My intent is not be an “ethics cop” and say all enhancements are good or bad, but to inform, help identify the issues, raise questions and advocate for a thoughtful approach, with careful weighing and balancing of the potential benefits and burdens. I’m using the term neurotechnologies in the broadest sense, ranging from brain-imaging devices, which can measure changes in blood flow, neurochemistry or neuroanatomy, to medical electronic devices that can improve and restore the function of the human nervous system. For the purposes of this specific presentation, I am limiting my review of current advances to the latest in brain imaging techniques and enhancements.
In recent years, research groups around the country have implanted electrodes in the brains of animals —and even a few humans —and have used signals detected by those electrodes to move robot arms, levers,and cursors on computer screens, creating brain-machine interfaces. The aim of the work has been to give paralyzed patients the ability to control prosthetic limbs and simple communication tools. But the objective of these experiment is even more far-reaching: to build a computer chip that will restore the cognitive abilities of the brain itself, aiding memory in patients who suffer from such neurological disorders as Alzheimer ’s disease and stroke and perhaps eventually enhancing the abilities of healthy minds. To do so, the researchers have to understand neural processes that may be more complicated than those that govern, say, the control of a prosthetic arm.
While it’s been a fantasy of mine to download French or Spanish tapes, were still a ways away from that, but…
The media hype suggests that these advances are here in the next few months…
A two-year, $24 million program from the U.S. Defense Advanced Research Projects Agency, launched last fall, is rapidly expanding the boundaries of brain-machine interface research. The six projects funded by DARPA ’s program — including Berger ’s at the University of Southern California — aim to develop technologies that will not only restore but will also augment human capabilities. This coordinated, well- funded “big science”approach to understanding how minds and machines can interact, he says, could have “transformational consequences for defense and society.” The effort will yield a new generation of electrodes, computer chips, and software that might eventually equip soldiers, for example, to control super fast artificial limbs, pilot remote vehicles, and guide mobile robots in hazardous environments, using only the power of their thoughts. Even more remarkable, such devices could enhance decision-making, upgrade memory and cognitive skills, and even allow one person ’s brain to communicate wirelessly with another ’s.
Although such applications are as speculative as they are spectacular, scientists no longer view them as pure fantasy. Their new optimism is fueled in part by a host of recent advances in neuroscience, interface hardware, and signal processing. And the influx of money certainly doesn’t hurt. “DARPA is putting much larger resources into the area than has ever been seen before,” says William Heetderks, director of the Neural Prosthesis Program at the National Institutes of Health. And because researchers in this field of innovative ideas, he adds, the new funding “will have a tremendous effect.”
The key to being able to restore or augment human capabilities, he says, will be gaining access to the brain signals in an unobtrusive way —ideally, without wires, electrodes, or surgeries. And though this vision is still years away, our minds may already be on the road to a new way of thinking.
A primary contribution of PETscans, in the 80s, was to confirm the detectable distinctions between comatose patients, locked-in patients, and patients with a dead cerebral cortex (PVS) and a variety of categories between. Now, 2000+, fMRI scans can produce images of brain activity as fast as every second, whereas PET usually takes 40 seconds or much longer to image brain activity. Thus, with fMRI, scientists can determine with greater precision when brain regions become active and how long they remain active. As a result, they can see whether brain activity occurs simultaneously or sequentially in different brain regions as a patient thinks, feels, or reacts to experimental conditions.
An fMRI scan can also produce high-quality images that can pinpoint exactly which areas of the brain are being activated. For example, fMRI can produce an image that distinguishes structures less than a millimeter apart, whereas the latest commercial PET scanners can resolve images of structures within 4 millimeters of each other. In contrast to the PETscan, the fMRI provides superior image clarity along with the ability to assess blood flow and brain function in seconds. However, recent FMRI’s studies have shown more cognitive activity in PVS and minimally conscious patients than previously thought.
To date, however, PET retains the significant advantage of being able to identify which brain receptors are being activated by neurotransmitters, abused drugs, and potential treatment compounds.
