International Neuroethics Society Annual Meeting Summary: Ethics of Neuroscience and Neurotechnology

By Ian Stevens

Ian is a 4th year undergraduate student at Northern Arizona University. He is majoring in Biomedical Sciences with minors in Psychological Sciences and Philosophy to pursue interdisciplinary research on how medicine, neuroscience, and philosophy connect. 



At the 2017 International Neuroethics Society Annual Meeting, an array of neuroscientists, physicians, philosophers, and lawyers gathered to discuss the ethical implications of neuroscientific research in addiction, neurotechnology, and the judicial system. A panel consisting of Dr. Frederic Gilbert with the University of Washington, Dr. Merlin Bittlinger, with the Universitätsmedizin Berlin – Charité, and Dr. Anna Wexler with the University of Pennsylvania presented their research on the ethics of neurotechnologies.

Dr. Gilbert discussed the cultivation and development of neurotechnologies that use artificial intelligence (AI) to operate brain-computer interfaces (BCI), such as the implanted seizure advisory system, which is implanted invasively into the brain for the treatment of drug-resistant epilepsy (1). He provided three main reasons for the ethical examination of such developing neurotechnologies. The first is that these devices could provide “neuro-signatures” that could aid in the detection of addiction and sexual urges. These issues could challenge our notions of privacy and autonomy, concerns that are being explored with other technologies (2, 3). Secondly these devices, as other similar invasive neurotechnologies, have been shown to cause or be associated with personality changes and because of this we need to understand how these technologies might affect a patient’s notion of self and identity (4). It seems concerning to enter a treatment as a certain person but leave as another. How the risks and benefits of treatment are balanced when a patient prior to surgery might not be the same afterwards challenges conventional standards of risk and benefit. Finally, the field of AI with BCIs is a very ambiguous one with the pace of developing predictive brain implants exceeding our understandings of how they will affect us (5).

Expanding on his second justification, Dr. Gilbert discussed his research on ways these artificially intelligent devices can alter subjects’ perception of themselves. He used qualitative data from interviews to assess the concern that BCIs alter personalities and shared two stories of a 52-year-old woman receiving an AI BCI for epilepsy and a younger female student also being treated for epilepsy with an AI BCI (6). The 52-year-old woman stated that, because of the implanted AI device, she felt like she could do anything, and nothing could stop her (AI BCI induced postoperative distorted perception of capacities).

An open brain-computer interface (BCI) board.

(Image courtesy of Wikimedia.)

This contrasted with the student who experienced postoperative symptoms of depression because she felt the AI device forced her to confront the fact that she was epileptic (AI BCI induced drastic rupture in identity leading to iatrogenic harms). These dialogues have lead Dr. Gilbert to argue for a distinction between restorative and deteriorative personality changes associated with BCIs (what he calls “self-estrangement”) (7).



This distinction is initially helpful for two possible reasons. One, it assists in confirming that a patient’s sense of identity can change in reference to the AI BCI they are treated with, but also that there are certain kinds of patients who are incompatible with being treated with BCIs. Like pharmacological treatments for mental health, some patients might not benefit from the deleterious identify changes associated with their AI BCI treatment. So, in conclusion, Dr. Gilbert advised that those who are not accepting of their neurologic disease should not undergo AI BCI treatment out of concern for the device having a destructive change in their core personality.

Dr. Bittlinger, whose current work focuses on the ethical, legal, and social aspects of psychiatric neurosurgery, presented his research on the ethical evaluation of innovative research involving unknown risk by using the example of deep brain stimulation (DBS) in Alzheimer’s Disease (AD). Dr. Bittlinger emphasized how much of a global burden AD is, with no cure within sight. With only a few drugs available for treating the symptoms of AD, there is an obvious need for innovative research. He said that using DBS as an innovative, or currently unconventional, treatment should be examined ethically before we proceed down the road to other treatment options. To support this, Dr. Bittlinger quoted the Declaration of Helsinki (8) and its sentiments on the need for the patients to be autonomous beings and the importance of consent in research. The notion that the risks undertaken by patients should be low and minimal is not addressed, however, and DBS is in the highest risk class of treatments being explored for AD because of its invasive nature. The Declaration of Helsinki points to this importance, stating “individuals must not be included in a research study that has no likelihood of benefit for them unless it is intended to promote the health of the group represented by the potential subject, the research cannot instead be performed with persons capable of providing informed consent, and the research entails only minimal risk and minimal burden” (9). While all treatments in clinical trials strive for this, the innovative nature of DBS for AD possess large risks for unknown benefits. While AD can be debilitating to the patient, the risk associated with invasive implantation may be too great. Because of this and the fact that clinical trials include possibly un-autonomous decision-makers (the Alzheimer’s populous), Dr. Bittlinger stressed the need for further evidence of DBS efficacy in the long-term.

