Report from the Society for Disability Studies: Bringing Ethics, Bioethics, and Disability Studies Together

By Jennifer C. Sarrett, MEd, MA



Jennifer Sarrett is a 2013 recipient of the Emory Center for Ethics Neuroethics Travel Award. She is also a doctoral candidate at Emory University’s Graduate Institute of Liberal Arts working on her dissertation which compares parental and professional experiences of autism in Atlanta, GA and Kerala, India as well as the ethical issues that arise when engaging in international, autism-related work.

From June 26 - 29, 2013, the Society for Disability Studies (SDS) held their annual conference in Orlando, Florida. SDS is the primary scholarly association for the field of Disability Studies, which is an academic field of study exploring the meanings and implications of normativity, disability, and community. As with other identity-based fields of studies, including Women’s Studies, Queer Studies, and African-American Studies, the Society for Disability Studies thinks about difference and works to expose and eradicate stigma and inequality related to people who identify as disabled. This particular field of identity-based work is closely related to Bio- and Neuroethics, as differences in minds and bodies present medical and scientific concerns to physicians, researchers, and scholars.

Via jeffpreston.ca

At SDS this year, I presented a paper titled “The Ethics of Studying Autism Across Cultures,” which is based on my research fieldwork. My dissertation looks at how culture influences parental and professional experiences of autism in Atlanta, GA and Kerala, India with the aim of developing guidelines for future scholars, interventionists, or advocates embarking on international work on autism and related disabilities. Because of many of the ethical issues I came across in my studies and research, my work extends to thinking about autism within current models of human rights and critically examining contemporary and historical ways of talking about and treating people on the autism spectrum. 

My work on autism in and out of my dissertation relates to several prominent concerns presented in current bioethical and neuroethical scholarship. In regards to research practices, issues related to obtaining informed consent, communicating research goals to participants and collaborators, and ensuring research aims and practices are not harmful (emotionally or otherwise) to participants were present. I have also engaged with concerns about the appropriateness and usefulness of promoting and exporting psychiatric labels from the West into regions without the ability or need to use and address these labels. And, because autism is a condition with no known etiology and is diagnosed based on behaviors and development, there are myriad autism-specific neuroethical issues, including pharmacological interventions, prenatal diagnosis, and the presence or absence of morality in autistic individuals. Additionally, there are debates concerning the need to provide intense intervention to autistic individuals: at one extreme is the belief that autism is an unwanted state of being and all efforts should be made to bring the ‘real’ person out of the autistic shell while at the other extreme is neurodiversity, the perspective that autism is just one manifestation of human neurological development that is necessary for the diversity and balance of the human race and should not be eradicated, rehabilitated, or treated.

At SDS, I focused on some of the ethical concerns that arise when culture is brought into consideration. My paper was built on the premise that ethical codes and guidelines set forth by institutions such as the American Anthropological Association (AAA) and the field of Bioethics are Western-centric and broad, making them difficult to apply to on-the-ground situations when researching intellectual, behavioral, or psychiatric disability outside of the Global North. Additionally, many ethnographers and cross-cultural psychiatrists do not report the ethical issues they encounter during research or applied work meaning that, despite their ubiquity, these issues are not widely discussed. Researchers and international mental health workers will continue encountering ethical issues in the field, therefore beginning a discussion of these concerns is critical. I argue that given the situation-specific and ambiguous nature of ethical issues—which, in a sense, differentiates ethics from morals—the best way to address this topic is through story-telling.

In his ethnography on HIV in Russia, anthropologist Jarrett Zigon uses the phrase “moral breakdown” to describe times when “some event or person intrudes into the everyday life of a person and forces him to consciously reflect upon the appropriate ethical response (be it words, silence, action or nonaction)” (2010; 69). This is similar to what is commonly called an ethical dilemma, but I prefer Jarrett’s term because often, in the moment, these events feel like a shattering of moral precepts perviously considered to be indestructible. In my presentation, I described several of the moral breakdowns I experienced while doing research in India. These fell into three themes: navigating my various roles (e.g., researcher, ‘expert’), differences in health care privacy, and the context of maltreatment (in this case, restraint). 

 

My paper was presented alongside a paper describing a program in Cambodia that encouraged and empowered disabled youth in their communities through employment, education, and social events. The audience brought up and participated in discussion on issues concerning how to further academic work and scholarly discussions on ethics of field work related to disability, differing perspectives on the importance of diagnostic labels, and how and whether to push an agenda of empowerment and advocacy rather than immediate physical and/or financial needs.

The discussion during and after my presentation was incredibly helpful for how I think about my work, as were other talks I attended. For instance, one presentation presented a project that brought women with disabilities from the U.S. to Jordan to learn about and discuss education, employment, and daily living. Many events presented here were familiar as participants faced similar ethical dilemmas, including how to discuss disabled sexuality in a conservative culture and how to respond to professionals who describe needing to quell the hopes and dreams of disabled youth for more ‘realistic’ goals.  

The conference also included a panel on bioethics and disability studies, two fields that often conflict on topics such as end of life decision-making and prenatal diagnosis. In the three years I have attended SDS, this was the first year I remember seeing a panel on bioethics and it was clear some more work needs to be done to better bridge these disciplines. The connection with bioethics was unclear in two of the three papers. The third was a talk by a Disability Studies scholar about his experience being hired at a bioethics center at a prestigious university. This talk touched on some of the concerns related to merging Disability Studies and Bioethics, however did not directly address the nature of these issues.

As I noted, I have attended SDS for three years and always leave feeling more connected to the field of Disabilities Studies and armed with new ways to approach my own work. It is my hope that next year, I can attend and promote more discussion on bioethics, neuroethics, and the ethics of disability and mental health related fieldwork. Disability Studies and Bioethics both focus on issues related to the body, health, illness, and have much to learn from as well as teach each other. A forum like SDS is just one venue to promote this collaboration. 

For more information on autism, psychiatry, culture, disability studies, and neuroethics see:

Daley, Tamara. (2002). The need for cross-cultural research on the Pervasive Developmental Disorders. Transcultural Psychiatry, 39. DOI: 10.1177/13634615203900409

Davis, Lennard. (2010). The Disability Studies Reader, 3rd Edition. Ed. Lennard Davis. New York: Routledge. 

Farah, Martha. (2010). Neuroethics: An Introduction with Readings. Cambridge: The MIT 

Press.

Feinstein, Adam. (2010). A History of Autism: Conversations with Pioneers. West Sussex: 

Wiley-Blackwell.

Grinker, Roy R. (2007) Unstrange Minds: Remapping the World of Autism. New York: Basic Books.

Kleinman, Arthur. (1988). Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: Free Press.

Sarrett, Jennifer. (2012). Autistic Human Rights—A Proposal. Disability Studies Quarterly, 

32(4). http://dsq-sds.org/article/view/3247/3186

Seibers, Tobin. (2008) Disability Theory. Ann Arbor: The University of Michigan Press.

