Selected Abstracts From the 2013 International Neuroethics Society Annual Meeting

Abstract

Click to increase image sizeClick to decrease image size Frontotemporal Dementia Provides Evidence for a Revised Dual-Process Account of Moral ReasoningWinston Chiong and Katherine Rankin, Memory and Aging Center, Department of Neurology, University of California San FranciscoGreene and colleagues (2001 Greene, J.D., et al. 2001. An fMRI investigation of emotional engagement in moral judgment. Science 293(5537): 2105–2108.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) reported distinct functional magnetic resonance imaging (fMRI) activation patterns during “personal” moral reasoning, as compared with “impersonal” moral reasoning and nonmoral practical reasoning. They proposed that these findings lend support for a dual-process account of moral reasoning on which utilitarian judgments reflect controlled cognition while counterutilitarian judgments reflect prepotent emotional influences. However, subsequent research has shown that the network of brain regions recruited during personal moral reasoning is not specifically related to emotional processing. Instead, neural activity within this “default mode network” exhibits coordinated activity during a broad range of cognitive states, most unrelated to emotion.These findings undermine the claim that personal moral reasoning and counterutilitarian judgment are specifically related to emotion; however, it remains notable that the default mode network is recruited during personal moral reasoning, while a reciprocally related “executive control network” is recruited during impersonal moral and nonmoral practical reasoning. The differential recruitment of these two networks does suggest that two distinct cognitive processes may be engaged by moral reasoning; however, the nature and implications of this dissociation remain obscure.Recently we have investigated the dynamic interrelationships of large-scale brain networks during moral reasoning in both patients and healthy subjects. Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative illness marked by profound impairments in emotional and social function, and bvFTD patients give abnormally utilitarian responses to personal moral dilemmas. Notably, bvFTD is marked by atrophy and disrupted connectivity not within the default mode network, but in a more anterior “salience network” that is consistently linked to emotional cognition. Our research provides converging behavioral, univariate fMRI, and multivariate fMRI evidence for directed causal influences from the salience network to the default mode network during moral reasoning (Chiong et al. 2013 Chiong, W., et al. 2013. The salience network causally influences default mode network activity during moral reasoning. Brain 136: 1929–1941.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).Building on earlier work characterizing the salience network, we propose that it plays an alerting and switching role during moral reasoning, utilizing social and emotional resources to appropriately recruit either the default mode or executive control network depending on the dilemma under consideration. We further propose an account of the default mode network's role in moral reasoning that appeals to recent work on this network's role in the mental simulation of different perspectives. One feature of personal moral deliberation is that it often involves consideration of the subjective points of view of the agent and of other affected parties. This understanding of the default mode network may therefore provide a neuroscientific framework for the claim that counterutilitarian moral judgments are closely tied to a personal, rather than a fully objective, point of view (Nagel 1986 Nagel, T. 1986. The view from nowhere. New York, NY: Oxford University Press. [Google Scholar]).Disclosures: None.Ethical Challenges of Large-Scale Brain SimulationsMarkus Christen, University of Zurich, Institute of Biomedical Ethics, Zürich, SwitzerlandObjective: Large-scale brain simulations are an increasingly important tool in neuroscience (De Garis et al. 2010 De Garis, H., C. Shuo, B. Goertzel, and L. Ruiting. 2010. A world survey of artificial brain projects, Part I: Large-scale brain simulations. Neurocomputing 74: 3–29.[Crossref], [Web of Science ®] , [Google Scholar]). This is exemplified by the selection of the Human Brain Project as one of the two scientific “flagships” of the European Union in January 2013. In my contribution, I discuss the ethical consequences when the brain is object of large-scale simulation approaches that intend to guide the research process in neuroscience. Referring to experiences made in climate modeling, I claim that the focus of an ethical assessment should not merely be output oriented, but should assess the (often hidden) normative decisions that model generation involves, may include the notion of value-sensitive design (Friedman 1997 Friedman, B. (Ed.). 