Image courtesy of Pixabay.

Dr. Bittlinger’s take home message was that “neuroethicists should encourage researchers to see methodological rigor not only as a liability but as an asset.” He is advocating for a form of methodological beneficence. While trials might normally look to cause minimal maleficence, questioning the implicit structure of research to be ethical could provide benefits in the realms of research with the highest risk. After an extensive literature review, Dr. Bittlinger made the important distinction between studies with no unknown risk compared to those with no knowledge of unknown risks (10). This uncertainty of the unknowns is the basis for Dr. Bittlinger’s question of exactly how much pre-clinical data is required to justify clinical interventions with DBS for Alzheimer’s disease. In line with this methodological beneficence and using probability models, Dr. Bittlinger finished off his talk when he stressed the need for neuroscientists to prioritize confirmatory clinical trials over exploratory ones in early stages of research.

Finally, Dr. Wexler presented on the use of brain stimulation in a variety of health and wellness clinics around the United States. Her work focused on the use of tDCS (transcranial direct current stimulation) and how the current studies on the subject have suggested its effectiveness in treating depression, chronic pain, and cognitive enhancement (though there is still debate in the literature about the efficacy of tDCS). She also noted that there is a larger presence of tDCS use in the DIY (Do It Yourself) community, where people fashion their own devices with batteries and sponges; however, it has been more common for tDCS products to be obtained as consumer products (11). Her fascination with the field came from the fact that two groups use these devices: researchers (a very controlled setting) and average consumers (a very uncontrolled setting). However, what struck her was the fact that a third group of people, clinicians, were also using tDCS devices as a means of treatment for their patients (a semi-controlled setting). This semi-controlled setting was curious to Dr. Wexler since it was fraught with ethical concerns distinct from the well-known DIY concerns, and the possible off-label use of tDCS in such a setting.



The semi-structured environment of the clinic presents a clinical bioethical inquiry. How should these devices be regulated and how should they be understood as treatment options? Should they only be approved as a clinical treatment for disease, or perhaps as an off-label procedure to enhance?

Image courtesy of Pexels.

She defined an off-label use as a device or drug used for an intention other than it was approved and referenced using Trazadone, a drug used to treat depression, for alcohol dependency as an example (12). She then went on to discuss the open-ended semi-structured interviews she conducted with health care providers that offered tDCS services. Although the analyses are still underway, she shared some insights she has had so far; namely tDCS use has been tied to complementary and alternative medicine, the pricing of using such devices varies by provider, and the treatment focused on depression, anxiety, and ADD. Out of the practitioners, some thought that tDCS was FDA approved (when in fact it was not), and overall those using tDCS came from people possessing an MD, Ph.D. or no clinical background. Regardless of the legal distinctions between the regulation of the sale of tDCS devices or the use of them, the ethical questions she left us with are pressing ones. Should these devices be allowed to be used in clinics without supporting research?

The developing neurotechnologies are broad in their application, but there are common threads of ethical reflection that Dr. Gilbert, Dr. Bittlinger, and Dr. Wexler have highlighted. As with all new treatment options, our outlook as scientists, philosophers, lawyers, and ethicists should be critical, although not pessimistic. Neurotechnologies look to be great treatment options for many chronic neurological problems; however, the side-effects, and therefore the risk and benefit trade-offs are unknown. The “how” question of connecting the human brain with technology has been solved on some levels; however, what this connection ethically means still needs to be unraveled.

References

1. Mark J. Cook et al., “Prediction of Seizure Likelihood with a Long-Term, Implanted Seizure Advisory System in Patients with Drug-Resistant Epilepsy: A First-in-Man Study,” The Lancet. Neurology 12, no. 6 (June 2013): 563–71, https://doi.org/10.1016/S1474-4422(13)70075-9.

