Even the most scientifically reductionist view of the individual reveals that we are complex systems nested within complex systems. These interactions within and among systems are based and depend on numerous variables of our environment. If we define ethics as a system of moral decision making, then it becomes clear that these decisions ultimately affect the situation of managing our activities and relationships with others in our environment. Given that ecology literally means “a study or system of wisdom and reasoning (...) about the interrelation of organisms in their environment or place of inhabitance,” Owen Flanagan's description of ethics as “human ecology” takes on considerable relevance and importance. (shrink)

In light of the recent events of terrorism and publicized cases of mass slayings and serial killings, there have been calls from the public and policy-makers alike for neuroscience and neurotechnology (neuroS/T) to be employed to intervene in ways that define and assess, if not prevent, such wanton acts of aggression and violence. Ongoing advancements in assessment neuroS/T have enabled heretofore unparalleled capabilities to evaluate the structure and function of the brain, yet each and all are constrained by certain technical (...) and practical limitations. In this paper, we present an overview of the capabilities and constraints of current assessment neuroS/T, address neuro-ethical and legal issues fostered by the use and potential misuse of these approaches, and discuss how neuroethics may inform science and the law to guide right and sound applications of neuroS/T to “deliver us from evil” while not being led into temptations of ampliative claims and inapt use. (shrink)

It examines three core questions. First, what is the scope and direction of neuroscientific inquiry?

The possibility of a human head transplant poses unprecedented philosophical and neuroethical questions. Principal among them are the personal identity of the resultant individual, her metaphysical and social status: Who will she be and how should the “new” person be treated - morally, legally and socially - given that she incorporates characteristics of two distinct, previously unrelated individuals, and possess both old and new physical, psychological, and social experiences that would not have been available without the transplant? We contend that (...) this situation challenges linguistic conventions and conceptual binaries, and calls into question the major philosophical approaches to personal identity: animalism and reductionism. We examine these views critically vis-a-vis head transplantation and conclude that they fail to provide an adequate account of the identity of the resultant individual because both neglect the key role of embodiment for personal identity. We maintain that embodiment is central to personal identity and a radical alteration of the body will also radically alter that person, making her a different person. Consequently, a human head transplant will result in an individual partly continuous with the head/brain, and partly continuous with the body donor. We conclude that the resultant person would be different from both the individual whose head was transplanted and the one to whose body the “new” head is attached. (shrink)

Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for prescriptively judging the ethical applications of neurotechnologies. Plentiful normative premises are available to ground such prescriptivity, however prescriptive neuroethics may remain fragmented by social conventions, cultural ideologies, and ethical theories. Herein we offer that an objectively principled neuroethics for international relevance requires a new meta-ethics: understanding how morality works, and how humans manage and improve morality, as objectively based on the brain and social sciences. This (...) new meta-ethics will simultaneously equip neuroethics for evaluating and revising older cultural ideologies and ethical theories, and direct neuroethics towards scientifically valid views of encultured humans intelligently managing moralities. Bypassing absolutism, cultural essentialisms, and unrealistic ethical philosophies, neuroethics arrives at a small set of principles about proper human flourishing that are more culturally inclusive and cosmopolitan in spirit. This cosmopolitanism in turn suggests augmentations to traditional medical ethics in the form of four principled guidelines for international consideration: empowerment, non-obsolescence, self-creativity, and citizenship. (shrink)

This Editorial introduces the thematic series on 'Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care' http://www.biomedcentral.com/series/newpsychiatry.

Neuroscience, together with a broadened concept of “mind” has instigated pragmatic and ethical concerns about the experience and treatment of pain. If pain medicine is to be authentic, it requires knowledge of the brain-mind, pain, and the relative and appropriate “goodness” of potential interventions that can and/or should be provided. This speaks to the need for an ethics that reflects and is relevant to the contemporary neuroscience of pain, acknowledgment and appreciation of the sentient being in pain, effects of environment (...) and value(s), and the nature of healing. It may be that neuroethics provides this viable meta-ethic for pain care. This essay describes how an integrative neuroethics of pain care allows, if not obligates, alignment of facts, values, and moral attitudes as a continuing process of re-investigation, analysis, and revision of what we know (and don’t know) about brains, minds, selves, and how we regard and treat the painient. (shrink)

Kolbe and de Melo-Martin (2023) describe fatal problems in current definitions and measurement of moral distress and injury (MD/I) in medical professionals, which impede development of genuine atte...

Abstract:An integrated and principled neuroethics offers ethical guidelines able to transcend conventional and medical reliance on normality standards. Elsewhere we have proposed four principles for wise guidance on human transformations. Principles like these are already urgently needed, as bio- and cyberenhancements are rapidly emerging. Context matters. Neither “treatments” nor “enhancements” are objectively identifiable apart from performance expectations, social contexts, and civic orders. Lessons learned from disability studies about enablement and inclusion suggest a fresh way to categorize modifications to the body (...) and its performance. The term “enhancement” should be broken apart to permit recognition of enablements and augmentations, and kinds of radical augmentation for specialized performance. Augmentations affecting the self, self-worth, and self-identity of persons require heightened ethical scrutiny. Reversibility becomes the core problem, not the easy answer, as augmented persons may not cooperate with either decommissioning or displacement into unaccommodating societies. We conclude by indicating how our four principles of self-creativity, nonobsolescence, empowerment, and citizenship establish a neuroethics beyond normal that is better prepared for a future in which humans and their societies are going so far beyond normal. (shrink)

