Are We in Need of a Neuromorality?

Neuroscience’s ability to observe the brain’s activity brings with it great promise. However, it simultaneously raises intriguing issues that reach well beyond the research laboratory and into the everyday lives of people. It would appear that early into the 21^st century we have arrived at the threshold of asking not whether we can monitor and manipulate brain function, but rather ought we? Therefore, faced with the familiar tendency of ethical questions to trail technological advances, the fledgling field of neuroethics—like its predecessors, medical ethics and bioethics—finds itself in a race to catch up with leading neurotechnological trends.

If neuroscience, with its developing technologies and techniques, can consistently and reliably demonstrate individual psychological traits and/or medical predispositions, what moral framework or ethical guidelines will govern its possible uses? Is there a need for a neuromorality?

Current brain imaging technology is in the process of correlating patterns of brain activity and psychological and personality traits. “Brainotyping” appears to have the potential to identify mental health vulnerabilities, predisposition to violent crime, racial attitudes, risk aversion, pessimism, etc. Most neuroscientists are quick to mention that brain imaging in its current state of development is helpful and informative but far from conclusive. Nonetheless, the potential is real, and ethical questions are beginning to be asked about prospective applications of these scientific advances and the information they might generate. Practical and philosophical problems associated with brain privacy, performance augmentation, and the very nature of personhood are among the areas of concern.

Prediction vs Privacy

If neuroscience can provide the means to expose predispositions and thus predict behaviors, it will challenge our cultural understanding of personal privacy and when or if society has the right to know what an individual is inclined to think or do before he thinks or does it.

Wouldn’t auto insurance companies be interested in identifying persons with a proclivity for risk-taking? Medical insurers would surely benefit from knowledge of the medical predispositions of their prospective clients. Can we envision a time when neuroimaging would be used to screen applicants for employment? Could the college admissions process someday be supplemented by brain scans to weed out candidates who would likely be diagnosed with schizophrenia during their college years?

Consider the serious implications of brain research in a judicial setting. What if we were able to detect brain patterns or defects that would predict the possibility of criminal behavior? Addressing this theme at an American Enterprise Institute conference in June 2005, Henry T. Greely, director of the Center for Law and the Biosciences at Stanford University, asked these thought-provoking questions: “How accurate will the predictions be? How accurate will society perceive them to be? And when should we act on predictions rather than on actions?”

If neuroimaging could help us discover increased blood flow or brain activation that signaled a predisposition for pedophilia, would it matter whether the information was obtained directly or surreptitiously? With whom should such brain-based knowledge be shared? Should we intervene before the committing of a crime, or perhaps require counseling, notification of neighbors, or the person’s disqualification from jobs with children and adolescents? Is the presumption of innocence rendered null and void by a brain-scan prediction?

If we deem intervention at this stage unacceptable, how would we face the parents of a potential victim knowing we had foreknowledge of the likelihood of a heinous crime being committed?

Performance Enhancement

What could be more natural than the impulse to improve? Doesn’t the desire to develop and become better at mastering life’s skills seem instinctual? Isn’t the desire to do better inherent within human consciousness?

What if “doing better” came in a capsule?

According to UN figures, growth in annual U.S. sales of methylphenidate in the decade from 1987 to 1997 increased from around 60 million defined daily doses to more than 300 million. Why the dramatic increase? Farah points out that “although methylphenidate (Ritalin) and amphetamine (Adderall) are ostensibly prescribed mainly for the treatment of ADHD, sales figures suggest that they are not uncommonly used for enhancement. Methylphenidate is currently widely used by high school and college students. Surveys have estimated that as many as 10 percent of high school students and 20 percent of college students have used prescription stimulants such as Ritalin illegally.”

These medications, designed to help individuals with a cognitive disorder, are being used for cognitive enhancement by healthy students who claim that they study better and longer and earn higher scores on exams.

Psychopharmacology is poised to play a major role in augmenting brain activity. Mood alteration, memory boosts, appetite suppression, improved libido, focused attention and alertness are not only possible but currently practiced through adjustments in brain chemistry. Increased sophistication in technique and treatment is expected.

Are human effort, ingenuity and accomplishment to be recognized in the same way, whether enhanced or not? In the athletic arena we traditionally say no. Olympic and professional athletes discovered attempting to augment their performance by drugs are disciplined or disqualified. What about the academic classroom or the boardrooms of the business world? Is a college student competing for admission to law school unfairly disadvantaged if others are using psychostimulants to enhance their study skills? Are the enhancers cheating? Is the stressed professional who uses the wakefulness-promoting agent modafinil to stay alert and get more work done in a day playing fair in the pursuit of recognition and reward?

Should we even be concerned? Are these examples any different than drinking a sufficient quantity of coffee to “pull an all-nighter” and thereby finish a paper at school or a proposal at work?

Whereas in time past we may have been reluctant to ask our awakening spouse a question until after his or her daily dose of caffeine, today the stakes would appear to be much higher. Modern mood-altering medications are so effective that they can cause confusion in relationships. Farah asks, “If we fall in love with someone who is on Prozac and then find she is difficult or temperamental off the drug, do we conclude that we don’t love her after all? Then who was it we loved? Are we treating people (including ourselves) as objects if we chemically upgrade their cognition, temperament or sexual performance? People vary in how troubling they find these scenarios, but at least some see a fundamental metaphysical distinction eroding, the distinction between things (even complex biophysical things) and persons.”

