Tuesday, March 31, 2015

Is Brain Dead Really Dead?

By Amber Green

Amber Green is currently a senior in the Emory College of Arts and Sciences, double majoring in Neuroscience and Behavioral Biology and Philosophy. Her majors led her to an interest in neurophilosophy and neuroethics. She hopes to pursue a MA in Bioethics and/or Neurophilosophy and go into a career as a clinical neuroethicist after graduating in May.

Having a family member pronounced dead is a very heartbreaking moment. Be it your pet, your sister, your mother, or your child, the pain you feel when the doctor reports that your loved one has passed away is overwhelming. Doctors know that there are no take-backs once they inform the family of the patient’s death, which is why there are strict procedures for a doctor to follow when declaring someone dead. However, when it comes to “brain death” and the advances of life support technology, these procedures become harder to follow and leads one to ask the question: “More importantly, if the brain is dead, are we dead?”

In Oakland, California, this past year, a 13-year old girl named Jahi McMath had been maintained on a ventilator since an elective procedure to treat her sleep apnea went horribly wrong. Jahi McMath had been pronounced brain dead, yet she had not been taken off of life support. In fact, her parents persuaded a judge to have her life support extended for at least a week past the doctor’s declaration of brain death. Her parents insisted that she is still alive and that taking their daughter off life support is equivalent to killing her. But, who is in the right: the doctors or the parents of Jahi McMath? And whose wishes should we honor?

Friday, March 27, 2015

Gray Matters Volume II Released by Presidential Commission

The highly-anticipated second volume of Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society was released by the US Presidential Commission for the Study of Bioethical Issues on March 26th. This report is in “response to President Obama’s request related to the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.”

According to the Commission’s announcement, in this volume “the Bioethics Commission broadly focused its analysis on three particularly controversial topics that illustrate the ethical tensions and societal implications of advancing neuroscience and technology: cognitive enhancement, consent capacity, and neuroscience and the legal system.”

“In its latest release, the Bioethics Commission seeks to clarify the scientific landscape, identify common ground, and recommend ethical paths forward. Cautioning against hyperbole and misinformation when discussing the promise of neuroscience, the report offers 14 recommendations to help clear a path to productive discourse.”

The full report can be read here.

Eleven members of the AJOB Neuroscience editorial board made presentations for the Bioethics Commission: Anjan Chatterjee, Martha Farah, Paul Ford, Hank Greely, Joshua Greene, Steven Hyman, Stephen Morse, Eric Racine, Peter Reiner, Adina Roskies, Paul Root Wolpe.

Tuesday, March 24, 2015

Early Intervention in Schools: A Site for Empirical Neuroethics

By Ilina Singh, MSc

Ilina Singh is a Professor of Science, Ethics, and Society in the department of Social Science, Health, and Medicine at King’s College London, and is cross-appointed to the Institute of Psychiatry. Her work examines the psycho-social and ethical implications of advances in biomedicine and neuroscience for young people and families. She is also a member of the AJOB Neuroscience Editorial Board.
The developmental logic of early intervention is currently all the rage across child care-related sectors, including education, mental health, juvenile justice and social policy. It’s not a new logic by any means (witness longstanding programmes such as HeadStart), but it has new energy and justification with the emergence of epigenetic theories of development. Epigenetics has brought attention to ‘environment’ to the fore, particularly in pediatrics and in child psychiatry. While epigenetic theories are still that – theories – the last few years have seen a surge in research and policy focused on children’s early environments: womb, home, school, community. Students and researchers interested in neuroscience ethics, particularly in relation to children and adolescents, should find rich and fruitful ground for research here. In this blog I outline some thoughts about why neuroethicists might be interested in early intervention programmes in one key environment – schools.

From iStockPhoto

Schools have a long history of collaborations with psychiatry, psychology and pediatric medicine. A rich and frequently critical sociological literature details how these collaborations have informed and embedded a range of normative understandings of child development, particularly in the interrelated areas of behaviour, morality, intelligence and attachment. Scientific discoveries have had an important influence on shifting tropes in child education; from the ‘well adjusted’ child in a psycho-analytic framework, to a contemporary focus on child ‘wellbeing’ and ‘flourishing’ informed especially by positive psychology and emerging discoveries in developmental biology and neuroscience. In this context, early years schooling provides both the environmental conditions to kindle the capacities that promote flourishing, and a pre-clinical site in which to monitor and evaluate children and deploy early intervention strategies when a child appears to be at risk of failure to flourish.

Thursday, March 19, 2015

The Montreal Neuroethics Conference for Young Researchers 2015

The Montreal Neuroethics Conference for Young Researchers 2015 will be held in Montréal, Québec, on April 17th, 2015 at the Institut de recherches cliniques de Montréal (IRCM), Montréal, Quebec. This one-day international conference is aimed at young researchers, trainees, and students from all fields interested in neuroethics. In addition to the program on the day of the event, we are hosting an essay competition where 5 winning papers in English will be candidates for fast-tracked publication in a special issue of the journal Neuroethics and 5 winning papers in French will be candidates for fast-tracked publication in a special issue of the journal Bioéthique Online. 

Tuesday, March 17, 2015

The Newly Released 6.1 Issue of AJOB Neuroscience

The 6.1 Issue of the American Journal of Bioethics Neuroscience (AJOB Neuroscience) is now hot off the presses with two target articles highlighting ethical issues behind the use of two very different therapeutic interventions: first-in-human trials to treat Parkinson’s disease using stem-cell based therapies and prescription stimulants to enhance motivation.

