Neuroethics: What It Is, Does, and Should Do James Giordano, Ph.D., M.Phil. Departments of Neurology and Biochemistry and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics Georgetown University Medical Center Washington, D.C. [email protected] John R. Shook, Ph.D. Philosophy Department University of Buffalo Buffalo, NY [email protected] Neuroethics is an interdisciplinary field that research, and its iterative and inventive uses. (1) engages scientific investigations of neuro- Medicine is paired with the ethics of cognitive processes involved in moral thought medicine, genetics is paired with the ethics of and action, and (2) addresses ethical, legal genetics, and so forth. Research ethics is a and social issues generated by brain research, well-established field in its own right, capable its varied applications, uses and misuse. The of addressing many issues fostered by the late Edmund Pellegrino considered conduct of brain science. To be sure, there is neuroethics to be a “hyphenated ethics” in considerable ethical expertise already well- which the prefix subject (here, positioned for dealing with the impact of ‘neuroscience’) is analyzed with the resources technology on all areas of society. Placing and techniques of ethics. This capacious view “ethics of” in front of a scientific discipline certainly allows deliberations about ethical might keep things simple; “the ethics of implications of neuroscience and neuroscience” might have sufficed as both neurotechnology – hereafter, ‘neuroS/T’ – as fitting under bioethics and ultimately covered well as reflections on neuroscientific by applied ethics. That approach presumes implications of our self-understanding as that ethics is a stable and independent field persons bearing moral value.1 Moral setting principled standards for rightness and philosophy, virtue traditions, professional goodness, ready for application to particular ethics, patient advocacy, public policy, and cases in a deductive manner. legal perspectives are each intrinsic to the scope and practices of neuroethics. But we believe that neuroethics does not fit well with a mere top-down approach. The Neuroethics has close academic company. brain sciences, from psychology and cognitive Similar fields are confronting problems science to neurology, are questioning whether arising in and from cutting-edge human the human capacity for ethics is mainly about Copyright © 2018 CHA. Permission granted to CHA‐member organizations and Saint Louis University to copy and distribute for educational purposes. Health Care Ethics USA | Spring 2018 1 principled rules. These fields are also and behavioral actions. Even greater investigating how moral judgment typically specificity of both assessment and control of functions in real-world situations. How fine-scale neural networks is being achieved people actually form and act on moral through the use of implantable devices that judgments may provide information sufficient are capable of recording and stimulating to place in doubt those ethical theories still brain structures and functions, the effects of grounded on outdated moral psychology.2 which can be manifest on a variety of levels, Neuroethics – as a discipline and set of from the cellular to the social. Thus, it practices – should avoid an awkward reliance becomes important to acknowledge the on ideas about moral thinking that ends up limitations as well as the capacities of these discredited by cognitive neuroscience. Sound approaches if and when the information they approaches to ethics need not suffer that fate, yield is used to infer, describe or define so neuroethics will have sufficient ethical meanings of normality and abnormality that resources. Still, the larger question remains, can be used in medicine, as well as legal and whether neuroS/T can be pursued ethically. political spheres. Ethical Challenges This is not unlike monitoring and/or tinkering with a motor’s parts to observe how Perhaps the potential for re-configuring engine performance is affected. If the humans’ (and other organisms’) neurological nervous system is treated like a repairable function through the use of new techniques and adjustable mechanism, then neuroethics and technologies is what is most worrisome can look to topics and methods in about brain research.4 Both the methods of engineering ethics that are applicable to “the brain research, and new neuroS/T human machine.” Some developments, such applications, are marvels of engineering as neuroprosthetics and brain-machine innovation. Investigating the structures and interfaces, could clearly be referred to, and functions of the brain at ever-increasing levels gain benefit from, an engineering ethics of granularity requires more capable (if not approach. However, humans, like all intrusive) methods, and greater intervention organisms, are not machines. Morality won’t and alteration of neurological processes. So, be reducible to biomechanics. While the use while important non-invasive assessment or abuse of technology remains focal to tools, such as neuroimaging and neuroethical address, neuroethical issues will neurogenetics, will increase in sophistication, have deeper philosophical implications than dynamic and real-time alterations of brain most technological problems. network activities will be of equal (if not greater) importance for acquiring more The Need for Watchful Scrutiny precise insights into neurological architectures and their respective roles. Indeed, we are far more than machines. The point to ethics, one would expect, is to For example, forms of transcranial uphold our status as moral agents, worthy of modulation, such as transcranial electrical morality’s protections against harm and and magnetic stimulation (i.e. tES and TMS) degradation. Technosciences of vast import, can be employed to modify neural activity to such as neuroscience, should arouse discern effects at targeted and interconnected thoughtful oversight. That oversight can areas, to discover how and why those areas broaden beyond the amazing applications participate in various cognitive operations able to change our lives, to include questions Copyright© 2018 CHA. Permission granted to CHA‐member organizations and Saint Louis University to copy and distribute for educational purposes. Health Care Ethics USA | Spring 2018 2 about how the adoption of those technologies wherever neuroS/T is investigated, translated can change conceptions of what human for clinical application, applied in non- beings are, and what we should be. It is not medical settings, and adopted into wider use. necessary to view the nervous system as It is relevant anywhere that the information mechanical to understand why alterations to and tools of neuroscience, from diagnostic our brains could easily alter who we are as methods to medical devices and consumer persons. Some neurological adjustments will products, may be beneficially used or be welcome, but we must be vigilant about dangerously misused within society.8 undesirable consequences. NeuroS/T will Neuroethics can provide timely guidance help alleviate neuropsychiatric disorders, about the genuine meaning and import of pain, suffering, and sadness, and contribute discoveries and advances in the brain to optimizing our capabilities. Alterations to sciences. Accurate interpretations to promote brain functioning may also disrupt our public understanding need to keep pace with mental well-being, and distort our sound self- exciting headlines from science journalism. understanding.5 Clarifying and cautionary neuroethical advice is also highly valuable in policy, legal, and We do not wish to sound too alarmist. It is military contexts.9 It should have both an unnecessary (and probably in error) to educational and evaluative role everywhere it suspect that all neuroS/T invites unnatural is needed.10 abominations in order to judge, as we do, that a wary stance of preparedness is The Global Context: Toward a warranted. Neuroethics must be part of the Cosmopolitan Palette watchful scrutiny that checks for unwanted deviations from psychological health and civil The acceleration of exploratory brain conduct.6 Neuroethics as an academically and research and novel neuroS/T is occurring in ethically responsible field must ponder what many countries. Major governmentally- it means to be a human being, and a personal funded research initiatives are underway, self. 7 Shall the implementations of neuroS/T including the U.S. BRAIN Initiative, the EU be encouraged to the point of transforming Human Brain Project, the China Brain this “self” into just another adjustable Project, the Japan Brain MIND Project, and implement, redesigned for whatever the South Korea Brain Initiative. Therefore, specialized work may be wanted? Perhaps neuroethical discussions must be not, but only an adequate theory of the self international, both in scope and in spirit. No can explain why not. Neuroethics directly country’s moral and legal framework will be overlaps with, and vitally contributes to able to dictate the plan or pace of another medical humanities, philosophy of country’s research project.11 Neuroethics technology, philosophical psychology, should not proceed as if domestically familiar philosophical ethics, and biopolitics. standards are straightforwardly applicable anywhere on the globe. Philosophical ethics While neuroethics is a specialized domain of can be more sensitive and responsive to ethics and bioethics, it need not, and should differing socio-cultural contexts,