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Emerging Ethical Issues in Neuroscience. Nature commentary Emerging ethical issues in neuroscience Martha J. Farah There is growing public awareness of the ethical issues raised by progress in many areas of neuroscience. This commentary reviews the issues, which are triaged in terms of their novelty and their imminence, with an exploration of the relevant ethical principles in each case. In less than a year, “neuroethics” has ical issues raised are similarly varied, and the possibility of safe mood enhancement. joined the vocabulary of most neurosci- include the rights to equal opportunity, The growth in sales of SSRIs clearly indi- entists. Exactly what the word signifies privacy and freedom. cates that more people, with less severe may not be clear to most of us, however. depression, are using them. Has the Both the word and the field to which it Enhancement of normal function threshold for SSRI use dropped below the refers come largely from individuals out- If drugs and other forms of central ner- line separating the healthy from the sick? side neuroscience. Newspaper columnist vous system intervention can be used to This question is hard to answer for sever- William Safire gave the field its name, and improve the mood, cognition or behavior al reasons. First, the line between healthy http://www.nature.com/natureneuroscience defining statements of the issues are found of people with problems in these areas, and sick is a fuzzy and perhaps arbitrary in such sources as Brain Policy1 by bioethi- what might they do for normal individu- one. There is no simple discontinuity cist Robert Blank, Our Posthuman Future2 als? Some treatments can be viewed as between the characteristic mood of by historian Francis Fukuyama and a ‘normalizers’, which have little or no effect patients with diagnosable mood disorders cover story in The Economist magazine on systems that are already normal (for and the range of moods found in the gen- (May 23, 2002). Neuroscientists them- instance, the mood stablizer lithium3) and eral population5. Second, diagnostic selves have been relatively scarce in pub- will not therefore figure in debates over thresholds are clearly moving downward lic discourse on neuroethics, perhaps enhancement. Other treatments can as a result of these very changes in treat- because many of the issues under discus- indeed make normal people ‘better than ment. For a given severity of illness, the sion seem far-fetched. Need we devote normal’. Pharmacological enhancement is better tolerated the treatment, the more serious attention now to the needs and arguably being practiced now in several likely patients are to present for diagnosis rights of cyborg humans with computer- psychological domains: enhancement of and the more likely physicians are to diag- augmented brains? Probably not, given mood, cognition and vegetative functions, nose and treat. As a related point, other the current state of technology. Yet neu- including sleep, appetite and sex. more common and less debilitating con- roscientists are just the people to guide the The enhancement potential of some ditions are also being treated with SSRIs, © Group 2002 Nature Publishing discussion toward issues of current and psychiatric treatments is, in itself, noth- such as cyclic changes in women’s moods near-term priority. How does neuroethics, ing new. Until recently, however, psy- before menstruation6. Third, although as presented to us in the literature, relate chotropic medications had significant depression is usually a remitting-relaps- to the current state of neuroscience and risks and side effects that made them ing disease with typically years between its foreseeable future? Here I attempt to attractive only as an alternative to illness. episodes, patients today are likely to be triage the issues that have been raised, sep- With our growing understanding of neu- treated prophylactically with antidepres- arating those that are both new and rotransmission at a molecular level, it has sant medication for periods of 1–3 years, immediate from those that are not new or been possible to design more selective even when symptom free7. Thus there are are likely to arise only in the distant drugs with better side-effect profiles. In many people now on antidepressant med- future. Although all three categories addition, adjuvant therapy with other ication who are healthy, with only a vul- deserve our continued attention, the first drugs is increasingly used to counteract nerability to depression as opposed to poses the most immediate intellectual and the remaining side effects. For example, depression. These changes in psychiatric social challenges. the most troublesome side effect for users practice have resulted in many people Three broad issues survive the triage of selective seratonin reuptake inhibitors using SSRIs and other antidepressants for novelty and imminence: enhancement (SSRIs) is sexual dysfunction, which who would not have been prescribed these of normal function, court-ordered CNS responds well to the drug sildenafil (Via- drugs ten years ago. There is no reason to intervention and ‘brain-reading’. Each gra). Other drugs specifically developed predict their ranks will not continue to emerges from work in multiple areas of to counteract the sexual side effects of swell, and to include healthier and high- neuroscience, from molecular to cogni- SSRIs are in development and clinical tri- er-functioning people. tive neuroscience. The nature of the eth- als (Vernalis press release, May 22, 2002). What changes might healthy individ- The result of both new designer drugs and uals hope to experience through the use Martha Farah is at the Center for Cognitive adjuvant drugs is the same: increasingly of antidepressant medication? Mood Neuroscience, University of Pennsylvania, selective neurochemical alteration of our enhancement belongs on the docket of 3815 Walnut St., Philadelphia, Pennsylvania mental states and abilities. new and imminent bioethical issues in 19104-6196, USA. Peter Kramer’s book Listening to neuroscience only if current and foresee- e-mail: [email protected] Prozac4 first focused society’s attention on able medications can deliver pleasing nature neuroscience • volume 5 no 11 • november 2002 1123 commentary results to healthy people. A handful of primarily on the basis of parent and teacher ing presynaptic neurotransmitter release studies have assessed the effects of SSRIs questionnaire responses, it can be difficult (for example, existing cholinesterase on mood and personality in normal sub- to free the diagnostic process from the val- inhibitors such as donezipil) and postsy- jects over short periods of a few months ues and standards of the respondents. naptic effects (such as the class of drugs or less (for example, refs. 8, 9). The effects Whereas diagnostic ‘over-reach’ is a known as ampakines). These drugs are are relatively selective, reducing self- reason that some arguably normal chil- currently considered treatments for reported negative affect (such as fear, hos- dren receive stimulants, many young dementia and so-called ‘mild cognitive tility) while leaving positive affect adults with no pretense at all to a diagno- impairment’, which is more severe than (happiness, excitement) the same. The sis are using stimulants to enhance their normal age-related cognitive decline. No drugs also increase affiliative behavior in performance in college. Methylphenidate drug companies have yet targeted normal laboratory social interactions and coop- is considered by some to be the most memory for enhancement, but there is erative/competitive games played with widely used recreational drug on Ameri- reason to believe that some of the prod- confederates, for example decreasing the can campuses12. Students have often ucts under development would work for number of spoken commands and approached me after talks on the topic to that purpose as well. For example, treat- increasing the number of suggestions. In relate their own stories about Ritalin use ment of healthy human subjects with an one double-blind crossover design, sub- among their non-ADHD peers, for exam- ampakine improved performance on sev- jects not only were more cooperative in a ple recalling a hockey coach who always eral memory tests18. game, but showed real-world changes in reminded her team to take their Ritalin Advances in the neurochemistry of behavior as well: roommates found them before playing another school. sleep, appetite and sex are paving the way less submissive on citalopam, though no Loss of cholinergic neurons is respon- for better pharmacological control of more dominant or hostile9. Much more sible for many of the cognitive changes in these functions as well, with results that research is needed to clarify the effects of Alzheimer’s disease, including the pro- will be of interest to normal people. The http://www.nature.com/natureneuroscience SSRIs and other antidepressant agents on nounced impairment of memory. Drug drug modafinil (Provigil), approved for mood and behavior of normal subjects, therapies such as donepezil (Aricept) that the treatment of narcolepsy, can prolong but the evidence so far suggests subtle increase acetylcholine can slow or reverse alert wakefulness for days19. Its use by salutary effects. the loss of memory ability in the early healthy people is currently being explored Pharmacological manipulations of stages of the disease. Can this or other by the military20. The appeal of such a other neurotransmitter systems can alter treatments improve the memory of drug to average people who would
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