Allies and Enemies in the Fight for Mental Health Reform

 By Nathan Ahlgrim



The Need for Allies

Image courtesy of Wikimedia Commons.

Mental healthcare in the United States is in need of serious reform. Mental healthcare is less accessible than other services, and efforts to repeal the Affordable Care Act could put adequate care out of reach for millions more Americans.

Opposition to mental healthcare reform comes from all sides, with the popular talking points demanding law and order, fiscal responsibility, and moral accountability. Still, the consequences of un- or under-treated people interacting with un- or under-trained authorities are hard to ignore, most strikingly in the criminal justice system. Americans with mental illnesses are sixteen times more likely to be shot by police, and more than half of all inmates in America suffer from mental health problems. Mental health reform, then, stands to benefit the healthcare system, criminal justice, and family structure itself.

Given the opposition, legislative policy victories will require a rallying of the troops and solidarity among all conceivable allies. Though it is tempting to welcome any and all help, even the purest of idealists can be hamstrung by allying with activists who actively fight the mainstream. The decisions of who to include and exclude as allies can determine a movement’s success as much as the message itself.

Patch Adams

Image courtesy of Wikimedia Commons.

I recently returned from a week of volunteering at the Gesundheit! Institute (yes, the exclamation point is a part of the name). The brainchild of Dr. Patch Adams (in collaboration with a group of classmates and now ex-wife Linda Edquist), the institute was established on the dream of providing free, personal, and caring healthcare as well as a healthcare system that seeks to improve quality of life instead of simply delaying death. Oh, and it is a clinic populated by clowns.

Clowns were and are intimately woven into the fabric of Gesundheit. The Institute was popularized by the sappy and critically derided (but personally cherished) 1998 biopic Patch Adams starring Robin Williams as the clown doctor himself. The movie chronicles Patch’s revolutionary approach to medicine and the opposition he faced to the unorthodoxy of putting the words “clown” and “doctor” in the same job description. In real life, the team operated a free clinic for a renegade twelve-year period, during which they saw more than 15,000 patients. They closed in 1984 to spread the mission, find funding, and build a permanent hospital in West Virginia. As I saw first-hand, the 321-acre land in rural West Virginia is a tangible counterpoint to the American healthcare system. Thirty-three years later, the work is still in progress.

Patch believes in holistic care. Critics often simplify his care philosophy to “laughter cures all.” As jarring as a clown doctor can be, he is far from the only one who takes advantage of laughter therapy. Many nursing homes incorporate deliberate laughter and humor into their care [1, 2], and laughter has been reported to increase psychological resilience and even some physiological measures like pain tolerance [3] and immune activity [4]. Although, not surprisingly, a major weakness in the research linking humor and health is its anecdotal and subjective nature [5, 6]. Patch does believe in laughter as medicine, in conjunction with traditional Western medicine and complementary treatment strategies. In modern parlance, Patch’s philosophy might best be described as promoting wellness above and beyond physical health.

The "Dacha": the main building on the property.

The Gesundheit! Institute grew out of his dissatisfaction with the ineffective and impersonal treatment he received as a patient. And yet, his beliefs about mental health, their causes, and the responsibilities of those struggling with mental health problems can be a hard pill for advocates and allies to swallow.

Conceptualizations of mental illness

Crucially to the matter at hand, Patch dismisses the physiological causes of mental health disorders like depression and attention deficit disorder, going so far as to label those with such illnesses as being morally responsible for their condition (see reactions to speeches here and here). He did release a touching statement following Robin Williams’ tragic suicide, but his primary reaction (relayed by his colleagues) was that “[Robin Williams] did not have any friends.” I cannot defend this position as a neuroscientist and an advocate for those suffering from mental health conditions.

The lens of depression blurs all existing friends until they cease to matter, an effect I have experienced first-hand. Biological mechanisms influence many diseases, and medications can provide relief for many patients. At the same time, I know that over-medicating patients is a real concern, even if a universal consensus seems out of reach. Herein lies the dilemma. Patch offers compassionate care, but disregards the biological basis of mental illnesses. In his mind, lifestyle choices are the principal cause, fault, and blame. His statements are jarring in the current medical context, but the pendulum of mainstream medical opinion has swung erratically between personal responsibility and biomedical etiology of mental illness over the past few centuries. Where the pendulum stops is more than a semantic matter. Everything from treatment outcomes to community acceptance is dependent on how we describe mental health and the people who suffer from related disorders

Stigma

Image courtesy of Pixabay user geralt.

Stigma, as described by Dr. Patrick Corrigan, grows out of the progression from stereotypes (attitudes about groups of people) to prejudice (when you agree with those stereotypes) to discrimination (behavior influenced by prejudice). Potential patients hide from the looming stigma, which can decrease treatment-seeking behavior and kick off a self-perpetuating cycle of isolation [7]. Just how members of the LGBTQ community had to overcome stigma and isolation at the beginning of the gay rights movement, Dr. Corrigan urges people with mental illnesses to “come out” about their status. The only way to decrease stigma is to show that everyone knows someone who is a part of this community.

Should we treat a person as sick or as deficient? I was tempted to champion the biomedical model in the face of Patch’s dismissal. I personally find Patch’s opinion, that mental illnesses like depression are a controllable choice, disrespectful to those suffering from mental illness. It minimizes the biological (and uncontrollable) hurdles that they must overcome. In doing so, his vision of universal healthcare would paradoxically remove necessary treatments from these patients.

Although the National Institute of Mental Health promotes the narrative of biological mechanisms in an effort to mitigate stigma felt by patients (from themselves and others), the net effect of this narrative depends on what sort of stigma is measured. Attributing mental illness to biological mechanisms correlates with decreased social distancing of the person with the illness (i.e. less shunning and shaming), but it also increases how dangerous people with schizophrenia or depression appear [8]. Not only that, but emphasizing the biological cause of a disorder above all other factors is an easy way to breed a perception of helplessness and a lack of control [9]. “Othering” is easy when mental illnesses are confined to a categorically different type of person [9]; however, negating the biology blames the person, causing any mental problem to spring from character flaws and weakness [10]. That is why an integrated biopsychosocial model is indispensable: illnesses are frequently triggered by the environment – be it relationship stress, emotional trauma, or other psychological insult – but the trigger will not spark an illness in the absence of a biological vulnerability (as in the diathesis-stress model [11]). As such, many psychiatrists and neuroscientists now promote an interdisciplinary and holistic view of mental health.

