Dr. Adrian Carter to Speak on Addiction Neuroethics | UBC Nov. 9, 2010

The National Core for Neuroethics at the University of British Columbia is proud to present Dr. Adrian Carter, NHMRC Postdoctoral Fellow from the University of Queensland, for a talk entitled, “Should We Trial Deep Brain Stimulation for Addiction? The Case for Caution” on Tuesday, November 9th, 2010 at 11:00am. The talk will take place in the University’s Brain Research Centre Conference Room. All are welcome. Please see below.

NEUROETHICS SEMINAR SERIES 2010-2011

Should We Trial Deep Brain Stimulation for Addiction? The Case for Caution.

Adrian Carter, PhD
NHMRC Postdoctoral Fellow
The University of Queensland

Tuesday, November 9th, 2010
11:00am – 12:00pm

The UBC Brain Research Centre Conference Room
2211 Wesbrook Mall | UBC Hospital | Koerner Pavilion
Vancouver, British Columbia, Canada

Abstract: Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. dbs is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. I will review preclinical and clinical evidence for the use of DBS to treat addiction to determine whether its use is currently warranted, making the case for caution. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a “cure” of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, I will examine the minimum ethical requirements for conducting such a trial.

About the speaker: Dr. Carter is an NHMRC Postdoctoral Fellow in Public Health at UQ. He is particularly interested in the impact that neuroscience has upon notions of autonomy and responsibility in addiction, the use of coercion and the capacity to consent in addiction treatment, as well as the use of novel neurological technologies to treat, and possibly, prevent addiction. Dr. Carter has published numerous articles on these issues, as well as reports for the who, the European Monitoring Centre for Drugs and Drug Addiction, and the Australian Ministerial Council on Drugs Strategy.

National Core for Neuroethics

UBC Brain Research Centre

Dr. Carter’s academic bio

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Disability by Design?

What is meant by ‘disability’ is subject for considerable debate, as little agreement exists on how the concept ought to be defined. Moral intuitions about disability in ‘ableist’ societies suggest that having a disability is something undesirable, as being disabled significantly reduces the individual’s quality of life* and social opportunities (Note: I am not aware, at this time, of experimental research which has explored the moral intuitions regarding disability. Perhaps an interesting area of exploration for the X-Phi folk…).

Progress in reproductive genetic biotechnology, such as preimplantation genetic diagnosis (PGD), has made it possible for prospective parents to select against particular genetic traits causing disability or disease in the offspring. For example, a parent who is a carrier of dominant mutations on HTT – the Huntington’s gene – and does not want to pass down an affected gene to his or her progeny can use PGD in tandem with other approaches such as in-vitro fertilization (IVF) to increase the likelihood that unaffected embryos are the only embryos implanted back into the woman’s uterus. Potential use of the biotechnology to intentionally select against ‘negative’ traits (such as future disability) or select for ‘positive’ non-medical traits (e.g., gender, eye or hair colour, height, intelligence), has caused outcry from slippery-slope skeptics concerning  fears over “designer babies” and “the new eugenics.” Although these arguments are worthy of reflection and consideration, I won’t attend to them in this post.

Unintended Consequences of Neuroscientific Explanations

René Magritte, Les Amants (1928)

In Madness and Civilization, French philosopher and activist Michel Foucault wrote that, “from the fifteenth century on, the face of madness has haunted the imagination of Western man.” Foucault argues that the concept of ‘madness’, at least in the 1800s, was characterized as a loss of ‘reason’ – the essential mental faculty which made human beings distinct from other animals. Those who lacked reason (which all rational beings possessed) were perceived as a threat to humanity. Eventually barriers were raised – both literally and figuratively – which separated these ‘irrational’ individuals from the rest of humanity.

Such stigmatizing and social-distancing attitudes towards those living with mental illness are still deeply enmeshed in the social and cultural norms of many industrialized nations. In the 1960s, sociologist Erving Goffman spoke of stigma as a “spoiled identity;” more closer to us Bruce Link and Jo Phelan conceptualize stigma as occurring when “elements of labeling, stereotyping, separation, status loss, and discrimination occur in a power situation that allows them.” A related concept, social distance, is defined as the degree of proximity an individual is comfortable with in relation to an individual who is living with mental illness, particularly as it relates to the perceived dangerousness or unpredictability of that individual. Prevailing views amongst the public see the behaviour of individuals living with mental illness as volitional; at times these individuals might be considered ‘lazy’ (in the case of major depression and the ethical values tied to participation in the workforce), and so, intuitions about mental illness are believed to be justified blaming these individuals, or perhaps even punishing them.

