Chair: Julian Savulescu
Respondents: Steve Hyman, Debra Mathews, Darlei Dall’Agnol
Researchers: Hannah Maslen, Jonathan Pugh
BRIEF
The Challenge of Neurotechnology
Advances in the biological and neurosciences afford great potential to not only treat neurological and psychiatric conditions but also:
A. Reading Human Minds
1. Imaging for consciousness: fMRI for disorders of consciousness. Consciousness is often understood to be a marker of personhood and it is central to an individual’s quality of life. Accordingly, end-of-life medical decisions often take assessments of consciousness into account. However, we currently lack the tools to accurately detect the presence of consciousness in the borderline cases of individuals suffering from disorders of consciousness.
2. Reading human thoughts: Brain decoding can be used to associate certain brain activity patterns with particular images or concepts. This technique currently allows researchers to test hypotheses about psychological processes. However, whilst significant obstacles remain, brain-decoding technology could potentially be used to develop devices capable of reading other people’s thoughts. Such devices would be of significant interest to law enforcement agencies, but they would significantly invade on an individual’s privacy and mental integrity.
3. Brain-computer interfaces: BCIs go beyond observation and interpretation of brain activity to allow such activity to be translated into commands for computers, ultimately to control devices of various sorts. Such technology is already of therapeutic interest, as BCI advances will allow development of neuroprosthetic limbs and prosthetic speech. BCI technology will also be of interest to the military, either in its potential to augment human capacities (e.g. cortically coupled computer vision) or to allow direct mind control of weapons. As well as raising bioethical issues, BCIs also raise novel legal challenges: neuroprosthetics challenge the traditional legal dichotomybetween body and property; direct mind control of devices challenges the distinction between mens rea(mental elements of a crime) and the actus reus(physical elements of a crime), as intention and action merge.
4. Predicting Behaviour: Neuroimaging is increasingly being investigated as predictive tool for specific human behaviors, particularly criminal behavior. A recent fMRI study showed that prisoners who show low activity in the
anterior cingulate cortex are more likely to re-offend. Neuroimaging mightplausibly come to have far more predictive power than our currently employed risk assessment tools.
B. Modifying Human Experience and Behaviour.
1. Brain stimulation techniques: Electrical and magnetic methods of neurostimulation, such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) have been used as therapeutic interventions in the treatment of neurological and psychiatric interventions. Some forms of neurostimulation are commercially available, and some, such as tDCS, may even be built following instructions available on the internet. In the future, optogenetics offers the prospect of increasingly fine grained and profound brain modulation that might furnish us with the ability to exert greater, and more precise degrees of control over which desires move us, or others, to act. As well as raising ethical questions about the effects of neurostimulation on human agency and personal identity, the possibility of ‘DIY neurostimulation’ raises regulative issues.
2. Cognitive enhancers: Drugs such as Modafinil, Ritalin, and Adderall are increasing human performance. In a global competitive market, these raise challenges as individuals from the developing world seek to enjoy the standard of living and luxuries of the developed world.
3. Mood and Emotional alteration: transcendental and psychedelic states have long been a part of religious and cultural traditions. There are an ever increasing number of drugs which could modify mood and conscious states. These are being used to increase happiness but also for religious and spiritual reasons. Moreover, oxytocin may also increase human ability to maintain monogamous relationships. Does the fact that these altered states and enhanced relationships have been facilitated by neuro-interventions undermine the contribution that they can make to genuine human well-being?
4. Moral Enhancement: The fruits of neuroscience have been used to modify human moral behaviour. For example cognitive behavioural therapy, neurofeedback and Ritalin have frequently been used in the treatment of impulsive aggression. More controversially, serious sexual offenders in some jurisdictions are mandated to take anti-libidinal agents such as Depo-Provera in order to reduce their risk or re-offending. Research suggests that other pharmacological agents and neurostimulation could be also used to affect traits that are linked to criminal behaviour.
C. (Semi) Automated Systems for Mental Health and Wellbeing
1. Apps: There has recently been a proliferation of apps designed to treat or to improve mental health and wellbeing. The goal of these apps is to achieve fully automated ‘therapies’ in which machine-learning algorithms
‘treat’ the patient. Although this would increase accessto mental health care, existing apps are unregulated and largely untested, though very scalable.