By departing from a holistic approach, figures like Patch can harm the very people I try to advocate for. When this happens, is he still an ally, or does he become an enemy to the cause?

What is doing ‘good’ look like?

The easiest approach would be to identify allies with a simple cost/benefit analysis. Within that framework, Patch’s philanthropy and humanitarian clown tours would land him solidly in the ‘ally’ category. Even so, his opinions can compromise the respect for people with mental health disorders, at a serious cost for those affected.

The communal farmhouse - a place of comfort.

Ultimately, I believe allies are anyone who helps, and Patch helps. According to the caretakers at the Gesundheit! Institute, much of the steady funding for the Institute comes from people with mental illnesses who were helped by Patch and put him in their wills. He does not help everyone, and he may even do some damage along the way, but his good is tangible. To be sure, Patch (and many of those at Gesundheit!) hold unscientific views. I heard everything from the moral model of psychiatric disorders to shamanism and practical magic (the latter two coming from the land managers, not Patch). As a scientist, I do not share those ideas. Even so, I recognize the utility in including everyone who shares the mission to help alleviate the suffering of mental illness as partners.

I loved my time at the Gesundheit! Institute. I truly did. I went to clowning workshops led by an Italian couple who spent their earlier years in a free love commune where they housed “the crazies that the crazy hospital kicked out.” I communally cleaned, ate, gardened, and slept. I connected on a human level in the absence of technology. I was recharged, reenergized, and rejuvenated. Even with objectives and missions so different from mine, I am honored to call them friends, and thankful to call them allies.

References

[1] Ko H-J, Youn C-H. (2011). Geriatrics & Gerontology International 11: 267-74.

[2] Low LF, Goodenough B, Fletcher J, Xu K, Casey AN, Chenoweth L, Fleming R, Spitzer P, Bell JP, Brodaty H. (2014). Journal of the American Medical Directors Association 15: 564-9.

[3] Weisenberg M, Tepper I, Schwarzwald J. (1995). Pain 63: 207-12.

[4] Bennett MP, Zeller JM, Rosenberg L, McCann J. (2003). Alternative Therapies in Health and Medicine 9: 38-45.

[5] McCreaddie M, Wiggins S. (2008). Journal of Advanced Nursing 61: 584-95.

[6] Martin RA. (2001). Psychological bulletin 127: 504-19.

[7] Schomerus G, Angermeyer MC. (2008). Epidemiologia e psichiatria sociale 17: 31-7.

[8] Parcesepe AM, Cabassa LJ. (2013). Administration and policy in mental health 40: 10.1007/s10488-012-0430-z.

[9] Hinshaw SP, Stier A. (2008). Annual Review of Clinical Psychology 4: 367-93.

[10] Feldman DB, Crandall CS. (2007). Journal of Social and Clinical Psychology 26: 137-54.

[11] Salomon K, Jin A. Diathesis-stress model. In: Gellman MD, Turner JR, editors. Encyclopedia of behavioral medicine. New York, NY: Springer New York; 2013. p. 591-2.

Want to cite this post?



Ahlgrim, N. (2017). Allies and Enemies in the Fight for Mental Health Reform. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/11/allies-and-enemies-in-fight-for-mental.html

Check out our 8.4 Special Issue on head transplantation!

Image courtesy of Flickr user ellajphillips.

AJOBN is proud to announce that our 8.4 Special Issue on head transplantation is live. This issue features posts from Dr. Paul Root Wolpe (“Ahead of Our Time: Why Head Transplantation is Ethically Unsupportable”) and Dr. Sergio Canavero and Ren Xiaoping (“HEAVEN IN THE MAKING BETWEEN THE ROCK (the Academe) AND A HARD CASE (a Head Transplant)”). This issue is being published amongst a flurry of news coverage surrounding head transplantation. Though Dr. Canavero has been planning and promoting his idea for a head transplantation surgery for the last several years (watch his 2015 TedTalk entitled, “Head Transplantation: The Future Is Now”), the actual transplant is scheduled to occur by the end of this year. In fact, just a few days ago Canavero announced that he has successfully completed a head transplant surgery on a human corpse. Karen Rommelfanger and Paul Boshears wrote the editorial piece for the 8.4 issue and also recently released a Newsweek article discussing Canavero’s upcoming head transplant surgery on a live patient.



Rommelfanger and Boshears state,

“We have been disappointed by the initial responses from experts weighing in on the matter. So far the general response has been either to mock the character of Sergio Canavero, the neurosurgeon proposing the operations, or ignore the subject in the hope it goes away. But we think these opinions and the reporting on this procedure has missed two critical questions: Why China? Why now?”

Sergio Canavero, image courtesy of Flickr.

In his article for Issue 8.4, Canavero states,

“Actually, not since Galileo has a scientific idea received so much scathing remarks and generated so much acrimony - even at a personal level- amid the medical, surgical, and ethical community than HEAVEN (Canavero 2013). Today this idea no longer faces up to the Catholic Church (at least not directly), but to its current Western substitute: the Academe. However, while the Catholic Church invited Galileo to defend his thesis, the academic world did not. As thousands of doctors from around the world wrote to be part of this effort (including several who had plans for a head/brain transplant themselves!), no single mainstream official association, on the back of media requests, contacted us for more details (some even refused to answer those requests!). Even worse, as proven by several conferences we have been invited to, surgeons and other professionals had not read our literature (“not enough time!”) and the supposed impossibility of reconnecting the spinal cord was based on nothing more than outdated notions on spinal anatomophysiology.”

Paul Root Wolpe

While Wolpe responds with,

“They claim that they have been the subjected to the most scathing remarks and acrimony since Galileo(!). Yet, their provocative use of the acronym HEAVEN for the procedure itself, their mis-citing of Collins and Pinch’s book “The Golem: What You Should Know about Science” to defend their practices, and their lack of convincing evidential support and ethical sensitivity for such an ethically fraught and unprecedented surgical undertaking, all point to a kind of social and scientific tone-deafness that might have been avoided with a more scientifically and ethically rigorous, transparent, and collegial approach to the endeavor.”

Read Canavero’s and Wolpe’s articles in their entirety and the rest of the 8.4 issue here. You can also revisit one of our past posts on head transplants here. We ask that you keep a level head as you read.

Summary of what you (may have) missed at last week’s International Neuroethics Society meeting!

Image courtesy of Gillian Hue.