World Health Organization. (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: World Health Organization.

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Sarrett, J. (2013). Report from Society for Disability Studies: Bringing Ethics, Bioethics, and Disability Studies Together. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/08/report-from-society-for-disability.html

Perceptions of Animals

Dr. Frans de Waal

By Frans de Waal, Ph.D.



Frans de Waal is the Charles Howard Candler Professor of Primate Behavior at Emory University and the Director of the Living Links Center at the Yerkes National Primate Research Center. He is also a member of the United States National Academy of Sciences and the Royal Netherlands Academy of Sciences and a member of the AJOB Neuroscience editorial board. His research focuses on primate social behavior, including conflict resolution, cooperation, inequality aversion, and food-sharing. 

At a recent workshop on
"Beastly Morality" (April 5, 2013, Emory Ethics Center), which drew
participants from all over the country, I asked an innocent question. We
had about sixty scholars presenting or listening to academic papers on
the human-animal relationship or the place of animals in literature, and
I asked how many of them worked with animals on a daily basis. The
answer: no one.

It was a naive question, because if I had
expected half of them to say that they did work with animals, these same
academics would probably be writing on something totally different,
such as the behavior of animals, their treatment by us, or their
intelligence. That's what I do, being a scientist. We rarely write about
anything that cannot be observed or measured, and so we assume it must
be the same for everybody else. But if one's focus is how Thomas Aquinas
viewed animals, the definition of personhood, or the moral status of
animals in Medieval Japan -- all of which were topics at the workshop --
first-hand knowledge of animals is hardly required.



Undeniably, there is a dearth of exchange between scientists and other
academics on the issue of animals, the reason being that for scientists
the animal is a concrete study object, whereas for scholars in English
departments or other corners of the humanities, the animal often is an
abstract entity judged by its place in literature, its perception in
history, its role in religion, or its relation to human self-identity.
Are we animals? Positions seem to be gradually shifting in this
direction, but none of this relates much to the essence of the animal
itself, even less to any specific species, such as our closest
relatives, the anthropoid apes.



On the other hand, it would
be naive for scientists to think that how we study animals is free from
cultural biases. It is impossible for us to break away from human
perceptions. There is a reason, for example, why treatment of animals as
individuals by giving them names and following their lives over time --
a common technique today -- is not a Western invention. Lacking souls,
animals were traditionally viewed as all the same. European ethologists
kept talking about species-typical behavior, and American behaviorists
did not even appreciate that species might differ. B. F. Skinner bluntly
said: “Pigeon, rat, monkey, which is which? It doesn’t matter” (Bailey,
1986).

There was enormous resistance, therefore, to the
personalization of animals, so much so that when Kinji Imanishi, the
father of Japanese primatology, visited American universities in 1958 to
explain how his students recognized a hundred different monkeys in each
troop, he only met raised eyebrows. His audience felt that doing so was
an impossibility (de Waal, 2001). The first to recognize the potential
of the Japanese approach was Ray Carpenter, an American primatologist.
Carpenter himself identified individuals by means of tattoos, hence with
an initial underestimation - typical for Western science - of their
individuality. It would be a bit like me going to a party and putting
colored dots on everyone’s foreheads saying that otherwise I couldn’t
tell these people apart. It is obvious, however, that Carpenter was an
astute observer. When he first heard of the Japanese studies, he did not
share the skepticism of his colleagues, who reacted with disbelief that
monkeys could be distinguished just from sight. They viewed all this
naming of individuals as hopelessly anthropomorphic, which at that time
was about the most damning label one could come up with. Animals were
supposed to be different. They wondered if the Japanese were not grossly
overestimating the social lives of their monkeys. Who said that monkeys
could tell each other apart even if human observers said that they
could? Even though the Japanese approach has now won many converts, I
call it a "silent invasion" given how reluctant Westerners have been to
recognize Imanishi's priority and influence (de Waal, 2003).

Kinji Imanishi with a baby gorilla

Clearly, the way we perceive animals affects how we conduct science.
There is every reason for scientists to listen to exposés on the
cultural views of animals, just as there is every reason for anyone
writing on animal representations to investigate what science actually
knows about the species in question. This way, both groups may come
together and have a more fruitful exchange than we have had thus far.

 



References     

• Bailey, M. B. (1986). Every animal is the smartest: Intelligence and
  the ecological niche. In: Animal Intelligence. R. Hoage & L. Goldman
  (Eds.), pp. 105-113. Washington, DC: Smithsonian Institution Press.

• de Waal, F. B. M. (2001). The Ape And The Sushi  Master: Cultural Reflections by a Primatologist. Basic Books, New York.

• de Waal, F. B. M. (2003). Silent invasion: Imanishi’s primatology and cultural bias in science. Animal Cognition 6: 293-299.

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(Hypothetical) Crimes Against Neural Art

We would expect that if there was any moral outrage to have over the treatment of cultured neural tissue, it would occur in an art gallery. Something about an art gallery sensitizes us to the well-being of critters we might not usually care about - as in the case of Garnet Hertz's Cockroach Controlled Mobile Robot (a three wheeled robot about half the size of R2D2, driven by a Madagascar hissing cockroach) - and to cry out over events that we might otherwise willfully ignore or even accept as routine - as in Guillermo Vargas's infamous “You Are What You Read,” (where a starving dog was taken off the street and brought into a gallery) [1].  Instead, when neural tissue is given a robotic body and placed on display (sometimes remotely) in an art gallery, most responses seem to focus on the ambiguous nature of the works.  Artist Stephane Dumas wrote, referring to MEArt (a drawing robot controlled by a culture of rat brain cells), that “the public can experience the drawing activity and at the same time sense the presence of its remote initiator, the brain [2],” implying a felt mental presence associated with the biological components of the work.  However, Dr. Stuart Bunt, one of the scientists who worked on Fish and Chips (a precursor to MEArt that used tissue taken from fish rather than rats), wrote that “many viewers of Fish and Chips embodied it with impossible sentience and feared it unnecessarily [3],” indicating that the attributed mental life (and implied moral obligations towards it) was an illusion constructed by the framing of the piece. This contradiction between the audience and creator's interpretation of these pieces is reflected in Dumas's assertion that embodied neural bioart (here referring to Silent Barrage, which featured a distributed robotic body that audience members could walk through) “is a work in progress that raises more questions about the relationship between neural mechanisms and creative consciousness than it answers [2].”  This ambiguity is even praised by artist Paul Vanouse, who states that “MEArt's creators have cleverly designed their thought-provoking apparatus to maximize cognitive dissonance [4],” while Emma McRae describes MEArt as an example of one of “an infinite multiplicity of agencies [5]” that don't fit into well established categories, which  humans must learn to share the world with [6].

If even cockroaches become objects of empathy in an art gallery, what would it take for us to feel sorry for neural culture?  Above photos by Sharmanka and Douglas Repetto, from here.