2. Tamara Denning, Yoky Matsuoka, and Tadayoshi Kohno, “Neurosecurity: Security and Privacy for Neural Devices,” Neurosurgical Focus 27, no. 1 (July 1, 2009): E7, https://doi.org/10.3171/2009.4.FOCUS0985.

3. Frederic Gilbert, “A Threat to Autonomy? The Intrusion of Predictive Brain Implants,” Ajob Neuroscience 6, no. 4 (October 2, 2015): 4–11, https://doi.org/10.1080/21507740.2015.1076087.

4. Frederic Gilbert et al., “I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation,” AJOB Neuroscience 8, no. 2 (April 3, 2017): 96–109, https://doi.org/10.1080/21507740.2017.1320319.

5, 6, 7. Frederic. Gilbert et al., “Embodiment and Estrangement: Results from a First-in-Human ‘Intelligent BCI’ Trial,” Science and Engineering Ethics, 2017, https://doi.org/10.1007/s11948-017-0001-5.

8. “WMA - The World Medical Association-WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects,” accessed December 28, 2017, https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.

9. “WMA - The World Medical Association-WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects.”

10. John Noel M. Viaña, Merlin Bittlinger, and Frederic Gilbert, “Ethical Considerations for Deep Brain Stimulation Trials in Patients with Early-Onset Alzheimer’s Disease,” Journal of Alzheimer’s Disease: JAD 58, no. 2 (2017): 289–301, https://doi.org/10.3233/JAD-161073.

11. Anna Wexler, “The Social Context of ‘Do-It-Yourself’ Brain Stimulation: Neurohackers, Biohackers, and Lifehackers,” Frontiers in Human Neuroscience 11 (2017), https://doi.org/10.3389/fnhum.2017.00224.

12. Letizia Bossini et al., “Off-Label Uses of Trazodone: A Review,” Expert Opinion on Pharmacotherapy 13, no. 12 (August 2012): 1707–17, https://doi.org/10.1517/14656566.2012.699523.

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Stevens, I. (2018). International Neuroethics Society Annual Meeting Summary: Ethics of Neuroscience and Neurotechnology. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/02/international-neuroethics-society_10.html

Transcranial Magnetic Stimulation and Humanity

By Ethan Morris



This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Ethan Morris is a rising undergraduate senior at Emory University, majoring in Neuroscience and Behavioral Biology with a minor in History. Ethan is a member of the Dilks Lab at Emory and is a legislator on the Emory University Student Government Association. Ethan is from Denver, Colorado and loves to ski.

Do you ever want to turn your brain off, even just for a moment? Most of us have probably wanted to get away from the daily stressors and concerns that plague our lives. But aside from a vacation, how can we truly get away? Some people are beginning to turn this hypothetical question into reality.

One man, Thomas Thwaites, decided he would live as a goat for a few days, choosing to forego life as a human in favor of four-legged prosthetics and an all-grass diet. To achieve goat-hood, Thwaites used an increasingly prominent technology called transcranial magnetic stimulation (TMS) that uses electromagnetic induction to temporarily alter brain function. Thwaites applied TMS to the temporal lobe of his brain, namely his speech areas of cortex, thus electromagnetically impairing his ability to speak like a human so he could become more like a goat.

Thwaites quite literally took a vacation from his brain in order to become a goat. This application of TMS has been in the making for decades. For example, studies have shown that TMS over our prefrontal cortex can seriously (albeit temporarily) impair our ability to make strategic decisions. TMS technology has been applied in clinical contexts as well, with various studies showing the effectiveness of TMS in potential treatment of PTSD and major depression.

Thwaites’ use of TMS may seem harmless; however, the way Thwaites achieved this—through a new brain technology—raises novel questions regarding TMS, trans-humanism, and whether it is ethical to “turn off” parts of our brain, even if it is temporary. Ironically, Thwaites himself said that he opposes the idea of trans-humanism, saying that his decision to become a goat was a “reaction against this cyborg-chip-in-your-brain thing” (Felsenthal, 2016).

