According to many researchers, it is inevitable and obvious that psychiatric illnesses are biological in nature, and that this is the rationale behind the numerous neuroimaging studies of individuals diagnosed with mental disorders. Scholars looking at the history of psychiatry have pointed out that in the past, the origins and motivations behind the search for biological causes, correlates, and cures for mental disorders are thoroughly social and historically rooted, particularly when the diagnostic category in question is the subject of controversy (...) within psychiatry. This is obscured by neuroimaging studies that drive researchers to proclaim 'revolutions' in psychiatry, namely in the DSM. Providing neuroimaging evidence to support the contention that a condition is 'real' is likely to be extremely influential, as has been extensively discussed in the neuroethics literature. This type of evidence will also reinforce the pre-existing beliefs of those researchers or clinicians who are already expecting a biological description. The uncritical credence given to neuroimaging research is an ethical issue, not in its potential for contributing to misdiagnosis per se but because of the motivations that often drive this research. My claim is that this research should proceed with an awareness of presumptions and motivations underlying the field as a whole, in addition to an explicit focus on the past and potential future consequences of classification and diagnosis on the groups of individuals under study. (shrink)

Joshua Greene has argued that several lines of empirical research, including his own fMRI studies of brain activity during moral decision-making, comprise strong evidence against the legitimacy of deontology as a moral theory. This is because, Greene maintains, the empirical studies establish that “characteristically deontological” moral thinking is driven by prepotent emotional reactions which are not a sound basis for morality in the contemporary world, while “characteristically consequentialist” thinking is a more reliable moral guide because it is characterized by greater (...) cognitive command and control. In this essay, I argue that Greene does not succeed in drawing a strong statistical or causal connection between prepotent emotional reactions and deontological theory, and so does not undermine the legitimacy of deontological moral theories. The results that Greene relies on from neuroscience and social psychology do not establish his conclusion that consequentialism is superior to deontology. (shrink)

Abstract Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial (...) nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. Content Type Journal Article Category Original Paper Pages 1-14 DOI 10.1007/s12152-011-9149-x Authors A. Demertzi, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium E. Racine, Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada M-A. Bruno, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium D. Ledoux, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium O. Gosseries, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium A. Vanhaudenhuyse, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium M. Thonnard, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium A. Soddu, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium G. Moonen, CHU Neurology Department, University Hospital of Liège, Liège, Belgium S. Laureys, Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology (...) about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice. (shrink)

The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...) these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness. (shrink)

Abstract Producing and interpreting functional brain data is part of the negotiation we imagine our brain. To take a closer look at the idea of brain imaging as a form of visual knowledge, it is necessary to put the research of today into a historical context. In my article I will point to a specific approach of functional imaging which depends on historical shifts entangled with the visual aspect of producing pictures of the brain. I will bring out the interaction (...) of issues like techniques, models and historical assumptions of the brain and link them with the way the brain images are presented. The aesthetic dimensions (Rancière) in the pictures are also questions of ethics and normativity. Content Type Journal Article Category Original Paper Pages 1-9 DOI 10.1007/s12152-011-9139-z Authors Hannah Fitsch, Technische Universität Berlin, Berlin, Germany Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

It has become evident that neuroimaging raises new normative questions that cannot be addressed adequately within the (in this regard unspecific) frameworks of existing research ethics. Questions that are especially troubling are, among others, provoked by incidental findings. Two questions are particularly intricate in view of incidental findings: (1) How can the research subject’s right not to know be guaranteed? And (2) should a diagnostic check of scans by a neuroradiologist become an obligatory part of neuroscientific research protocols? The present (...) paper examines these question against the background of two recent recommendations. The differentiation between difference position and similarity position serves as an analytic tool to further investigate the issue and to develop a distinct proposal for answering the questions. (shrink)

Purpose: Whereas ethical considerations on imaging techniques and interpretations of neuroimaging results flourish, there is not much work on their preconditions. In this paper, therefore, we discuss epistemological considerations on neuroimaging and their implications for neuroethics. Results: Neuroimaging uses indirect methods to generate data about surrogate parameters for mental processes, and there are many determinants influencing the results, including current hypotheses and the state of knowledge. This leads to an interdependence between hypotheses and data. Additionally, different levels of description are (...) involved, especially when experiments are designed to answer questions pertaining to broad concepts like the self, empathy or moral intentions. Interdisciplinary theoretical frameworks are needed to integrate findings from the life sciences and the humanities and to translate between them. While these epistemological issues are not specific for neuroimaging, there are some reasons why they are of special importance in this context: Due to their inferential proximity, 'neuro-images' seem to be self-evident, suggesting directness of observation and objectivity. This has to be critically discussed to prevent overinterpretation. Additionally, there is a high level of attention to neuroimaging, leading to a high frequency of presentation of neuroimaging data and making the critical examination of their epistemological properties even more pressing. Conclusions: Epistemological considerations are an important prerequisite for neuroethics. The presentation and communication of the results of neuroimaging studies, the potential generation of new phenomena and new 'dysfunctions' through neuroimaging, and the influence on central concepts at the foundations of ethics will be important future topics for this discipline. (shrink)