1997. Human values and the design of computer technology. New York, NY: Cambridge University Press. [Google Scholar]), and should be sensible to side effects of the research project, for example, with respect to differences in “working philosophies” of the involved disciplines.Methods: I made a comparative assessment of recent examples of large-scale brain simulations with respect to the history of the brain–computer relation and to sociological and ethnographic research on climate modeling. The former is important because in neuroscience, the relation between the tool for simulation and the object of simulation is bidirectional. The latter is illustrative due to the long history and political importance of climate modeling, such that there is some ethnographic and sociological work available on the various social processes that accompany model generation.Results: The historical analysis points to difficult epistemic problems that are related to the conceptualization of information in neuroscience (Garson 2003 Garson, J. 2003. The introduction of information into neurobiology. Philosophy of Science 70: 926–936.[Crossref], [Web of Science ®] , [Google Scholar]) and makes the attractiveness of brain simulations comprehensible, as they allow a reference to various deep philosophical problems. The comparison with experiences in climate modeling (Lahsen 2005 Lahsen, M. 2005. Seductive simulations? Uncertainty distribution around climate models. Social Studies of Science 35: 895–922.[Crossref], [Web of Science ®] , [Google Scholar]) shows that collaboration between modelers and empirical scientists are tricky, that visualizations tend to blur important differences between the object of simulation and the simulations themselves, and that various psychological mechanisms are at work that may undermine the critical function of the knowledge base of the modeling process.Conclusions: I conclude that several ethical challenges that large-scale simulations in neuroscience will have, are currently not sufficiently addressed in the neuroethics community. A reason for that may be that most neuroethicists have a background in medicine, such that issues that relate to medical problems like enhancement or incidental findings dominate. Furthermore, I predict that brain simulations will become equally politically influential as climate models, both with respect to guiding research investment allocation with with respect to informing political decision making.Charting a Course for Mapping the Brain—The Noetics and Neuroethical Challenges of Homo sapiens (Neuro)TechnologicusTaisa Coleman1, Guillermo Palchik2,3, and James Giordano2,4,5, 1Graduate Program in Science Policy, Georgetown University, Washington DC, USA, 2Interdisciplinary Program in Neurosciences, Georgetown University Medical Center, Washington, DC, USA, 3Department of Neurosciences, University of Texas Southwest Medical School, Dallas, Texas, USA, 4Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA, 5Human Science Center, Ludwig-Maximilians Universität, München, GermanySince antiquity, the brain and its functions have been both enigmatic and a source of human inquiry, invention, and intervention. The newly proposed Brain Activity Map (BAM) and Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative represent the most contemporary iteration of this pursuit. By employing knowledge and technical convergence that conjoins the physical, natural, social sciences, and humanities in tools-to-theory-to-tools (T-3) heuristics, the disciplines of neuroscience enable heretofore unparalleled knowledge, through techniques to assess, access, and target neural substrates of cognition, emotion, and behavior in ways that offer potential translation in medicine, public life, international relations, and national security and defense.The technical capability and theoretical revision afforded by contemporary neuroscientific advances—inclusive of those leveraged in the BRAIN agenda—have potential to incur profound change in the sophic, empiric, and epistemic domains of human knowledge (i.e., the noetic contribution of neuroscience), and such change prompts questions about the boundaries of scientific intervention and effect, and the social implications and ramifications of each and any discovery.Herein we offer that while history may provide salient object lessons against frank misuse of neuroscience and its technologies, the historical record also upholds the reality that “change happens” and is reflective of human progress. Simply put, the more that is known, the more that can be—and is—done with said knowledge, and the noetics of neuroscience are no different. But a map is of little value absent the means to travel and deal with exigencies and contingencies along each step of the route. In this light, we argue that agendas such as BAM and BRAIN must entail an equally strong substantiation of programs dedicated to (1) elucidating what