It is not difficult to imagine situations where TMS may be misappropriated in the future, particularly when this sort of technology becomes readily available. Those in search of a new recreational drug could apply “doses” of TMS over the visual cortex to cause hallucinations (or phosphenes) and over the prefrontal cortex to impair impulse control and decision-making in order to have a good time. Do-it-yourself enthusiasts are already using technology such as transcranial direct current stimulation (tDCS) to cognitively enhance areas of the brain such as the motor cortex. It is not impossible that people, dissatisfied with their own brain chemistry, may use TMS to “turn off” what they don’t like about their brains. Perhaps in the future, deep-brain TMS could be used to eliminate bad memories, alleviate situational sadness, or target regions of our brain associated with the parts of our personality we do not like (Bersani, 2013).

Image courtesy of The Ohio State University

These uses are highly questionable, particularly because they begin to raise questions about whether we should be able to fundamentally change our brains—thus changing who we are. I personally do not think it is ethical to significantly alter our brain chemistry outside of a clinical setting because it would begin to eliminate the errors, struggles, and characteristics that make us human in the first place. Beyond this, I believe strongly that to appreciate what is good about our lives, we must also experience what is less desirable. Finally, to give only those with access to TMS the ability to cognitively depress unwanted brain function would exacerbate existing socioeconomic divisions. For example, consider a job interview between two equally qualified candidates, but only one had the financial resources to apply TMS before the interview to temporarily eliminate anxiety. The applicant with TMS would likely appear confident and calm while the other candidate may be subject to normal human nervousness and jitters. While this is only one example, it elucidates how access to mental state alterations may add one more component that further disadvantages those without access to this technology.

However, the distinction between enhancement and clinical use is blurry. For example, when does sadness cross the line into major depression? While I believe that TMS is acceptable for treatment of major depression and PTSD, I do not believe it is ethical to use TMS to rid yourself of temporary sadness or an embarrassing memory. This line is convenient in theory, but it may be difficult to apply in real life situations, where there are additional challenges, such as clinical diagnosis accuracy and the agency of ultimate diagnosis (e.g. who gets to decide who has major depression, the patient or the doctor?).

Trans-humanists are a group of people who view immortality as a human right and see technology as the medium through which human enhancement can be achieved. Trans-humanists will likely embrace TMS as another exciting technology for their purposes. Through synergistic use of tDCS to enhance certain cognitive functions and TMS to depress unwanted cognitive functions (e.g. stress, anxiety), trans-humanists may see these technologies as one step closer to a utopian brain. I do not think it is ethical to use repetitive TMS as a means to a utopic brain for a couple reasons. First, it will degrade our humanity, which is by definition imperfect and better for being so. Second, while chronic stress is problematic for our health, acute stress has shown to be a behaviorally adaptive resource for humans. To trans-humanists, TMS may be another tool to elevate humans over our neurobiological constraints, and perhaps over other “normal” humans—raising another issue with cognitive enhancement.

One final consideration to make in the ethical discussion about TMS is the current limits of technology. I believe it is of the utmost importance to regulate TMS use outside of the scientific and clinical realm because we still do not know all of the effects of TMS if it is misused. For example, could too high of a TMS “dosage” cause serious long-term neurological impairments? Ultimately, TMS is an exciting technology with proven benefits in clinical and research environments, but as it becomes increasingly accessible and its uses increasingly non-clinical, there are serious problems that deserve the attention of the public and policy-makers alike.

References



Bersani, F.S., A. Minichino, P.G. Enticott, et al., 2013. Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: A comprehensive review. European Psychiatry, 28(1): 30-39.



Carpenter, L., P.G. Janicak, S.T. Aaronson, et al. 2012. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety, 29: 587-596.



Felsenthal, J. 2016. Why did this man decide to become a goat? Vogue, May 24. Available at: http://www.vogue.com/13439679/goatman-thomas-thwaites-interview/ (accessed June 10, 2016).



Humanity Plus. Available at: http://humanityplus.org (accessed June 23, 2016)



Johns Hopkins Medicine. Transcranial magnetic stimulation (TMS) service. Available at: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/ (accessed June 12, 2016).



Kammer, T. 1999. Phosphenes and transient scotomas induced by magnetic stimulation of the occipital lobe: their topographic relationship. Neuropsychologia, 37: 191-198.



Knoch, D., L.R.R. Gianotti, A. Pascual-Leone, et al. 2006. Disruption of right prefrontal cortex by low-frequency repetitive transcranial magnetic stimulation induces risk-taking behavior. Journal of Neuroscience, 26(24): 6469-6472.