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of (...) carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point - even a backbone - for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. (shrink)

A pressing issue in neuroscience is the high rate of misdiagnosis of disorders of consciousness. As new research on patients with disorders of consciousness has revealed surprising and previously unknown cognitive capacities, the need to develop better and more reliable methods of diagnosing these disorders becomes more urgent. So too the need to expand our ethical and social frameworks for thinking about these patients, to accommodate new concerns that will accompany new revelations. A recent study on trace conditioning and learning (...) in vegetative and minimally conscious patients shows promise as a potential diagnostic and prognostic tool, both for differentiating between states of diminished consciousness, and for predicting patient outcomes, but it also generates fresh concerns about quality of life in patients previously thought to be completely unaware. Optimism about progress in diagnosing and treating disorders of consciousness must be tempered by the understanding that not all progress will necessarily be good for all patients. The prognosis for most patients remains bleak, and we must remain vigilant to acute questions and concerns about welfare and quality of life. (shrink)

Abstract Disorders of consciousness pose a substantial ethical challenge to clinical decision making, especially regarding the use of life-sustaining medical treatment. For these decisions it is paramount to know whether the patient is aware or not. Recent brain research has been striving to assess awareness by using mainly functional magnetic resonance imaging. We review the neuroscientific evidence and summarize the potential and problems of the different approaches to prove awareness. Finally, we formulate the crucial ethical questions and outline the different (...) articles in this special issue on disorders of consciousness. Content Type Journal Article Category Original Paper Pages 1-3 DOI 10.1007/s12152-011-9138-0 Authors Ralf J. Jox, Institute for Ethics, History and Theory of Medicine, University of Munich, Lessingstraße 2, D-80336 München, Germany Katja Kuehlmeyer, Institute for Ethics, History and Theory of Medicine, University of Munich, Lessingstraße 2, D-80336 München, Germany Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

Michael Pardo and Dennis Patterson have recently put forward several provocative and stimulating criticisms that strike at the heart of much work that has been done at the crossroads of neuroscience and the law. My goal in this essay is to argue that their criticisms of the nascent but growing field of neurolaw are ultimately based on questionable assumptions concerning the nature of the ever evolving relationship between scientific discovery and ordinary language. For while the marriage between ordinary language and (...) scientific discovery is admittedly not always a happy one, it is an awkward union that nevertheless seems to work itself out with the passage of time. In the following pages, I will try to show that Pardo and Patterson’s primary argumentative strategy ultimately depends on basic assumptions concerning the fixity of language that we should reject. (shrink)

I will argue that the fairly common assumption that brain imaging may compromise people’s privacy in an undesirable way only if moral crimes are committed is false. Sometimes persons’ privacy is compromised because of failures of privacy. A normal emotional reaction to failures of privacy is embarrassment and shame, not moral resentment like in the cases of violations of right to privacy. I will claim that if (1) neuroimaging will provide all kinds of information about persons’ inner life and not (...) only information that is intentionally searched for, and (2) there will be more and more application fields of fMRI and more and more people whose brains will be scanned (without any coercion), then, in the future, shame may be an unfortunately common feeling in our culture. This is because failures of privacy may dramatically increase. A person may feel shame strongly and long, especially if his failure is witnessed by people who he considers relatively important, but less than perfectly trustworthy. (shrink)

Brain images are used both as scientific evidence and to illustrate the results of neuroimaging experiments. These images are apt to be viewed as photographs of brain activity, and in so viewing them people are prone to assume that they share the evidential characteristics of photographs. Photographs are epistemically compelling, and have a number of characteristics that underlie what I call their inferential proximity. Here I explore the aptness of the photography analogy, and argue that although neuroimaging does bear important (...) similarities to photography, the details of the generation and analysis of neuroimages significantly complicate the relation of the image to the data. Neuroimages are not inferentially proximate, but their seeming so increases the potential for misinterpretation. This suggests caution in appealing to such images in the public domain. (shrink)

This is a report on the 3-day workshop The Neuroscience of Responsibility that was held in the Philosophy Department at Delft University of Technology in The Netherlands during February 11th–13th, 2010. The workshop had 25 participants from The Netherlands, Germany, Italy, UK, USA, Canada and Australia, with expertise in philosophy, neuroscience, psychology, psychiatry and law. Its aim was to identify current trends in neurolaw research related specifically to the topic of responsibility, and to foster international collaborative research on this topic. (...) The workshop agenda was constructed by the participants at the start of each day by surveying the topics of greatest interest and relevance to participants. In what follows, we summarize (1) the questions which participants identified as most important for future research in this field, (2) the most prominent themes that emerged from the discussions, and (3) the two main international collaborative research project plans that came out of this meeting. (shrink)