the T-3 heuristics of neuroscience will be focused upon and most likely enable in the short and intermediate term (i.e., the “where are we going?” question); (2) depicting the realities of the situations that will be produced at these epistemological and technical waypoints (i.e., the “what will really happen when we get there?” question); and (3) elucidating the true benefits, burden, risks, harms—and controls that can and should be implemented upon arrival (i.e., the “what are we going to do with and about it?” question). Toward this end, we propose that any and all neuroethical focus should not be esoteric or agnostic, but rather should direct a realistic appraisal of the positive, neutral, and negative trajectories that viably result from specific undertakings of BRAIN.Cognitive scientist Merlin Donald claims that the next phase of human cognitive evolution will be technological. We agree, and call for and outline a paradigm and program in the spirit of Arendt's homo faber—the reflective, creative human—through which to develop and maintain homo sapiens (neuro)technologicus: humanity that employs knowledge and insight to the ways, ends, realistic products, outcomes, effects, guidance, and adjudication of the ways we use tools—of neuroscience, if not the brain itself—to shape our present and future world.Italian Neuroethics Society: History and Perspectives of a Research ProgramChiara D’Alessio1, Mario De Caro2, Michele Di Francesco3, Andrea Lavazza4, and Roberto Mordacci5, 1University of Salerno, and Università Europea, Rome, Italy,2 Università Roma Tre, Italy, and Tufts University, 3IUSS, Pavia, Italy, 4Centro Universitario Internazionale, Arezzo, Italy, 5Università Vita & Salute San Raffaele, Milano, ItalyThe Italian Neuroethics Society was founded in July 2013. The founding of the society is the culmination of a process that began in 2009, with the first national conference dedicated to this new field of research. The conference was held, as it is every year, at the University of Padua, one of the world's oldest universities (where Galileo Galilei taught for 18 years).The initial purpose of the conference (now an international meeting with scientists from many countries) was to bring together scholars from various different disciplines: neuroscientists, cognitive scientists, philosophers, psychologists, legal scholars, economists, art experts, and theologians. The idea was to draw together, in addition to neuroscientists, all those scholars who explored the neurological aspects of their field: neurophilosophy, neuropsychology, neurolaw, neuroeconomics, neuroaesthetics, and neurotheology.After this initial phase, the conference's promoters (Andrea Lavazza and Giuseppe Sartori) turned their efforts toward identifying the specifics of research in neuroethics, with regard to both the international debate and the Italian research tradition, especially in neuroscience, philosophy, and law, in an attempt to overcome A. Roskies's classic partition between the ethics of neuroscience and the neuroscience of ethics.One possible approach to research sees the specific field of neuroethics as an exploration of what we learn about ourselves and our “functioning” thanks mainly (but not exclusively) to neuroscience. In other words, a metadiscipline that deals with the intersection of the various disciplines just cited is made pertinent by the strong naturalization of research on the human being. The subject of study—in light of its new and controversial character—would thus not be what we can do, but what we know or reliably think we know.Indeed, unlike what happens with bioethics (which can aim to prescribe or ban certain medical practices), there is no possibility of limiting the diffusion or effects of our understanding regarding “how we are”; in other words, the availability of knowledge has philosophical consequences and leads to self-understanding of the human being, with more or less significant social, political, and legal implications.The ideal goal is a comprehensive theory on the functioning of the mind/brain, but not in order to reduce all the explanations provided by the disciplines that contribute to neuroethics to a single neuroscientific explanation. The goal is to arrive at an explanation that begins from the functioning of the mind/brain—implied both subjectively in research activities and in the object of the research itself (namely, human beings in all their activities, from philosophy to economics)—while leaving some autonomous room for the “special sciences” of humans.Neuroscience and Technology (NeuroS/T) as the New Dual-Use Frontier: Importance and Necessity of Neuroethical Guidance and ArticulationDiane DiEuliis and James Giordano, Georgetown UniversityDual-use research in the life sciences has long been recognized as uniquely distinct from nuclear or other defense-adapted technologies, due to its intrinsic inseparability from human health needs within the context