If Fish and Chips, MEArt, and Silent Barrage didn't raise any overt ethical alarms, what would be required for such an embodied neural artwork to be 'wronged'?  While moral transgressions are certainly possible on a multitude of grounds (e.g. affronts to the dignity of the cultures, or more likely the dignity of the animals they were derived from), for the moment let us narrow ourselves down to the possibility of causing morally relevant pain in such a system.  Previously on this blog I've discussed several different ways of looking at the possibility of pain embodied neural cultures.  Here I'd like to present my own hypotheses for what might be the minimal requirements for creating morally relevant pain under these different perspectives.



Both behavioral and anatomical perspectives on pain have serious problems with identifying the presence of morally relevant pain in neural culture.  This is as these perspectives both require the existence of reference points that both clearly demonstrate pain, as well as defining that pain based on qualities can be shared with neural culture.  From the behavioral perspective, such pain might seem possible if one created a robotic body that constantly whimpered or otherwise generated pain-associated behaviors.  However, we wouldn't trust that system to have any sort of 'authentic' pain; the signal produced could just as easily be giggling, and there wouldn't be any change from the perspective of the culture.  The relationship between bodily activity and morally relevant mental states, which while not fixed does possess evolved biological structure in 'full' animals, is arbitrary in the case of embodied neural culture.  From the anatomical perspective, pain also might seem possible at first.  Works like Silent Barrage and MEArt share some cellular similarities to some of the most morally relevant parts of the pain system - the cortical regions that appear necessary for caring about pain.  However, these isolated neural tissues lack the connections to other parts of the brain and body that usually interpret what the cortex does in such a way that pain is produced.

What would it take to 'wrong' a culture of dissociated rat neurons?  Image by Dr. Steve Potter, from here.

 A mathematical perspective on pain gets around the reference issues of the behavioral and anatomical perspectives by holding that the internal structure of a system determines its ability to feel different states, including pain.  Thus, this perspective can be applied to any system, whether naturally or artificially constructed - the only thing that matters are the (mathematical) rules that govern how the system changes over time.  Such a definition hasn't been built yet, but Integrated Information Theory of Consciousness seems poised to construct such a definition.  In the mean time, we might hypothesize that such a description of pain would include essential qualities such as aversion, negative reinforcement, redirection of attention, and sensitization to other 'painful' stimuli.  The described mathematical structure would need to be rich enough that it was convincingly authentic, such that even if the system under investigation was 'wired up incorrectly' - as in the case of the neural culture that could just as easily be made to laugh as to cry - there would be some latent structure present in the culture's actions that was clearly identifiable as pain.



Lastly, we might trade these views on moral pain that focus on the neural culture in isolation for a perspective that focuses on the interactions between the neural culture and its environment - what I have previously termed a 'social' perspective.  This perspective looks for grounds on which audience members might interpret the activity of a neural culture the same way as they might interpret morally relevant pain in animals - as a signal that the audience is obliged in some way to help the culture deal with its imminent destruction, whether real or perceived.  As the neural culture is not any living animal that the audience is familiar with, the social perspective does not attempt to interpret the neural culture as such. (Though certainly, such similarity if it did exist would be reasonable grounds for a different interpretation.  We have the option of treating a slice of ACC as if it still existed with the rest of a rat, just as we have the option of treating a deposed dictator with the same respect they commanded while in power.)  It is useful to note here that by treating the neural culture as a sign open for interpretation, the social view actually encompasses the other views examined above, each as methods of interpretation in their own right, and perhaps appropriate in their own sets of situations.

A torn image created by MEArt.  In early shows the control system for the robotic arms was still being developed.  Was the destruction of one of MEArt's products, the drawing, a moral failing of the artists who created the piece?  Could such destruction be considered analogous to the painful experience of the destruction of one's own body?  Image from here. 

Without an evolutionary 'narrative' to tell us how to behave (as we do when interpreting the facial expressions and vocalizations of social mammals, for instance), we are left up to the artists and scientists who created the work to provide some sort of moral structure.  From this perspective, pain might be something as simple as a LED that the culture could trigger if the pH of its media deviated to far from homeostatic limits.  All the necessary components are there - the audience can receive the signal, the signal signifies the pending doom of the culture, and the signal is in some way generated by the culture itself (that is, the signal would stop if the culture actually did die - as might be the case if we 'euthanize' the culture).  However, while there is enough structure in this scenario for some audience members to interpret the signal as pain, the lack of interaction between the audience and the culture makes this pain seem flat and robotic.  A more 'authentic' pain might require a richer relationship between the audience and the culture.  For instance, perhaps the audience has the ability to feed the culture and thus 'relieve' its pain (by bringing the media back to a safe pH limit) - or at least a way to request the researchers to feed the culture.  Such a moral relationship could be strengthened by adding repercussions for the audience's actions [6] - the culture could respond to feeding with a neutral sound that was described by the creators as a 'thank you,' the culture could blink its LED with greater frequency if it found that 'polite' requests for feeding were ignored, or human protesters could be staged outside of the gallery crying for 'tissue culture liberation' and preaching that only a philosopher could ignore pain in neural culture.  The key bit here isn't so much the qualities of the culture itself, but the interactions between the culture and the audience that might generate a truly moral pain.



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Zeller-Townson, RT. (2013). (Hypothetical) Crimes Against Neural Art. The Neuroethics Blog. Retrieved on
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[1] Other examples of this trend include  Gregor Schneider's “Death Room” (a room intended specifically for someone to die in, with plans to allow a volunteer to pass away publicly, of natural causes), or Huang Yong Ping's “Theatre of the World” (where a variety of reptiles, amphibians, insects, and arachnids were allowed to hunt and eat one another).  Perhaps in an art context, with its overtones of control and even frivolity, prevents us from excusing events such as starvation and natural death as being unavoidable, and predation as being necessary for some greater good.



[2] Dumas, Stephane. "Creation as Secretion. An externalist model in esthetics."  Situated aesthetics: art beyond the skin. Ed. Riccardo Manzotti.  Imprint Academic, 2011.



[3] Bunt, Stuart.  "Cybernetics and the Interaction Between Pure and Applied Sciences and the Humanties."  Proceedings of The 17th International Symposium on Electronic Art, Istanbul, September 14-21 2011. retrieved from <http://isea2011.sabanciuniv.edu/paper/cybernetics-and-interaction-between-pure-and-applied-sciences-and-humanities> on July 19th, 2013



[4] Vanouse, Paul. "Contemplating MEArt- the semi-living artist"  retreived from <http://www.paulvanouse.com/MEART_PV_essay.pdf> on July 19th, 2013



[5] McRae, Emma. "A report on the practice of SymbioticA Research Group in their creation of MEART-the semi living artist." retrieved from <http://www.fishandchips.uwa.edu.au/project/emma_text.pdf> on July 19th, 2013



[6] McRae does go on to point out how such works, performed in a university setting and using animal tissue, required ethical approval by animal ethics committees/Institutional animal care and use committees.  She notes that such committees often focus on the scientific merits of these works to justify them, even refusing to comment on works where the value is primarily artistic.  These committees are primarily concerned with the use of the animals from which these tissues will be derived, however, so they don't reflect ethical concerns with neural cultures themselves so much as the processes that produce them.  