The AJOBN Editorial team recently returned from the 11th annual International Neuroethics Society (INS) meeting, which took place on November 9-10th in Washington, DC. The theme for the meeting was Honoring our History, Forging our Future, and it brought together scientists, philosophers, professionals, and scholars from over 10 countries to both summarize the first 15 years of the neuroethics field and to discuss our prospective future. The day and a half conference included plenary lectures, a public forum, panel discussions, and a poster session, and addressed topics ranging from the development of lying in children to the neuroethical considerations that accompany the use of transcranial direct current stimulation (tDCS).

In case you didn't get the chance to attend the conference this year, here is a brief summary of what you missed (a full program recap can be found here).

Image courtesy of Gillian Hue.

The conference opened on Thursday afternoon with a plenary lecture delivered by Remi Quirion, the Chief Scientist of Quebec, who discussed the history of neuroethics and where he thinks the field will go moving forward. This was followed by a riveting panel discussion entitled, “Neuroscience, Communication, and Public Engagement,” which was moderated by chief executive officer of AAAS, Alan Leshner, and featured Joseph J. Fins from Weill Cornell Medical College, Tali Sharot from University College London, and Ed Yong from The Atlantic. This panel focused on the interaction between scientists and the media and incorporated discussion of the Goldwater Rule and science journalism. This panel was followed by the annual Ambassador Session (this year’s session was entitled, “Reflecting on our International Roots and Planning our Collaborative Futures”), where liaisons from neuroethics research efforts around the world summarized what progress in neuroethics looks like in each country. Perspectives from Korea (Jinni Jeong), The Kavli Foundation (Caroline Montojo), the US BRAIN Initiative (Khara Ramos), and the EU Human Brain Project (Arleen Salles) were represented. The session was co-moderated by Emory Center for Ethic Neuorethics Program Director Karen Rommelfanger who spoke about her work creating the Global Neuroethics Summit. The day closed out with a public program entitled, “To Tell the Truth!” This session included talks by Elizabeth Loftus from the University of California, Irvine, who spoke about the validity of our memories; Victoria Talwar from McGill University, who spoke about the development of lying in children; and Charles Dike from Yale University School of Medicine, who spoke about pathological lying.

Friday morning began with a plenary lecture from Arthur Caplan of NYU School of Medicine that was a call to action for the field of neuroethics—Caplan emphasized that we should spend time discussing and engaging the neuroethical dilemmas happening now, instead of speculating about predicted dystopian futures. The morning continued with a panel entitled, “The Brain in Context,” which featured Moriah Thomason of Wayne State University, Martha Farah of the University of Pennsylvania, and Herve Chneiweiss of Ecole des Neurosciences de Paris. This panel emphasized the multidimensional factors that affect neurodevelopment. This was followed by a panel on addiction policymaking entitled, “Legal Responsibility, Agency, and Addiction Neuroethics: Reconciling Frameworks for Policymaking.” This panel featured Rachel Wurzman from the University of Pennsylvania Medical School; Jessica Birkett from the University of Melbourne; and Stephen J. Morse from the University of Pennsylvania Law School, who debated the claim that “addiction is a brain disease,” and discussed where to place responsibility and how to punish and/or treat addiction.

Image courtesy of Gillian Hue.

After a lunch break, the afternoon continued with two concurrent sessions on neurotechnology (“Ethics of Neuroscience and Neurotechnology” with Frederic Gilbert from University of Washington, Merlin Bettlinger from Charite-Universitatsmedizin Berlin, and Anna Wexler from the University of Pennsylvania) and law (“Neuroscience of the Law” with Andreas Kuersten from the University of Pennsylvania Law School, Nicholas Sinclair-House from the University of Sussex, and Jason Kerkmans from the consulting firm, MINDSET). The conference closed out with two plenary lectures given by Karola Kreitmair from Stanford University and Patricia Churchland from the University of California, San Diego. Kreitmair enumerated seven criteria that she feels should be applied in the development of ethical consumer neurotechnologies, while Churchland discussed how neuroethics has helped us understand our social lives and moral behavior.

If you missed this year's annual INS conference, don't fret. INS is already planning its next conference in San Diego in November 2018—check out neuroethicssociety.org for updates on the meeting program and registration details. We will also be posting more in-depth summaries of some of the sessions from this year’s conference in the coming weeks, so stay tuned!

Want to cite this post?

Hoffman, C. (2017). Summary of what you (may have) missed at last week’s International Neuroethics Society meeting! The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/11/summary-of-what-you-may-have-missed-at.html

International governance of Neuroscience and Neurotechnology: Whom to trust with the assessment of future pathways?

By Nina María Frahm

Nina María Frahm is a research fellow and PhD candidate at the Munich Center for Technology in Society, Technical University Munich. Previously, she obtained a BA in European Studies and an MSc in Science and Technology Studies at Maastricht University, and was a research fellow at the Technical University of Berlin, where she investigated heterogeneous cultures of cooperation in collaborative forms of research and development of emerging technologies. Her interest in the crossroads of science, technology, and public policy was fueled during a junior research position at University of Quilmes, Buenos Aires, where she conducted a project on technologies for social inclusion. Her current interest in neuroethics focuses on different cultures of responsible knowledge-making in emerging brain science, and the limits and opportunities these cultures represent for transnational neuroscience. 

There is a growing consensus about the need to better align neuroscience and neurotechnology (NS/NT) with societal needs, values, and expectations. In particular, researchers and policy-makers are increasingly calling for better international coordination of neuroscientific research and neuroethical consultation.

One major challenge for establishing international governance principles in NS/NT is the difference in national and regional cultures of integrating society into research and innovation, which is a crucial prerequisite to achieving a sustainable and socially robust agenda. A comparative perspective on European and American brain projects and key reports reveals such substantial differences. In Europe, the main emphasis has been on ‘Responsible Research and Innovation’ frameworks and corollary public engagement mechanisms for neuroscience. In contrast, the U.S. has focused primarily on ‘Ethical, Legal, Social Implications’ (ELSI) frameworks and bioethical expert assessments, with a smaller role for lay publics.

At the heart of this divergence is a difference in understanding of who we trust with the assessment of future pathways in NS/NT. Different political cultures embrace questions of risk and uncertainty in emerging neurotechnology in different ways. Attempts to mainstream brain science on a global scale might profit from being sensible towards regional and national political commitments to the inclusion of society into neuroscientific advancements. In these situations, some scholars have argued for a model of ‘epistemic subsidiarity’ (Jasanoff, 2013) in which these fundamental commitments are calibrated and guaranteed, which is paramount to addressing the grand challenges for global brain sciences in the future.

