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Judy Illes, editor of Neuroethics, is a past director of the Program in Neuroethics at the Stanford Center for Biomedical Ethics. She is one of the main proponents of neuroethics as a new field of study, which has rapidly gained a great deal of attention. For example,
This may not seem much until one considers how many programs there are in the USA that focus on mental health ethics: zero. While plenty of work is being done concerning ethical questions in mental health, it is scattered in many different areas: law schools, medical schools, training programs, nursing programs, and social work programs. There is no program at a prestigious university, or indeed, at a less known university, that focuses on ethical issues in mental health. Yet mental health practice has a massive effect on modern society, while neuroscience has had rather minimal effect outside of university life. The reason that neuroethics has created such enthusiasm is that, like genetics, scholars see neuroscience as having a potentially huge effect on society in the future, and they want to be prepared.
So the stakes for neuroethics are high. The early publications need to show that it is worth investing so much into it if it is going to live to expectations. In examining these early publications, we will be asking whether it can make a contribution to the debate that significantly goes beyond existing discussion in medical ethics and philosophy of psychiatry.
This collection of papers is one of the first systematic attempts to show what neuroethics will look like. The book has 21 papers divided into three sections:
- Neuroscience, ethics, agency, and the self
- Neuroethics in practice
- Justice, social institutions, and neuropolitics.
The contributors are bioethicists, philosophers, educational specialists, legal scholars, neuroscientists, and engineers. The breadth of topics covered is striking. They include
- Moral decision-making
- Moral and legal responsibility
- The detection of lying
- Being an ethical agent
- The humanity of those with neurodegenerative diseases
- Connections between genetics and neuroscience
- The rights of human experimental subjects
- The ethics of brain stimulation and surgery
- Legal issues in neuroscience
- Poverty and neuroscience
- Religion and neuroscience
- The media representation of the mind sciences
With 21 papers and an afterword, it would be a nigh impossible task to please all possible readers, and for all papers to be equally interesting. Indeed, apart from book reviewers, I wonder how many readers read all the papers in such collections, or exactly what function such books are meant to serve. This collection might be used for graduate classes, or by other researchers in the field of neuroethics. Possibly some individual papers could be used as resources in undergraduate courses. Given the broad range of topics, individual papers will also be of interest to researchers in many other fields.
Given the range of different authors and topics, it is no surprise that the papers here approach their subjects in a variety of different ways. In the first part, most authors are philosophers and present a systematic argument for a thesis. The papers in the other two parts tend to be surveys of scientific findings, raising flags about possible ethical concerns, or authors raise questions instead of providing answers. Many of these papers conclude that the issues need to be studied further. This gives the strong impression that with the practical applications still in infancy, it is very hard to give arguments with strong interesting conclusions about what is good and what would be bad in the use of neuroscience. The argument is mostly at an early exploratory stage, and there is not much discussion between participants in the field.
Nevertheless, the papers here do build on previous discussion in other sub-disciplines of philosophy, medical ethics, and neuroscience. Take for example a nice paper by Franklin Miller and Joseph Fins, "Protecting human subjects in brain research: a pragmatic perspective." They spell out what they mean by pragmatism in ethics, relating it to the views of John Dewey. They discuss some of the general ethical issues in using randomized control trials; a central issue is whether it is unethical to use a placebo-control when there is a proven effective treatment available. However, using placebo-control trials is scientifically more informative than other sorts of controls. The authors discuss some of the issues in testing antidepressant medication to illustrate what is at stake, and then go on to set out the parallel issues that apply to deep brain stimulation. Then they take a strong stand against the principle of 'clinical equipoise,' which states roughly that the justification of clinical trials requires a state of uncertainty in the medical knowledge. To put it another way, the basic idea is that it is only ethical to do potentially risky experiments on people with medical problems when we have no better treatment to offer them. The authors draw on previously published critiques of clinical equipoise to establish why the principle is fundamentally mistaken. They proceed to argue that there can be occasions when it is ethical to use placebo controls when they are necessary or desirable to assess a new experimental treatment, when the risk to patients is minimized and not excessive. Much of the rest of the paper is spent on the issue of when it can be ethical to perform experiments on subjects who are not themselves competent to give informed consent to the experiment. We see in this paper that most of it builds on prior discussion, and the application to trials of deep brain stimulation does not extend that prior discussion very far. The existing literature in the ethics of medical and especially psychiatric research has already covered most of the issues, so extending it to neuroscientific research is a small step.
This observation applies to a great many of the papers in this collection. The book shows that there is nothing that is fundamentally new about neuroethics. It is exciting that there is so much enthusiasm bring brought to the topics addressed in Neuroethics, and we can hope that they will gain more prominence in philosophy, medical ethics, medicine and in the media more generally. The book also shows the richness of this area of study. I especially liked the paper by Stephen Morse, on "Moral and legal responsibility and the new neuroscience," in which he urges for some skepticism regarding what light the latest scientific findings can shed on people's moral and legal responsibility. There are several other provocative papers here that I will return to for my own research and assign in my classes. Neuroethics is a valuable book, not just for those who are identified with the new area of neuroethics, but also for those in medical ethics, philosophy of mind, and philosophy of psychiatry.
© 2007 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.