*Nuclear magnetic resonance ( NMR ) is a physical phenomenon involving the interaction of atomic nuclei placed in an external magnetic field , measured by monitoring the radiation absorbed and emitted by the atomic nuclei, so we are talking about measuring changes in the brain at the quantum level.
This is one of my favorite slides – not intended to denigrate Prozac and the wonderful things it has done for people coping with the serious disease of depression, but it does illustrate that to a large extent, a market driven economy can lead to advertisements/enticements like this one.
Lest you think I am merely joking…. Here are some of my favorite illustrative websites.
Plastic Surgery provides some excellent contrast of healing/restoration vs. enhancement.
The race is on to develop the thinking person’s Viagra.” David Stipp, A Pill to Help You Remember , Fortune , Oct 28, 2001. Average scores on memory tests decline steadily after age 25. By late middle age we’re losing, on average, about 1% of our brain volume each year. When it comes to total brainpower—the kind that’s increasingly in demand in the info age—well, you may as well put on sneakers and try to literally outsprint the hungry young lions circling your job as to out-cogitate them. Tests that mimic practical memory tasks, such as associating names with new faces and remembering phone numbers after a short delay, suggest that by age 55 most of us are only about 75% as good at learning and recalling new things as we were at 25
The isolating ambiguity of whether human interactions represent human action or drug action * Also an interesting question, will enhancement choices lead to revisit what it means to be a “person”? Should Beings (i.e. – Non-humans with Numerous Neural Implants and Augmentations be considered persons if they can make rational choices?) Note: In US law, you do not have to be a human to be a “person”
If we are just “meat-bots” programmed by our genetics and biological chemistry, what does that say about our views of self, identity, and personal responsibility?
Lawyers would have a field day!
Should patients have the right to expect the physician to use memory enhancing drugs to keep abreast of the medical literature? Should pastors be expected to take drugs that enhance their skills to listen, to be socially restrained or passionate in the pulpit, to be nonjudgmental? Should the Catholic priest taking confession be given versed so that the next day he will have forgotten the confessed sin? Such an expectation refuses to accept the limits of human being. Would expect professionals to behave in ways that contradict their personal integrity or force them to exhaustion? These are all arguments against enhancements …
This can be analogized to the current debate regarding steroid use among athletes – how many of you say that adult athletes should be allowed to freely use steroids? How will the courts deal with the concept of free will and legal intent? What are the legal implications for employment screening, school admissions, insurance policies? What liability is there for an long-term effects or neurotoxicity?
Brain In A Box McGill
Linda MacDonald Glenn McGill University Montreal March 18, 2005 Brain in a Box and other Cognitive Curiosities: Legal and Ethical Implications in NeuroEnhancement
Presenter <ul><li>Linda MacDonald Glenn, JD, LLM </li></ul><ul><li>LL.M. in Biomedical Ethics from McGill University, Montreal, Canada, 2002 </li></ul><ul><li>Former Senior Fellow, Institute for Ethics, American Medical Association and Current Women’s Bioethics Project Scholar </li></ul><ul><li>Adjunct Assistant Professor, Lecturer, Writer and Consultant. Recent publications: Ethical Issues in Transgenics and Genetic Engineering at www.actionbioscience.org and Neuroethics, Criminal Responsibility and the Law, Summer 2004 ASBH Exchange, and Biotechnology at the Margins of Personhood: An Evolving Legal Paradigm , available at www.jetpress.org </li></ul><ul><li>Coined the phrase “evolving notions of personhood” </li></ul><ul><li>In a previous life, a trial attorney </li></ul><ul><li>Director, Board of the Converging Technologies Bar Association </li></ul>
