Is Brain Dead Really Dead?

By Amber Green



Amber Green is currently a senior in the Emory College of Arts and Sciences, double majoring in Neuroscience and Behavioral Biology and Philosophy. Her majors led her to an interest in neurophilosophy and neuroethics. She hopes to pursue a MA in Bioethics and/or Neurophilosophy and go into a career as a clinical neuroethicist after graduating in May.







Having a family member pronounced dead is a very heartbreaking moment. Be it your pet, your sister, your mother, or your child, the pain you feel when the doctor reports that your loved one has passed away is overwhelming. Doctors know that there are no take-backs once they inform the family of the patient’s death, which is why there are strict procedures for a doctor to follow when declaring someone dead. However, when it comes to “brain death” and the advances of life support technology, these procedures become harder to follow and leads one to ask the question: “More importantly, if the brain is dead, are we dead?”



In Oakland, California, this past year, a 13-year old girl named Jahi McMath had been maintained on a ventilator since an elective procedure to treat her sleep apnea went horribly wrong. Jahi McMath had been pronounced brain dead, yet she had not been taken off of life support. In fact, her parents persuaded a judge to have her life support extended for at least a week past the doctor’s declaration of brain death. Her parents insisted that she is still alive and that taking their daughter off life support is equivalent to killing her. But, who is in the right: the doctors or the parents of Jahi McMath? And whose wishes should we honor?

Brain death, according to the Uniform Determination of Death Act, is a concept used to describe the “irreversible cessation of the entire brain, including the brain stem.” Moreover, in 1968, the Report of the Ad Hoc Committee of the Harvard Medical School stated that brain death is the primary basis for declaring someone dead. If the brain, including the brain stem, is harmed in any sufficient amount, respiratory failure, followed by terminal cardiac arrest will ensue. This is because the brain is the ultimate control center of the body, sustaining the functions of other organs (Pernick 1999). With advances in cardiac life support technology, patients could be resuscitated after a traumatic injury to either the brain or the heart. Also, in order to be viable for organ donation, organs have to be able to function, i.e. the heart should be able to pump blood and beat. But, there is no need for the brain to function for vital organ transplantation. Therefore, with its institution in the University of Pittsburgh in the early 1990s, brain death became an important criterion for declaring death that also allowed for functioning organs for organ donation. Furthermore, it is also speculated by Professor Charles Vincent of Clinical Safety Research in the Imperial College in London that having brain death be a criterion for defining death would take care of the overcrowding problem plaguing hospitals, an idea that is controversial. By permitting hospitals to have a reason to reallocate resources from people like Marlise Munoz, a pregnant mother declared brain dead but being kept on life support by the state of Texas, the hospital provided resources towards patients who might be considered to have better prospects at living and not just living, but living with what by many would be considered a higher quality of life than living dependently on a ventilator.



The quality of life issue raises the question of whose voice do we listen to when making determinations of what quality of life means. Neuroscientists like Adrian Owen have decided to investigate the one voice that has remained unheard and ignored: that of the patient who may be unable to speak or communicate by conventional means. Using neuroimaging and looking at changes of blood flow to certain parts of a patient’s brain who has been determined to be in a vegetative state, Owen has been able to communicate and exchange information with patients in a coma. Studies like these don’t only have the promise of allowing family members to communicate with loved ones who may seem lost to them, they also can identify patients who might respond to rehabilitation, determine the dosage of analgesics by asking about pain, and give voice to patients who might not otherwise be able to communicate their feelings and desires. He has yet to ask, “Do you want your life support ended?” However, he has asked “Are you in pain?” A podcast of his communications with patients who have been determined to be in a vegetative state can be found here.

From ABC News

The first patient to communicate with Owen was a 26-year-old patient named Kate Bainbridge. In 1997, a deadly viral infection caused Bainbridge to go into a coma. Using positron-emission topography (PET) to examine a brain area called fusiform face area (FFA), which is activated whenever one sees a familiar face, Owen decided to investigate what would happen to Bainbridge if she saw the face of someone she knew. Bainbridge showed significant brain function according to the neuroimaging data. By 2010, she was in a wheelchair, but otherwise active following rehabilitation. Despite similar responses in other patients in comas, he and his research has still been met with backlash (Cyranoski, 2012). Both scientists and the general public have shown dislike for Owen’s brain imaging on patients in a vegetative state. Owen's method raises many questions for physicians, for it radically changes the standard procedures of the treatment of patients in comas. One question it raises is what type of effect will his research have on a family's or clinician's decision to end a life. “If a patient answers questions and demonstrates some form of consciousness, he or she moves from the 'possibly allowed to die' category to the 'not generally allowed to die' category,” says Owens. This will put the general public in an awkward position when it comes to processing the death of a loved one. Some will be given hope, whereas others will be burdened financially by the prospect of keeping them alive for these not particularly understood signs exhibited by the patient. Also, this leads to the major concern: How much say does the patient have in their death.