Intervening in the brain: with what benefit?

By Hannah Maslen, DPhil and Julian Savulescu, PhD

Hannah Maslen is based at the Oxford Martin School, University of Oxford. 

Julian Savulescu is Uehiro Professor of Practical Ethics at the University of Oxford, Fellow of St Cross College, Oxford and the Director of the Oxford Uehiro Centre for Practical Ethics. He is also a member of the AJOB Neuroscience editorial board.



Novel neurotechnologies

Last week, Nuffield Council on Bioethics released its report entitled Novel neurotechnologies: intervening in the brain. The aim of the report is to provide a reflective assessment of the ethical and social issues raised by the development and use of new brain intervention technologies. The technologies that the report examines include transcranial brain stimulation, deep brain stimulation, brain-computer interfaces and neural stem cell therapies. Having constructed and defended an ethical framework to navigate the ethical and social concerns raised by novel neurotechnologies, the report proceeds to discuss 1) the care of the patients and participants undergoing interventions, 2) what makes research and innovation in neurotechnologies responsible research and innovation, and 3) how novel neurotechnologies should be regulated.



The remainder of the report moves on to explore non-therapeutic applications of novel neurotechnologies (such as enhancement and gaming) and how research into these technologies should be communicated in the media. Amongst the Council’s conclusions is the view that whilst the ethical issues raised by novel neurotechnologies are not necessarily unique or exceptional, the significance of the brain in human existence (to sense of self and to personal relationships) generates powerful reasons both to intervene when function is damaged and to proceed with caution before intervening without good evidence of safety and benefit (para10.3).



Assessing the benefits of a technology

Requiring evidence of the benefits of a potentially risky technology is common to assessments of a technology’s overall permissibility, particularly within the clinical domain. We wish to focus here on the Council’s conception of benefit as outlined in its ethical framework, suggesting that whilst its approach is appropriate for assessing the permissibility of clinical applications, it should not transfer to discussions of neurotechnologies used for enhancement.





Paragraph 4.20 of the report explains:

"The ethical challenges presented by uncertainty do not pertain to knowledge of risks alone; it is equally important that the benefits of intervening are well understood. … Even if, as in the case of non-invasive neurostimulation, risks are considered low, given the special status of the brain even less serious risks must be counterbalanced by clear indications of effectiveness in comparison with other therapeutic options if their use is to be supportable. (Second emphasis added)"



Whether the Council’s intention or not, this paragraph portrays the benefits of a technology as being closely linked – or perhaps even identical – to its effectiveness. This makes sense in the clinical domain where interventions are intended to have particular remedial or protective effects, easily measured as improvements to, or maintenance of, function or physiology. What constitutes an improvement or decline in health is mostly not controversial and can be measured objectively. For example, how far a person can walk after hip surgery is objectively measurable? Further, in the clinical domain, whilst the informed consent of patients is routinely obtained before proceeding with any intervention, a patient’s decline in health puts her in a vulnerable position where it is likely she will be inclined to accept the treatments on offer. This inclination may be bolstered by the perception that the intervention on offer is ‘endorsed’ by the medical profession, with its authority. This being the case, good evidence of effectiveness (benefit) must be gathered before offering interventions posing any risks.



The benefits of enhancement

Some of the technologies under discussion by the Council are also being marketed for the purpose of enhancement. Brain stimulation devices and other neurotechnologies are, among other things, being used in pursuit of improvements to memory and concentration. The Council is of the view that the effectiveness of interventions used for enhancement is yet to be established (para 8.44), and further suggests that it is not even clear how the benefits of technologies used for enhancement should be assessed, nor what constitutes proportionate risk where an intervention is non-essential (para 8.30). Whilst equating benefit with effectiveness is a sound strategy for an ethical framework assessing the use of neurotechnologies in the clinical context, we suggest that, when technologies are marketed to competent individuals not considered unwell, 1) ‘benefit’ should be understood differently and 2) the requirement of strong evidence of benefit should (partly as a consequence) be relaxed.



Although the risks and side effects of neurotechnologies used for enhancement could be assessed in a similar way to the risks and side effects associated with their clinical application, it is less clear how the benefits of these interventions should be measured. It could be argued that, unlike clinical interventions – which succeed or fail in improving or maintaining health to a measurable degree – technologies used for enhancement confer benefits that are more subjective and context specific. Parallels might be drawn with cosmetic enhancements: a nose might be made smaller or straighter in a way that we can measure, but how beneficial this is will vary from person to person and culture to culture. Granted, it is possible to measure the size of any improvement to cognitive performance: an improvement to the memory of an individual using a brain-stimulating device will be something that could be determined through laboratory tests. However, whilst we can measure the size of improvements to cognitive function, it could be argued that the value of enhancement is something that varies between people to a greater extent than the value usually attached to health. This value will depend on the circumstances specific to each individual. Improvement of memory for a vigorous professor will have a different value to improvement of memory for a retired gardener, though both will have some objective value.





Consequently, we suggest that ‘benefit’ should be understood as an estimation of the technology’s propensity to increase wellbeing, where an increase in a person’s wellbeing is related to the chances of her leading a good life in the relevant set of circumstances. Crucially, what constitutes a good life will vary depending on the person’s goals and values, their nature and their circumstances. In fact, this ‘welfarist’ definition of enhancement also subsumes those effects commonly thought to be treatments: if a neurointervention is used to alleviate symptoms of Parkinson’s Disease, for example, it is likely to have increased the patient’s chances of leading a good life .



But, it could be asked,  if this concept of increase-to-wellbeing is supposed to encompass both effects seen as treatments and effects seen as enhancements then why do we agree with the Council that benefit should be understood as effectiveness when assessing technologies used in the clinical context? We emphasize our earlier points: the first reason is that the ‘therapeutic’ effects of the clinical applications are likely to be valued by most people – to be necessary for leading a good life on most conceptions. Most people want to be able to walk around after hip surgery, and get back to the ‘activities of daily living’. This value accorded to health is likely to be more universal than the value accorded to enhancement. The second reason appeals to our argument that decisions about undergoing an intervention made in the clinical context are importantly different from the decisions made in the non-clinical context due to the particular vulnerabilities present when one’s health is in jeopardy. Understanding size of benefit as degree of effectiveness in the clinical context serves as a justifiable safeguard.



However, absent these particular vulnerabilities, the concept of benefit should be understood as the broader notion of increase-to-wellbeing. Both these factors speak in favour of giving individuals more choice about how to assess the risks and benefits of any particular device in the context of their own values, nature and life circumstances. As medical need falls, consumer freedom-to-choose should rise, other things being equal. People are generally the best judge of what is best for themselves, a point made a long time ago by John Stuart Mill.