European Neuroscience and Society

The European Citizen Deliberation 'Meeting of the Minds,'

image courtesy of dialogbasis.

Brainscience in Europe, for example, is deeply embedded in the growing European commitment to Responsible Research and Innovation (RRI). Drawing heavily on previous social science research on the Public Understanding of Science and Technology (Wynne, 1992; Irwin, 2001), Public Engagement (Wynne, 2006; Stilgoe et al., 2014), Anticipatory Governance (Barben, 2008; Guston 2013), Constructive Technology Assessment (Rip 2008), and Sociotechnical Integration (Fisher 2008), as well as on strong traditions of deliberative and participatory democracy in countries such as Denmark and the Netherlands, RRI has become a ‘cross cutting issue’ in the European Commissions’ Horizon2020 framework program. The political commitment to this inclusive form of scientific and technological governance builds on repeated experiences in Europe with public controversy around and opposition to the unprepared push of emerging technologies into society (e.g. debates around Nanotechnology and Genetically Modified Organisms) and the risks of such resistance to the widespread dissemination of technological innovations.

Key to this framework is the upstream engagement of society in the governance of emerging technologies through a variety of tools, in which the general public is considered as an active partner in knowledge co-creation, the role of the expert is one of facilitation (not authority), and the touchstone of validity is robustness in the real world (not in the lab). Taken seriously, RRI is hence a move towards democratizing sources of assessing the perils and pitfalls of emerging technologies, including neurotechnology— an ambitious project, which is still very much in the making and, to be fair, has been taken up rather patchily by member states of the European Union (Mejlgaard and Griessler, 2016).

Nevertheless, talk and practice of responsibility is prominent in European recommendations on NS/NT, as well as in European brain projects. For example, the most significant European reports in the field, the Royal Society’s ‘Brain Waves’ series (2011) and the Nuffield Council on Bioethics’ ‘Novel Neurotechnologies’ report (2013), call for the principle of responsibility for the governance of neuroscience. According to the authors, this includes accountable public engagement practices in neuroscientific research and innovation governance. To date, the only recommendation brought forward by citizens themselves on the future handling of neuroscience and technology has taken place in Europe: the Meeting of Minds European Citizen Deliberation. This large public engagement exercise, which has brought together 126 participants from all over Europe, already took place in 2006 and resulted in an extensive list of recommendations on questions such as regulation and control, normalcy vs. diversity, and the equal access to treatment. Informed by the new governance regime of RRI, European brain projects such as the HBP, BNCI Horizon 2020, and BrainLinks-BrainTools feature new mechanisms for the responsible conduct of brain science and the early integration of the public into ethical assessments, such as participatory foresight labs (HBP) or User Centered Design (BNCI Horizon2020). While such exercises might not yet be seen as authoritative decision-making instruments, experiments with public engagement represent an increasing trend in Europe to open up knowledge-making for the governance of neuroscience to society at large. 

American Neuroscience and Society

Former President Barack Obama speaking about the BRAIN

Initiative, image courtesy of Flickr user Open Knowledge.

Sources of brain science assessment in the U.S., in contrast, are operating mainly under the framework of ‘Ethical, Legal, and Social Implications’ (ELSI). Drawing on roots in the Human Genome Project, ELSI approaches – like RRI – are striving for better integration and anticipation of societal needs and concerns in neuro-innovation. Unlike its European counterpart, however, the impact assessment and foresight is mostly left to scientific experts, with a strong preference for professional ethicists and other powerful stakeholders, such as industry or the military. Here, the general public more is frequently considered to be lacking the required knowledge and skills for assessing the risks and benefits of complex technologies such as NS/NT, and great efforts are put into strengthening the scientific and ethical ‘literacy’ of and ‘outreach’ to society.

This preference for including societal concerns through expert bodies is also apparent in two of the most prominent U.S. reports on NS/NT – Gray Matters Volumes I and II – which were drafted by the Presidential Commission for Bioethics (2014). Albeit the terminology of responsibility, engagement, and early integration of ethics is used in these reports, to my knowledge there is no institutionalized practice for putting these recommendations into action. The U.S. Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative, which was initiated by the BRAIN 2025 report, covers questions of neuroethics through a voluntary, unpaid multi-council working group that consists of members of the U.S. American regulatory apparatus and academia. A similar construct can be found in the BRAIN Initiative’s partner institution, the Defense and Advanced Research Projects Agency (DARPA), where an expert panel meets regularly to discuss ELSI issues in neuroscience and technology.

Given these national differences in public knowledge-making about the brain, frameworks and mechanisms for aligning NS/NT with society at an international level will likely face considerable challenges and will require cautious negotiation. Simply agreeing on “responsible and ethically sound conduct and application of neuroscience” alone will not suffice to straddle these vastly different institutionalized traditions of technology assessment. This challenge becomes even more exigent when including other emerging neuroscience leaders such Korea, Japan, China or Latin America, where the commitment for responsible conduct in NS/NT rest on yet different social, economic, and institutional foundations. Eventually, the perceived need to harmonize the governance of NS/NT across the globe will have to find an appropriate model of subsidiarity for countries and regions to maintain compatibility with local values and participatory cultures and will need to continue emphasizing communicating and learning from each other’s principles and procedures for assessing shared futures.

References

Barben, D., Fisher, E., Selin, C. and Guston, D.H. (2008) Anticipatory governance of nanotechnology: Foresight, engagement, and integration. In: Hackett, E.J. et. al. (Eds.) The Handbook of Science and Technology Studies. Cambridge, MA: The MIT Press, pp. 979–1000.

Fisher, E. et. al. (2006) Midstream Modulation of Technology: Governance from Within. Bulletin of Science, Technology and Society, Vol. 26 (6).

Guston, D. (2013) Understanding anticipatory governance. Social Studies of Science, Vol. 44(2): 218-242.

Irwin, A. (2001) Constructing the scientific citizen: science and democracy in the biosciences. Public Understanding of Science, Vol. 10(1): 1-18.

Jasanoff, S. (2013) Epistemic Subsidiarity – Coexistence, Cosmopolitanism, Constitutionalism. European Journal of Risk Regulation, Vol. 2: 133-141.

Mejlgaard, N. and Griessler, E. (2016): Monitoring RRI in Europe: approach and key observations. In: Lindner, R. et. al. (Eds.): Navigating Towards Shared Responsibility in Research and Innovation. Approach, Process and Results of the Res-AGorA Project, Karlsruhe, p. 115-118.

