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

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.

A modest proposal: introduce bioethical review into the drug approval process

There has been raucous furor over the decision of Kathleen Sibelius, the Secretary of Health and Human Services in the Obama administration, to overrule the FDA’s approval of the drug known as Plan B One-Step as an over-the-counter drug. It has never previously transpired that the FDA has been overruled on a matter that falls under its jurisdiction such as this, and FDA Commissioner Margaret Hamburg issued a carefully worded response which, given that Sibelius is her boss, was remarkable for its forthrightness:

The High Price of Materialism

The Center for a New American Dream has just posted a great video by Tim Kasser entitled The High Price of Materialism.  In the video, Tim points out the myriad ways in which consumer culture degrades the quality of our lives. Worth noticing are the myriad neuroethical issues that he raises, from the effects of advertising upon our brains to the education that we provide to our children.

For a list of references on the subject, visit here

Neurosociety Conference: podcasts and more

The Institute for Science, Innovation and Society (InSIS) and the European Neuroscience and Society Network (ENSN) recently jointly organised an international conference at Oxford’s Saïd Business School on Neurosociety. The theme of the conference was the rise of the brain and the emergence of the brain industry or ‘neuro markets’. The aim was to explore how, why and in what ways the figure of the brain has come to permeate so many different areas of thinking and practice in academic and commercial life. What are the consequences for academia, business, commerce and policy?

They have now posted podcasts and slides for many of the talks here.

Speakers include:

• Kelly Joyce (College of William and Mary, Williamsburg, VA)
• Sabine Maasen (University of Basel)
• Patricia Pisters (University of Amsterdam)
• Nikolas Rose (London School of Economics and Political Science)
• Jonathan Rowson (Royal Society for the encouragement of Arts, Manufactures and Commerce (RSA)
• Steve Woolgar (InSIS, Said Business School, Oxford)
• Paul Wouters (Leiden University)

21st century enlightenment

Another great video from RSA-Animate.  Matthew Taylor, Chief Executive of the Royal Society for the for the Encouragement of Arts, Manufactures and Commerce (RSA) explores the meaning of  21st century enlightenment. There are many worthy ideas here, and given the way understanding of the brain is highlighted, I was naturally smitten.  My favourite line: “21st century enlightenment calls for us to see past simplistic and inadequate ideas of freedom, of justice, and of progress.” [2nd place: "The moral and political critique of individualism now has an evidence base." ]

Watch, and feel free to note your favourite (or most reviled) line in the comments.

Divergent Thinking

Ken Robinson on Changing Education Paradigms.

I won’t say much about it, except that it raises all kinds of issues about how the world that we live in, and in particular the educational system which engulfs us, is doing a bit of a disservice to us.  Manifest, of course, through our brains.

Watch and enjoy.

Techno-enthusiasts and techno-phobes

The December edition of the Atlantic Monthly has a very interesting article about Freeman Dyson’s famously skeptical view of climate change – he has come out forcefully suggesting that it is just not something we should worry about.  For those who don’t know, Dyson is a brilliant physicist who has spent much of his career at Princeton’s Institute for Advanced Studies, and has been both a practicing scientist as well as one who shares his insights on a regular basis with the general public – in 1996 winning the Lewis Thomas Prize for writing about science.  The author of the article, who has known Dyson for many years, ponders the question of how someone so brilliant could be in such profound disagreement with the rest of the scientific community?

The interesting part of the answer for me was this: that Dyson has an unfailing confidence in the redemptive power of technology.  I think that this attitude is at the heart of the many of the debates in neuroethics – are we enthusiastic about the potential advantages that a particular technological development (be it drug, device, or something else) may provide, or are we skeptical, referring again and again to the precautionary principle as our guiding light?

Kevin Kelly, founding executive editor of Wired magazine and hardly a technophobe writes,

“The idea of progress has been slowly dying. I think progress lost its allure at the ignition of the first atom bomb at the end of WWII. It has been losing luster since. Even more recently the future has become boring and unfashionable. No one wants to live in the future. The jet packs don’t work, and the Daily Me is full of spam. No one finds the Future attractive any longer.”

Prosocial enhancement

Over at The Atlantic website, they have a special section called The Ideas Report which is chock full of interesting thoughts about ‘the themes that shape our times’. Chris Good, a staff editor at the Atlantic.com recently posted a piece entitled, “Give Scientists Performance-Enhancing Drugs”.  The ideas in the article are, to put it delicately, a bit problematic. There are many issues that Chris raises which I disagree with, but I will limit my comments to a few choice items.

The essential message of the piece is that sometimes it might be good for society as a whole to have a subset of people take cognitive enhancers. Chris trots out the ‘unfair advantage’ argument, but then dismisses it with the following logic:

“But for scientists and researchers, particularly those working on medical advancements, things are different. They’re working for the public good. Fairness matters less. If one biochemist or physicist “cheats” to gain an edge over a rival research lab, university department, or grant competitor, it may be unethical, but we should be willing to forgive if it means one less day on earth with incurable cancer or massive emissions of carbon gas.”

This argument might stand as a nice little bit of consequentialist thinking, but for the naive notion that scientists are all working for the public good. It is true that many scientists do so (that is one reason why the public often holds them up as paragons of virtue), but it is hardly the case that arc of scientific progress is monolithic, or that every discovery leads inexorably towards a cure for cancer. But Chris is prepared to carry out an experiment, with scientists as the guinea pigs.  He concludes by suggesting:

Throw fairness out the window, and let’s see what happens.

I don’t even know what to say about that comment.

Does the Science of “Prosocial Behaviour” Smuggle in a Political Prior?

Over at Pharyngula, PZ Myers’ reliably lively ScienceBlogs province, a recent post offers some incisive treatment of a philosophically arresting debate between Sam Harris and sundry interlocutors, most prominently Sean Carroll. The topic – whether science can answer moral questions, or, more perilously rendered, whether one can, in fact, derive “ought” from “is” – exerts a tidal attraction upon my blogging muscles, but I can resist for now; Myers’ relevance to this entry issues specifically from a choice bit of phraseology in his write-up.

When Harris claims that the discernment of human well-being (and hence of utility-maximizing courses of action) is a purely empirical matter, Myers finds him guilty of “smuggling in an unscientific prior in his category of well-being.” What I want to explore after the jump is the following possibility:

It may be that the developing body of work in neuroscience and psychology probing various morally charged phenomena has been smuggling in a politically loaded prior under the terminologically neutral guise of the category “prosocial behaviour.”