Novakovic, V., L. Sher, K.A.B. Lapidus, J. Mindes, J.A. Golier, R. Yehuda. 2011. Brain stimulation in posttraumatic stress disorder. European Journal of Psychotraumatology, 2: 5609-.



Riggall, K., C. Forlini, A. Carter, et al. 2015. Researchers’ perspectives on scientific and ethical issues with transcranial direct current stimulation: An international survey. Scientific Reports, 5: 10618.



Schneiderman, N., G. Ironson, and S.D. Siegel. 2005. Stress and health: Psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology 1: 607-628.





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Morris, Ethan. (2016). Transcranial Magnetic Stimulation and Humanity. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/transcranial-magnetic-stimulation-and.html

Cognitive Enrichment on Cognitive Enhancement at the Michigan Undergraduate Philosophy Conference

By Shweta Sahu

Photo Credit: Anne Trelfa

On February 19, the Michigan Undergraduate Philosophy Conference assembled for the 4th annual meeting at the Insight Institute of Neurosurgery and Neuroscience in Flint, Michigan. The program is jointly hosted by the Center for Cognition and Neuroethics and the University of Michigan-Flint Philosophy Department. I had the pleasure of attending and presenting at this incredible event through the generous support of the American Journal of Bioethics Neuroscience and the Neuroethics Program at Emory. The goals of the Center for Cognition and Neuroethics are to promote “the exploration of conceptual foundations of neuroscience” and to “study the implications of their advances for society in the legal, political, and ethical realms.” The conference, organized by Cody Hatfield-Myers, a senior at the University of Michigan- Flint, brought together students from multiple states in the US and even a few students from Canada.

The event, directed at undergraduate students, aimed to foster the sharing of students’ diverse papers, all linked by the common themes of cognition and neuroethics. Central topics of discussion included: philosophy of mind, cognitive science, neuroscience, philosophy of action and free will, identity, medical ethics and memory, learning, belief, and knowledge. Common questions that seemed to resurface included: What is self-identity? Can you freely alter your own self-identity? Are there aspects of one’s personal identity that it would be wrong to alter, eliminate or hide? If so, why? What is the proper role of medicine—to eliminate illness or to enhance people (physically, morally, psychologically) to make them “better than well”? What are the limits of parental control over the health and well-being of the body and mind of their child (as was the case with my talk)? Do children have the right to determine whether or not they are subjected to medical or psychological treatments? How are health, life and death, medicine, physical and mental illness portrayed in art, music, and in literature?



The conference was structured to facilitate discussion and interdisciplinary collaboration. Each session consisted of two talks. After some inspiring opening remarks by Cody Myers from University of Michigan-Flint, the first session consisted of talks from Albwin Wagner Scmitzer from University of Cincinnati, who presented his paper “Fantasy, Reality, and the Self,” and from Ryan Powers from Ohio University, who presented his paper, “Logical Fatalism: Origins as Essential Properties of Events.” In his talk, Schmitzer asked and expanded upon the question, if we usually discredit fiction as having value in the real world, is there any point to reading it? The second session featured a talk from Juensung Kim from University of Toronto on “Predicting Encoding of Acupuncture” along with my own talk, “Responsibility: Revis(ion)ing Brains via Cognitive Enhancement.” Kim’s talk was particularly engaging because he spoke more from a neuroscience background and found ties to connect his Asian culture back to early ancient medicinal rituals, like acupuncture.

The purpose of my paper was to explore the ethical issues surrounding cognitive enhancement, which is the augmentation of one’s intellectual ability via medicine or various methods of therapy, especially transcranial direct current stimulation (tDCS). I also wrote a bit about this in an earlier post here. I began by introducing tDCS and noting its rise in popularity, along with its growing fervor in the DIY community. I then reviewed and expanded on some of Dr. Anjan Chatterjee’s concerns regarding “cosmetic neurology,” including, but not limited to, whether cognitive enhancement is worth the potential risks; if we have the ability to enhance, should we enhance; and could we alter the individual and erode character through enhancement? I delved further into the personal realm and questioned whether my parents would have opted for cognitive enhancement for me, but from the unique perspective of a first generation student and the complications that ensued.

Image courtesy of Flickr user Steven S.