Conference Announcement: Brain Matters II

Just received the following announcement from Dr. Barbara Russell, bioethicist at Toronto’s Centre for Addiction and Mental Health, and coordinator of the Canadian Bioethics Society Neuroethics Interest group.  It has just been announced that the Brain Matters neuroethics conference will be held in Montreal in the spring of 2011. The theme of Brain Matters II appears to have a clinical ethics focus. The first Brain Matters conference occurred September 2009 in Halifax, Nova Scotia and was a great success. Looking forward to the call for abstracts and seeing who the organizers secure for the plenaries.

INTERNATIONAL NEUROETHICS CONFERENCE

BRAIN MATTERS II: Ethics in the Translation of Neuroscience Research to Psychiatric and Neurological Care

Montreal, Quebec, Canada

May 26-27 2011

Call for abstracts forthcoming. For more information, please contact: neuroethics@ircm.qc.ca

Links

Peter Reiner and I wrote a post on our reflections of the first Brain Matters conference: Brain Matters

Brain Matters: New Directions in Neuroethics from Dalhousie’s Novel Tech Ethics website.

IRCM Neuroethics Research Unit

Objectivity in Science

I recently had the good fortune to attend the Objectivity in Science conference, this past June 17 -20, 2010 at the University of British Columbia. The question that attendees set to examine was, what is objectivity and why does it matter? The conference was part of a SSHRC-funded network called Situating Science: Science in Human Contexts which aims to connect those “engaged in the humanist and social studies of science examining the sciences in situ“. Major universities across the country have held their own Situating Science events in the past year, all relating to science and technology studies or the history of the philosophy of science.

While there were many sessions to report on — in particular plenaries by Ian Hacking and Peter Galison which I found to be quite intriguing and inspiring — I’ll speak to the first two papers (apologies to Moira Howes) delivered in Session VI: Objectivity: Norms & Trust. On the whole, these papers were speaking to the facts and values which underlie science communication to the public.

Day 3: Better belated than never.

Although the conference came to a close on Saturday afternoon, there were several sessions we didn’t report on, which included summaries of Joanne Reimer’s talk from Friday and the closing panel presentation on Saturday. Below you can find Joanne’s summary of both her presentation, and the final panel:

Spinal Cord Injury and the Clinical Translation of Stem Cells:  Stakeholder Perspectives – Joanne Reimer, National Core for Neuroethics, UBC

On Friday, June 11, I had the opportunity to present on our research study on stakeholder perspectives regarding the clincal translation of stem cell therapy for spinal cord injury.  The presentation enabled a discussion about how primary stakeholders – people living with spinal cord injury and various health care providers – balance risks and benefits of potential stem cell therapy and how their perspectives may not align with scientific targets for clinical trials. This prompted discussion about  how primary stakeholders can inform science as science progresses to clinical trials.

Panel Presentation – “Responding to Voices”

On Saturday, June 12, the conference concluded with a Panel Presentation – Responding to Voices.  The four panelists (who’s names unfortunately escape us at the moment, and the names were not included in the program), all work for Interior Health (the regional health authority), and included a family nurse practioner, an aboriginal outreach worker, Chief, a nursing professional practice leader, and a family physician working in emergency and long term care.  The panelists offered their personal perspectives on care situations they were involved in and the ethical struggles they encountered.   Collectively, the participants’ case examples illustrated the systemic culture of “not hearing” on a personal, professional, and organizational level and the consequences of that on patients, families, and themselves as health care providers.  Their stories resonated with the audience who commended the panelists for sharing their vulnerability, humility and compassion.

Day 2: Humility in Research and Clinical Care

Day 2 of the conference got off to an early start, beginning with several special interest group meetings, followed by a full day of concurrent sessions, including two from our own group.

CBS Neuroethics Interest Group

This year the Neuroethics Interest group welcomed its new chair, Dr. Barbara Russell, bioethicist at the Centre for Addiction and Mental Health and member of the Joint Centre for Bioethics at the University of Toronto in Toronto, Ontario. The group spoke on the CBS Executive decision on the status of the Canadian Neuroethics Interest Group, governance of the group, and the development of a tab on the (currently under re-development) CBS website for the Group. Representatives from the three main neuroethics research groups in Canada gave updates on current happenings at their respective facilities. Syd Johnson reported from the Novel Tech Ethics at Dalhousie University; Lucie Wade reported from the Neuroethics Research cohort at the IRCM in Montreal; and I reviewed the current research activities of the Neuroethics group at the University of British Columbia. The whole interest group spoke to a need for a clinical neuroethics community to discuss cases that come up in front-line work. Those who were calling for case-based discussion were not only clinicians, but bioethicists as well. Next steps include plans for thinking about a special journal issue which includes a clinical neuroethics case, followed by invited follow-up.