Rip, A. and Te Kulve, H. (2008) Constructive Technology Assessment and Sociotechnical Scenarios. In: Fisher, E. et. al. (Eds.), The Yearbook of Nanotechnology in Society, Volume I: Presenting Futures, Berlin etc: Springer, pp.49-70.

Stilgoe, J., Lock, S.J., Wilsdon, J., 2014. Why should we promote public engagement with science? Public Understanding of Science, Vol. 23: 4–15.

Wynne, B. (1992) Misunderstood misunderstanding: social identities and public uptake of science. Public Understanding of Science, Vol.1(3): 281-304.

Wynne, B. (2006) Public Engagement as a Means of Restoring Public Trust in Science – Hitting the Notes, but Missing the Music? Community Genetics, Vol. 9: 211-220.

Want to cite this post?



Frahm, Nina. (2017). International governance of Neuroscience and Neurotechnology: Whom to trust with the assessment of future pathways? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/11/international-governance-of.html

The Neuroethics Blog Series on Black Mirror: Men Against Fire

By Sunidhi Ramesh

Image courtesy of Pexels.

Humans in the 21st century have an intimate relationship with technology. Much of our lives are spent being informed and entertained by screens. Technological advancements in science and medicine have helped and healed in ways we previously couldn’t dream of. But what unanticipated consequences may be lurking behind our rapid expansion into new technological territory? This question is continually being explored in the British sci-fi TV series Black Mirror, which provides a glimpse into the not-so-distant future and warns us to be mindful of how we treat our technology and how it can affect us in return. This piece is part of a series of posts that will discuss ethical issues surrounding neuro-technologies featured in the show and will compare how similar technologies are impacting us in the real world. 

SPOILER ALERT: The following contains plot spoilers for the Netflix television series, Black Mirror. 

Plot Summary

“Men Against Fire” begins with the introduction of Stripe, a young man decked in army gear who, among other soldiers, is tasked with a “roach-hunt.” The soldiers are situated in a foreign land (possibly Denmark, as the “civilians” all speak Danish) and are attempting to help the locals with a recent “roach” invasion. As the team gathers information about the roaches’ whereabouts, they plug data into their MASS systems, a device that allows the soldiers to actively manipulate maps, data files, and local information on a projected screen in front of their eyes.

An image of an American arm sick bay.

(Image courtesy of Flickr.)

Stripe and the other soldiers get a lead about a pack of roaches hiding at a ranch nearby. They immediately raid the location, discovering three roaches (revealed to be blank, zombie-like inhuman animals that screech, claw, and howl); Stripe manages to kill two of them, one with his gun and the other with his bare hands.

The next day, Stripe observes momentary glitches in his MASS technology, so he visits a medical examiner at the army base’s sick bay. After a full exam, no signs of errors are observed, and Stripe is sent home. The team, including Stripe’s new friend Raiman (“Rai”), embarks on yet another roach hunt the following morning; this time, Stripe is immediately aware of his MASS implant’s insufficiency, as he is now able to smell the grass around him (MASS strips the soldiers of some of their senses). Still, he trudges on and joins the group as they raid an abandoned building.



When there, Stripe sees a group of civilians—all of whom Rai guns down and shoots. Shocked, Stripe attacks Rai, shouting at her with four words: “What did you do?” He knocks Rai out with his gun and helps the other two civilians (a mother and her son) escape. Once in a safe shelter, Stripe is confronted by the civilian, Catarina, who explains that the MASS implants trick the soldiers into seeing humans as roaches. As she completes her declamation, Rai comes in and shoots Catarina and her son. Stripe is then sent to the psychiatric ward of the army base.

Image courtesy of Pixabay.

When there, Stripe is visibly in shock, rocking back and forth and whispering, “the whole thing is a lie.” The doctor appears and tries to explain the situation to Stripe, claiming that the MASS and the roaches have a purpose. “Do you have any idea… [what is] in their DNA?” the doctor shouts. “Higher rates of cancer, muscular dystrophy, MS, SLS, substandard IQ. Criminal tendencies, sexual deviances, it’s all there. The screening shows it… and it’s a lot easier to pull the trigger [on the enemy] when you’re aiming at the Boogeyman, hm?” He then tortures Stripe into a whimpering mess, forcing him to re-watch his own kills—this time unmasking the roaches and depicting them as the human beings that they are.

At the end of the episode, Stripe is shown in front of a bright, welcoming home; an alluring woman approaches him warmly, although she (and the home) is likely a figment of his (now functioning) neural device.

He is smiling at the world in front of him, but a tear visibly rolls down his cheek.

The Current State of Technology

“Men Against Fire” questions the murky future of warfare by suggesting the possible roles of technology in advanced combat. Among those depicted is the cryptic “MASS system,” a neural implant that appears to be useful in augmenting the army’s efficiency (it is implied throughout the episode that MASS helps the soldiers think clearer, see better, perform more effectively, shoot more precisely, hear selectively, and suppress emotions/feelings/senses that are irrelevant to the mission at hand). But later, in the unexpected plot twist with Catarina (shocking, in many ways, because it seems so conceivable), MASS proves to be something else entirely.

Still, the possibility of a technology that could use (or, rather, integrate into) our own brains to augment and modify our senses and abilities is mystifying. How far are we from this being a reality?

Image courtesy of Flickr.

Augmentation of the Senses: Touch, Vision, and Hearing 

In late 2012, researcher Gregg Tabot and his team (1) “developed approaches to convey sensory information critical for object manipulation—information about contact location, pressure, and timing— through intracortical mic-rostimulation of the somato-sensory cortex.” In other words, in experiments where the brains of nonhuman primates were electrically stimulated, Tabot was able to elicit sensations from projections specifically to a “localized patch of skin”— ones that can not only “track the pressure exerted on the skin” but also the specific “timing of contact events.” This form of biomimetic feedback is projected to be able to help “restore touch to individuals who have lost it.” Other experiments of this nature have used electrical interfaces with peripheral nerves to “convey basic somatosensory feedback” (2).

Technology that focuses on restoring eyesight in the blind has been in the works since the early 1970’s (3). Epiretinal devices, ones that bypass retinal processing such as the Argus II Retinal Prosthesis System (4), have been developed and approved to help stimulate the ganglion cells that merge at the back of the eye to form the optic nerve. The difficulty with visual impairment, however, is that it can be caused by numerous different underlying impairments—from the retina, the optic nerve, the lateral geniculate nucleus (LGN), to the striate cortex (V1) itself (among other relevant visual processing areas) (5). The field of neurobionics attempts to mediate these differences by offering the opportunity for cortically-based implant devices that stimulate these brain areas; and, although current improvements in eyesight with implant recipients is minimal, improvements are happening (5).