of dynamically changing ecosystems. Since the historic Asilomar Conference convened with the advent of recombinant DNA, there has been a “ground up,” intensely ethical dialogue involving academia, federal agencies, and the medical, health, and lay communities, to determine how to ethically guide the use of emerging biological technologies, particularly revolving around infectious disease organisms or organisms that produce life-threatening illness. Indeed, the Fink report outlined the “seven deadly sins,” or those experiments that represent the most ethically questionable scientific endeavors in microbiological disciplines (Committee on Research Standards ), and following the anthrax attacks of 2011, the “select agent list” further circumscribed the field. The debate continues today at the highest levels of government (National Institutes of Health n.d.).We propose that neuroscientific and neurotechnological (neuroS/T) advancements represent new, unique frontiers in the dual use dilemma, which require similar—but we posit perhaps more specifically focused—(neuro)ethical discourse on potential use and misuse that is apace with, realistically analytic toward, and thereby appropriate to current and near-future scientific and technological advances. As a traditional life science, neurobiology in and of itself does not connote immediate dual-use concerns within the academic community. However, with convergence of genetic, cellular, and molecular techniques, advances in imaging, computation, and various interventional techniques (e.g., trans- and intracranial stimulation, neuropharmacologicals, nanomaterials, etc.), neuroS/T enables strong pillars of both civilian and military applications, and currently these pillars exist as primarily distinct silos. NeuroS/T affords clear benefits to both civilian and military medicine, in areas such as neural prosthetics, therapeutic chemical neuromodulation, promotion of psychological “hardiness,” and others, any of which can be purposefully utilized for nefarious dual-use application. Importantly, by advancing understanding of cognition, behavior, and decision making, neuroS/T offers unique dual-use potential to assess, access, and target/manipulate the “essence” of human thought and action.In this context, we have developed the term “neurodeterrence,” a merging of cognitive neuroS/T to deterrence theory. We view this as a novel tool that can be applied to a traditional philosophy of defense and security actions and decision making, and hope to mature this potential with the full input of each discipline. However, dual-use neuroS/T and agendas and programs of neurodeterrence each and all foster neuroethical, legal, and social issues (NELSI) and concerns. Recognizing this, we propose that the responsibility to begin, direct, and sustain pragmatic, genuine dialogue between the neuroscience and defense communities be borne by neuroethics as a field, and be engaged on several levels. We offer a tentative infrastructure of personnel, process(es), protocols, and policies with which to articulate address, and potential resolution of dual-use and neurodeterrence NELSI, and discuss the potential strength, limitations, and delimitations of this model, advocating the importance and need for such NELS guidance and governance before, during, and sustainably through current and new neuroS/T development and application(s).REFERENCESCommittee on Research Standards and Practices to Prevent the Destructive Application of Biotechnology, National Research Council. 2004. Front matter. In Biotechnology research in an age of terrorism. Washington, DC: National Academies Press. [Google Scholar]National Institutes of Health. n.d. United States government policy for oversight of life sciences dual use research of concern. http://oba.od.nih.gov/oba/biosecurity/PDF/United_States_Government_Policy_for_Oversight_of_DURC_FINAL_version_032812.pdf [Google Scholar]Pedophilia and Hemodynamic Brain Response: Is Arousal Guilt?M. Carmela Epright, Furman UniversityUntil recently, the most common method of determining the sexual preferences of pedophiles has been the use of penile plethysmography or “phallometry,” an invasive procedure that measures blood flow to the penis when the subject is exposed to sexually suggestive materials. Phallometry is notoriously unreliable insofar as little testing has been conducted on non-sexual offenders, and because it tells us little about the origin of the sexual arousal (e.g., perhaps the subject was a victim of sexual abuse and is responding to his or her own victimization). More recently, studies have suggested that functional magnetic resonance imaging could be used to achieve more accurate (insofar as the testing has also been conducted on non-sex offenders) and less invasive results.The argument for hemodynamic brain scanning is that it could be used not merely to test arousal, but to identify known brain structures that contribute to abnormal