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A Neuroethics Backbone for the Evolving Canadian Brain Research Strategy

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A Neuroethics Backbone for the Evolving Canadian Brain Research Strategy Neuron NeuroView A Neuroethics Backbone for the Evolving Canadian Brain Research Strategy Judy Illes,1,* Samuel Weiss,2,* Jaideep Bains,3 Jennifer A. Chandler,4 Patricia Conrod,5 Yves De Koninck,6 Lesley K. Fellows,7 Deanna Groetzinger,8 Eric Racine,9 Julie M. Robillard,10 and Marla B. Sokolowski11 1Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, BC, Canada 2Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, and CIHR Institute of Neurosciences, Mental Health and Addiction, Calgary, AB, Canada 3Department of Physiology & Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada 4University of Ottawa, Centre for Health Law, Policy and Ethics, Ottawa, ON, Canada 5De´ p Psychiatrie, Universite´ de Montre´ al, Centre de Recherche, CHU Ste-Justine. Montreal, QC, Canada 6CERVO Brain Research Centre and Department of Psychiatry & Neuroscience, Universite´ Laval, Que´ bec, QC, Canada 7Department of Neurology & Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, QC, Canada 8Neurological Health Charities Canada, Toronto, ON, Canada 9Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montre´ al (IRCM) and Department of Medicine, Universite´ de Montre´ al 10University of British Columbia, Scientist in Patient Experience, BC Children’s and Women’s Hospital Vancouver, BC, Canada 11Departments of Ecology and Evolutionary Biology & Cell and Systems Biology, University of Toronto, Toronto, ON, Canada *Correspondence: [email protected] (J.I.), [email protected] (S.W.) https://doi.org/10.1016/j.neuron.2018.12.021 Building on Canada’s strong traditions in neuroscience and ethics, neuroethics provides a backbone for the evolving Canadian Brain Research Strategy (CBRS) that, from the outset, incorporates ethically responsible discoveries in brain science into clinical, societal, educational, and commercial innovation. A Grand Neuroethics Challenge carrying on today (Quirion, 2002). The standing the mechanisms underlying this One in three Canadians will be affected embedding of an already strong neuro- plasticity is at the root of any effort to treat by a brain or nervous system illness, dis- ethics platform into the new Canadian neurological and mental disorders. Neuro- order, or injury within their life. These con- Brain Research Strategy (CBRS; www. ethics is a necessary anchor into this ditions span the life cycle. Mental health canadianbrain.ca) is the latest and most question. It intersects with all pillars and conditions often affect young Canadians exciting step forward. The building of forms an explicit foundation for the Apply in the prime of life, with an estimated CBRS was initiated in 2015 and has pillar on which we focus in this paper. 75% of mental illnesses beginning before been nurtured under the leadership of The Apply pillar draws upon Canada’s the age of 24. Injuries to the nervous INMHA. Following a consensus meeting long tradition of pioneering work in neuro- system, such as concussion, occur of directors of neuroscience programs ethics, beginning with Canadian neuro- frequently in adult life and can lead to life- across Canada and other key stake- surgeon and neuroscientist Dr. Wilder long disability. Age-associated dementia holders in Halifax in September 2018, Penfield, who founded the Montreal Neuro- has surpassed other conditions as the the CBRS is moving forward as an orga- logical Institute. Penfield’s writings may be largest financial burden on the Canadian nizing entity independent of INMHA, with viewed as a precursor to neuroethical healthcare system today. A 2016 report an intersectoral steering committee that deliberation. Penfield was a student of Sir from the Evaluation Panel from the CIHR will work in continuous liaison with the William Osler, to whom Canada attributes Institute of Neurosciences, Mental Health conference leaders and participants and deep insights into science and the biomed- and Addiction (INMHA) placed the overall with a strategic eye on developing and ical sciences. Physician-bioethicist Joseph cost of neurological and mental health situating Canada as a neuroscience- J. Fins quotes a 1919 address by Osler, disorders to the Canadian economy at driven nation. ‘‘The Old Humanities and the New Sci- $61B CAD annually. In addition to a high Here we discuss the proposed key pil- ences,’’ to Oxford’s Classical Association, economic cost, brain disorders impose lars—Understand, Address, Apply, and in which he ‘‘admonished the divide be- staggering personal and societal tolls. Build—inspired by the distinguishing and tween the sciences and the humanities, Canadians firmly support the need for central question of the unfolding CBRS— observing that . the so-called Humanists ethical health research, innovation and how does the brain learn, remember, and have not enough Science, and Science economic advancement in neuroscience. adapt?