The Target Article “Ethical Criteria for Human Trials of Stem-Cell Derived Dopaminergic Neurons in Parkinson’s Disease”1 by Samia A. Hurst et al. discusses three specific considerations of a phase I(safety)-II (efficacy) clinical trial designed to test an experimental neurorestorative stem cell therapy for Parkinson’s disease. Parkinson’s disease is a result of the loss of dopamine-producing neurons in the substantia nigra, and significant depletion of dopamine leads to the tremors, rigidity, and difficulty initiating or halting movement that is often seen as the disease progresses. To compensate for the diminishing levels of the neurotransmitter, standard treatment relies on the drug levodopa, which is converted to dopamine in the body. Levodopa is not curative though, and for that reason, researchers are beginning to study the neurorestoration technique of dopamine-producing stem cells transplants2. As promising and groundbreaking as stem-cell therapy is, protecting human subjects will be of utmost importance as the therapies enter clinical trials.

Parkinson’s disease is progressive, meaning that patients could exhibit a wide spectrum of mild to debilitating symptomology. After considering the risk-to-benefit ratio of enrolling patients who have either just been diagnosed or are at an advanced state of the disease, the authors suggest that only patients with approximately less than 15 years to live with “moderately advanced” Parkinson’s disease should be enrolled. Moderately advanced Parkinson’s is defined as a time when patients have been diagnosed and are responding to levodopa therapy. These patients should have minimal motor impairments and no impairment of cognitive function. Since neurosurgery is not without risks and stem-cell therapy benefit may not be obvious for a long time period, a clear informed consent process is critical. The patients must understand that the study’s purpose is not to alleviate Parkinson’s symptomatology immediately, but to instead increase understanding for the disease and the experimental, high risk nature of the procedure.

The authors conclude that a sham surgery, which involves inserting a needle into the brain, but not injecting stem cells, cannot be justified in a phase I-II clinical trial. Sham surgery is fraught with its own ethical concerns related to the powerful placebo effect, especially when research has suggested that Parkinson’s disease patients are especially susceptible to the placebo effect3,4. While a 2005 investigation of sham surgeries in Parkinson’s disease research suggested that the majority of clinicians support sham surgeries over unblinded controls5, finding interventions better than placebo or sham is challenging if sham is the ultimate threshold over which novel therapy should pass6. The authors ultimately recommend an open-label clinical trial design or a trial that compares stem-cell therapy to alternative medicines other than highly invasive surgery. The authors also remark that even if Parkinson’s disease patients are more likely to improve based on a placebo, Parkinson’s is degenerative and the placebo effect would most likely not survive declining motor function over the long-term of this study.

Thursday, March 12, 2015

Primordial soup to nuts: are some men naturally selected to be better dads?

Children are the future. So “why do some men choose not to invest in their children?” This was the question that Dr. James Rilling set out to answer over the last few years. Dr. Rilling is the head of the Laboratory for Darwinian Neuroscience in the Anthropology Department at Emory University and states one of the lab’s aims is “exploring the neural basis of human social cognition and behavior, particularly those aspects that have been under strong evolutionary selection pressure.” But are absent fathers the result of natural selection?

In the last half-century, the basic structure of American families has been changing. Within two-parent households, fathers are spending more time with their children than they used to as more mothers work outside the home. However, there are also many more single mothers raising children without any paternal help and roughly half of all American children are raised by a single parent at some point during childhood [1].

These changes have occurred far too rapidly to be the result of natural selection, but this trend compels additional study into the factors underlying paternal commitment. It is not known if there may in fact be an evolutionary explanation for why some men are more committed fathers than others. More to the point, do biological differences between men influence behavioral variation? Life History Theory posits that natural selection shapes the allocation of finite resources toward aspects of growth, survivorship, and reproduction. Within reproduction, there is arguably a trade-off in this zero-sum game between parenting and mating activities, and natural selection shapes phenotypes to support optimal strategies.

Tuesday, March 3, 2015

Diversity in Neuroethics: it’s more important than you might think

By Nicholas Fitz and Roland Nadler**

Nicholas Fitz
Nick is a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia. 

Roland is a third-year J.D. student at Stanford Law School and previously worked as a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia.

**equal contribution

Roland Nadler
The second decade of neuroethics is now well underway. Much like the human brain itself, some of its developmental “critical periods” have run out, but many others remain open. How will we use these remaining opportunities to shape the field?

Junior participants in these spaces should take the initiative to engage with unresolved questions about the nature and structure of neuroethics as a discipline. After all, those of us at the beginning of our careers have a particularly significant stake in the answers to those questions, with most of our academic and professional lives still ahead of us. As we work to integrate society’s growing technological power with best ethical practices and societal values, we must ask: whose practices, whose values?

Last year, in a bid to foster this discussion, we offered three visions for diversity in neuroethics. In that article, we devoted much attention to diversity along intellectual, disciplinary, and political lines.

Today, we offer a few more thoughts on the importance of diversity in neuroethics in the more familiar sense of having a wide array of identities and backgrounds represented in the field.

Chiefly, we hope to convince you that robust identity diversity is beneficial — indeed, crucial — to neuroethics. The field simply could not provide the kinds of insights that it promises if its practitioners were a homogenous group of people speaking comfortably from positions of social power and privilege.