2. Virtual Reality: The advent of affordable mobile virtual reality (VR) headsets has raised the prospect of the use of this technology in mental health care and wellbeing. VR could allow for decentralized treatment, increasing access to mental health care. However, there is currently a lack of clinical evidence to support either the routine clinical use of VR, or its use as a ‘telemedicine’.
3. Care-bots: Automated systems could be developed to provide care and companionship to socially isolated patients, such as the elderly.
4. Key Research Areas:
How would the development of more powerful neuro-imaging that were better equipped to detect consciousness effect the ethics of end-of-life medical decisions?
How should decisions to be deploy medical interventions which directly affect the human mind be made?
Such interventions raise questions about what role, if any, they should have in the criminal justice system,and whether their use would unacceptably threaten human freedom.
How is ‘care’ constituted when it is delivered via an algorithm, or a robot? Are there particular concerns about care delivery in the context of mental health and wellbeing?
How should mental health and wellbeing apps be regulated?
Is there a universal morality that should guide normative judgments about interventions to improve moral behavior and decision-making?
Panel One: Case Studies in International Ethics of Neuroscience
A. Aysha is 16 and attends a school in a poor section of town. The school is an example of the general state of state funded schools in the country; it is overcrowded, the students are underperforming and unmotivated, and the teachers don’t have sufficient training or time to support high educational achievement. The regional governing body for education has initiated a novel plan to support higher achievement in all state-funded secondary schools, by offering free cognitive enhancing drugs to both students and teachers. The state will also offer additional training days for teachers, and reward incentives for students who achieve certain goals. These benefits are open to all, regardless of whether they choose to accept the drugs or not. The decision to accept cognitive enhancing drugs is initially made by the school, and, if the school decides to accept, then individuals and families will opt in or opt out of the programme.
- Should cognitive enhancers be available to poor people in poor countries?
- Who should pay?
- Is it important to establish the evidence for cognitive enhancement safety and efficacy prior to launching such a programme?
- Who should pay for developing that evidence?
- Could widespread, sanctioned cognitive enhancement reinforce stigma and oppression of those who opt in / out?
- Could cognitive enhancement programmes be used to target specific groups for ‘treatment’
- Is cognitive capacity just a brain matter; or other there other ways to enhance cognition that should be attended to?
B. Diego is a young violent criminal offender who has already been charged three times with carrying out serious assaults and causing grievous bodily harm to others. He has attended mandatory cognitive behavioural therapy sessions during periods of incarceration, but these sessions have been ineffective in changing Diego’s behaviour. Prisons in the city are vastly overcrowded, andcriminal justice authorities are awarethat the prison environment exposes offenders like Diego tomembers ofcriminal networks that he may take advantage of upon release. Furthermore, Diego has alsopreviouslybeen severely beaten by rival gang members in prison. However, despite these reasons not to putDiego in prison, criminal justice authorities have beenreluctant to hand down a community sentence to punish Diego, due to the risk he poses to the rest of society.Before Diego is charged again, scientists announce that they have developed a drug that significantly reduces the recipient’s violent impulses. The drug has undergoneextensive clinical trials,and shows nosigns of adverse side-effects. It also seems to behighly effective. The researchers suggest that the drug could represent an alternative to traditional prison sentences for violent criminal offenders, and that it would probably be far more effective in preventing recidivism.
- Would it be permissible to incorporate such a neurointervention into a criminal sentence?
- If so, would it be permissible for judges to hand down a sentence mandating that the offender undergo this intervention?
- Alternatively, should the intervention be offered as an alternative to carrying out a normal prison sentence? Would this be coercive? Does this matter?
- Would this intervention undermine retributive aims of punishment? Does this matter?
- Does the particular type of behavior that a crime-preventing neurointervention aims to influence affect the permissibility of the intervention’s use in the criminal justice context? Is there a difference between using an intervention that reduces violent impulses on an offender like Diego and using anti-libidinal agents on violent sex-offenders?