Implications of the well-being framework for enhancement regulation

As noted, the Council suggests that it is neither clear how the benefits of technologies used for enhancement are to be assessed nor what constitutes proportionate risk where an intervention is not essential for maintaining an individual’s health. However, given their recommendation that neurotechnologies used for enhancement should be regulated in the same way as medical devices (para 8.52; we have argued for a similar model elsewhere ), these issues are important ones to resolve: the legislation controlling the placing of medical devices on the market requires a comprehensive risk-benefit assessment. For clinical neurointerventions, we have argued that there is a good case for imposing strict restrictions based on risk and efficacy in order to protect vulnerable patients. By contrast, when technologies are intended for enhancement we have suggested that, whilst it will be very important that potential consumers are well informed about an intervention’s mechanism, risks and effectiveness, the assessment of benefits and the weight they should be accorded should be made by the consumer. This points to a regulatory model whereby the most dangerous enhancement technologies will be filtered out of the market, leaving individuals free to choose which small-to-moderate risks they are willing to take in pursuit of their wellbeing.

References 

Nuffield Council on Bioethics, ‘Novel neurotechnologies: intervening in the brain’, published 24th June 2013.



Savulescu, J., Sandburg, A. and Kahane, G. (2011), ‘Well-being and Enhancement, in J. Savulescu, R. ter Meulen, and G. Kahane (eds.), Enhancing Human Capacities, Wiley-Blackwell.



Kahane, G. and Savulescu, J. 2009. “The welfarist account of disability”. In Disability and disadvantage, Edited by: Brownlee, K. and Cureton, A. 14–53. Oxford: Oxford University Press.



Mill, J.S., On Liberty



Maslen, H., Douglas, T., Cohen Kadosh, R., Levy, N. and Savulescu, J. (forthcoming), ‘Do-it-yourself brain stimulation: a regulatory model’, Journal of Medical Ethics.

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In Sickness and in Health - What Jewish Law Can Say about Psychology and Psychiatry

By Rabbi Ira Bedzow, MA

Rabbi Ira Bedzow

Rabbi Ira Bedzow is a 2013 recipient of the Emory Center for Ethics Neuroethics Travel Award. He is the project director for Moral Education research project for the TAG Institute, and is currently pursuing his PhD in Religion at Emory University.



While it is obvious that the term "insanity" expresses the value judgments of a society's legal system, psychology and psychiatry also accept social mores as a guideline for determining mental illness and health, even when their practitioners deny doing so.  For example, according to the DSM-5, mental illness is diagnosed by dysfunctional behavior (though some psychiatrists are pushing for a biological categorization of mental illness) and thus assumes social or cultural norms by which to interpret behavior in order to determine whether it is dysfunctional or not.  Because insanity and mental illness are both predicated on social norms, they are by definition determined by society's ethical posture.



In Jewish law, and in the Jewish tradition more generally, there is a rich debate over the nature of mental health and mental illness, which can provide insight into the ethical influence over diagnosing and treating mental illness.  In general, the key question found in Jewish juridical sources with respect to mental illness is how to understand a person's behavior and how to habituate different, healthier behavior.  Of course, this may not apply to major mental disorders, yet given the current critique, that the DSM-5 has psychiatrized daily life, this discussion would apply to certain less serious mood and addictive disorders.



At first glance, the criteria in the Talmud to determine whether a person is mentally ill seem to be behavioral; a person is mentally ill when he or she acts in a socially dysfunctional manner.  In the pursuant Talmudic discussion regarding how many symptoms a person must possess to indicate whether he or she has a mental illness, however, it becomes clear that behavior alone is not a marker; rather, the question is whether the person is capable of rational thought which can explain the abnormal behavior.  If a person has no rational explanation for his or her behavior, he/she should be regarded as insane; rational explanation would imply sanity.  Questions arise over the extent to which one can interpret a person's actions as rational.  (The Talmud gives the following examples: If the signs that a person is mentally ill are that he that goes out alone at night, or he spends the night in a cemetery, or that he tears his garments, then if a person actually does one of these things, it may nevertheless be possible to say, "He spent the night in a cemetery in order to perform magic, or he went out alone at night because he was seized with the need to go outside, or he tore his garment because he was lost in thought."  If, however, he performs all of these actions, it becomes much more difficult to provide rational reasons for his behavior.)

Rabbi Moshe Feinstein

Because rationality, and therefore insanity, is often dependent on interpretation, Jewish law provides a scale for mental illness, whereby a person could be considered sane in some respects yet not in others.  For example, in one of his responsum, Rabbi Moshe Feinstein discusses a case where a person seems to be completely normal except for the fact that he believes himself to be the Messiah.  The person would climb trees in order to give speeches to the people below and he would walk around naked claiming to emulate the first human being.  Rabbi Feinstein distinguishes between being capable of comprehending the purpose and worldview embedded within Jewish law and being capable of conducting oneself in a greater society, whereby the person engages in trade and has social responsibilities.  Because the person who claims to be the Messiah is unable to comprehend the mores and values of Jewish law, not that he does not believe in them but rather that he cannot understand them, he is exempt from its (Jewish law's) obligations by virtue of being mentally ill.  On the other hand, with respect to living in the greater society his transactions would be effective since he can understand social norms as any other sane person.  In this sense, he is both sane and insane, depending on the standard by which his behavior is judged.

From: www.i09.com

Rationality is an important marker for mental health in the Jewish legal tradition for two reasons.  First, the tradition acknowledges that all people naturally create cognitive schemata (worldviews) in which their thoughts and actions make sense to them.  Rationality, therefore, gives the person the ability to understand accepted social norms as well as the ability to understand his or her own behavior vis-à-vis those norms.  Second, rationality allows for free choice through which a person can change his or her habits.  Changes in habits are believed to create changes in a person's temperament and thinking.



If a person is incapable of rational thought, then adherence to Jewish law has no beneficial effects. If, on the other hand, a person is rational, then even if he or she has a mood or an addictive disorder, Jewish law is meant to be the means by which to return to full mental health.  From the perspective of cognitive behavioral therapy, Jewish law attempts to create small tests which allow a person to find success easily when he or she observes the law and allows the person to avoid the "What the hell" effect when he or she does not.  It is able to do this because the legal framework provides the ability to perceive each act as independent of the next, yet the totality of one's daily behavior still gives rise to a unified sense of living according to a measurable standard.  Also, Talmudic thinking, which allows for greater hermeneutical flexibility than other forms of reasoning, can allow a person to reinterpret negative experiences and make them pivot-points towards different choices.  The benefits of this type of approach in therapy has been explored recently in acceptance and commitment therapy.  (This is not to negate the possible benefits of psychopharmacology; however, psychopharmacology is completely cosmetic.  It does not cure a person, it only deals with his or her symptoms.  Once the patient stops taking medication, the symptoms will return.)



