
Communication with vegetative state patients: Dialogue or soliloquy?
By Ania Mizgalewicz and Grace Lee
The world first heard from Canadian Scott Routley this past week. Routley, who has been in a diagnosed vegetative state for the last 12 years, seemed to communicate to scientists via signals measures from blood flowing in his brain that he was not in pain. The finding caught the headline attention of major news sites and spurred vast public commentary. Comments ranged from fearful to hopeful about mind reading, clinical applications of technology, and the ability of this technology to allow patients to communicate their desires to live.
Leading neuroscientist Adrian Owen in London, Ontario, articulates that the technology currently allows patients to respond to yes or no questions, but may one day be used to aide in more interactive communication. Questions would center on daily living preferences, attempting to improve quality of life and health care.
The findings by Owen and his group are truly exciting and provide great hope to the historically neglected population of people with serious brain injuries. Here at the National Core for Neuroethics, we encourage more discussion about the ethical implications of this technology. Questions such as those surrounding decisions about end of life are far in the future. The focus at the present should thus remain on how to validate this technology to one day be used in the clinical setting. If clinical use will be feasible in the future, we would need to address questions about access to the technology and the impact that its availability would have on families of patients.

Great caution and restraint is needed when coupling this still emerging technology with concerns about mind reading, or clinical decision-making about end of life. Hype here unfairly detracts from the true value of this work. With one in five vegetative patients showing signs of consciousness in these studies, the focus should remain on improving their daily surroundings, providing them a means of communication, and supporting their family members. It should also spark a conversation on the effectiveness and validity of current clinical tests used to diagnose these patients at the bedside.
Top image: wellcome images / flickr
Bottom image: Noel A. Tanner / flickr
Neuroscience in the public sphere
Here at Neuroethics at the Core, we have been trumpeting the rise of neuroessentialist thinking in the eyes of the public for some time (here and here and here), and it represents one of the two pillars of my research program in neuroethics. In today’s issue of Neuron, there is a great paper by O’Connor et al. entitled “Neuroscience in the Public Sphere“. The abstract sums it up rather well:
The media are increasingly fascinated by neuroscience. Here, we consider how neuroscientific discoveries are thematically represented in the popular press and the implications this has for society. In communicating research, neuroscientists should be sensitive to the social consequences neuroscientific information may have once it enters the public sphere.
There are a few points that I would like to highlight. First, as my graduate student Roland Nadler relayed in an email to me last night after we both had a first glance at the paper:
…this is a fantastic article from start to finish. Worth really savoring as an example of how to do the normative stuff well, and its lessons are important for us to avoid producing stuff that could be tarred as neurotrash. Particularly neat that they get the definition of neuroessentialism right. Their discussion of it near the end is trenchant. It makes it clear that some philosophical work needs to be done to save neuroessentialism from the pitfalls of essentialism tout court - as they rightly point out, the latter is some bad juju.
Neuroscience does not take place in a vacuum, and it is important to maintain sensitivity to the social implications, whether positive or negative, it may have as it manifests in real-world social contexts. It appears that the brain has been instantiated as a benchmark in public dialogue, and reference to brain research is now a powerful rhetorical tool. The key questions to be addressed in the coming years revolve around how this tool is employed and the effects this may have on society’s conceptual, behavioral, and institutional repertoires.
Not only do O’Connor et al. provide thoughtful normative comments, they also carried out empirical work, employing content analysis to study the themes that arise most frequently in the popular press. At the top of the list is enhancement of the brain, which represented 28.3% of the articles retrieved from the LexisNexis database. As this just so happens to be the other pillar of my research program, how could I not like this paper?
Excellent stuff.
Jonathan Haidt in conversation
Jonathan Haidt, Professor of Psychology at the University of Virginia and author of The Righteous Mind has been visiting UBC the past few days, and he stopped by at the National Core for Neuroethics to discuss a variety of issues in which we have a common interest. While he was here, he was kind enough to sit with me and have a conversation about groupish genes, the response to his upcoming appearance on the Colbert Report, and current events.