Personhood

What is the defining distinction between a person and a thing that, according to Farah, appears to be eroding? For many, the slippery slope is the distinction between the brain, a physical organ of the body, and the human mind exercising free will.

“We have no idea how the brain enables the mind. We know a lot about the localization of function, we know a lot about neurophysiological processes, but how the brain produces mental states—how it produces conscious, rational intentionality—we don’t have a clue.”

Are you your brain? Or is there something else that makes us human beings?

Biological determinism, in attempting to answer that question, presents a comprehensive explanation of human nature and behavior based on the brain’s physiological processes. It professes that human conduct arises from the hardwiring of the brain and that free will is implausible. Steven Pinker, professor of psychology at Harvard University, resists the “determinist” label but nevertheless concludes that free will is an irrelevant concept because we are the sum total of our brain’s purely physical mechanisms. If that is so, are we responsible for our attitudes and actions? Pinker proposes that instead of asking whether an individual is personally responsible, we should ask “Does the person have an intact version of the human brain system that ordinarily responds to public contingencies of responsibility?” He suggests that a new neuromorality should focus on exploring and establishing contingencies that can deter inappropriate behavior and not concern itself with personal culpability.

This perspective appears to be gaining significant ground. Farah states, “As ethicists and legal theorists have grappled with neuroscientific accounts of bad behavior, they have increasingly turned to alternative interpretations of responsibility that do not depend on free will, and to so-called ‘forward-thinking’ penal codes, designed not to mete out punishments for previous behavior but to encourage good behavior and protect the public. The ‘disease model’ of substance addiction, and the extension of the medicalized notion of addiction to other compulsive behaviors such as compulsive gambling and compulsive sex, is another way in which brain-based explanations of behavior have impacted society. The disease model emphasizes the deterministic and physiological nature of the behaviors and thereby reduces their moral stigma.”

“The problem with neuroscience accounts of behavior is that [they suggest that] everything we do . . . results from a chain of purely physical events that are as impossible to resist as the laws of physics.”

The disease model, as applied to human behavior, implies that we are helpless victims of our brain’s biochemical reactions, that our brain-based behavior is an irresistible physiological imperative. Psychiatrist and scholar Sally L. Satel argues that, using this model, an addicted person is understood to be unable to control his behavior. However, she suggests that an addict is actually someone who does not control his behavior and has the perception that he is helpless. The primary purpose of drug treatment is to teach the addict that he is not helpless at all, that he has clear-thinking periods in which he makes dozens of microdecisions every day that contribute to whether he continues to use or not. Individuals with a brain disorder such as schizophrenia cannot decide not to hallucinate, just as those with multiple sclerosis cannot choose not to have spasticity. On the other hand, Satel contends that addicts can—and often do—choose to modify their behavior.

So what are we to conclude from this debate? Are we helpless to resist our brain chemistry? Or are we entities exercising free will and conscious choice? As Satel points out, a brain scan cannot tell us whether a “craving impulse is irresistible or whether it was simply not resisted.”

Studies show that the public appears open to the findings of neuroscience, expressing considerable confidence in brain scans as a virtual test of truth. The public’s receptivity reportedly exceeds the confidence that many brain researchers are presently willing to express. Farah suggests that statements like “the brain doesn’t lie” illustrate “a failure to appreciate the many layers of signal processing and statistical analysis that intervene between actual brain function and resulting image or waveform, as well as the complex set of assumptions required to interpret the psychological significance of such images.”

Even among a seemingly open-minded public, most people still believe that they have a mind as well as a brain and that the two are not the same. Advances in neuroscience appear to collide with this almost universally held belief.

Science vs the Spirit

The Judeo-Christian ethic, deeply rooted in Western civilization, has at its core the belief that man is a free moral agent made in the image and likeness of God and accountable to his Creator for his life’s conduct. The apostle Paul describes this concept in his first letter to the church at Corinth. He writes, “For what man knows the things of a man except the spirit of a man which is in him?” (1 Corinthians 2:11). Paul describes a spirit component in man that enables him to function as a human being, “to know the things of a man.” Could it be that we intuitively acknowledge that we are more than complex biochemical entities because we have “the spirit of man”? Could it be that there is a nonphysical feature that resides in us and functions in conjunction with a healthy human brain system?

Impossible to prove scientifically, but plausible to people of sincerely held conviction, is the belief that human beings have minds capable of a relationship not only with each other but with God. Before we embrace the tenets of a materialist neuromorality, perhaps we should revisit the Judeo-Christian ethic to examine whether it has indeed failed us or whether we have simply failed to appreciate, respect and apply it.

Stay Tuned

In anticipation of increased interest in performance enhancement, neuroethics, to its credit, is attempting to prepare for the challenges ahead. More invasive and sophisticated methods of brain manipulation and enhancement are currently being explored, such as brain nerve stimulation, brain surgery and brain-machine interfaces. How brain research is conducted, what it discovers, and how society will use these findings are issues of great interest, with implications for many aspects of human experience.

Fasten your seatbelt as we journey to the innermost recesses of the mind. Professor Farah declares that the question is “not whether, but rather when and how, neuroscience will shape our future.”