Medicine & Neuroethics: Perspectives from the Intersection
By Somnath Das
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Cognitive Enhancement
Different and sometimes conflicting concerns spring up when debating cognitive enhancement for healthy individuals from neuroethical versus medical ethics perspectives. In seeking to address this debate from the biomedical perspective, medical ethicists often choose to focus on measurable cognitive benefits (improvements in memory or concentration), adverse effects (stimulant side effects or stimulant-drug interactions), patient autonomy, and informed consent. The distributive justice of cognitive enhancers is also of concern to medical ethicists, being that physicians currently possess significant financial incentives, under the current medical model to prescribe pharmacological stimulants (Cheung & Pierre 2015). Neuroethicists add to the discussion by debating the ethics of both current and future neuroscientific advances in the field of cognitive stimulation (Racine 2010, pg 10). I have previously written about how neuroethicists, in a similar vein to medical ethicists, voice concern over how individuals with more financial resources can use enhancement to gain an unfair cognitive advantage in society; however, others in neuroethics have argued that healthy individuals should have the right to use enhancement at will, being that stimulation may be necessary to adapt to a more cognitively-demanding future (Clark 2014). Indeed, some bioethicists, such as Arthur Caplan note that cognitive enhancement should “always be done by choice, not dictated by others.” Greely et al. adopts a similar view, noting that the cognitive enhancement debate should not focus on “when,” but rather “how” future leaders mitigate the risks and maximize the benefits of stimulants (Greely 2008).
By emphasizing the ethics of neuroscientific advancements, neuroethicists have pointed out the need to further study the motivations for healthy individuals to seek enhancement. In fact, some neuroethics literature has demonstrated that users may seek enhancement due to less medically quantifiable benefits such as “increased energy” as opposed to increased performance on cognitive tasks (Illeva & Farah 2013). A more complete understanding of the motivations of cognitively healthy individuals seeking to further enhance their abilities will inform the role physicians should play in the future of enhancement distribution (Forlini, Gauthier, & Racine 2013; Chatterjee 2017). These motivations are particularly important to assess as people resort to do-it-yourself (DIY) methods of brain enhancement.
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Advanced Neural Diagnostics & Patient Privacy
The advancement of brain imaging has greatly changed how we think about the nature of using cognitive data for research. The predictive capacity of advanced diagnostics for psychiatric and neurological disorders remains a hotly debated topic. In their response to the Nature article “Attention to Eyes Is Present but in Decline in 2–6-Month-Old Infants Later Diagnosed with Autism,” neuroethicists Karen Rommelfanger & Jennifer Sarrett note that clinical investigators stand as some of the last and most important arbiters of clarifying the nature of imaging data to patients. As brain imaging becomes increasingly complex and precise, it will be necessary for physicians to play an ever-increasing role in constructing the guidelines by which these techniques are used in clinical practice to ensure both informed consent and responsible use and interpretation of data.
It is necessary to note that physicians have the responsibility to not only clarify the nature of medical data collection, but also to protect this data from being used irresponsibly. In 1996, HIPAA introduced further regulations as to what information is considered “protected,” and it created protocols for the transmission of this information via physical and electronic methods. Within their first weeks of medical school, medical students are introduced to HIPAA, and the importance of protecting patient data persists within both scientific and medical training. However, with the advancement of brain imaging the very nature of what data physicians collect on patients is rapidly changing, potentially to the point where neural data is now too sensitive to be transmitted without further legal change.
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Conclusion
The future of medicine is intimately tied to emerging neurotechnologies, and therefore will require a keen understanding of what motivates the public to seek new technologies and how the public conceptualizes these technologies in terms of risks, benefits, and long-term impacts. Gaining this understanding will help physicians and neuroethicists alike to protect individual patient safety and privacy. I believe the physician can serve as the strongest bridge between the worlds of academia and individuals who will be impacted by this technology. This idea is hardly new; from transplantation to novel cancer therapeutics, physicians stand to interpret the intersection of what is possible and what needs to be done in order to heal the patient. Being that some technologies may do more harm than good, the “ideal” physician ultimately should serve to protect their patient from the dangers of novel technologies when the risks outweigh the benefits. It is through proper training and exposure to neuroethics that I believe physicians can better treat their patients and be more adequately prepared to address the future of what is to come in modern medicine.
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Somnath Das is a second year student at Sidney Kimmel Medical College. His interests currently involve integrating neuroethics education into the training of future medical professionals. His interest began at Emory University under the instruction of Dr. Karen Rommelfanger, and he still enjoys occasionally contributing to the blog to this day. The implications of futuristic technologies both within and outside medicine interests him, and he views Neruoethics as a toolbox to think, debate, and perceive the sequelae of the latest neuroscientific innovations.
References
Clark, V. P., & Parasuraman, R. (2014, 01). Neuroenhancement: Enhancing brain and mind in health and in disease. NeuroImage, 85, 889-894. doi:10.1016/j.neuroimage.2013.08.071
Chatterjee, A. (2017). Grounding ethics from below: CRISPR-cas9 and genetic modification. The Neuroethics Blog. Retrieved on July 24, 2018, from http://www.theneuroethicsblog.com/2017/07/grounding-ethics-from-below-crispr-cas9.html
Davis, J. K., Hoffmaster, B., & Hooker, C. (n.d.). Pragmatic Neuroethics. Retrieved from https://mitpress.mit.edu/books/pragmatic-neuroethics
Farah, M. J. (2012, 01). Neuroethics: The Ethical, Legal, and Societal Impact of Neuroscience. Annual Review of Psychology, 63(1), 571-591. doi:10.1146/annurev.psych.093008.100438
Forlini, C., Gauthier, S., & Racine, E. (2013, September 03). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761009/
Greely, H., Sahakian, B., Harris, J., Kessler, R. C., Gazzaniga, M., Campbell, P., & Farah, M. J. (2008, December 10). Towards responsible use of cognitive-enhancing drugs by the healthy. Retrieved from https://www.nature.com/articles/456702a
Ilieva, I. P., & Farah, M. J. (2013). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813924/
The Medical Ethics of Cognitive Neuroenhancement. (n.d.). Retrieved from https://www.semanticscholar.org/paper/The-Medical-Ethics-of-Cognitive-Neuroenhancement-Cheung-Pierre/2425ce612b41ca803de9a1d0c437958836193bf4
Racine, E. (2010). Pragmatic neuroethics: Improving treatment and understanding of the mind-brain. The MIT Press.
Das, S. (2018). Medicine & Neuroethics: Perspectives from the Intersection. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/11/medicine-neuroethics-perspectives-from.html