The influence of Jewish social values on the determination of mental illness and on treatment is demonstrated by the fact that the techniques to treat a mentally ill person (such as observance of Jewish law and interpreting experience so as to promote positive goal-oriented development) are the same as those used to improve a mentally healthy person's well-being.  Because the ethical posture of Jewish law is consistent, prescriptions for mental illness and health are on the same spectrum as those for human flourishing.  If the Jewish tradition can impart one insight to contemporary discussions in psychology and psychiatry, it should be that categorizing mental illness also sets the boundaries for what is normal.  Whether those boundaries are fixed by biology or by social markers, diagnostics must also entail a good look into what kind of society we want to be and what type of people we want to become.





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Bedzow, I. (2013). In Sickness and in Health - What Jewish Law Can Say about Psychology and Psychiatry. The Neuroethics Blog. Retrieved on
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About the Physiological Society of Japan Ethics Symposium

By Tamami Fukushi, Ph.D



Tamami Fukushi is a Senior Research Scientist at the Platform for the Realization of Regenerative Medicine at the Foundation for Biomedical Research and Innovation in Kobe, Japan and a member of the AJOB Neuroscience editorial board. Her research focuses on areas in neuroethics, neurophysiology, and the regulation and ethics of stem cell research.



At every annual meeting since 2003, the Physiological Society of Japan has scheduled a research ethics symposium, usually dealing with animal experiments and research misconduct. One purpose of the symposia has been to raise audience awareness regarding current ethical issues in neuroscience research. In addition, the symposia have sought to open their audience’s eyes to taking action regarding ethical practices in their daily research activities.



This year, the society took up ethical issues in neuroscience. The symposium was organized by Dr. Kiyoshi Kurata, the society’s Chief of Research Ethics Committee, and Dr. Atsushi Iriki, the Editor-in-Chief of Neuroscience Research, which is published as the official journal of the Japan Neuroscience Society.



The development of neuroscience research in the past several decades has brought two characteristic trends to the research community. From the experimental perspective, progress in research protocols has extended research targets in various biological scales, from molecule(s) to intact animal or human subject(s); technical innovations in imaging, recording, and stimulating tools have enabled us to observe the neural function of these subjects more precisely. However, it also puts subject(s) at risk of invasive procedures with neurosurgery and encroaches on the autonomy of human subjects. In addition, the advancement of computer software has brought us various methodologies for data illustration which may encourage the modification of unfavorable original data for unethical reasons. Several articles have reported that between 2-14% of academic journal papers may have ethical problems, which should be seriously considered in efforts to preserve just practices among peer-reviewed publications [1].



On the other hand, from the social perspective, neuroscience has been getting more popular and familiar to the general public through mass media and entertainment  devices such as TV programs, the internet, the Nintendo Brain Age game, and free online software for brain training. A popularization of neuroscience has led researchers to explain their research results with “broader” and “easier” words, as well as to consider the ethics of neuroscience research in the public sphere and in their scientific practices. The symposium organizers and speakers considered both of these trends in preparing their presentations.



The Ethical Components of Neuroscience Research



At the symposium presentation, I first outlined a history of neuroethics in Japan and Asia, and summarized the ethical components of neuroscience research using a matrix with two different X-axes. In figure1, the lower X-axis indicated the biological hierarchy of experimental targets and the upper one represented social layers in the research community [2]. The lower components in the figure were mainly related to safety and efficacy issues, which might be regulated by quantitative criteria based on the (pre-clinical) experimental data and case studies of subjects/patients. On the other hand, the upper components referred to more complicated issues in social, legal, and public contexts, and more qualitative approaches and open discussions would be needed to provide a suitable solution. The matrix was useful for categorizing current issues in neuroethics and their relationships with other presentations, in which each speaker explained further details of selected topics.



Dr. Kurata discussed the significance of information disclosure in relation to the renewal of Japanese laws pertaining to animal experiments in 2012, and recent changes in guidelines regarding conflicts of interest in the Physiological Society of Japan [3]. He also suggested a possible role for non-profit organizations (NPO), where researchers could help address legal and political issues surrounding animal experimentation.



Dr. Iriki reported on ethical problems in scientific publishing, which he has experienced as the editor-in-chief of the peer-reviewed journal Neuroscience Research. These problems have included multiple submissions, gift authorship (or the practice of awarding authorship to an individual who has not significantly contributed to the study), data fabrication, falsification, and plagiarism [4]. While certain kinds of misconduct can technically be prevented, it is important to engage with the personal morality of individual researchers to ensure transparency in peer-review process.



The last speaker, Dr. Tashiro, introduced recent developments in ethical principles geared toward clinical research. He focused on the concepts of “collaborative research partnerships” and “respect for human research participation,” and drew upon the eight ethical principles issued by the Bioethics department at National Institutes of Health Clinical Center [5, 6]. He also emphasized the importance of support from the ethics consultation system as well as the IRB system and the needs of professionals for effective consultation.

Figure 1. Ethical Components of Neuroscience Research

There were 30 audience-members who had various backgrounds in different fields of physiology, with various  roles and responsibility at their institutions/academic research communities. Through the open discussions, we recognized that appropriate actions based on the morality of individual researchers would be key to keeping competition fair in peer-reviewed science, in both the basic and clinical settings. It was also suggested that institutional/organizational monitoring systems at higher levels of the research community are needed to strengthen the community's accountability to the public. While we had less opportunity to discuss ethics of neuroscience from the perspective of the general public (or in the media), which might be the “third X-axis” on our matrix, the meeting was a successful in encouraging the researchers to refine their moral principles in both their individual and societal dimensions.



In recent years, the Japanese neuroscience community has achieved great progress in laboratory ethics by revising experimental guidelines and developing safety criteria for human brain research (see http://www.jnss.org/en/guideline/rinri/ (in English) and http://jscn.umin.ac.jp/news/index.html#121116-2 (in Japanese)). The next neuroethical issue to be faced by the Japanese research community, and which should be more extensively considered, is “how to visualize, explain, and share the experimental result(s) more ethically to others.” This kind of ethical problem must be considered by integrating media ethics, research misconduct, and public relations.



References



[1] Fanelli, Daniele. “How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data.” PLoS ONE 4, (2009) e5738.

[2] Fukushi, T. "A decade of neuroethics: Impact on neuroscience in Japan and Asia." The journal of physiological Sciences 63 supplement 1, (2013):S88.

[3] Kurata, K. "Importance of information disclosure in animal experiment ethics and conflict of interest." The journal of physiological Sciences 63 supplement 1, (2013):S88.

[4] Iriki, A. "Responsible conduct of research and ethics of scientific publishing." The journal of physiological Sciences 63 supplement 1, (2013):S88.

[5] Tashiro, S. "New trends in clinical research ethics: Eight ethical principles and research ethics consultation" The journal of physiological Sciences 63 supplement 1, (2013):S89.

