CE: Namrta; YCO/200430; Total nos of Pages: 5; YCO 200430 What is neuroethics? Empirical and theoretical neuroethics Georg Northoff Canada Research Chair for Mind, Brain and Purpose of review Neuroethics, Michael Smith Chair for Neuroscience and Mental Health, Institute of Mental Health Neuroethics is a recently emerging field that deals with predominantly empirical Research, University of Ottawa, Ottawa, Ontario, and practical issues of ethics in neuroscience. In contrast, theoretical and Canada methodological considerations have rather been neglected and thus what may be Correspondence to Georg Northoff, Institute of Mental called theoretical neuroethics. Health Research University of Ottawa, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada Recent findings Tel: +1 613 722 6521; fax: +1 613 798 2982; The review focuses on informed consent and moral judgment as examples of empirical e-mail: [email protected] neuroethics and norm–fact circularity and method-based neuroethics as issues Current Opinion in Psychiatry 2009, 22:000–000 of a theoretical neuroethics. Summary It is argued that we need to consider theoretical and methodological issues in order to develop neuroethics as a distinct discipline, which as such can be distinguished from both philosophy/ethics and neuroscience. Keywords informed consent, method-based neuroethics, moral judgment, norm–fact circularity Curr Opin Psychiatry 22:000–000 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 0951-7367 about moral judgment. What is a moral judgment and Introduction how does it affect our ethical decisions in the current Therecentprogressinneurosciencehasledtoethical neuroscience? The question about the nature of moral questions concerning the emergence of a novel field, judgment has triggered many neuroscientific investi- neuroethics. Neuroethics can broadly and preliminarily gations of the neural mechanisms underlying moral judg- be defined as drawing relationships between neuroscien- ment (see [4]) that touches upon the neuroscience of tific observations and ethical concepts. Roskies [1] dis- ethics. However, the focus on the impact of moral judg- tinguished between ethics of neuroscience and neuro- ment on our ethical decisions in neuroscience may rather science of ethics. The ethics of neuroscience deal with be considered a question for the ethics of neuroscience. ethical problems in neuroscience arising from new forms The discussion of moral judgment thus provides one of interventions into the brain, whereas the neuroscience possible node point where both neuroscience of ethics of ethics investigates the neural mechanisms that and ethics of neuroscience intersect and converge. may possibly underlie ethical concepts and practices like informed consent, moral judgment, free will, and Although a clear-cut distinction between neuroscience of so on. ethics and ethics of neuroscience seems to remain unclear, they share their focus on empirical issues; be No sharp distinction exists between the neuroscience of they predominantly neuroscientific, as in the neuro- ethics and the ethics of neuroscience. Consider the science of ethics, or rather practical or ethical, as in the example of informed consent: How valid is the informed ethics of neuroscience. One may consequently subsume consent of patients whose cognitive and emotional both ethics of neuroscience and neuroscience of ethics capacities are altered or deteriorated by the nature of under the umbrella what may be called empirical neu- their disorder, as, for instance, in dementia or schizo- roethics. The first aim of my paper is to highlight some phrenia? This is an issue in the domain of ethics of recent development in empirical neuroethics, thereby neuroscience. It has also triggered empirical investi- focusing on informed consent and moral judgment. gations of those cognitive and neural functions that are implicated in giving a valid informed consent that falls more into the domain of neuroscience of ethics (see [2] as Empirical neuroethics well as [3 ]). Empirical neuroethics focuses on the empirical, that is, psychological and neural conditions that may underlie Another such example where neuroscience of ethics and ethical concepts like informed consent, free will, and ethics and neuroscience converge is the recent discussion so on. 0951-7367 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/YCO.0b013e32832e088b CE: Namrta; YCO/200430; Total nos of Pages: 5; YCO 200430 2 History and philosophy Informed consent and emotions affective and cognitive functions [34]. This suggests that Informed consent is crucial in clinical scientific studies of a valid informed consent may be necessarily (though not healthy individuals and psychiatric patients. This has led sufficiently) dependent on a specific balance between to an extensive research of the factors and functions affective and cognitive functions and thus between determining the kind of consent psychiatric patients give, medial and lateral prefrontal cortex. If the medial–lateral that is, whether they accept, refuse, or remain ambivalent prefrontal cortical neural activity is altered and unba- about study participation (see [2,5–13]). Giving informed lanced, as, for instance, in depression and schizophrenia consent requires the capacity to make a decision, that is, (see [35,36,37]), the constitution of decision making decision making [7,8,12–20]. Decision making is a com- implicated in informed consent may be affected. This in plex process that involves both cognitive and affective turn may diminish the validity of the consent. Such functions, as pointed out by recent neuroscientific scenario remains highly speculative though at this point research [2,21,22]. because no imaging study during the decision making of informed consent has yet been conducted. Cognitive functions in decision making concern atten- tion, working memory, executive functions, and others Moral judgment (see [7,8,13–20,23]). More specifically, the capacity to We make moral judgments daily like whether we should make a decision in informed consent, the so-called deci- help the person in front us to get up to his feet even if it sional capacity, involves cognitive functions like under- means that we would then come too late to work, entail- standing, appreciation, and reasoning. These cognitive ing possible rebuff by the boss. These kinds of situations functions and, therefore, decisional capacity have present us with a moral dilemma whether we should act recently been systematically investigated with the in the interest of others or rather according to our own MacArthur Competence Assessment Tool for Clinical goals and interests. Various imaging studies [4,38,39,40] Research (MacCAT-CR) [5,11]. The MacCAT-CR presented sentences where persons described moral focuses predominantly on cognitive functions like under- dilemma situations where they had to choose between standing, appreciation, reasoning, and expressing a choice self-interest and moral decisions, that is, decisions that that are supposedly implicated in the decisional capacity were in favor of other persons rather than their own. for informed consent. These imaging studies revealed the regions that are particularly active during moral action and judgment. In addition to cognitive functions, decision making in Various studies (see [4,38,39,40]) demonstrated the general and decisional capacity in informed consent in involvement of the medial prefrontal cortex (MPFC) particular involve empathy and emotions [2,6,9,10,21, and the ventral striatum in moral judgment. 22,24]. Empathy describes the ability to share another person’s cognitive and emotional inner life (see [25,26, This, however, raises several problems. The above-men- 27,28,29,30,31]). Empathic sharing between the con- tioned regions, the MPFC and the ventral striatum, are senting individual and the investigator may be crucial in not only involved in moral judgment but also in various determining decisional capacity and ultimately the con- other processes ranging from emotion, mentalizing with sent itself. This is possible only when the consenting inference of other’s mental states, learning of reward person is able to recognize the investigator’s emotions, contingencies (reward representation), and thinking thus requiring emotion recognition [32]. In contrast to about one’s own mental states resulting in self-awareness cognitive functions, the impact of empathy and emotion (see [41] for an overview). This raises not only the recognition on decisional capacity and the consent pro- question about the anatomical specificity of these regions cess has yet to be investigated empirically. for moral judgment but also about the psychological components implicated in moral judgment. The involvement of specific cognitive and affective functions in informed consent may also provide some Does moral judgment implicate various psychological clues about its possible underlying neural mechanisms. functions as diverse as learning, reward, mental state Cognitive functions like working memory and attention attribution, theory of mind, and so on? How can we are well known to be associated with neural activity in the characterize moral judgment in both psychological and lateral prefrontal cortex, whereas emotional functions neural terms? The above-mentioned studies clearly rather involve medial cortical and subcortical regions indicate that emotions and empathy are central psycho- [33,34]. If so, the balance between, for instance, medial logical processes in moral judgment