sexual desires; thus, such information could be employed to develop effective treatment strategies. However, there are obvious ethical issues at stake in this testing. One might ask, for example, how should such testing be used and in what contexts? Phallometry has been used as evidence to deny inmates parole, and to maintain the civil incarcerations of so-called “sexually violent predators.” Early proponents of phallometry also argued that it could be used to develop therapies or treatments for pedophiles; however, these tests have not lived up to these promises and pedophilia remains nearly impossible to treat. Should brain scans be substituted in similar contexts and be used for the same purposes? Would such scans be more compelling to the general public than phallometry, such that there could be a call to use such testing as a screening device for non-offenders applying for jobs that require subjects to care for and/or supervise children? And finally, what do such tests tell us, if anything, about whether the subject is going to act on his or her desires?Neuroethics of Pain and Suffering in Disorders of ConsciousnessM. Farisco1 and A. Gini2, 1Center for Research Ethics and Bioethics, University of Uppsala, Sweden, and Biogem, Genetic Research Centre, Ariano Irpino (AV), Italy, 2Neuroradiology Division, San Camillo-Forlanini Medical Center, Rome, ItalyThe intriguing issue of pain and suffering in patients with disorders of consciousness (DOCs), particularly in unresponsive wakefulness syndrome/vegetative state (UWS/VS) and minimally conscious state (MCS), needs empirical and theoretical assessment. We present an overview of recent neuroscientific literature to sketch an ethical analysis, given that the issue is very problematic and potentially innovative in neuroscientific as well as in neuroethical literature (Demertzi et al. ; Farisco ).To date, not many studies have been dedicated to pain perception and suffering in patients with DOCs and, despite a progress in our knowledge, a critical uncertainty remains (Schnakers, Laureys, and Faymonville ). Additionally, only acute pain has been well investigated; our understanding of possible chronic pain in these patients is insufficient, particularly on the presence of baseline pain or suffering and whether it interferes with the ability to perceive a particular noxious stimulus (Laureys et al. ). Further investigation is certainly useful since the issue of pain and suffering in patients with DOCs raises not only scientific but also ethical questions.In particular, our work investigates the possibility of pain perception by patients with DOCs, not to assign them a moral status (in relation to the so-called “end-of-life decisions”), but only to determine whether it is ethically right, due, or optional to treat them with analgesics. Notwithstanding the relevance of both issues, the latter is surely an ethical and legal problem affecting the everyday practice of a greater number of people.Given this state of art, what degree of uncertainty is acceptable at a legal and ethical level? We believe that from a social and public point of view, in order to make decisions regarding the management of patients with DOCs, the best strategy would be to connect neuroscience with other fields, especially law and ethics; we do not have to wait for neuroscience to clarify all its doubts, but we have to deal exactly with this uncertainty. If we were not uncertain, we would not need juridical and ethical principles to assess our actions.As a tentative conclusion we suggest formal guidelines and a situationist ethics in order to best manage the critical scientific uncertainty about pain and suffering in DOCs and to ensure the best possible care for such patients.REFERENCESDemertzi, A., E. Racine, M.A. Bruno, et al. 2013. Pain perception in disorders of consciousness: neuroscience, clinical care, and ethics in dialogue. Neuroethics 6(1): 37–50. [Google Scholar]Farisco, M. 2013. The ethical pain. Detection and management of pain and suffering in disorders of consciousness. Neuroethics 6(2): 265–276. [Google Scholar]Laureys, S., M.E. Faymonville, P. Peigneux, et al. 2002. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage 17: 732–741. [Google Scholar]Schnakers, C., S. Laureys, and M.E. Faymonville. 2009. Ethical implications: Pain, coma, and related disorders. In Encyclopedia of consciousness, vol. 1, ed. W. Banks, 243–250. Amsterdam, The Netherlands: Elsevier. [Google Scholar]Sources of Angst About Cognitive Enhancement: Hard Work, Authenticity, Worth, and SuccessNicholas S. Fitz and Peter B. Reiner, National Core for Neuroethics, University of British ColumbiaImagine that a friend of yours has been assigned a new project at work and decides to take a safe and effective cognitive-enhancing pill to improve her working memory. Is her performance authentic? Is she worthy of promotion? Despite well-reasoned refutations of the authenticity concern, questions concerning authenticity and the value of hard work touch on deep cultural motifs surrounding the use of technological tools writ large. The essence of the issue is not whether enhancement is a shortcut to success—it is—but rather whether such shortcuts are problematic (Parens 2005 Parens, E. 2005. Authenticity and ambivalence. Hastings Center Report, 1–8.