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

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.

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.

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.

On the one hand, a fairly good argument can be made for the fact that many of us are a bit weak in one or more of these arenas. So, the argument goes, it is better to outsource the work rather than to succumb. After all, apps are really just manifestations of the extended mind, and there is nothing particularly novel or problematic about that. I am pretty partial to that argument, especially insofar as I accept the need for the occasional nudge to help me, and others, achieve goals that are consistent with my second order desires.

Of course, when there is a paragraph that begins ‘on the one hand’, there is always an alternative point of view. In this case, it goes something like this: as Socrates warned us, if we don’t use a particular cognitive domain often enough, it will atrophy. One particularly vexing example is GPS, the ubiquitous navigation system that now populates cars, smartphones, and more. In a worrying set of studies, Veronique Bohbot and her colleagues at McGill have obtained preliminary data indicating that excessive use of a GPS unit may lead to atrophy of the hippocampus, an area of the brain critically involved in both spatial navigation and short-term memory. The inverse of Bohbot’s observations are the well-documented observation that London taxicab drivers who learn “over four years, the complex layout of London’s streets while training to become licensed taxi drivers. In those who qualified, acquisition of an internal spatial representation of London was associated with a selective increase in gray matter (GM) volume in their posterior hippocampi and concomitant changes to their memory profile.”

In many ways, the discussion reprises one facet of the debate over cognitive enhancement, in particular the admonishment regarding the inauthenticity of the achievements one obtains using artificial means. The Calvinist intuition that there is something inherently wrong about getting help to achieve one’s goals may be correct for reasons that were opaque to the Puritans: it is not so much that the effort inherent in character building exorcises our brains as much as it exercises them.

Use it or lose it.

Image credit: Kyle Pitt

One of the least gruesome of the proposed images for cigarette packs.

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. Here, then, are three loosely-connected points along those lines.

The crux of the issue is decisional autonomy. Indeed, our conversation ultimately connected up with some broader philosophical work on autonomy and addiction, particularly as embodied in this 2006 paper by Neil Levy. The gist of Levy’s perspective is that we would be mistaken to conceive of an addicted person as fully autonomous, but equally mistaken to conceive of such a person as entirely lacking autonomy. Because of the way addiction works on a temporal scale (frequently resistible in particular instances, yet incredibly difficult to hold out against over long periods of time), we can best understand addiction as an impairment of autonomy. Nicotine addiction is no exception. This understanding alters the topography of the issue in a few ways. For one thing, it challenges the familiar libertarian perspective that people’s decisions about cigarette use (like anything else) will be Homo economicus-esque. In doing so, it also serves to make the grounding for a regulatory intervention of this sort narrower: one can resist slippery-slope arguments about government regulation of speech by pointing out that the marketing of such starkly autonomy-impairing products constitutes a special case.

However, understanding nicotine addiction in terms of autonomy impairment is not, by itself, a sufficiently nuanced approach. We need to dig a little deeper, because there are – of course – different kinds of addicts, on whom these labels will work in different ways. A particularly handy framework for thinking about this can be found in Harry Frankfurt’s classic 1971 paper, Freedom of the Will and the Concept of a Person. In the paper, Frankfurt identifies two kinds of desires people have: first-order desires, which are desires for certain things or outcomes (e.g. food or sex, but also desires to avoid bad things like trouble with the law or interpersonal strife), and second-order desires, which are a person’s desires about which one of their first-order desires will win out and manifest as behaviour.  Specifically for our purposes, Frankfurt parses addicted persons into three groups, based on their second-order desires (and second-order volitions, but that level of detail must be glossed over here): unwilling addicts keep using a drug despite wishing that their motivations to quit would win out against their addiction, willing addicts identify more with their desire for the drug than their desire to avoid the consequences of its use, and wanton addicts have conflicting first-order desires but are simply not invested in one or the other winning out. In considering how graphic warning labels might be received in the minds of cigarette consumers, we feel it would be helpful to begin by thinking in terms of Frankfurt’s categorizations. I will only raise, rather than attempt to answer here, the question of how each group might be differently affected.