Nudge symposium proceedings
The current issue of the European Journal of Risk Regulation has the proceedings of a symposium on nudging, and it contains a set of insightful papers. The introduction by the editor says it best.
The EJRR starts the new year by hosting a pioneering symposium devoted to one of the latest policy innovations that is currently experimented in the United Kingdom and the United States: the ubiquitous, yet controversial, Nudge. This idea originates from the homonymous, 2008 best-selling book published by the economist Richard Thaler and the legal scholar Cass Sunstein. By building upon the findings of behavioural research, they refute the classic economic assumption that “each of us thinks and chooses unfailingly well”1 and they advocate the need for public authorities to nudge people to make decisions that serve their own long-term interests without however removing their right to choose.
At a time in which governments are taking considerable interest in the use of nudging, we have asked some of the leading authors who have already contributed to the literature surrounding the regulatory innovations, generally referred as New Governance, to share their ideas on this appealing regulatory approach.
In his opening essay, Nudging Healthy Lifestyles, Adam Burgess provides a critical assessment of the introduction of behavioural, nudging approaches to correct lifestyle behaviours in the UK. His thought-provoking analysis triggered a lively debate that has been framed along the subsequent essays signed by On Amir and Orly Lobel, Evan Selinger and Kyle Powys White, Alberto Alemanno and Luc Bovens.
The article by Alberto Alemanno, Managing Editor of the European Journal of Risk Regulation is a fulsome account of the propriety of nudging in the case of tobacco control (recently highlighted by Roland on these pages); that nudging in this instance overcomes many of the objections that are raised in the other contributions to the symposium.
I also liked Selinger & White’s analysis of nudging in the context of Brad Allenby and Dan Sarewitz’s insight on the three levels by which we should view technological fixes (as articulated in their excellent book The Techno-Human Condition, which I have written about before). In particular, they point out the naiveté of only considering shop-floor arguments, a topic we will return to again.
Hat tip to Marleen Eijkholt for alerting me to this symposium.
Image credit: Transcapitalist
Use it or lose it

As the technology of memorializing dialogue (in stone, no less) came into vogue, Socrates famously admonished Phaedrus his protegé Plato on its dangers: if people are able to write everything down, their ability to remember what was said will diminish. Plato, being an early version of an early adopter, memorialized the debate, and that is why the apocryphal story is with us today. But even without a grounding in modern neurobiology, Socrates had a valid point: the plasticity of our brains are such that the less we use them for a given function, the more our ability to carry out that function is impaired.
This becomes a tricky issue when thinking about the world in which we live today. In a thoughtful essay over at The Atlantic, Evan Selinger reviews a number of arguments for and against the use of ‘apps’ to make us, as he puts it in his title, a better person. What Evan is particularly concerned with are digital willpower enhancements: the suite of technologies that have been developed to help us do everything from not being distracted by a tweet to refrain from eating more than we would like. Continue reading
Graphic Warnings on Cigarettes: Nudge or Shove? A Neuro-Perspective
Although the topic of cigarette packaging regulation may not leap immediately to mind when one thinks “neuroethics,” this Bob Greene opinion piece over at CNN nonetheless touched off a stimulating discussion among some of us at the Core recently. The neuroethics connection, in fact, struck us as quite natural: our group has researched (and blogged about) the ethics of “nudging” frequently of late, and, as I worded it when I first emailed the article around, “certainly the images at issue here are a kind of behavioural nudge.” The question that we grappled with was whether the kind of nudge that the graphic warning labels provide is warranted in the case of cigarettes. And, indeed, that discussion called my original characterization into question. Do these labels truly constitute a nudge – a subtle biasing technique that makes a particular option more cognitively accessible than another while preserving the freedom to choose between them – or are they something more akin to a “shove?”
As with any highly politicized issue, the question of whether cigarettes ought to be labeled with disturbing imagery is likely to be filleted into oblivion by pundits, bloggers, legal experts, economists, et cetera, et cetera. All I hope to do here, then, is sketch some ways in which the view from neuroethics – informed as it is by philosophy and the cognitive sciences – can shed some interesting and hopefully useful light on the question. Continue reading