Purpose of Presentation: 1.) Current Developments in Neurotechnologies 2.) Ethical considerations 3.) Legal implications
First, a little quiz… <ul><li>How many of you went to private </li></ul><ul><li>schools? </li></ul><ul><li>2.) How many took Kaplan or some </li></ul><ul><li>other course to help with your SAT </li></ul><ul><li>scores ? </li></ul><ul><li>3.) How many wear contact lenses? </li></ul><ul><li>4.) How many have body piercing? </li></ul><ul><li>4.) How many of you know someone who </li></ul><ul><li>has had plastic surgery? </li></ul>
If you answered yes to any of these questions, …. <ul><li>If you answered yes to any of these questions, you, too, could be…an “enhanced human”. </li></ul>
Current Developments in Brain-Imaging <ul><li>Positron emission tomography ( PETs can) is nuclear medicine imaging technique where radioactive 'tracer' isotopes which emit a positron are injected into a living participant (usually into blood circulation) </li></ul><ul><li>Functional MRI ( fMRI ) relies on the magnetic properties of blood to enable scientists to see images of blood flow in the brain as it is occurring. Thus researchers can make "movies" of changes in brain activity as patients perform various tasks or are exposed to various stimuli. </li></ul>
Current developments, continued… <ul><li>An fMRI scan can also produce high-quality images that can pinpoint exactly which areas of the brain are being activated. </li></ul><ul><li>But, f MRIs and PETscans have also d etected residual cognitive function in persistent vegetative state and more cognitive function in “minimally conscious” patients. </li></ul><ul><li>Evidence that neurons can regenerate, (i.e., with the help of stem cells) and that cognitive function can be restored/enhanced . </li></ul><ul><li>(Brain activation from fMRI shown as patch of colour on MRI scan) </li></ul>
Image Courtesy, Society for Neuroscience – Brain imaging with positron emission tomography (PET) reveals the different regions of the human brain active during various verbal tasks.
Current developments, continued… <ul><li>Combination with other data collection techniques such as </li></ul><ul><li>Electroencephalogram (EEG), recording of the electrical activity of the brain, or </li></ul><ul><li>Magnetoencephalography (MEG) the measurement of the magnetic activity of the brain, </li></ul>
Current developments, continued... <ul><li>Magnetic resonance spectroscopic imaging (MRS) is another, Nuclear Magnetic Resonance -based process for assessing function within the living brain. MRS takes advantage of the fact that protons (H) residing in differing chemical environments depending upon the molecule they inhabit (H2O vs. protein, for example) possess slightly different resonant properties </li></ul>
Enhancing drugs are here now <ul><li>Cognitive enhancement </li></ul><ul><ul><li>Stimulants </li></ul></ul><ul><ul><li>Provigil </li></ul></ul><ul><ul><li>Nootropics Piracetam </li></ul></ul><ul><ul><li>Caffeine Starbucks </li></ul></ul>How we use these will influence future decisions about more powerful or invasive enhancing technologies.
Piracetam : Benefit has not been rigorously proven. European and internet market estimated at billions of dollars.
www.hedweb.com www.biopsychiatry.com www.lovedrug.com “the molecular biology of paradise”
<ul><li>Healing </li></ul><ul><ul><li>to restore, to preserve, to prevent human malfunctioning and to put right what has gone wrong with the body. </li></ul></ul><ul><li>Enhancement </li></ul><ul><ul><li>to exceed what is normal and to improve on nature. </li></ul></ul>Distinction In many cases the distinction is common sense. In other cases, where the two categories overlap, it is less obvious.
Legitimate Enhancement <ul><li>If restoring these lost capacities is considered legitimate, </li></ul><ul><ul><li>Eyeglasses </li></ul></ul><ul><ul><li>Hearing aids </li></ul></ul><ul><ul><li>Joint prostheses </li></ul></ul><ul><li>It may be difficult to defend the assertion that enhancing drugs should not be used to compensate for the decline in cognitive function that normally and universally occurs with aging. </li></ul><ul><li>At what age is cognition normal? </li></ul>
What if there were a mental equivalent for Viagra?