[6] Emanuel, Ezekiel J. et al. (2008). “An ethical framework for biomedical research,” Emanuel, Ezekiel J. et al. eds., The Oxford Textbook of Clinical Research Ethics, Oxford University Press, 123-135.



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Fukushi, T. (2013). About the Physiological Society of Japan Ethics Symposium. The Neuroethics Blog. Retrieved on
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Robots: the Answer for Treating Children with Autism Spectrum Disorder?

By Guest Contributor Irina Lucaciu, Emory University  



A smile appears on Jack’s face as the robot he is playing with congratulates him for accomplishing a task. Aiden seems captivated by the moving arms of Nao, a robot that has become his new playmate. Thousands of miles away, in London, a copy of Nao sits in the middle of a circle of five boys no more than 10 years old, encouraging them to imitate his movements, touch his hands, and try to identify the feelings he is describing.

Nao

When asked how the robot makes him feel and why, one of the boys replies that he is happy because the robot feels happy too.



However, Nao and the other robots are not simply toys, and neither are Jack, Aiden, and the five British boys simply children at play. They have autism spectrum disorder, and Nao is acting as a treatment tool for improving their life experience and helping them develop socially-relevant skills. Above are described the results of robot-assisted therapy [1, 3, 9, 13].



What is autism spectrum disorder, and why would the use of robots benefit those who have it?





Social interaction is embedded within human nature. We engage in it continuously, and, when deprived, we seek it to alleviate an immediate absence that provokes pain and anxiety. Regardless of whether it manifests in the form of dialogue, gestural interchange, or touching, social interaction is crucial for maintaining emotional and psychological well-being. The prevalence of communication is mirrored by its significance in human societies, and it justifies the persistent demand for socially-adaptable individuals as members of societal structures. [10]



However, individuals with autism spectrum disorder (ASD) have significant challenges with performing social functions, which makes it harder for them to be self-sufficient, follow a traditional education, or form families. Their difficulties primarily rest on an inability to relate to other people, understand the social information conveyed by gesticulations and facial expressions, and reciprocate touch or conversation initiated by an interlocutor [6].



Researchers are focusing on different strategies to encourage the development of social functions in autistic individuals. Because early intervention has been shown to be particularly effective in helping people with ASD develop skills for living autonomous lives as adults, children are currently the age group most targeted by autism researchers [10].



At present, the main therapies targeting children with ASD are applied behavioral analysis and non-human facilitation. With applied behavioral analysis, trained specialists interact with the autistic child, encouraging reciprocation, attention, and following of directions, and discouraging anti-social behaviors. Non-human facilitation can involve partnering with a trained pet that would subsequently ease the challenge of interacting with another human, engaging with an interactive computer program, or undergoing virtual training that offers gradual exposure to common social environments, such as a classroom or a playground. [6, 10]



Both human-facilitated and non-human facilitated therapies have helped children with ASD to develop better social skills over time. However, problems remain. For example, pet-assisted therapies include a risk of being bitten or hurt during the therapy session, and some children are allergic to the pets. Furthermore, emotional attachment to a pet can lead to a traumatic experience of the death or loss of the animal [8]. In a recent study done by Dr. Sandra Y. Okita at Columbia University, the risks of pet-facilitated therapy were removed with the introduction of Paro, a robotic seal and class II medical device. Equipped with various sensors that detect touch, recognize speech, and generate behavior based on the information collected, Paro was previously recognized for its therapeutic effects in the treatment of children and elderly with mental and cognitive disorders. In Dr. Okita’s study, at interest were Paro’s qualities as a social facilitator between parents and their children. Would the robotic seal increase social interaction and modelling of parental behavior, thereby reducing the pain of the patients or helping them cope better with the treatment? The results showed that the children who interacted with Paro together with their parents had lower levels of pain than children who interacted with the robot alone. In turn, parents proved a heightened ability to empathize with their children and react in ways that comforted them [8]. In the light of many studies showing that children often model parental behavior in interpreting social stimuli and forming a reaction, Paro seems to have succeeded in improving this transfer of information.

Paro

Considering the previous work using robots to both better understand human social behavior and to improve human experience in general, it is no surprise that the recent technological advancements led to the introduction of robots in a variety of fields, including autism research and treatment. But how can robots such as Paro facilitate the therapy of children with ASD? The answer lies in the many studies using social robots– or robots meant to stimulate social behaviors and increase the perception of social cues– which proved that children with ASD tend to engage actively with social robots [7]. In the following videos, both Jack and the five boys from Britain prove the above stated.  


The results of these studies are particularly uplifting considering that autistic children seem to show the more enthusiasm and interest for interacting with a person after they have interacted with a robot. A study by Elizabeth Kim and her collaborators at Yale University showed that children with ASD who interacted with a robot spoke more with an adult partner than children who interacted with a person alone [7]. In other words, it appears that interaction with a robot facilitates social interaction with an adult, at least in the short-term.

Another study showed that when a therapy session is led by a human facilitator, children with ASD spent significantly less time watching the instructor than children without the condition. However, when the session was led by a robot, both groups spent approximately the same amount of time directing their eye gaze towards the robot [9]. What is it that social robots can offer and human facilitators cannot? Dr. Kim attributes the amplified interest shown by children with ASD towards robots to a greater curiosity in them, as well as to the design of the protocol [7]. Dr. Brian Scassellati, Henny Admoni, and Dr. Maka Matarić suggested that perhaps the simplified appearance and behavior of the robot in comparison to that of a person helps with the overstimulation problem specific to many people with ASD [4, 10, 12]. Furthermore, robots might not be perceived as judgmental, helping the children to be more open to interacting with them [12].

However, no long-term studies on the benefits of robot-assisted therapy have been conducted yet. Despite the benefits that robots seem to bring, many questions remain about the ethical implications of introducing robots as large-scale therapy aids.

• What should the robot look like? At present, the appearance of robots used in autism varies widely [10]. Nao, for instance, looks like the stereotypical machine-like robot. Keepon has the appearance of a toy duck, and it was even introduced as merchandise at Toys ‘R’ Us in 2011 [14]. Paro, on the other hand, is clearly more complex, and its appearance resembles closely that of a real seal. Kaspar shares many features with a human child, but it is still clearly a man-made object. However, FACE looks incredibly human-like, and has complex mechanisms that allow her to express human emotions with very accurate facial expressions.