Owen is now planning on using an electroencephalogram (EEG) to complement these imaging studies. EEGs also have the advantage of being portable, cost-effective and relatively fast. Owen will examine 25 people a year to prove that this may be a way to communicate with patients in vegetative states. However, one must ask oneself one question: Is this enough to say that what is being seen in a brain image or EEG is an accurate representation of a patient’s desires and needs? Could it possibly be simply an automatic versus intentional response?

Caption: fMRI images comparing a patient given the diagnosis of existing in a vegetative state to healthy volunteers. All participants in the study completed two imagery tasks under the direction of Adrian Owen. From Owen et al

Determining death based on brain death is flawed according to both sides of the debate. There is no reliable universal way to determine brain death unless the entire brain has been destroyed and the circulatory and respiratory systems have also stopped functioning. Moreover, people pronounced brain dead can “survive” on life support for extended periods of time. This is because the “survival” of the body is not solely dependent on brain functions; it’s also dependent on circulatory and respiratory functions, which can exist even if the brain is not functioning at all. But is living without brain function, or more importantly a cognitive life, living? As of the present, one year later, Jahi McMath is still surviving with the help of a ventilator. There is even recent videotape footage of her moving her foot and hand at the request of her mother. So is this girl who was declared neurologically dead really dead? Doctor say “yes,” her parents say “no,” and I say the uncertainty surrounding her case makes it better to be safe than sorry to keep her on the ventilator. According to Georgia Law, Statute 31-10-16, death is either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the brain, including the brain stem. Advanced directives will be recognized first and foremost, for Georgia replaced its Living Will and Durable Power of Attorney for Health Care as of July 1st, 2007. Therefore, if a patient were to write both a living will and advanced directive of contradictory orders for what to do in the face of their impending death, the advanced directives will be followed. (These laws can be seen here and here). However, if a person were to undergo Owen’s test and brain activity were to be found, an advanced directive, in the state of Georgia would not be able to be honored. The legal consequences of utilizing such a technology complicate things even further. Furthermore, with all these varying opinions and stakeholders in Jahi McMath’s death declaration, this prompts the question: Who has the right to be involved in this kind of decision anyways?



Reference



Owen, A. M.; Coleman, M. R.; Boly, M.; Davis, M. H.; Laureys, S.; Pickard, J. D. Detecting Awareness in the Vegetative State. Science 2006, 313 (5792), 1402.



Caplan, Arthur. "Brain Death Really Is Death." Time. Time, 3 Jan. 2014. Web. 25 Feb. 2015.



Cyranoski, David. "Neuroscience: The Mind Reader." Nature.com. Nature Publishing Group, 13 June 2012. Web. 06 Mar. 2015.



"Organ Donation/ Transplantation." Education Organ Donation / Transplantation End of Life Care: When Is a Person Really Dead? American Life League, n.d. Web. 25 Feb. 2015.



Pernick, M., 1999, “Brain Death in a Cultural Context: The Reconstruction of Death, 1967–1981,” in in S. Youngner, R. Arnold, and R. Shapiro (eds.), The Definition of Death: Contemporary Controversies, Baltimore, MD: Johns Hopkins University Press: 3–33.



Vincent, C. (2012). The essentials of patient safety. Download disponibile all’indirizzo www1. imperial. Ac. uk/medicine/about/institutes/patientsafetyservicequality.





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Green, A. (2015). Is Brain Dead Really Dead? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/03/is-brain-dead-really-dead.html

Gray Matters Volume II Released by Presidential Commission

The highly-anticipated second volume of Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society was released by the US Presidential Commission for the Study of Bioethical Issues on March 26th. This report is in “response to President Obama’s request related to the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.”

According to the Commission’s announcement, in this volume “the Bioethics Commission broadly focused its analysis on three particularly controversial topics that illustrate the ethical tensions and societal implications of advancing neuroscience and technology: cognitive enhancement, consent capacity, and neuroscience and the legal system.”



“In its latest release, the Bioethics Commission seeks to clarify the scientific landscape, identify common ground, and recommend ethical paths forward. Cautioning against hyperbole and misinformation when discussing the promise of neuroscience, the report offers 14 recommendations to help clear a path to productive discourse.”

The full report can be read here.

Eleven members of the AJOB Neuroscience editorial board made presentations for the Bioethics Commission: Anjan Chatterjee, Martha Farah, Paul Ford, Hank Greely, Joshua Greene, Steven Hyman, Stephen Morse, Eric Racine, Peter Reiner, Adina Roskies, Paul Root Wolpe.

