Proposers
Ilina Singh
Steven Hyman
Vikram Patel
Julian Savulescu
Carol Worthman
A. For what purpose:
To support an international meeting entitled: Our Brain, Ourselves, Our World (O3).
The premise of the meeting is that neuroscience research should be aligned with a set of ethically grounded goals for human development, health and well-being. This alignment drives the need for an integrated approach to a distinctive set of global problems. The major goal of this meeting is to initiate a global research consortium, organized across key international sites, to identify and to tackle the most pressing international challenges at the intersection of neuroscience, ethics and social science.
This meeting will:
1. Explicate why and how human development, health and wellbeing in a global context are relevant to neuroscience and ethics
2. Identify a set of key priority areas at the intersection of neuroscience, ethics and society
3. Specify and illustrate the need for, and value of interdisciplinary collaboration to address questions of major global concern within each priority area
4. Draft a structure, workplan and funding scheme for a global research consortium in global neuroscience ethics (see Outcomes Section, under E)
B. Background. Why is the O3 meeting necessary?
Several intersecting realities inspire O3’s basic premise:
- Poor mental health is a leading cause of global disability and economic burden. Millions of people have no access to mental healthcare, and, despite efforts to improve access to treatments, a substantial treatment gap between rich and poor countries remains (Patel, 2012). Stigma around mental illness is a global ethical concern, and it is a major barrier to treatment access (Thornicroft, 2006) . The lack of a robust pathogenic model for any mental disorder is a major barrier to treatment availability, in so far as this lack seriously hampers research and development of novel interventions (Insel et al, 2010). There have been no substantial improvements in mental health treatments since the middle of the last century, and the pharmaceutical industry has moved its focus away from developing new psychiatric drugs. A better pathogenic model would inspire new treatments research while helping to undermine stigma. In this way, scientific and ethical barriers to improved global mental health overlap and exacerbate each other, and need to be tackled simultaneously.
- In the absence of good models, crude neuroreductionism too often fills the gap in understanding human behavior, emotion and cognition, and may also lead to erroneous conclusions that difference is equivalent with disorder. Pathologising normal human variation and medicalising or biologising human behavior through neuroreduction poses threats to autonomy, agency and notions of free will, among other ethical concerns, with impacts at the individual and the societal level.
- The proportion of children living below the poverty line is shrinking; however, millions of families still face limited access to medicines, clean water, nutrition and health services (https://sustainabledevelopment.un.org/?menu=1300). The inability to meet these basic needs has significant developmental and physical consequences, particularly for children. Contemporary scientific discoveries underline the extent to which these consequences have both direct and indirect implications for mental health, cognitive capacities and psychological functioning over the life course (Farah et al). Children living though war and conflict face similar challenges, which are frequently exacerbated by poverty. Urgent questions have arisen about
the impacts of conflict experiences on brain development, mental health and psychological functioning in children (Betancourt & Kahn, 2008). In these contexts, neuroscientific research and intervention may be seen to take on humanitarian dimensions. - A rapidly ageing global population is living longer than ever before. Major advances in the prevention and treatment of chronic diseases are likely to amplify this situation in this century and beyond (Sahakian, 2014). One consequence of these advances is that incidences of neurological disorders associated with old age, such as dementia, Parkinson’s Disease and stroke related disability are growing, with significant individual, familial and societal impacts. A further consequence of stabilizing treatments for chronic disease is the rising incidence in long-term disease-related psychological distress and mental illness, in patients and in carers. Living longer may not always mean living with good quality of life. Neuroscience research and innovation can help to promote brain health across the life course, but it is also imperative to understand and to innovate ethical conceptions of wellbeing, quality of life, and quality of care in light of these developments, in order to promote autonomy and dignity, among other principles.
- The technology of brain-machine interfaces (BMI) has grown substantially in the past half century, bringing hope in a range of areas, from individuals with neurological disability and injuries, to those with cognitive vulnerabilities who might benefit from brain training games or neurofeedback (Clausen, 2009). Some of this research is conducted in the military context, which has its own, significant ethical considerations (Mehlman et al, 2013). Some BMI devices are used to try to enhance cognition in healthy people; the goals of enhancement through novel neurotechnologies also requires ethical analysis. At the same time, BMI technologies could have important positive impact both in treatment of mental and neurological disability and in promotion of brain health, in the global context. At a more fundamental level, these intersections of mind, brain and machine raise questions about the nature of the human and the human self, about the importance of neural privacy, and the limits of volition and autonomy.
The O3 meeting will distill these background realities into five major priority areas. Each of these is explicated through one big question. The question is meant to serve as an example; it is not the only or even the best question that can be asked under the theme:
EARLY CHILD DEVELOPMENT AND THE BRAIN – Martha Farah, Chair
1. How can we maximise developmental capacities of children and promote their developmental resilience, particularly in the context of environmental, familial andeducational challenges?
BRAIN HEALTH AND CAPACITY THROUGH THE LIFE COURSE – Paul Root Wolpe, Chair
2. How can we sustain and/or improve human brain capacity, mental health and wellbeing through the life course, and in the context of significant life and/or planetary challenges?
GLOBAL MENTAL HEALTH AND WELLBEING – Carol Worthman, Chair
3. What are the barriers to the development of equitable, fair and effective interventions in the context of global mental health, and how can neuroscience contribute to their resolution ?
BRAIN, SELF and IDENTITY – Walter Sinnott-Armstrong, Chair
4. Are there core characteristics of human personhood? How might these be affected by technologies that aim to resurrect, improve or extend brain, cognitive, moral or psychological health and wellbeing?
NORMALITY, NEUROREDUCTION and TECHNOLOGY– Julian Savulescu, Chair
5. How ought differences in neurological function contribute to understanding of disease and normality, and how can technology close the gap between ‘health’ and ‘impairment’?
References
Betancourt, TS and Kahn, KT. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. Int Rev Psychiatry, 20(3), 317–328.
Clausen, JS. (2009). Man, machine and in between. Nature 457, 1080-1081.
Farah, MJ, Noble, KG, Hurt, H. (?) Poverty, privilege, and brain development: Empirical findings and ethical implications.
Insel, TR, Cuthbert, B, Garvey, M, et al. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167:748-51.
Maxwell, M, Lin, P & Abney, K. (2013). Enhanced warfighters: A policy framework. In ML Gross & D. Carrick, Eds, Military Medical Ethics for the 21st Century. London: Ashgate.
Patel, V. (2012). Global mental health: from science to action. Harvard Review of Psychiatry, 20, 6-12.
Sahakian, BJ. (2014). What do experts think we should do to achieve brain health? Neuroscience Biobehavioural Reviews, 43, 240-58.
Thornicroft, Graham. (2006). Shunned: Discrimination Against People with Mental Illness. New York: OUP.