Moral philosophy and psychology have sought to define the nature of right and wrong, and good and evil. The industrial turn of the twentieth century fostered increasingly technological approaches that conjoined philosophy to psychology, and psychology to the natural sciences. Thus, moral philosophy and psychology became ever more vested to investigations of the anatomic structures and physiologic processes involved in cognition, emotion and behavior - ultimately falling under the rubric of the neurosciences. Since 2002, neuroscientific studies of moral thought, emotions (...) and behaviors have become known as – and a part of – the relatively new discipline of neuroethics. Herein we present Part 2 of a bibliography of neuroethics from 2002–2013 addressing the “neuroscience of ethics” – studies of putative neural substrates and mechanisms involved in cognitive, emotional and behavioral processes of morality and ethics. (shrink)

Abstract:Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in (...) neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can—and arguably should—be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere. (shrink)

Substantial discussion in the neuroethical literature has addressed the possibility that deep brain stimulation (DBS) and adaptive DBS (aDBS) could result in changes in personality, agency, and ide...

Using a metaphorical reminiscence upon holiday toys - and the hopes, challenges and possibilities they presented - this essay addresses the ways that the heuristics, outcomes and products of neuroscience have effected change in the human condition, predicament, and being. A note of caution is offered to pragmatically assess what can be done with neurotechnology, what can't, and what should and shouldn't - based upon the capacities and limitations of both the science, and our collective ability to handle knowledge, power (...) and the unknown. This is not an appeal to impede brain research. To the contrary, it is a call to engage neuroethics as a discipline and set of practices 1) to allow a deeper, more finely-grained understanding of brains and their functions in ecological dynamics (that we define as morality and ethics), and 2) to intuit how to engage neuroscientific research and its applications in the social sphere (inclusive of medicine, public life and national agenda), to more accurately perceive how neuroscience is changing human society and the human being, and to instantiate more relevant ethics and laws that are in step with advancing epistemological capital and technological capability. (shrink)

Fiester and Yuan (2023) highlight ethical concerns important for considering behavioral contracts to manage charged/challenging interactions with patients and/or families. We support the viability...

Foni phronimos - An interview with Edmund D. Pellegrino.

Hillel Braude offers a thoughtful paper that explores the nature of suffering, with particular relation to—and distinction from—pain, as regards the work of Eric Cassell, and in reflection of the perspectives of Karl Jaspers and Emmanuel Levinas. To be sure, establishing distinction(s) between pain and suffering is not an easy task. As Yuri Maricich and I have noted, pain and suffering are often used synonymously, even in medical conversation(s). Yet, we have urged that such colloquialisms should be rectified, particularly in (...) clinical contexts, because they can, and often do, foster ambiguities regarding the nature of these experiences, meanings to patient and clinician, and attendant trajectories and .. (shrink)

Neurosurgeon Sergio Canavero proposed the HEAVEN procedure – i.e. head anastomosis venture – several years ago, and has recently received approval from the relevant regulatory bodies to perform this body-head transplant in China. The BHT procedure involves attaching the donor body to the head of the recipient, and discarding the body of R and head of D. Canavero’s proposed procedure will be incredibly difficult from a medical standpoint. Aside from medical doubt, the BHT has been met with great resistance from (...) many, if not most bio- and neuroethicists.Given both the known challenges and unknown outcomes of HEAVEN, several important neuroethical and legal questions have emerged should Canavero be successful, including: What are the implications for transplantology in the U.S., inclusive of issues of expense, distributive justice, organizational procedures, and the cost of novel insight? How do bioethical and neuroethical principles, and legal regulations of human subject research apply? What are the legal consequences for Canavero performing a BHT? What are the tentative implications for the metaphysical and legal identity of R should they survive post-BHT? These questions are analyzed, issues are identified, and several solutions are proposed in an attempt to re-configure HEAVEN into a safe, clinically effective, and thus realistically viable procedure.Notably, the permissibility of conducting the BHT in China fosters additional, important questions, focal to whether Western ethics and professional norms be used to guide the BHT – or any neuroscientific research and its use - in non-Western countries, such as China; if the models of responsible conduct of research are identical, similar, or applicable to the intent and conduct of research in China; and what economic and political implications are fostered if/when such avant garde techniques are successful.These questions are discussed as a further impetus to develop a globally applicable neuroethical framework that would enable both local articulation and cosmopolitan inquiry and oversight of those methods and approaches deemed problematic, if and when rendered in more international settings. (shrink)

Pro Doernberg and Truog (2023), we recognize and acknowledge five spheres of morality in medicine. We posit that these spheres represent domains of practical engagement, which, as the authors note,...

Neuroethics entails investigations of neurocognitive mechanisms of morality and ethics; and studies and address of the ethical issues spawned by the use of neuroscience and its technologies to investigate cognition, emotion and actions. These two principal emphases, or what have been called “traditions” of neuroethics both mirror traditional bioethical discussions (such as debates about the safety of technological and pharmaceutical advances and ethical implications of new scientific and technological discoveries), and engage discourse about neuroscientific investigations of (proto-moral and moral) cognition, (...) emotions and behaviors, and what such findings may mean for human beliefs and conduct - from the individual to the political levels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture (...) provided an interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

In this issue, Joshua Shepherd (2023) offers defensible argument for broader consideration of cognitive and psychological features viable and valuable for sentiments about and interactions with non...

As Herrera-Ferrá et al. (2023) carefully explain, the contentious legacy of human rights should not prevent the re-crafting of particular ethico-legal responsibilities and obligations focal to the...

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature (...) and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. (shrink)