Image courtesy of Pixabay.

Cochlear implants (6, 7) and the advancement of cochlear implantation has allowed patients who have lost their hearing after their own development of language to “regain significant auditory benefit.” But, in a small group of individuals whose hearing deficits result from significant damage of the cochlear nerves, cochlear implantation fails to serve as a viable treatment (8). In these patients, an auditory brainstem implant (ABI) allows for the restoration of limited hearing (9), “allowing them to recognize environmental sounds” in addition to amplifying their abilities to communicate effectively (8).

It is important to note that the vast majority of these technologies are preliminary, rooted in mostly restoring prior function rather than enhancing normal functioning to super-human levels (as is implied by the MASS technology in Black Mirror).

Augmentation of Human Memory, Attention, and Learning Ability

The enhancement of human abilities (namely memory, attention, and learning) is not a foreign concept; in fact, a series of posts on this blog (which can be found here, here, and here) have addressed this topic. I will leave them here with the overarching statement that research on these forms of augmentation is currently being done, although, again, the extent of these modern methods allows for little of the precision and accuracy that is afforded to the devices depicted in Black Mirror.

Neuroethical Considerations

The notion of sensory and moral alleviation highlighted in “Men Against Fire” is, on the surface, necessary. Recent statistics put the number of returning war veterans with PTSD at anywhere from 10% to 18%, citing “combat stressors” such as “seeing dead bodies, being shot at, being attacked, receiving mortar fire, or knowing someone who has been killed” as triggers of the disorder (10).

The biggest trigger, though, remains being behind the trigger; men and woman who kill in battle are at a dramatically higher risk of developing PTSD and often display higher levels of trauma than those who have not killed (11, 12). So, what if we could desensitize our army from these triggers altogether? Sounds promising. But is it?

A soldier battling PTSD (post-traumatic stress disorder).

(Image courtesy of Wikimedia.)

MASS is, by every definition, a weapon—a device designed or used for inflicting physical damage. In the eyes of the soldier, MASS strips the humans targeted in this eugenic crusade of their humanness—their voices, their language, their faces. And it does all of this with a purpose—to make killing easier.

At the end of the episode, the doctor’s sickening monologue elucidates this purpose: “Humans. You know we give ourselves a bad rap, but we’re generally empathetic as a species. I mean, we don’t actually really want to kill each other. Which is a good thing. Until your future depends on wiping out the enemy… even in World War II, in a firefight, only 15, 20 percent of the men would pull the trigger. Fate of the world at stake, and only 15 percent open fire… plus the guys who did get a kill, most of them came back messed up in the head.” Lt. Col. Dave Grossman’s book, On Killing, suggests that these numbers aren’t fiction (12).

But this is the reality of war—killing and death are inherent in the nature of battle. If MASS technology makes killing easier (by removing the smells and sounds of death) and keeps soldiers from feeling the aftermath, is it really that bad? Why wouldn’t we want an army that can fight relentlessly, without morality in the way?

The answer lies in our doctor’s soliloquy: we’re human.

Image courtesy of the Military Health System.

Soldiers are not “naturally born” to pull the trigger for a reason, and neural implants that engineer them to be that way would, at the least (and with the current state of technology), cause a great deal of cognitive dissonance—dissonance that, in ways, could be more disturbing than the trauma otherwise caused by warfare. Moral injury in war today could, in part, be a result of this dissonance, where soldiers who engage in “acts of transgression” that grossly undermine moral and ethical expectations suffer from shame, guilt, anxiety, or anger (13).



This construct of moral injury can exhibit itself behaviorally, forcing war veterans who have killed in war (among other things) into self-handicapping behaviors, anomie, and self-harm. A real-life example of this unusual dichotomy between morality and death can be found in pilots of remotely piloted aircrafts (RPA), or drones, who are in the fairly unique situation of not physically being situated in the war theater; still, perhaps surprisingly, RPA pilots have been shown to display war-related challenges beyond PTSD, often exhibiting high levels of fatigue and social isolation as a result of the compartmentalization of their work (14).

Perhaps the last teardrop on Stripe’s face in “Men Against Fire” points to these elements; even with the functioning MASS implant, a part of him may in fact be cognizant of the false reality of the world around him.

So are there other functional consequences of using technology to separate soldiers from the war zones they are otherwise immersed in? Most likely. But would these technologies modulate a soldier’s perception of battle? Of war? Of death? What does putting a device between a human and the environment do to his/her sensitivity to the real world? Perhaps we can answer these questions with regards to our own use of cellular and technologic devices. 

War technology has evolved substantially

since this picture was taken during WWII.

(Image courtesy of Wikimedia.)

(It is worth noting that there continues to be a long-standing debate about “dual-use” or repurposing technologies for war; whether or not we will firmly agree on implementing technologies for military use that were otherwise created for civilian purposes is a question for the near future.)

A whole series of posts on this blog could be dedicated to the misplaced use of DNA technology and “screenings” in “Men Against Fire”—all of which allows for the blatant eugenics of the “roaches.” What is concerning about this argument is the claim that DNA is the direct and only basis for the plethora of disorders the doctor listed—that the environmental contributions to disease are not relevant to the prevalence of the many illnesses we face as a human race. In an paper entitled “Genetic Essentialism: On the Deceptive Determinism of DNA,” authors Ilan Dar-Nimrod and Steven J. Heine argue that “…there are rare cases of ‘strong genetic explanation’ when… responses to genetic attributions may be appropriate, however people tend to over-weigh genetic attributions compared with competing attributions even in cases of ‘weak genetic explanation,’ which are far more common” (15).

Conclusions

While Black Mirror primarily serves to entertain audiences, the underlying messages presented in "Men Against Fire" about the potential consequences of futuristic technology cannot be ignored; it is nonetheless important to remain grounded in the current state of these devices, as MASS or any version of it is far from widespread implementation.



That said, the conversation about wartime morality and the suppression of it is an important one, as soldiers today, in years past, and in the years to come will continue to suffer from the traumatic consequences of combat-related experiences.

References

1. Tabot, Gregg A., et al. "Restoring the sense of touch with a prosthetic hand through a brain interface." Proceedings of the National Academy of Sciences 110.45 (2013): 18279-18284.


2. Saal, Hannes P., and Sliman J. Bensmaia. "Biomimetic approaches to bionic touch through a peripheral nerve interface." Neuropsychologia 79 (2015): 344-353.