FACE, image from sciencespacerobots.com  

     

Keepon, image from clockers.co.uk

Kaspar, image from blogs.herts.ac.uk

    

         







































Considering that children with ASD are easily overstimulated [10], would it be wiser to introduce them to robots with a simplified appearance such as Keepon or Nao, rather than a robot like FACE? In that case, how are they to interpret such an interaction, and transfer what they learned from it to the interaction with a human? All these robots are programmed to reproduce the characteristics of either humans or animals. Nao, for instance, uses language. His speaking abilities, along with many other human-like behaviors he shows suggest to the child that Nao’s actions are governed by a brain very similar to that of a human. But Nao does not have a brain of its own, and despite its multiple sensors that make him able to adapt its behaviors according to the responses of a child, he does not possess the human ability to produce behavior and speech that are sensitive to context. Even robots such as Kismet, which received a social “brain” based upon the four modules identified by psychiatrist Simon Baron-Cohen as necessary for social interaction– Intentionality Detector, Eye Direction Detector, Shared Attention Mechanism, and Theory of Mind Mechanism [11]– can only simulate simplified human behaviors, such as following people with its gaze and seeking human company. The only way to increase a robot’s range of behaviors and make its reactions more particular to the emotions and responses of the child is to increase the amount of information that the robot receives from its interaction partner. In turn, that would require more physiological detectors, which could range from galvanic skin response detectors and pulse monitors to brain activity detectors. Such recording devices could become bothersome and invasive, and could have a negative effect on therapy. [10]

• Take the case of FACE. Her appearance is, indeed, very human-like. However, modern-day technology has not been able to give her the ability to express more than six basic human emotions. Facial expressions are possible on account of sensitive nervous control of multiple muscles of the face. As expected, such control is difficult to reproduce using modern-day technology [10].

• What if a malfunction occurs in the mechanisms of the robot during its interaction with the child [10]? It was discussed above that the death of a pet providing animal-assisted therapy could be traumatic for the child. However, death is at least embedded within human experience, and it is something that the child with ASD will have to face as a functional member of society. Robots cannot die, but they can be damaged, because they are currently not designed to resist bumps, spills, and falls.

• Last but not least, what role should the robot take around the child? Should it be a friend, instructor, parental figure, or simply a toy [10]? Using a robot during therapy would not be as simple as using a pet. While a pet, although trained, remains essentially an animal with the characteristics of its own species, a robot borrows many essential human features, such as language and gesticulation. In the case of Nao, for example, the robot also looks drastically different from a human. The child holds the hard and cold hand of the robot, and then the warm and soft hand of a human, and yet, both the robot and the human play games, talk, and dance. How will the child react to such conflicting features?

A robot, no matter how advanced the technology invested in its creation is, does not think similarly to a human. Despite its many sensors, it cannot integrate information with the same efficiency, simply because its motors do not possess the level of connectivity that characterizes the human brain. While there are still so many things to be understood about our brain, it seems unlikely that a robot with the ability to mimic human emotions and behaviors could be created. Until neuroscience can decipher the secrets of the brain, the introduction of robots as a means to teach children with ASD about human social behaviors should be carefully thought-out. Only long-term projects investigating both the benefits and the downfalls of using robots for treating children with autism spectrum disorder could testify either in support or in opposition to robot-assisted therapy.



References

[1] Aldebaran Robotics. "Robots teach communication to children with autism." Online video clip. YouTube. YouTube, 29 Apr. 2013. Web. 30 Apr. 2013. Retrieved from http://www.youtube.com/watch?v=lm3vE7YFsGM

[2] Associated Press. “Kaspar the Friendly Robot Helps Autistic Kids.” Online video clip. YouTube. YouTube, 8 Mar. 2011. Web. 30 Apr. 2013. Retrieved from http://www.youtube.com/watch?v=D6gTHPoO9VI

[3] Breen, Tom, and Bret Eckhardt. "How Robots Can Help Children with Autism Learn and Communicate." UConn Today. 25 Apr. 2013. Web. 30 Apr. 2013. Retrieved from http://today.uconn.edu/blog/2013/04/how-robots-can-help-children-with-autism-learn-and-communicate/

[4] Foss-Feig, Jennifer H., Duje Tadin, Kimberly B. Schauder, and Carissa J. Cascio. "The Journal of Neuroscience." A Substantial and Unexpected Enhancement of Motion Perception in Autism. Web. 5 May 2013. Retrieved from http://www.jneurosci.org/content/33/19/8243

[5] Goodrich, Michael A., Mark Colton, Martin Fujiki, Alan Atherton, Lee Robinson, Daniel Ricks, and Margaret H. Maxfield. "Incorporating a Robot into an Autism Therapy Team." Incorporating a Robot into an Autism Therapy Team. IEEE Life Sciences, n.d. Web. 29 Apr. 2013. Retrieved from http://lifesciences.ieee.org/articles/134-incorporating-a-robot-into-an-autism-therapy-team

[6] "How Is Autism Treated?" Autism Speaks. Web. 3 May 2013. Retrieved from http://www.autismspeaks.org/what-autism/treatment

[7] Kim, Elizabeth S., Lauren D. Berkovits, Emily P. Bernier, Dan Leyzberg, Frederick Shic, Rhea Paul, and Brian Scassellati. "Social Robots as Embedded Reinforcers of Social Behaviors in Children with Autism." National Center for Biotechnology Information. U.S. National Library of Medicine, 31 Oct. 2012. Web. 16 May 2013. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23111617

[8] Okita, Sandra Y. "Self-Other's Perspective Taking: The Use of Therapeutic Robot Companions as Social Agents for Reducing Pain and Anxiety in Pediatric Pacients." National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 16 May 2013. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23505968

[9] Salisbury, David. "Humanoid Robot Helps Train Children with Autism | Research News @ Vanderbilt | Vanderbilt University." Vanderbilt Research. N.p., 23 Mar. 2013. Web. 3 May 2013. Retrieved from http://www.youtube.com/watch?v=lZSDnvOoX84

[10] Scassellati, Brian, Henny Admoni, and Maja Matarić. "Robots for Use in Autism Research." - Annual Review of Biomedical Engineering, 14(1):275. N.p., 9 May 2012. Web. 16 May 2013. Retrieved from http://www.annualreviews.org/doi/abs/10.1146/annurev-bioeng-071811-150036

[11] Smith, Jeremy Adam. "Can Robots Feel Your Pain?" Greater Good. University of California, Berkeley, Summer 2007. Web. 16 May 2013. Retrieved from http://greatergood.berkeley.edu/article/item/can_robots_feel_your_pain

[12] "Talking Robots Play Part in Therapeutic Treatment for People with Special Needs." PBS. 9 Jan. 2013. Web. 5 May 2013. Retrieved from http://www.pbs.org/newshour/bb/science/jan-june13/robots_01-09.html

[13] UConn. “A Story of Robots and Autism.” Online video clip. YouTube. YouTube, 25 Apr. 2013. Web. 30 Apr. 2013. Retrieved from http://www.youtube.com/watch?v=nwJsxLOilcc

[14] Vance, Ashley. “Toys ‘R’ Us Wants a Robot to Sell for Christmas. Bloomberg Business Week Magazine. (2011). Retrieved from http://www.businessweek.com/magazine/toys-r-us-wants-a-robot-to-sell-for-christmas-08112011.html



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Lucaciu, IM. (2103). Robots: the Answer for Treating Children with Autism Spectrum Disorder? The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2013/07/robots-answer-for-treating-children.html