3 The Context for Neuroethics

3.1 Introduction

Neuroethics is emerging as an area of interest where many streams of thought and research are converging and mixing.  Neuroscience itself is becoming a discipline that incorporates different scientific traditions. Genetics, development studies, immunology, bioengineering, as well as traditional anatomy and neuroscience are all becoming important, and bring their own particular sets of analytical tools and conceptual assumptions.  Scientific thinking about the brain and associated neural systems in not settled territory but is constantly developing, and increasingly multi-faceted. [This review does not attempt to cover neuroscience research per se. However, two review articles of interest are Walton 1997, and Greenfield 2005.  See also Rose 2005.]

That said, the literature reviewed for this paper identified particular scientific developments that require ethics attention.  These include brain scanning technologies, implantation of stem cells or neural tissues in the brain (and the possible future scenario of brain transplants) and drugs able to target particular brain activity or functions. (The writing on implantation of stem or neural cells into the brain largely dates from the 1990s, and the trialling of techniques to treat Parkinson’s disease.)  In addition, some established scientific understandings or technologies were recognised to have implications that are specific for the use in association with brain function e.g. genetic testing for mental or degenerative cognitive conditions.

Bioethics is a discourse that has always drawn on multiple theoretical disciplines – philosophy, law and theology were the early ones, but now also disciplines such as sociology, feminist theory, history of science and philosophy, political studies, anthropology, and public health.  Since its early days in the 1970s bioethics has moved well out from the initial focus on protection of individuals in the research context, and attention on the doctor-patient relationship. Thinking has been extended by developments in genetics, the challenges of new birth technologies and stem cell research, threats of global pandemics, and the moral demands to address health inequalities, particularly in the developing world. It has however, largely remained focused on research with human subjects, and health applications of biotechnology.

In addition to conversations in bioethics there are conversations in philosophy (that have been running in parallel with bioethics) that are now being brought into the bioethics discussions about neuroscience – in particular understandings of free will and responsibility, and how (if at all) this thinking is affected by material understanding of the brain, and the relationships between brain, mind and ‘self’.  Neurophilosophy has emerged as an area interested in neuroscience and philosophy of mind – looking for a unified theory of mind and brain (Evers 05).

This confluence of so many strands of thought therefore requires analysis of multiple discourses – scientific, ethical, socio-cultural, and philosophical (Illes and Racine 05, Evers 2005, Singh  and Rose 2006) –  each of which comes to the discussion with its own history, and all of which play a part in shaping the current landscape of the bioethical discussions of neuroscience. 

This review reports predominantly on those strands of the conversation that are found in the bioethics and medical literature captured within particular databases.  However, it does signal areas (referred to in that literature) that are explored in other communities of knowledge and investigation, particularly in philosophy and sociology.

It is also important to note that only a very small proportion of the papers reviewed for this literature survey came from the peer reviewed bioethics literature per se.  Neuroethics has only a small (though growing) presence in the bioethics journals.  There is a small cluster of papers from around 1996 (at the time when fetal transplants into the brain for the treatment of Parkinson’s disease was being trailed), and then later clusters of papers as journals such as the AJOB run special issues, and invited commentaries on lead papers. These lead writers (e.g. J Illes, M J Farah, and P R Wolpe) often turn up in the general medical literature, and/or are to be special editors of forthcoming special issues in other journals.

Thus, a great deal of this literature is in the wider medical literature captured by the Medline database.  Much of it is of a preliminary nature – alerting readers to the developing technologies and possible ethical implications, and inviting professionals to become involved in the discussions.

3.2 Describing the Landscape (The geological history!)

Neuroethics is situated in an historical and political landscape with at least three key features that affect how current conversations are pursued in different contexts.

• The history of the neuroscience, and its use for political agenda
• The history of other disciplines concerned with related areas e.g. philosophy, sociology – how certain language and ideas have been used and developed
• Other areas of science (genetics) and of ethics enquiry (e.g. human enhancement) that raise similar or parallel concerns

It is at the confluence of these and other streams of thought that ‘Neuroethics’ is developing as a particular conversation – the territory is being mapped out, and certain participants are choosing to join.  This is not necessarily happening in a coherent or self-conscious way.  The conversations are as yet quite tentative (and largely descriptive of the issues that need to be discussed rather than in-depth discussions), and led by a small number of writers.  But indications are there of the fault lines of enquiry.

Science

Our current understanding of the brain as central to our human abilities and identity is of recent origin. Only in the seventeenth century were the connections made between the soft matter in the head and our ability to think and reason (Zimmer 2004).  In subsequent centuries this progressed into craniometry and phrenology (study of the shape of the skull as a measure of the development of ‘organs’ within the brain – which in their turn enabled the determination of character and intellect).  In addition to being used to detect the character of the individual, measurements were also used to create intelligence hierarchies within and between races.

