot of issues surrounding that."
As research goes forward into degenerative illnesses of the brain, methods of protecting patients who suffer from these illnesses and who need to be included in clinical trials will also become an issue. "Many neurological and psychological conditions involved reductions in cognitive ability, so our whole ability to conduct research and intervene is more complicated," says Koenig.
And, because the brain contains so much of what our society considers to be the self, a decision to deliberately alter a person’s brain, even to heal a deadly disease, should be carefully examined, says Hall. "The brain is responsible for many of the things that make us individuals," he notes. "If I do something to treat your liver, I am not going to change your personality. But if I do something to treat your brain, I may." These questions should not just be answered by medical researchers and academic ethicists, but also must be addressed by society, he says. "These are not questions that physicians or scientists should answer alone. They have to do with the core values of our society and we need to engage a broad spectrum of people," he says.
The San Francisco conference was limited to 50 participants carefully selected to balance representation from the fields of neuroscience, bioethics, and public policy, says Hall. In addition, the sessions and breakout groups were scheduled to be two hours long, to allow an hour for discussion following each presentation. Conference organizers plan to develop a consensus of what the attendees felt were the key neuroethics issues that require immediate attention. They are planning to publish a summary of the conference to inform the public and other interested parties, Hall reports.
"One of the things we hope to end up with is something that is accessible to the public," he says. "If someone asked, What is neuroethics?’ they could sit down and read our document in a couple of hours and have a sense of what happened at the conference and what the main problems are." —Cathi Harris
Cathi Harris is the Editor of Medical Ethics Advisor.
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