3. Dobelle, W. H., and M. G. Mladejovsky. "Phosphenes produced by electrical stimulation of human occipital cortex, and their application to the development of a prosthesis for the blind." The Journal of physiology 243.2 (1974): 553-576.


4. Falabella, Paulo, et al. "Argus® II Retinal Prosthesis System." Artificial Vision. Springer International Publishing, 2017. 49-63.


5. Lewis, Philip M., et al. "Restoration of vision in blind individuals using bionic devices: a review with a focus on cortical visual prostheses." Brain research 1595 (2015): 51-73.


6. House, William F. "Cochlear implants." Annals of Otology, Rhinology & Laryngology 85.3_suppl (1976): 3-3.


7. Svirsky, Mario A., et al. "Language development in profoundly deaf children with cochlear implants." Psychological science 11.2 (2000): 153-158.


8. Schwartz, Marc S., et al. "Auditory brainstem implants." Neurotherapeutics 5.1 (2008): 128-136.


9. Hitselberger, William E., et al. "Auditory brain stem implants." Operative Techniques in Neurosurgery 4.1 (2001): 47-52.


10. Hoge, Charles W., et al. "Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care." N engl J med 2004.351 (2004): 13-22.


11. Van Winkle, Elizabeth P., and Martin A. Safer. "Killing versus witnessing in combat trauma and reports of PTSD symptoms and domestic violence." Journal of traumatic stress 24.1 (2011): 107-110.


12. Pitts, Barbara L., et al. "Killing versus witnessing trauma: Implications for the development of PTSD in combat medics." Military Psychology 25.6 (2013): 537.


13. Grossman, Dave. On killing. Open Road Media, 2014.


14. Maguen, Shira, and Brett Litz. "Moral injury in the context of war." Department of Veterans Affairs, www. ptsd. va. gov/professional/pages/moral_injury_at_war. asp (accessed Jan. 13, 2013) (2012).


15. Otto, Jean L., and Bryant J. Webber. "Mental health diagnoses and counseling among pilots of remotely piloted aircraft in the United States Air Force." Medical Surveillance Monthly Report 20.3 (2013): 3-8.


16. Dar-Nimrod, Ilan, and Steven J. Heine. "Genetic essentialism: on the deceptive determinism of DNA." Psychological bulletin 137.5 (2011): 800.

Want to cite this post?



Ramesh, S. (2017). The Neuroethics Blog Series on Black Mirror: Men Against Fire. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/10/the-neuroethics-blog-series-on-black_13.html

Too far or not far enough: The ethics and future of neuroscience and law

By Jonah Queen

Image courtesy of Pixabay.

As neurotechnology advances and our understanding of the brain increases, there is a growing debate about if, and how, neuroscience can play a role in the legal system. In particular, some are asking if these technologies could ever be used to accomplish things that humans have so far not been able to, such as performing accurate lie detection and predicting future behavior.

For September’s Neuroethics and Neuroscience in the News event, Dr. Eyal Aharoni of Georgia State University spoke about his research on whether biomarkers might improve our ability to predict the risk of recidivism in criminal offenders. The results were published in a 2013 paper titled “Neuroprediction of future rearrest¹," which was reported in the media with headlines such as “Can we predict recidivism with a brain scan?” The study reports evidence that brain scans could potentially improve offender risk assessment. At the event, Dr. Aharoni led a discussion of the legal and ethical issues that follow from such scientific findings. He asked: “When, if ever, should neural markers be used in offender risk assessment?”

Dr. Aharoni started by explaining that determining the risk an individual poses to society (“risk triage”) is an important part of the criminal justice system and that it is used when making decisions around bail, sentencing, parole, and more. He presented the cases of Jesse Timmendequas and Darrell Havens as opposite extremes of what can happen when risk is miscalculated. Timmendequas is a repeat sex offender who had served less than seven years in prison for his crimes and had not been considered a serious threat before he raped and murdered a seven-year-old girl, a crime which led to the passing of Megan’s Law. Havens, a serial car thief, is serving a 20-year prison sentence for assaulting a police officer, despite being rendered quadriplegic after being shot by police, because parole boards are reluctant to grant him an early release due to his extensive criminal history.

Risk triage is currently done through unstructured clinical judgements, where a clinician will offer his or her opinion based on an interview of the subject, and the more accurate evidence-based risk assessment, which assesses various known risk factors, such as age, sex, criminal history, drug use, impulsivity, and level of social support. Dr. Aharoni and the other authors of the paper propose that neurological data could potentially be introduced as an additional risk factor to help improve the accuracy of such assessments¹.

With the understanding that impulsivity is a major risk factor for recidivism², the researchers focused their study on the anterior cingulate cortex (ACC), a limbic brain region shown to be heavily involved in impulse control and error monitoring (in fact, behavioral changes in people with damage to the ACC are often extreme enough for those individuals to be classified as having an “acquired psychopathic personality³”).

In Aharoni’s paper¹, the volunteers (96 currently incarcerated adult men) were presented with a go/no-go (GNG) task (which tests impulse control) while their ACC activities were monitored with functional magnetic resonance imaging (fMRI, which measures changes in blood flow within different regions of the brain—an increase in blood flow is taken to mean that a region has increased neural activity). The researchers found that participants with greater activation of the ACC during impulse control errors were half as likely to be arrested within four years of their release (when controlling for other factors such as age at release, Hare Psychopathy Checklist scores, drug and alcohol use, and performance on the GNG task). In other words, the study seems to show that, when used in conjunction with currently recognized risk factors, the fMRI data improved the accuracy of the risk assessment. The authors conclude that this finding “suggest[s] a possible predictive advantage” of including the neurological data in risk assessment models¹.

Image courtesy of Flickr user Janne Moren.

After emphasizing the need for additional research, the authors discuss several possible applications, for the use of these “neuromarkers.” One of the more controversial ones (and the one that the media has mostly focused on) is to add neuromarkers (such as ACC activity during a GNG task) to the other factors that are currently used for risk triage in the criminal justice system. The authors recognize that this will raise ethical and legal issues, specifically that such scans might not meet the legal standard of proof, and that such techniques might threaten offenders’ civil rights in ways that currently used risk assessment methods do not.