Early Intervention in Schools: A Site for Empirical Neuroethics

By Ilina Singh, MSc



Ilina Singh is a Professor of Science, Ethics, and Society in the department of Social Science, Health, and Medicine at King’s College London, and is cross-appointed to the Institute of Psychiatry. Her work examines the psycho-social and ethical implications of advances in biomedicine and neuroscience for young people and families. She is also a member of the AJOB Neuroscience Editorial Board.

 

The developmental logic of early intervention is currently all the rage across child care-related sectors, including education, mental health, juvenile justice and social policy. It’s not a new logic by any means (witness longstanding programmes such as HeadStart), but it has new energy and justification with the emergence of epigenetic theories of development. Epigenetics has brought attention to ‘environment’ to the fore, particularly in pediatrics and in child psychiatry. While epigenetic theories are still that – theories – the last few years have seen a surge in research and policy focused on children’s early environments: womb, home, school, community. Students and researchers interested in neuroscience ethics, particularly in relation to children and adolescents, should find rich and fruitful ground for research here. In this blog I outline some thoughts about why neuroethicists might be interested in early intervention programmes in one key environment - schools.

From iStockPhoto

Schools have a long history of collaborations with psychiatry, psychology and pediatric medicine. A rich and frequently critical sociological literature details how these collaborations have informed and embedded a range of normative understandings of child development, particularly in the interrelated areas of behaviour, morality, intelligence and attachment. Scientific discoveries have had an important influence on shifting tropes in child education; from the ‘well adjusted’ child in a psycho-analytic framework, to a contemporary focus on child ‘wellbeing’ and ‘flourishing’ informed especially by positive psychology and emerging discoveries in developmental biology and neuroscience. In this context, early years schooling provides both the environmental conditions to kindle the capacities that promote flourishing, and a pre-clinical site in which to monitor and evaluate children and deploy early intervention strategies when a child appears to be at risk of failure to flourish.



From a critical perspective, these educational tropes and the aligned clinical, social, economic and political interests can appear as largely suspect forms of disciplinary “biopower” (to use a Foucaultian concept). The very notion of early intervention could suggest an institutional desire to impress prevailing norms upon the mind and body of the child even before the child has exhibited problems. The presence of formal early mental health identification and intervention procedures in schools can thus be represented as a first step in a ‘psychiatric career’; that is, a path to medicalization, diagnosis and psychiatric treatment. Post-genomic scientific discoveries that highlight the importance of early environments and early interventions with children can be seen to provide biological impetus for an ethically problematic agenda.



It could equally be argued, however, that the move away from pathological labeling of children to a more open and generic vision of ‘wellbeing’ engenders a more ethically sensitive ground on which to identify children at risk. From this perspective, schools can be seen to provide a more neutral site for early identification and intervention, in so far as support on the basis of flourishing is not dependent upon a medical label and therefore does not require or presuppose a pathway to medicalization, diagnosis and treatment. Moreover, school-based early intervention is likely to reduce the potential for a form of reductionism that views a child’s behavioural and developmental difficulties largely in light of individual factors, thereby eliding attention to the ecological conditions that mitigate and potentiate a child’s capacities for key cognitive and emotional skills; e.g. attention, self-regulation and decision-making. Finally, the presence of school-based early intervention may to some extent evade the stigma associated with mental illness labels and treatments, thereby increasing the chances that children in need will themselves engage support at an early stage. Scientific explanatory models are not necessary to support the intuition that children’s early experiences have lasting effects, but such models can engage political and social support for required resources.

From youthtoday.org

It’s probably quite easy to come up with critical arguments about these early intervention programmes (interventions to ‘build character’ in children particularly worry me!), but I predict that criticism alone will shed little light on the substantive social and ethical goods and harms involved. I think empirical neuroethics has an important role to play here, in so far as it can help achieve more nuanced understandings through a ‘bottom-up’ investigation of school-based early intervention. Researchers might study the ‘local ethics’ of a school-based programme, in order to better understand how participation in the programme configures social-biological identities, moralities and futures. The empirical work can then be used to inform a normative analysis (although how one moves between empirical data and normative analysis should be the subject of another blog!)



One of the lovely aspects of working on issues related to children is that the researcher is freed from the confines of ‘the usual ethical concerns’. Child development centrally involves issues of love, care and hope, as well as responsibility, value, freedom and citizenship. The scientific and policy focus on environment in developmental wellbeing opens neuroethics up to research opportunities in new sites, such as schools and other spaces that children frequent and inhabit. I’m hopeful that neuroethics will come to focus more on the lives and experiences of children and young people in the future, particularly as they are increasingly subjects of neuro- and psy-interventions. For those interested in the area, I’ll soon be starting a few projects on early intervention strategies in child and adolescent mental health and wellbeing, funded by the Wellcome Trust. Do get in touch, especially if you have projects and/or experience in talking with young people about moral and ethical concerns.