Finally, an important consideration here lies in discerning what, exactly, makes a particular intervention a shove as opposed to a nudge. There are (at least) two strategies for drawing the conceptual line here. One is in terms of sheer efficacy: how swift a kick in the amygdala can a warning label deliver before it can reasonably be said to swamp all capacity for resistance? And how can we tell from population-level data about the efficacy of such labels what proportion of consumers are being nudged rather than shoved? (That much is probably impossible, at least not without some innovative research methods.) The other approach focuses on how nudges / shoves interact with a person’s first- and second-order desires. It seems at least plausible to argue that nudges remain nudges when they merely augment or undercut the strength of a given first-order desire. When second-order desires are impacted by the intervention, then it becomes something decidedly more coercive – or so the idea goes.

On balance, our group concluded that the graphic warnings constitute more of a nudge than a shove, albeit a stronger nudge than the bland textual warnings from the Surgeon General that accompany cigarettes in the US today. This is not a conclusion we will attempt to establish by argument here, as that task is beyond the scope of a blog post. One piece of preliminary evidence that the labels do not rise to the level of a shove is the example of our own beloved Canada, where graphic warnings are already in use: a sizable percentage of the Canadian population continue to smoke. At the same time, graphic warning labels seem to be effective; otherwise the tobacco companies would not be up in arms about their sale. In our discussions, we settled quite comfortably on the idea that this kind of nudge, engaging as it does with our emotions, is entirely appropriate as a means to help individuals overcome the autonomy-impairing effects of addiction and achieve greater clarity on the question of whether it is worthwhile to them to continue smoking in full appreciation of its often-grisly consequences.

There are several statements in the article that will raise hackles in the neuroethics community, but that is the norm in the course of these discussions. With all due respect to my Oxford colleagues, I found the following comment to be troublesome:

The current consensus is that TDCS is likely to prove most effective when coupled with appropriate behavioural training. If this is true, it reduces a common objection to cognitive enhancements: the objection that artificially induced capacities do not belong authentically to the person.

This claim hinges upon an implicit assertion: that the authenticity objection for other cognitive enhancements is based upon the fact that they require either no training or less training than TDCS. Pharmacological cognitive enhancers, to the extent that they work, do not impart knowledge, but rather enhance existing cognitive function. With the exclusion of such extended mind enhancements as computers (or even encyclopedias printed on paper!!), any enhancement, in use today or on the horizon for tomorrow, acts by altering the ability of brain to carry out extant computations. It is only in fantasy stories such as the one spun in Limitless that enhancement confers abilities without training. As such, all enhancements seem to require active engagement in a manner that is not drastically different than that involved in TDCS-based enhancement. Thus, in my view, TDCS does nothing to change the authenticity argument.

Of course, none of this is to say that the authenticity argument is an airtight objection against cognitive enhancement: it is not. But stating that TDCS reduces concerns regarding authenticity as a declarative sentence (and repeating it in interviews with the press) seems to me to over-reach a bit.

Today the Nuffield Council on Bioethics launches its consultation on novel neurotechnologies that intervene in the brain as part of its inquiry into the issues raised by these technologies.

The Nuffield Council on Bioethics is an independent body based in the UK that examines the ethical, social and legal issues raised by new developments in biological and medical research, and recently it has established a Working Party to consider the issues raised by novel neurotechnologies that intervene in the brain, such as neurostimulation, brain–computer interfaces and neural stem cell therapy. As you will be aware, these neurotechnologies are the focus of intense research for the development of new treatments for diseases such as dementia and conditions like severe brain injury. There is also significant ongoing research into the development of non-medical applications like computer gaming and human enhancement.

The Nuffield Council on Bioethics would very much like to hear your thoughts on these neurotechnologies. The consultation can be found here and the deadline for responses is 23 April 2012, 5pm. All responses will be considered and a report will be published during autumn 2013.

Applicants for these competitive fellowships must hold an MD and/or PhD degree. Scholars selected for the Vancouver-based program will receive both travel support and a monthly stipend. Openings are currently available and applications will be reviewed upon receipt.

To apply, please submit a short statement describing your interest in the scholarship and proposed project, a cover letter and CV c/o Janice Matautia: matautia@mail.ubc.ca