In his presentation, Dr. Aharoni expanded on some of these concerns, focusing on the scientific limitations, legal limitations, and ethical implications of this research. The scientific limitations refer to the accuracy and replicability of this method and the general question of whether current neuroimaging techniques can provide useful data to criminal risk assessments. The legal limitations include questions of how and when such methods could legally be used. Would they be legally admissible, or would they be found to be unconstitutional if used in certain ways? Would the results of a brain scan be legally classified as physical evidence (which, under the Fourth Amendment, can be obtained with a warrant) or testimony (under the Fifth Amendment, an individual cannot be forced to testify if it would incriminate them)? Similar questions are being asked regarding fMRI lie detection.

And then there are the ethical implications. Using such a technique to keep people in jail who would not be otherwise (for lengthened sentences or denying parole, for example) is worrisome to many and runs the risk of violating offenders’ civil rights in an attempt to increase public safety. Dr. Aharoni mentioned that neuromarkers could also be used in an offender’s best interests if, for example, MRI data showed that they might be less likely to reoffend. An audience member pointed out, though, that this could be unfair to the people whose brain data does not help their case.

Another application that the authors mention is how this research could pave the way for possible interventions (including therapies, programs, and medications) for people with poor impulse control caused by low ACC activity. This could still raise concerns around convicts being required to undergo medical treatments (like medication or even surgery) if their criminal activity is thought to be caused by “defective” brain regions. And even if no practical applications come of this research, the authors point out that their findings still contribute to our understanding of the brain and human behavior.

Image courtesy of Wikimedia Commons.

Media outlets that reported on the study mostly focused on the predictive aspect, often referencing the film Minority Report, in which people are arrested for crimes they have not yet committed. Dr. Aharoni explained that incarcerating people based on the likelihood of re-offense is currently happening in cases of involuntary civil commitment, where defendants who are found not guilty by reason of insanity can be confined to psychiatric hospitals until they are deemed safe. If neuromarkers such as brain scans are used to improve the accuracy of the predictions, it might not be as much of a radical change as it seems.

But still, as explained above, even if brain scans were to be incorporated into the predictive models currently used, it would raise many ethical issues. And things could become even more worrisome if this technology were to be (mis)used in ways the researchers have not intended and the science does not support. For example, the criminal justice system could buy into the hype around brain imaging and develop a process that only looks at the scans and not at the other factors. Scans could also be performed on people who have not committed a crime to see if they need “monitoring” or “treatment,” possibly even non-voluntarily, even though they have not done anything wrong (in something more similar to a Minority Report-like scenario). Even without any intervention, there could also be the issue of stigma, like there is with testing for predisposition to mental illness. If someone is found to have a “criminal brain” how would people view them? How would they view themselves? And an audience member raised the possibility of this technology being used in the private sector. There are companies that offer MRI lie detection services—what if a company were to start testing people for predisposition to criminal behavior?

In the paper, the authors admirably discuss the ethical issues that could arise from their research. And the discussion Dr. Aharoni led at the event showed the importance of looking at controversial research such as this with a critical eye and in context in order to avoid resorting to sensationalist claims and unfounded fears. Not only is it important to make sure the science behind new neurotechnologies is accurate, but we also need to consider the societal effects of new technologies, whether they are used in the way their creators intended or not.

References



1)  Aharoni, E., Vincent, G. M., Harenski, C. L., Calhoun, V. D., Sinnott-Armstrong, W., Gazzaniga, M. S., & Kiehl K. A. (2013). Neuroprediction of future rearrest. PNAS, 110(15), 6223-6228. doi:10.1073/pnas.1219302110

2)  Monahan, J. D. (2008) Structured risk assessment of violence. Textbook of Violence Assessment and Management, eds Simon, R., Tardiff, K. (American Psychiatric Publishing, Washington, DC), pp 17–33.

3)  Devinsky, O., Morrell, M. J., Vogt, B. A. (1995) Contributions of anterior cingulate cortex to behaviour. Brain 118(pt 1), 279–306. doi:10.1093/brain/118.1.279

Want to cite this post?



Queen, J. (2017). Too far or not far enough: The ethics and future of neuroscience and law. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/10/too-far-or-not-far-enough-ethics-and.html

Hot Off the Presses: The Neuroethics Blog Reader and Issue 8.4

It is our pleasure to present you with two newly released publications: the second edition of The Neuroethics Blog reader and the 8.4 issue of the American Journal of Bioethics Neuroscience.

Image courtesy of Flickr user Leo Reynolds.

The second edition of The Neuroethics Blog reader features the most popular posts on the site, with topics ranging from human knowledge and its enhancement to mental illness to gut feminism. The reader includes posts from luminaries in neuroethics, scientific pioneers, undergraduates, graduate students, and established scholars from both within and outside the field of neuroethics. The Neuroethics Blog, now in its 6th year of creating weekly publications, is pleased to present this reader to you and would like to thank our amazing blog editorial team: Sunidhi Ramesh (Volume Editor of this reader and Assistant Managing Editor), Carlie Hoffman (Managing Editor), Nathan Ahlgrim, Kristie Garza, and Jonah Queen (Supporting Editors and blog contributors). Please find the reader below.

We are also pleased to announce the publication of issue 8.4 of AJOBN, which is a special issue focused on head transplantation. This issue contains two target articles, “HEAVEN IN THE MAKING BETWEEN THE ROCK (the Academe) AND A HARD CASE (a Head Transplant)” by Ren Xiaoping and Sergio Canavero and “Ahead of Our Time: Why Head Transplantation is Ethically Unsupportable” by Paul Root Wolpe. In the editorial for the issue, Karen Rommelfanger and Paul F. Boshears comment,

“The prospect of a near future wherein a head transplant has become a therapeutic procedure available to people suffering from the effects of failing bodies has been surrounded by pageantry, vitriolic responses, and a sense melodrama that has made a caricature of what discussions of neuroethics can and should be . . . It is our position that averting our gaze from the development of technologies and techniques that we find morally repugnant or technically incredible does not free us from the results of those techniques and technologies. Indeed, if we fail to examine and carefully consider this technique and the technologies attendant to Canavero’s work, we risk something greater than the value of our self-satisfaction at the moment of declaring our disinterest.



Whether or not we find them to be morally unsupportable, or we anticipate that head transplants will not be viable procedures in the future, the fact of the matter is that head transplant technology is being developed and practiced right now. And this body of research is happening in China.”

Issue 8.4 also contains numerous open peer commentaries that generate a rousing discussion of the ethics of head transplantation. We would like to thank Karen Rommelfanger for coordinating this special issue and Paul F. Boshears for his contribution to the issue. Keep an eye out for the official publication of Issue 8.4 in the coming weeks.

Please enjoy the latest blog reader and issue 8.4 of AJOBN!