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Singh, I. (2015). Early Intervention in Schools: A Site for Empirical Neuroethics. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/03/early-intervention-in-schools-site-for.html

The Montreal Neuroethics Conference for Young Researchers 2015

The Montreal Neuroethics Conference for Young Researchers 2015 will be held in Montréal, Québec, on April 17th, 2015 at the Institut de recherches cliniques de Montréal (IRCM), Montréal, Quebec. This one-day international conference is aimed at young researchers, trainees, and students from all fields interested in neuroethics. In addition to the program on the day of the event, we are hosting an essay competition where 5 winning papers in English will be candidates for fast-tracked publication in a special issue of the journal Neuroethics and 5 winning papers in French will be candidates for fast-tracked publication in a special issue of the journal Bioéthique Online. 

Special Note from the Organizers:



"Our immediate goals in organizing this conference are to increase the visibility of neuroethics among different international student populations and to bring young researchers in neuroethics together to facilitate future collaborations. Young researchers are the future of neuroethics. We feel that a conference specifically tailored for them – no registration fee, opportunities to meet their peers and present their work, panels on hot topics in neuroethics and on career development, etc. – helps to highlight their importance and encourage future work in this field. Montreal is in an excellent position to kick off an event specifically targeted to young researchers because of the institutional support neuroethics has received here over the past several years. The IRCM’s Neuroethics Research Unit was one of the first dedicated Neuroethics Units in the world and it collaborates with Université de Montréal and McGill University to train the next generation of neuroethicists, including through the offer of neuroethics courses and graduate training."



-- Veljko Dubljevic Ph.D./D.Phil, Victoria Saigle, and Eric Racine Ph.D.,

Montreal Neuroethics Conference for Young Researchers

Local Organizing Committee

PROGRAM

8:30-9:00 Welcome



9:00-10:00 Panel: Social responsibility of neuroscience 

John Breitner, M.D. (McGill); Emily Bell, Ph.D. (IRCM); Artur Kania, Ph.D. (IRCM) 



10:00-10:15 Break (coffee)



10:15-11:15 Panel: Cognitive enhancement  

Jennifer Chandler, LL.M. (UOttawa); Alexandre Erler, Ph.D. (UdeM); Veljko Dubljevic,  Ph.D./D.Phil. (IRCM); Walter Glannon Ph.D./D.Phil. (UCalgary) 



11:15-12:30 Poster session & lunch



12:30-1:30 Roundtable: How to be successful in your early Neuroethics career   

Eric Racine, Ph.D. (IRCM), Tommaso Bruni, Ph.D. (UWestern), Lucie Wade, M.Sc. (McGill/JGH), Jaime Flamenbaum, M.D. (CIHR) 



1:30-1:45 Break (coffee)



1:45-2:45 Oral presentations of essay winners



2:45-3:00 Break (coffee)



3:00-3:30 Keynote: The Neurobiology of Morality, James Blair, Ph.D. (NIH) 



3:30-4:00 Awards Ceremony and Closing Statement

 For more information, click here.

Local Organizing Committee

The Newly Released 6.1 Issue of AJOB Neuroscience

The 6.1 Issue of the American Journal of Bioethics Neuroscience (AJOB Neuroscience) is now hot off the presses with two target articles highlighting ethical issues behind the use of two very different therapeutic interventions: first-in-human trials to treat Parkinson’s disease using stem-cell based therapies and prescription stimulants to enhance motivation.

The Target Article “Ethical Criteria for Human Trials of Stem-Cell Derived Dopaminergic Neurons in Parkinson’s Disease”¹ by Samia A. Hurst et al. discusses three specific considerations of a phase I(safety)-II (efficacy) clinical trial designed to test an experimental neurorestorative stem cell therapy for Parkinson’s disease. Parkinson’s disease is a result of the loss of dopamine-producing neurons in the substantia nigra, and significant depletion of dopamine leads to the tremors, rigidity, and difficulty initiating or halting movement that is often seen as the disease progresses. To compensate for the diminishing levels of the neurotransmitter, standard treatment relies on the drug levodopa, which is converted to dopamine in the body. Levodopa is not curative though, and for that reason, researchers are beginning to study the neurorestoration technique of dopamine-producing stem cells transplants². As promising and groundbreaking as stem-cell therapy is, protecting human subjects will be of utmost importance as the therapies enter clinical trials.