One fascinating question that fellow Emory University student, Lokita Rajan, brought up was whether the use of calculators could be considered a form of coercion. She astutely noted that teachers frequently write exams assuming that students use calculators on math or science exams, and that the time frame allowed for the test assumes the use of a calculator. However, in doing so, are they taking away our free will or are they enabling us to reach our full potential? She was prompted to ask this question in response to my statement that “enhancements just augment people’s existing capabilities, so they may enable them to lead a more 'authentic life' and reach their full potential.” Conversely, one may argue that “natural” excellence is worth more than bought talent. In my view, if there are shortcuts to excellence, then access to those shortcuts is what determines success or failures, not one’s inherent hard work. Moreover, some shortcuts in our society are completely acceptable. For example, performance enhancing athletic shoes and the use of calculators in high school physics promote authenticity by allowing a person to concentrate on more complex challenges that relate to goals rather than spending time developing thick soles or trudging through algebra. While we may be implicitly coerced into using calculators, I think it is acceptable because the use of a calculator allows us to focus our energies on the subject we are trying to master (whether it be using equations in biochemistry or formulas in physics), rather than “wasting time” doing the algebra and not grasping the main idea of the science we are learning.

Another question that was particularly intriguing was brought up by Cody Myers, the event coordinator. He asked about the cultural responses to enhancements. Since I came at my paper from more of a neuroscience and ethics view, and less of a sociological or anthropological background, I didn’t know much about the existing literature except to know that most cultures probably view it differently. However, based on personal experience, I can tell you that when speaking with my cousin my age in India, he does not know of peers with ADHD, has never heard of Ritalin, or even study drugs commonly used in colleges in the US, though he goes to a prestigious university in India. This got me wondering whether parents there immediately discredit those ideas and frown upon enhancements other than natural remedies. As a kid, I would always mix up my P’s, F’s and 5’s and I had a hard time sitting in one place, so I thought that maybe I needed to get tested for ADHD or dyslexia. I remember that when I voiced this thought to my parents, they immediately said nothing was wrong with me I just needed to focus better. A study done by Ilina Singh on kids with ADHD in the UK and the US backs up the idea that different cultures view enhancements differently. After asking children in both countries why they took Ritalin, the study found that kids in the UK mainly reported that they take Ritalin so they can “manage anger and bad behaviors,” but kids in the US reported that they take Ritalin to “be more productive and improve academic performance.”

Upon further investigation into the literature, it is found that traditional Chinese medicine and Indian ayurvedic treatments using a plethora of plants and naturally occurring substances are widely practiced in China and India, respectively. Moreover, one WHO report found that "up to 80% of people in developing countries use traditional medical therapies as the first line of defense against illness." Another study notes that these holistic systems of health care are commonly used in the "prevention and management of chronic, non-communicable and systemic disease." Yet another study has reviewed the applications of plants used in ayurvedic medicine and found that these natural treatments have been used in: "stimulating intellect and sharpening the memory... restoring youth, memory and longevity... combating physical and mental exhaustion..." Thus, we can see that some cultures do seem to prefer natural enhancements over "unnatural enhancements" such as pills. Extending this idea by association, therefore, leads us to believe these same cultures would most probably value natural cognitive enhancement methods (like exercise, meditation, and ayurvedic plants) over unnatural ones (noninvasive brain stimulation and pills). If presented with a pill containing a crushed up herb with added chemicals, perhaps these individuals would hesitate to comply with such medication.

Photo Credit: Cody Hatfield-Myers

Another stimulating question Juensung Kim brought up stumped me at first. He asked whether glasses and clothes are considered enhancements. The answer to this question lies in the definition. Though there are many definitions of cognitive enhancement, most say something among the lines of: “the use of drugs, biotechnological strategies or other means by healthy individuals aiming at the improvement of cognitive functions such as vigilance, concentration or memory without any medical need." So yes, while glasses can improve your ability to see what a professor is writing on the board, thereby allowing you to engage with the material more, they are not an enhancement, in my opinion because they are not augmenting your cognitive ability [memory, reasoning, problem solving, etc.] as do other enhancements.

