- Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine; President, www.haciendapub.com, Macon, Georgia, USA
Miguel A. Faria
Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine; President, www.haciendapub.com, Macon, Georgia, USA
DOI:10.4103/2152-7806.142323Copyright: © 2014 Faria AM Jr. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?. Surg Neurol Int 07-Oct-2014;5:146
How to cite this URL: Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?. Surg Neurol Int 07-Oct-2014;5:146. Available from: http://sni.wpengine.com/surgicalint_articles/the-road-being-paved-to-neuroethics-a-path-leading-to-bioethics-or-to-neuroscience-medical-ethics/
In 2013, U.S. President Barack Obama decreed the creation of the Presidential Commission for the Study of Bioethical Issues, as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. In the wake of the work of this Commission, the purpose, goals, possible shortcomings, and even dangers are discussed, and the possible impact it may have upon neuroscience ethics (Neuroethics) both in clinical practice as well as scientific research. Concerns were expressed that government involvement in bioethics may have unforeseen and possibly dangerous repercussions to neuroscience in particular and to medicine in general. The author emphasizes that the lessons of history chronicle that wherever governments have sought to alter medical ethics and control medical care, the results have frequently been perverse and disastrous, as in the examples of the communist Soviet Union and National Socialist (Nazi) Germany. The Soviet psychiatrists’ and the Nazi doctors’ dark descent into ghastly experimentation and brutality was a product of convoluted ethics and physicians willingly cooperating with authoritarianism citing utilitarianism in the pursuit of the ‘collective’ or ‘greater good.’ Thus in the 20th century, as governments infringed on the medical profession, even the Liberal Democracies have not been immune to the corruption of ethics in science and medicine.
Keywords: Bioethics, medical ethics, morality, neuroethics, neuroscience, scientific research
In a recent interview, prompted by the launching of the Presidential Commission for the Study of Bioethical Issues by US President Barack Obama as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative last year [
But let us start at the beginning: What is neuroethics? Simply, it is the ethics of neuroscience, that is, what is right and what is wrong morally in the medical or technological manipulation of the human brain when practicing or conducting research in the fields of the neurosciences. Neuroethics deals with the legal, clinical, socioeconomic, technological, and moral impact that can be expected or predicted when modifying human behavior and the implications of “integrating neuroscientific knowledge with ethical and social thought.”[
New York Times columnist William Safire chaired a seminal conference on neuroethics in 2002 and cited Cicero for coining the Latin term moralis derived from the Greek ethicos, but opined that there was an overlapping distinction between the terms. I agree with Safire on that there is still a fine distinction between the two terms. “Morality,” stemming from conformity with religious standards, has to do with the (moral) absolutes of right and wrong. “Ethics,” on the other hand, implies “subtle,” more complex “questions of equity” and refers to good and bad. Since what is good is usually right and what is bad is usually wrong, the terms overlap and have thus become interchangeable in modern times.[
Returning now to President Obama's Bioethics Commission, another and even more momentous question was posed to me: “What do you think are the greatest dangers in modern neuroscience?” I responded that as with the fashionable term “bioethics,” I have some concerns that “neuroethics” may become a system of population-based ethics and is thereby potentially dangerous when applied to patients or human experimental subjects. The application of population-based bioethics is a dangerous path for neuroscience. Consequently, I continue to prefer the term “medical ethics” when dealing with patients and human subjects. Why? Because bioethics is (and potentially neuroethics may be) centered on utilitarianism, social engineering, and/or monetary considerations, rather than committed to placing the interest of individual patients or the safety of human experimental subjects first. I admit bioethics principles may be helpful when the ethics of Hippocrates are not applicable, as when dealing with laboratory animals in neuroscience or other medical research.[
Another consideration is that technology, in general, and neurotechnology, in particular, have outpaced both moral and ethical considerations, and many young medical scientists have not been properly introduced to medical ethics.[
Fortunately, many physicians, clinicians, and medical researchers adhere to the individual-based ethics of Hippocrates [
The State still has an important role, that is, to make sure the legal guidelines are complied with, that the guidelines and amendments set by physician-ethicists are followed by clinicians and experimenters, and that medical ethics are observed. But the State should not be propounding or directly involved with funding institutions, medical personnel, or managing programs in neuroethics.[
The understandable concern is that if the State became a third party payer in neuroethics programs, it would seek to guide it or even control it and, in the process, pervert medical ethics in the context of financial or political considerations. As I have stated elsewhere:
“Once the State enters the equation, it would, if history is any guide, tilt the balance, not on behalf of the individual patient's interest, but in its own budgetary or political interest. And so, were this process to go forward, the physicians must guard the interest of the patient (or human experimental subject) first, and the collective benefit to society, second. History forbids it otherwise.
“Participating physicians, surgeons, and researchers must be very careful and remember what has been written and restated elsewhere. Namely, the lessons of history sagaciously reveal wherever the government has sought to alter medical ethics and control medical care, the results have been as perverse as they have been disastrous. In the 20th century, both in the communist Soviet Union and in National Socialist (Nazi) Germany, medicine regressed after these authoritarian systems corrupted the ethics of the medical profession and forced it to descend to unprecedented barbarism. The Soviet psychiatrists’ and the Nazi doctors’ dark descent into ghastly experimentation and brutality was a product of physicians willingly cooperating with the totalitarian state, purportedly in the name of the ‘collective’ or ‘greater good,’ at the expense of their individual patients.”[
Recently, in an informal dialog on this topic and the inception of President Obama's Bioethics Commission, three members of the Editorial Board of Surgical Neurology International (SNI) agreed that neuroscience ethics – neuroethics – is a momentous issue in which neuroscientists and private physicians in the field worldwide cannot remain on the sidelines, while the government and its agents act [
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