Surgical techniques were developed last century, including the infamous lobotomy, devised as means of controlling aggressive or violent behaviour.  In more recent decades there have been surgical interventions for obsessive- compulsive disorder and for Parkinson’s and other movement disorders.  And of course there has been the development of pharmaceutical interventions for treating a range of psychiatric disorders (Finns 2003, Illes and Racine 2005, Williams 2002, Wolpe 2002b).  Most recently, the development of various scanning techniques has allowed insight into the biological activities of the brain, and with fMRI the ability to follow these in real time.

The future directions of science are always difficult to predict, but some look forward to greater ability to treat mental illness and enhance human mental capacities, including through neurotechnology.  Some hold very high hopes.  The emergent technologies will create new industries and products, provide competitive advantage (both via treatment of mental illness and through enhancement of mental capacities of workers) and drive a debate about the right of individuals to enhance themselves.  There is also the possibility of new behaviours, as we learn to ‘see things differently’ through shifts in mental perspectives.  There will be a new type of human society, a post-industrial, post-informational neurosociety (Lynch 2004)!

Philosophy

Philosophy has long concerned itself with ethics, and with broader analysis of concepts such as self, identity, freedom and responsibility. Philosophers have also been concerned to understand the nature of the mind, mental events, mental functions, mental properties and consciousness, and of the nature of their relationship with the physical body: the so-called ‘mind–body’ problem.  This area of work (philosophy of the mind) and neuroscience converged in the field of neurophilosophy in the 1980s, which draws together the methods of analytic philosophy with empirical neuroscience methods to seek a unified theory of mind/brain (Evers 2005).

Other areas of bioethics enquiry

Bioethics as a discipline or area of study, is of relatively recent origin.  Its early work focused on the ethics of research with human subjects (driven in large part by various scandals where vulnerable populations were exploited in research, but building on reflections on research carried out in Nazi Germany), and the use of innovative clinical technologies such as organ donation and end of life decision-making (Rothman 1991).  In the last 10-15 years, bioethics’ attention has widened out from the doctor-patient relationship to encompass the ethical, social and legal challenges raised by genetics, and the public health issues of HIV and other potential pandemics.  There is also increasing recognition of the need to address issues specific to particular countries or political dynamics e.g. ethics of research in the developing world.

There is thus a track record now of bioethics considering both the research and clinical implications of new technologies, and their social, ethical, legal, policy and political ramifications.

‘Neuroethics’ history

References to ‘neuroethics’ and neuroethical issues made their first appearances in the late 1980 and early 1990s, around issues to do with the role of the neurologist at end of life decisions, philosophical perspectives on the brain and the self (possibly in association with trials of transplantation of brain tissue to treat Parkinson’s disease), and the neurophysiological and neuropsychological influences on child rearing and education (Illes and Raffin 2002).
But a new level of activity and intensity of focus seems to have emerged since 2002. The Economist picked up on the topic in 2002, as did Francis Fukuyama in his Our Posthuman Future. A first world conference, Neuroethics: Mapping the field was held in the US in that year and later initiatives have included a special conference on Neuroscience and the Law in 2004, and the US President’s Council on Bioethics attention to the topic in 2004 (Illes and Raffin 2002, Kennedy 2004, Farah 2002). 

By 2002 the field was being divided into ‘the ethics of neuroscience’ (both ethical issues raised in the course of designing and instituting neuroscientific studies, and the evaluation of the ethical and social impact of the results of those studies) and the ‘neuroscience of ethics’ – what can be learnt about traditional philosophical notions such as free will, self-control, personal identity, and intention by studying the brain (Roskies 2002).

Neuroethics is now expanding as a sub-field with established journals extending their coverage to deliberately include neuroethics (e.g. the Journal of Cognitive Science), or putting out special issues (e.g. The AJOB will be devoting 3 special issues to neuroethics in 2007). Special neuroethics research centres have been established (for example the Centre for Cognitive Neuroscience at the University of Pennsylvania [http://ccn.upenn.edu/], and the Stanford Center for Biomedical Ethics [http://scbe.stanford.edu/]).  The (US) President’s Council on Bioethics website holds transcripts of discussions held on neuroethics [http://www.bioethics.gov/topics/neuro_index.html], and a European initiative, The Meeting of the Minds, is a two year project to help citizens learn about the impact of brain science and support greater involvement of the public in the debate on future research, technological decision making and governance. [http://www.meetingmindseurope.org/europe_default_site.aspx?ID=13&SGREF=13]

However, it will be interesting to see to what extent the bioethics community shapes the discourse of neuroethics.  The discussions are being profiled in other bodies of literature, and the discourse being strongly shaped by individuals and institutions whose training is in neuroscience (e.g. Farah) or who are grounded in other disciplines such as sociology (e.g. Singh).

[ Previous page | Next page ]