Little did I know that my talk would be just one of the stimulating, spectacular talks given by my peers; a full itinerary of the talks and lecturers can be viewed here. Following each talk, there were several other enthralling debates, questions, and discussions brought up by conference members. Some questions that were discussed in depth were in regards to the role/extent of free will in determining responsibility in criminal trials, how much sensorimotor understanding was comparable to Kant's epistemology, how responsibility differs in parents putting their children to bed on time and dieting in comparison to applying some sort of noninvasive brain stimulation, whether the brain is more malleable if it has been primed earlier in life, and the uses of N, N-Dimethyltryptamine (similar to serotonin) in the brain and its role in evolution.

It was truly an engaging day filled with excellent questions. My hope is that more people will present and attend in the future, and I hope to attend next year for another wonderfully eye-opening event.

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Sahu, S. (2016). Cognitive Enrichment on Cognitive Enhancement at the Michigan Undergraduate Philosophy Conference. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/05/cognitive-enrichment-on-cognitive.html

Responsibility: Revis(ion)ing brains via cognitive enhancement

By Shweta Sahu

The Statue of Liberty, an iconic symbol of

American opportunity; courtesy of Wikipedia

Most every parent wants their child to grow up to be a neurosurgeon, a lawyer, or the next gen Mark Zuckerberg. That was especially true in my case, as a first generation child. When I was two, my parents came to the United States, "the land of opportunity," seeking the success that they had only heard about in India. I grew up hearing their stories of hardship when they first moved here with an infant, without a car, without any extended family, and knowing very little working English. I witnessed them struggle tirelessly to make a life for themselves and they always said that without education you are nothing and will be no one. As a child, while my friends would go to sleepovers and camping trips with friends, my dad would spend time checking my math problems on the white board at home and my mom would make me spell 50 words correctly every night. But even with all that pressure, I never had the best GPA, I had to work incredibly hard to stay above the class average, and I almost always fell short of their expectations. So given the opportunity, would my parents have tried to enhance my cognitive ability?

Transcranial direct current stimulation (tDCS) is one intervention, particularly in the DIY community, which is becoming increasingly popular in hopes of achieving enhancement of cognition, though it is not available clinically for this express purpose. While it has been deemed safe in the short term from 10,000 trials of adults, studies (like this one and this one) indicate that tDCS does not result in significant enduring improvements in cognitive performance.

To do or not to do

Dr. Anjan Chatterjee asks, “If we have the ability to make brains better, should we do so when there is no acute 'disease?'” He calls such enhancement administered by the neurologist “cosmetic neurology.” In his article, Chatterjee contemplates “ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems.” The definition of “enhancement” is a moving target: what is deemed worthy of treatment is characterized as disease, whereas that which is only modified is known as enhancement. Ideas about the line between enhancement and therapy are dictated not only by medical professions, but also influenced by culture.

Dr. Chatterjee suggests that one of the ethical dilemmas surrounding the issue of enhancement is manifested in safety, since most medications and treatments have side effects. He notes that “in disease states one weighs risks [like death] against potential benefits,” but asks whether enhancement is worth the risk in healthy patients who simply wish to become even better.

However, in reality, little is known about the long term effects and true benefits of interventions like tDCS in typically-performing (not considered diseased or disabled by the medical community) individuals. Dr. Martha Farah, a renowned cognitive neuroscientist, notes that much of the research currently published on existing pharmacological enhancers may need to be taken with a grain of salt, because a) many studies used small sample sizes that could have easily led to false conclusions and b) enhancement outcomes *in laboratory experiments* differ based on biological and psychological traits of the user.

Schematic of transcranial magnetic stimulation,

courtesy of Wikipedia

Even less is known about effects on children, though there are experiments indicating potential success. In one experiment in London, 12 children with mathematical learning disabilities were given nine 20-minute training sessions, 6 of whom wore the cap (but did not receive stimulation) while the other 6 received transcranial random-noise simulation (tRNS), which is a newer transcranial stimulation method that utilizes a randomly varied current. “In this case, the children moved their bodies from side to side to guide a ball on a screen to land at a certain point on a number line, with the difficulty increasing as they progressed.” Results indicated that “children who received stimulation showed greater progress in performance [and reached a 20% higher level on the game] than did the controls, as well as significant improvements in general mathematics test scores.”

But whose responsibility is it to decide whether one receives treatment?