—a question that seeks to under- sadly lacks the Humanities’’ (Fins, 2008). This commitment is underpinned by Can- stand the most fundamental aspects of We provide specific examples of neuro- ada’s multi-million-dollar investment in what defines the self (Figure 1). The ethics leadership in this country that bridge dedicated funding for neuroethics teams, powerful ability of the brain to change or the divide that Osler described, highlighting operating grants, and research chairs and rewire itself in response to experience is this country’s advances in neuroscience fellowships beginning in early 2000 and the foundation of human identity. Under- and law, mental health and addiction, 370 Neuron 101, February 6, 2019 ª 2018 Elsevier Inc. Neuron NeuroView Figure 1. Scientific Framework for the Proposed Canadian Brain Research Strategy (CBRS) as of September 2018 public outreach, and knowledge mobi- d Increase collaboration, data sharing, tively supported by six enabling principles: lization through patient engagement. We and technology development and collaboration, interdisciplinarity, open sci- conclude with a look to the future of inter- dissemination among Canadian re- ence, career development, education, and national collaboration with the International searchers and build on collective commercialization. These principles both Brain Initiative (IBI) and Neuroethics Global strengths. guide how research within the CBRS is Summit colleagues and partners. d Identify targets and milestones for conducted and set targets to advance a strategic and coordinated invest- sustainable mission and vision. The princi- ment in Canadian neuroscience and Co-creation of a CBRS ples are interwoven with five specifically mental health. The CBRS aims to be an integrated na- identified technology development areas d Train the next generation in interdis- tional research effort that builds on Cana- to probe, manipulate, decode how the ciplinary brain research, bridging da’s strengths and current investments in brain functions—imaging, stimulation, pho- diverse disciplines spanning the cutting-edge collaborative neuroscience tonics, genomics, and neuroinformatics— physical and computational sciences to drive transformative outcomes in neuro- that, together with embedded and rigorous to anthropology, sociology, and eco- logical and mental health for Canadians. experimental trial designs and outcome nomics. Its final design will enable Canada to: measurements, serve as platforms for d Develop meaningful collaborations a competitive Canadian neuroscience d Accelerate the understanding of with other Brain Initiatives on the research world today. the brain and translation to clinical international stage. The first pillar, Understand, focuses on treatments that address grand chal- normal braindevelopment and functioning, lenges in brain and mental health for To achieve these goals, the four pillars from synapses to circuits to behavior, Canadians. on which the CBRS is building are collec- and neuroplasticity across the lifespan. Neuron 101, February 6, 2019 371 Neuron NeuroView Important insights by Canadian neurosci- that they are adapted to human capabil- novel neurodevelopmental and adult bio- entists have come from explorations of ities to support productive, socially cohe- markers for diseases for which diagnosis plasticity in a wide range of species, sive, and healthy lives on the one hand has historically relied largely on interview studies of human memory, discoveries and to mitigate triggers of distraction, data and patient reports. With this trans- in neural stem cells and regenerative alienation, and burnout on the other. formation comes the significant responsi- medicine, pain research, and inter- Learning is possible because brains are bility both for deliberation and action, actions among genes and environments plastic and capable of change. Education, especially when applied to pediatric popu- during early childhood that guide human therefore, must be tailored to the mecha- lations, for which prediction is not 100% development. nisms that both enable and constrain accurate, and for cases where interven- From the outset, the Understand pillar underlying brain plasticity. Reciprocally, tions might modify outcomes. embraces the change in culture needed— techniques in cognitive neuroscience The management of unexpected inter- from traditional siloed disciplines of ge- allow neuroscientists to study in ever ventional consequences or abnormal netics, neurophysiology, neurocomputing, greater depth how human factors, such findings in research and clinical
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