Parkinson’s disease is progressive, meaning that patients could exhibit a wide spectrum of mild to debilitating symptomology. After considering the risk-to-benefit ratio of enrolling patients who have either just been diagnosed or are at an advanced state of the disease, the authors suggest that only patients with approximately less than 15 years to live with “moderately advanced” Parkinson’s disease should be enrolled. Moderately advanced Parkinson’s is defined as a time when patients have been diagnosed and are responding to levodopa therapy. These patients should have minimal motor impairments and no impairment of cognitive function. Since neurosurgery is not without risks and stem-cell therapy benefit may not be obvious for a long time period, a clear informed consent process is critical. The patients must understand that the study’s purpose is not to alleviate Parkinson’s symptomatology immediately, but to instead increase understanding for the disease and the experimental, high risk nature of the procedure.



The authors conclude that a sham surgery, which involves inserting a needle into the brain, but not injecting stem cells, cannot be justified in a phase I-II clinical trial. Sham surgery is fraught with its own ethical concerns related to the powerful placebo effect, especially when research has suggested that Parkinson’s disease patients are especially susceptible to the placebo effect^3,4. While a 2005 investigation of sham surgeries in Parkinson’s disease research suggested that the majority of clinicians support sham surgeries over unblinded controls⁵, finding interventions better than placebo or sham is challenging if sham is the ultimate threshold over which novel therapy should pass⁶. The authors ultimately recommend an open-label clinical trial design or a trial that compares stem-cell therapy to alternative medicines other than highly invasive surgery. The authors also remark that even if Parkinson’s disease patients are more likely to improve based on a placebo, Parkinson’s is degenerative and the placebo effect would most likely not survive declining motor function over the long-term of this study.



In the second Target Article, “Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement,”⁷ author Torben Kjaersgaard raises questions about the nature and value of human effort. The enhancement debate has been ongoing for over a decade⁸, and revolves around the value of “hard work” and integrity to complete a goal. For some, the idea of enhancing cognitive function is a shortcut that creates an unfair playing field where certain individuals have surpassed their natural talents. Others argue that there is nothing wrong with a world full of only the smartest and motivated people. The discussion is made more complicated by research suggesting that current stimulants do not enhance performance^9,10.



While this debate is not new, Kjaersgaard adds a fresh perspective by arguing that prescription stimulants, such as Adderall and Ritalin, impact motivation (rather than the task performance itself), raising distinct ethical concerns from those related to simply enhancing cognitive function. A lack of motivation or a tendency to become distracted could be signs of moderate depression or ADHD, or as the article notes, feelings of worthlessness and escape. If stimulants are needed to get through most days, then is the user trying to escape from reality and avoiding tackling a more significant problem? Medically enhancing motivation turns a lack of drive or inspiration into a fixable, physiological problem, which is convenient, but Kjaersgaard argues that this undermines important aspects of the human condition.

from Institute for Ethics and Emerging Technology

The editorial written by Karen S. Rommelfanger and L. Syd M Johnson discusses the first Gray Matters Report from the President’s Commission for the Study of Bioethical Issues and what lies ahead for research, funding, and education for future neuroscientists in light of the lauded and equally contested Human Brain Project and the BRAIN Initiatives. The authors note that these articles are examples of the types of pertinent discussions that result from infusing neuroscience research and medical advances with ethical questions. In moving forward with the UK and US Brain Projects, it is absolutely necessary that ethicists work alongside researchers to ensure these types of dialogues continue.



The Emory Neuroethics Program offers forums for discussion on these pertinent issues and cutting edge topics in neuroscience. The upcoming Neuroethics and Neuroscience in the News event will be held on March 18^th, 2015. AJOB Neuroscience Editor John Banja and AJOB Neuroscience Editorial Intern Ryan Purcell will facilitate a discussion on the science, ethics, and media portrayals of neuroenhancement including the recent Kjaersgaard article.

References

(1)  Hurst, S. A.; Mauron, A.; Momjian, S.; Burkhard, P. R. Ethical Criteria for Human Trials of Stem-Cell-Derived Dopaminergic Neurons in Parkinson’s Disease. AJOB Neurosci. 2015, 6, 52–60.

(2)  Grealish, S.; Diguet, E.; Kirkeby, A.; Mattsson, B.; Heuer, A.; Bramoulle, Y.; Van Camp, N.; Perrier, A. L.; Hantraye, P.; Björklund, A.; Parmar, M. Human ESC-Derived Dopamine Neurons Show Similar Preclinical Efficacy and Potency to Fetal Neurons When Grafted in a Rat Model of Parkinson’s Disease. Cell Stem Cell 2014, 15, 653–665.

(3)  Goetz, C. G.; Wuu, J.; McDermott, M. P.; Adler, C. H.; Fahn, S.; Freed, C. R.; Hauser, R. A.; Olanow, W. C.; Shoulson, I.; Tandon, P. K.; Parkinson Study Group; Leurgans, S. Placebo Response in Parkinson’s Disease: Comparisons among 11 Trials Covering Medical and Surgical Interventions. Mov. Disord. Off. J. Mov. Disord. Soc. 2008, 23, 690–699.