In their article, Brain stimulation for treatment and enhancement in children: an ethical analysis, Dr. Hannah Malsen et al. argue that because such intervention may include “compensatory trade-offs” or functional cognitive losses, more emphasis should be placed on parental judgment of the child’s best interest if the child has a neurological disease and is in need of treatment. However, in absence of disease, then more weight should be placed on the child’s autonomy, since one cannot justify the need for enhancement as was deemed necessary in the treatment case.

But how do you know a child would have wanted enhancement in the first place? At age 10 is he/she equipped with the information necessary to make such a decisions with such potentially profound impacts? I know I sure wasn’t as a 10 year old. Even now, I still cringe every time class registration time comes around because I know that small choices like what classes to take and when have enduring impacts on my career. Say the child took the opportunity and turned out successful—would he/she be glad he/she received enhancement? Would his or her quality of life be the same or better?

Would the child be the same person, at the end of the day?

This is another dilemma Chatterjee addresses—one of “eroding character” and “altering an individual,” and if “such interventions threaten essential characteristics of what it means to be human.” Taking a step back, most of us can relate to this and wonder, if we do modify a person’s state or prescribe antidepressants and other drugs, then aren’t we fundamentally altering a person and keeping them from being who they are, or are we instead enabling them to become their best selves? When someone is chronically on a drug, who is to say they would make different decisions if they weren’t always on said drug? If we believe that our actions define us, then how do we know that we are not, in fact, slowly changing the person and not just their temperament or their personality? I personally think that prolonged use of a drug does change a person. Take, for example, the case of antidepressants, which are known to protect people from the adverse effects of stress. The prolonged use of antidepressants could cause someone to make different decisions than they normally might have when they felt stress, and if these different decisions lead to different actions, then yes, I think you are altering a person by prescribing them a chronic drug. Others, however, do not share my opinion. In a qualitative case study done by interviewing parents of children with and without cognitive disabilities, it was found that some parents actually justified their child’s use of [ADHD] medication and felt that the “drugs were facilitating the expression of their child’s identity, not changing it.” Again, in the case of enhancing children, we’re led to wonder how we might be altering the trajectory of the development of the child’s personality and temperament: some believe that personality is set at a young age, which leads us to question whether there is an age after which enhancement may be less likely to alter personality, since the brain and personality, are less malleable after youth.

Is the decision to choose something like tDCS actually a choice?

First generation students sometimes feel pressure to succeed

academically; image courtesy of flickr user Tim Pierce

Linda Geddes reports, “There are currently no laws in either Europe or the US to regulate the use of tDCS in people merely hoping to enhance cognition, and companies now sell the tDCS headsets online,” thus enabling those who choose the DIY route. In fact, with a bit of science background, coming up with your very own tDCS invention is a surmountable feat with common household materials, since it is essentially two sponges hooked up to a battery/ power source! In the competitive culture today, might parents feel the need to utilize any intervention they can to improve their child’s chance of succeeding? Perhaps the stakes are too high? Parents raising first generation American children like my own for instance, might feel additional pressures. A first generation student myself, I used to always question why I received so much pressure from my parents. Now, I realize it’s because they just want me to succeed and to not have to struggle the way they did just to put food on the table, so pushing me to succeed in academics was their utmost priority. They knew I wasn’t the brightest Crayon in the box, but given the chance, would they have considered enhancement? Has society influenced our need to enhance ourselves or our children because we know that, as Chatterjee suggests, “to not take advantage of cosmetic neurology might mean being left behind?” Is it a parental responsibility to enhance their children? Are we creating a new culture of millennials who will one day want to similarly enhance their children?

I asked my parents if they would have done so and somewhat surprisingly, they said no. At first they agreed and said there’s always the risk of further complications and you potentially risk more than you can gain. Moreover, they noted that since I didn’t have any known deficits or explicit neurological shortcomings, then no they would not go for it because it wouldn’t be worth it. Finally, my mom stated that every parent’s main wish is that their kids just be safe and happy, and that academic success was only a means to achieve happiness. She would never do anything to threaten that (and she viewed that such enhancement might do so), even if it means having an “ordinary” daughter when she wanted an extraordinary one, because to her, I am extraordinary.

Want to cite this post?



Sahu, S. (2015). Responsibility: Revis(ion)ing brains via cognitive enhancement. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/01/responsibility-revisioning-brains-via.html