To Enhance or Not: Is that the question? <ul><li>If we believe that the best way to modify human behavior is through drugs and implants , then </li></ul><ul><ul><li>Does Virtue becomes obsolete ? Is it easier to take a pill? </li></ul></ul><ul><ul><li>Do Human choices become less personal*? </li></ul></ul><ul><ul><li>Is that you? Or you on drugs? </li></ul></ul><ul><ul><li>If we are nothing but chemicals, does that matter? </li></ul></ul>
The possible costs of cognitive enhancement – TNSAFL (There’s No Such Thing As a Free Lunch) <ul><li>Possible Medical side effects </li></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Personality changes, e.g. irritability </li></ul></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><li>Only a redistribution of the brain’s chemical economy </li></ul><ul><ul><li>Robbing one neurotransmitter supply to boost another </li></ul></ul><ul><li>Implants may exhaust the biological substrate or induce undesired epiphenominal effects by bypassing normal internal regulation & integration </li></ul>
<ul><li>The ethical cost </li></ul><ul><ul><li>What unintended personal, social, and cultural consequences would result? </li></ul></ul><ul><ul><ul><li>Enhanced ability may entail reduced self-control </li></ul></ul></ul><ul><ul><ul><li>Perfection an unattainable goal, can never be satisfied </li></ul></ul></ul><ul><ul><ul><li>A culture of drug or implant seekers </li></ul></ul></ul><ul><ul><li>What moral principles would be violated for the sake of the seemingly greater goal? </li></ul></ul><ul><ul><ul><li>Excessive concern for oneself and less for others </li></ul></ul></ul><ul><ul><ul><li>Modications may violate the fundamental nature and integrity of the individual </li></ul></ul></ul><ul><ul><ul><li>Justice: the haves and the have-nots </li></ul></ul></ul>Possible costs…
<ul><li>How will these influence our definitions of “normal”? </li></ul><ul><li>What should insurance pay for? </li></ul><ul><li>Can such drugs be ethically used for the “normal”? </li></ul><ul><li>How do we promote fairness in access, and avoid discrimination? </li></ul>
<ul><li>As long as they do not subsequently engage in behavior that harms others, individuals should not be prohibited from, or criminalized for, using new mind-enhancing drugs and technologies. </li></ul><ul><ul><li>Assumes “enhancement” is benign. What if the harm occurs cumulatively or progressively over time? </li></ul></ul><ul><ul><li>We prohibit other forms of self harm: seat belts, Schedule III, IV drugs, etc. </li></ul></ul><ul><ul><li>What if agent alters or potentially alters capacity? By definition, if you lack capacity, you lack autonomy (Autonomy requires both capacity and liberty). What if the agent would (or potentially) alter the decisions made? </li></ul></ul>
In Conclusion <ul><li>Some questions we are left to ponder: </li></ul><ul><li>Who decides? You, the parents, the “bioethicists” or the government? </li></ul><ul><li>If you’re not willing to outlaw cosmetic plastic surgery, how can you ban cosmetic neurology and cognitive enhancements? </li></ul><ul><li>Further discussion and attempts to reach consensus are desperately needed!!! </li></ul>
This slide sponsored by the maker of Prothink ® <ul><li>Do you feel inadequate to understand today’s bioethical questions? </li></ul><ul><li>Do you lay awake at night struggling to solve bioethical dilemmas? </li></ul><ul><li>If so, have you asked your doctor about Prothink? </li></ul><ul><li>The new cognitive enhancing drug to help you </li></ul><ul><ul><li>Focus your thoughts </li></ul></ul><ul><ul><li>Forget unpleasant information and outdated obligations </li></ul></ul><ul><ul><li>Lifts the emotional burden of feeling as if you were responsible for other people </li></ul></ul><ul><ul><li>Helps you make the decision that’s right for you </li></ul></ul><ul><ul><li>The first pill to enhance your ability to think ethically </li></ul></ul><ul><li>Better ethics through neuropharmacology </li></ul>
Thank you for your attention! <ul><li>For further info, references contact me at [email_address] or [email_address] </li></ul>
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