(4)  McRae, C.; Cherin, E.; Yamazaki, T. G.; Diem, G.; Vo, A. H.; Russell, D.; Ellgring, J. H.; Fahn, S.; Greene, P.; Dillon, S.; Winfield, H.; Bjugstad, K. B.; Freed, C. R. Effects of Perceived Treatment on Quality of Life and Medical Outcomes in a Double-Blind Placebo Surgery Trial. Arch. Gen. Psychiatry 2004, 61, 412–420.

(5)  Kim, S. Y. H.; Frank, S.; Holloway, R.; Zimmerman, C.; Wilson, R.; Kieburtz, K. Science and Ethics of Sham Surgery: A Survey of Parkinson Disease Clinical Researchers. Arch. Neurol. 2005, 62, 1357–1360.

(6)  Freed, C. R.; Greene, P. E.; Breeze, R. E.; Tsai, W.-Y.; DuMouchel, W.; Kao, R.; Dillon, S.; Winfield, H.; Culver, S.; Trojanowski, J. Q.; Eidelberg, D.; Fahn, S. Transplantation of Embryonic Dopamine Neurons for Severe Parkinson’s Disease. N. Engl. J. Med. 2001, 344, 710–719.

(7)  Kjærsgaard, T. Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement. AJOB Neurosci. 2015, 6, 4–10.

(8)  Farah, M. J.; Illes, J.; Cook-Deegan, R.; Gardner, H.; Kandel, E.; King, P.; Parens, E.; Sahakian, B.; Wolpe, P. R. Neurocognitive Enhancement: What Can We Do and What Should We Do? Nat. Rev. Neurosci. 2004, 5, 421–425.

(9)  Lucke, J. C.; Bell, S.; Partridge, B.; Hall, W. D. Deflating the Neuroenhancement Bubble. AJOB Neurosci. 2011, 2, 38–43.

(10)  Smith, M. E.; Farah, M. J. Are Prescription Stimulants “Smart Pills”? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. Psychol. Bull. 2011, 137, 717–741.

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Strong, Katie. (2015). The Newly Released 6.1 Issue of AJOB Neuroscience. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/03/the-newly-released-61-issue-of-ajob.html

Primordial soup to nuts: are some men naturally selected to be better dads?

Children are the future. So “why do some men choose not to invest in their children?” This was the question that Dr. James Rilling set out to answer over the last few years. Dr. Rilling is the head of the Laboratory for Darwinian Neuroscience in the Anthropology Department at Emory University and states one of the lab’s aims is “exploring the neural basis of human social cognition and behavior, particularly those aspects that have been under strong evolutionary selection pressure.” But are absent fathers the result of natural selection?



In the last half-century, the basic structure of American families has been changing. Within two-parent households, fathers are spending more time with their children than they used to as more mothers work outside the home. However, there are also many more single mothers raising children without any paternal help and roughly half of all American children are raised by a single parent at some point during childhood [1].



These changes have occurred far too rapidly to be the result of natural selection, but this trend compels additional study into the factors underlying paternal commitment. It is not known if there may in fact be an evolutionary explanation for why some men are more committed fathers than others. More to the point, do biological differences between men influence behavioral variation? Life History Theory posits that natural selection shapes the allocation of finite resources toward aspects of growth, survivorship, and reproduction. Within reproduction, there is arguably a trade-off in this zero-sum game between parenting and mating activities, and natural selection shapes phenotypes to support optimal strategies.

In the non-human world, there is evidence for a connection between mating strategy and testicular size in males. For example, gorillas, who typically live in harem-like situations with little competition from other males have rather small testes for their body weight whereas chimpanzees, who typically face much more mating rivalry are much better-endowed [2]. Other studies have found a relationship between testicular volume and mating success within species [3,4].



Dr. Rilling’s group reasoned that perhaps testicular volume would also be indicative of mating investment within a species (ours) and tested whether testicular size or testosterone levels correlated with measures of paternal involvement. To take it a step further, they also used fMRI to examine the activation of reward pathways in fathers’ brains while viewing photographs of their children. The researchers recruited fathers of children (age 1-2) in Atlanta, GA who were co-habitating with their partner and child. They then asked the fathers – and also the mothers – to come into the lab and answer a series of questions designed to gauge the fathers’ involvement and parenting responsibilities, and also their desired level of involvement.



They then asked the fathers – and also the mothers – to come into the lab and answer a series of questions designed to gauge the fathers’ involvement and parenting responsibilities, and also their desired level of involvement. The survey assessed involvement by asking who is responsible for the child on a 1 – 5 scale (1 being mother almost always to 5 father almost always) in 24 different tasks and situations like bathing the baby or getting up at night to attend to waking. The mothers’ ratings served to corroborate the fathers’ self-reported involvement and supplemental information showed that there was in fact a very high level of agreement. The fathers then provided blood samples for hormonal measures and received structural and functional MRI scans. In the fMRI scanner, they were shown pictures of their own child, an unknown child, and an unknown adult with neutral, happy, or sad facial expressions. Finally, testicular volume was measured by structural MRI.