Day 1: A Diversity of Voices

This conference has chosen the theme of “voices of communities” as its running conference narrative. Interestingly, on this first day of the conference we were hearing a diversity of voices from the bioethics community. In a given session, there might be a philosopher, a health care administrator, and an entrepreneur presenting one after another. And those in the audience responding to their “performances” (thanks Alistair Browne), may include physicians, academics, allied health professionals, and lawyers. Each discipline tends to have their own way of presenting their findings, which requires a certain flexibility on the part of the conference attendees to adjust their gaze towards the particular disciplinary styles.

Plenary Lecture: Voice of the Voiceless – Andrew Robinson, BC Representative for Children and Youth.

The Plenary on Day 2 of the Canadian Bioethics Society meeting was given by Andrew Robinson, the Associate Deputy Representative Advocacy, Community and Aboriginal Relations with the BC Representative for Children and Youth (RCY).  The mandate of the RCY is to support “children, youth and families who need help in dealing with the child welfare system and advocate for changes to the system itself”.  Robinson started his talk with the appalling statistic that BC leads Canada in child poverty rates and that his organization is involved in 4500 children’s lives – children whose lives are significantly affected by decisions made by the state for their care.  Aboriginal children are disproportionately affected – they make up 3% of the populuation but 50% of the children in care.  Robinson cited the UN Convention on the Rights of Children on which Canada is a signatory.  He asserted that it is a right for children to know “what’s going on in their life”.  Drawing from his work with children, he shared stories of what happens when children are listened to.  He spoke of one 7 year old girl who phoned their office and demanded to speak with the top person to ask “Can someone tell me why I can’t see my Mom?”  Her mother had been removed from her because of mental health issues that put the daughter at risk.  No one had explained to the little girl what was going on in her life.  In another case, an abused child kept telling social workers that it wasn’t his father abusing him, but his mother.  Based on the mother’s account the father was removed from the home.  Only when Robinson’s organization got involved was the child heard, and made safe.   Robinson feels that it is our obligation to listen to the voice of children and make sure it is heard. “Ethics”, Robinson says,  “is humanizing each other.”

Opening Night: CBS Kelowna

“Holding space for possibilities in a time of uncertainty” – Carole Robinson, on her definition of hope.

Carole Robinson, from UBC Okanagan, gave the plenary talk last night to open the conference. She approached end-of-life issues from a relational ethics perspective. In particular, she concentrated on emphasizing the need conversations with families around advanced care planning. Robinson’s take on relational ethics was inclusive of both individualistic perspectives on autonomy and decision-making, in addition to relational views which emphasize human relationships as being crucial. For example, Robinson advised shifting the question from “what do you want” to “if you can’t speak for yourself, how would you guide your family to speak for you”? This question would thus open up the ethical space for a larger conversation that enables dialogue around options for care. This may include, for example, what would a do not resuscitate order (DNR) look like, and how successful a DNR would likely be. Robinson reported that most conceptions of interventions such as DNR come from popular medical television dramas which sensationalize high success rates. Although much of Robinson’s presentation has been an important topic of discussion for many years, her plenary was a call to action for medical professionals to begin the advanced care planning conversation with their patients and families.

Today, Thursday June 10, we look forward to the plenary session on child and youth welfare, and concurrent sessions on clinical equipoise, the ‘hidden curriculum’ in post-graduate ethics training for psychiatry residents, end-of-life issues, and autonomy and decision-making in plastic surgery.

Blogging Canadian Bioethics: Kelowna 2010

The 21st Annual Canadian Bioethics Society Conference will be taking place this year in Kelowna, British Columbia from June 9th – 12th. The theme of this year’s conference is “Voices of Communities”.

Like last year, I will be blogging live from the conference. However this year I won’t go at it alone, as I’ve managed to coerce a few other UBC Neuroethics folk to contribute to conference blog posts. These include Joanne Reimer and Elana Brief, who both will be presenting papers. Joanne will be discussing her study, Spinal Cord Injury and the Clinical Translation of Stem Cells: Stakeholder Perspectives, June 11 at 10:30 am. Elana will be presenting Protecting or Silencing: The Benefits and Harms of Community Anonymity, the same afternoon at 2:00 pm. Check the official program for room designations. Research Coordinator Emily Borgelt will also post her reflections on sessions during the conference.

For those interested, the Canadian Neuroethics Interest Group will be held Friday, June 12th at 7:30 am in the Selkirk room. Yes. That is a.m. as in ante meridiem as in morning. Early morning. See you there!

Conference Webpage: http://en.cbskelowna2010.ca/

Image source: CBS Kelowna