[Crossref], [PubMed] , [Google Scholar]; Schermer 2008 Schermer, M. 2008. Enhancements, easy shortcuts, and the richness of human activities. Bioethics 22(7): 355–363.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).We practiced experimental neuroethics: exploiting the traditional methods of cognitive science—systematic experimentation and statistical analysis—to gain insight into the way people make judgments about neuroethical issues. Here, we employed the contrastive vignette technique to probe public attitudes about authenticity of performance and worthiness of achievement when using a cognitive enhancer. Respondents recruited from Mechanical Turk (n = 698) were randomly assigned to one—and only one—vignette that described an individual who enhances to improve performance in the workplace. In the realm of cognitive enhancement, shortcuts to success might be achieved in two ways: Technology might improve productivity, allowing one to work more efficiently per unit time, or technology might facilitate cognitive perseverance, allowing one to work longer without mental effort. For these reasons, the vignettes systematically differed by virtue of the presence or absence of enhancement, the effort expended, and time invested in performing the task.Members of the public view enhanced performance as less authentic than unenhanced performance. Irrespective of whether the hypothetical individual in the vignette succeeded or failed at the task, the individual's performance was viewed as significantly more authentic when that person did not use a cognitive enhancer (p <.001). Diminished authenticity did not translate into diminished worthiness: Respondents felt that enhanced individuals who succeeded at the task were rated as significantly more worthy of promotion than those who did not enhance and failed (p <.001). Perhaps most important was the observation that respondents felt that the agent was significantly more worthy still when that agent was successful without the use of cognitive enhancers (p <.001).Our results suggest that members of the public endorse success while also placing value on how that success is obtained—supporting both meritocratic and character values. Despite entreaties by philosophers to dismiss the authenticity concern, members of the public appear to attach substantial value to the issue. Concerns about authenticity may represent a continuing source of angst about cognitive enhancement. (Fitz et al. Fitz, N.S., R. Nadler, P. Manogaran, E. Chong, and P.B. Reiner. Submitted. Public attitudes toward cognitive enhancement. [Google Scholar] submitted).FUNDINGSupported by the Canadian Institutes of Health ResearchDiagnosing Mental Disorders, Psychiatric Metaphysics, and the Neuroethics of Mental Health and PsychiatryChristine Fitzpatrick1 and James Giordano1,2,3, 1Graduate Liberal Studies Program, Georgetown University, Washington, DC, USA, 2Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA, 3Human Science Center, Ludwig Maximilians Universität, Munich, GermanyThe American Psychiatric Association's Diagnostic and Statistical Manual (DSM) is a knowledge tool influenced by technological advances and philosophical theories, as well as the sociocultural environment in which it has been developed and used. The 2013 fifth edition (DSM-5) will be employed in an American population in which the lifetime incidence of mental disorders renders these conditions statistically “normal.” In international terms, the World Health Organization's International Classification of Disease (ICD) may soon constrict the DSM's influence. Thus, the presumed medical model that theoretically supports some form of universal psychiatric classification system may conflict with the present diagnostic paradigm, which relies on culturally variable phenomenological and social experiences. This raises questions about the scientific validity of globalizing nonobjective diagnostic and treatment standards and fosters ethical dilemmas regarding what type(s), extent, and system(s) of resources are needed to address international mental illness.A number of factors affect the scope and conduct of psychiatry, including: (1) expectations of a self-medicalized society; (2) public health conceptualizations of psychiatric normality and related public policy agendas; (3) clinical ambiguities of attempting to discern “disorder” from ordinary troubles; (4) clinical utility in selecting and implementing effective treatment and prognosis; and (5) the need for research to demonstrate biological etiologies of mental disorders able to support the development an