They hypothesized that the more invested fathers would have lower testosterone levels and smaller testes – reflecting more of an energetic investment in parenting than in mating behavior. Furthermore, they reasoned that this behavior may be related to activity in the ventral tegmental area – a part of brain’s reward system – because more involved fathers may find interaction with their children more rewarding. Indeed, this is what they found.



Mascaro and colleagues published the results of their study entitled “Testicular volume is inversely correlated with nurturing-related brain activity in human fathers” in PNAS [5]. As one might expect, headline writers (this one included) made the most of this opportunity: “Men with smaller gonads are better dads”, “Have you got the balls to be a good dad?”, “How your big balls lead to bad parenting”, etc., etc.

From The Onion

Some Internet commenters and science bloggers who, admittedly, are not by-and-large known for their levelheadedness and foresight, found the study pointless or a waste of money. These remarks may reflect a public attitude that scientific research reported by the mainstream press needs to have some impact on our daily life. They also reflect a lack of understanding of the way science funding works, as this finding was a small piece of a larger study that examined the more general biological influences on paternal behavior and which has resulted in multiple non-testes related publications. This quick-trigger dismissal of science as a waste of money is worrisome given the current state of science funding.



One couldn’t be faulted for asking, “what am I supposed to do with this information?” Does this mean that deadbeat dads should be excused for their irresponsibility so long as they are well-endowed? Not so fast. The authors were careful to note that this study does not establish causality: “it remains unclear whether greater testes volume is a cause or a consequence of male life-history strategies.” In other words, it might also be the case that fathers who choose to be more invested in child rearing experience a drop in testosterone and mating drive (but this doesn’t mean that changing diapers will shrink your manhood!). One limitation of this study is that it confined its analysis to the heteronormative parenting model. An interesting next step could be to determine if these correlations also hold in same-sex male couples.



This study, presented by lead author Dr. Jenny Mascaro at the Emory Neuroethics Program’s monthly Neuroscience, Ethics, and the News Journal Club, is exactly the type of article that this forum was created to discuss. It was published in a high-impact journal and distributed to a wide audience in many fields. The press immediately pounced on it and broadly disseminated the main findings, which is understandable due to how the topic is relatable and digestible (not to mention provocative). In addition, these findings raise interesting questions about biological reductionism and what it means for individual responsibility.



It is difficult to communicate findings such as these – which shed light on our nature and tendencies but do not necessarily explain any single individual’s behavior – to the general public without misinterpretation. Still, it is relatable, fascinating studies like this one that can keep the public engaged with scientific research and help all of us understand a little more about the complexity of human nature.



References



1. Cabrera, Natasha J., Catherine S. Tamis-LeMonda, Robert H. Bradley, Sandra Hofferth, and Michael E. Lamb. “Fatherhood in the Twenty-First Century.” Child Development 71, no. 1 (January 1, 2000): 127–36.



2. Harcourt, A.H., P.H. Harvey, S.G. Larson, and R.V. Short. “Testis Weight, Body Weight and Breeding System in Primates.” Nature 293, no. 3 (September 3, 1981): 55–57.



3. Schulte-Hostedde, Albrecht I., and John S. Millar. “Intraspecific Variation of Testis Size and Sperm Length in the Yellow-Pine Chipmunk (Tamias Amoenus): Implications for Sperm Competition and Reproductive Success.” Behavioral Ecology and Sociobiology 55, no. 3 (October 31, 2003): 272–77.



4. Preston, B. T., I. R. Stevenson, J. M. Pemberton, D. W. Coltman, and K. Wilson. “Overt and Covert Competition in a Promiscuous Mammal: The Importance of Weaponry and Testes Size to Male Reproductive Success.” Proceedings of the Royal Society of London B: Biological Sciences 270, no. 1515 (March 22, 2003): 633–40.



5. Mascaro, Jennifer S., Patrick D. Hackett, and James K. Rilling. “Testicular Volume Is Inversely Correlated with Nurturing-Related Brain Activity in Human Fathers.” Proceedings of the National Academy of Sciences of the United States of America 110, no. 39 (September 24, 2013): 15746–51.





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Purcell, R. (2015). Primordial soup to nuts: are some men naturally selected to be better dads? Retrieved on , from http://www.theneuroethicsblog.com/2015/03/primordial-soup-to-nuts-are-some-men.html

Diversity in Neuroethics: it’s more important than you might think

By Nicholas Fitz and Roland Nadler**

Nicholas Fitz

Nick is a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia. 



Roland is a third-year J.D. student at Stanford Law School and previously worked as a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia.



**equal contribution

Roland Nadler

The second decade of neuroethics is now well underway. Much like the human brain itself, some of its developmental “critical periods” have run out, but many others remain open. How will we use these remaining opportunities to shape the field?



Junior participants in these spaces should take the initiative to engage with unresolved questions about the nature and structure of neuroethics as a discipline. After all, those of us at the beginning of our careers have a particularly significant stake in the answers to those questions, with most of our academic and professional lives still ahead of us. As we work to integrate society’s growing technological power with best ethical practices and societal values, we must ask: whose practices, whose values?



Last year, in a bid to foster this discussion, we offered three visions for diversity in neuroethics. In that article, we devoted much attention to diversity along intellectual, disciplinary, and political lines.



Today, we offer a few more thoughts on the importance of diversity in neuroethics in the more familiar sense of having a wide array of identities and backgrounds represented in the field.



Chiefly, we hope to convince you that robust identity diversity is beneficial — indeed, crucial — to neuroethics. The field simply could not provide the kinds of insights that it promises if its practitioners were a homogenous group of people speaking comfortably from positions of social power and privilege.



To be sure, neuroethics is off to a strong start in establishing itself as a diverse field. The successes of Neuroethics Women Leaders, especially well-represented at this year’s Society meeting, deserve special recognition in this regard. While there is always room for improvement, we can be glad that neuroethics is not especially male-dominated as disciplines go.



Our purpose in this post, then, is not to allege that neuroethics is insufficiently diverse — though we should and surely can do better. Our aim, rather, is to highlight that our existing levels of diversity are not merely tangential goods. Heterogeneity is in no way incidental to the field’s ability to carry out its job effectively — much less mere window dressing, a matter of appearances.



Much more than simply insulating the discipline from charges of being exclusionary, diversity positively contributes to the mission of neuroethics. Its contribution can be understood in two senses: a generating sense and an inoculating sense.



Bringing a wide variety of personal experiences and worldviews — along the axes of race, gender, socioeconomic status, (dis)ability, and more — to bear on neuroethics acts as a generator for novel perspectives. If neuroethics is to help steer the responsible use of emerging technology and knowledge, it must acknowledge the ways in which that project touches on bias (from implicit identity biases to larger structural inequalities) and on the heterogeneity of lived experience. And it needs a maximally broad pool of perspectives to draw its critiques from: if that pool lacks, for example, the perspective of transgender people, we may go a long time without realizing how our conversations about the relationship between personal identity and the brain skate blithely over flawed assumptions about gender.



Concretely, then, those at the field’s power centers must reach out in support of investigators from a variety of backgrounds. There is much wisdom to be found in a diverse crowd.

From Phillips, 2014

Meanwhile, one of the greatest pitfalls for any meta-scientific discourse is the tendency to interpret seemingly neutral or objective facts in ways that serve established ideologies. This risk is heightened even more when the science under discussion has some claim to dealing with the “essence” or fundamental nature of human beings — as the history of research on race and IQ so chillingly reminds us. Diversity in the ranks of neuroethics helps inoculate us against this threat. Ideology has a characteristic way of quietly infecting the way we talk about “the big questions,” and bringing people who are ordinarily pushed to the edges of the discourse into the conversational spotlight is the first step towards immunity.



As we know all too well from recent work on biological essentialism, stereotyping, and the seductive allure of neuroscientific explanations, contemporary neuroscience does not operate in a vacuum, but rather can reinforce social categories. The fact that neuroscience is science — not pseudoscience like its predecessors, craniometry and phrenology — affords little defense against its potential to serve such unacknowledged agendas. As the late Stephen Jay Gould put it, “Shall we believe that science is different today simply because we share the cultural context of most practicing scientists and mistake its influence for objective truth?” By fostering a mosaic community of practicing neuroethicists, the field can help protect itself — and society — from these side effects of neuroessentialism.



Indeed, neuroethicists are especially well-situated to understand the value of diversity. Given that the literature on the causes and consequences of biased and motivated reasoning is an essential point of departure for neuroethical investigation, those in the field already have access to tools and techniques that reduce these biases. But we still have work left to do.



Our next step is to brainstorm ways to collectively wield these tools, and to do so effectively and responsibly. As we further diversify the field, we have a responsibility to convince rather than foist, and to seek grassroots engagement rather than tokenize. Having lent our voices in this call to action, the two of us writing here — hardly embodiments of the diversity we are extolling, after all — ought to step back and open up the space for underrepresented neuroethicists to helm the conversation. We hope our readers will join us in helping this happen!





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Fitz, N. and Nadler R. (2015). Diversity in Neuroethics: it’s more important than you might think. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/02/diversity-in-neuroethics-its-more.html