The Competing Identities of Neuroethics

By Brad Segal

This past week week I attended the International Neuroethics Society’s (INS) annual conference in San Diego, California. Neuroethics is multidisciplinary field that grapples with the implications of neuroscience for—and from—medicine, law, philosophy, and the social sciences. One of the many excellent panels brought together scholars from each of these four disciplines to discuss the diverse approaches to the field. The panel featured; Paul Appelbaum, a Professor of Psychiatry at Columbia University; Tom Buller, Chair of philosophy at Illinois State University; Jennifer Chandler, Professor of law at the University of Ottawa, and; Ilina Singh, Professor of Neuroscience & Society at the University of Oxford.

The panel started by considering the importance of the “competing identities” present in the field of neuroethics. As moderator Eric Racine explained, right from the start, even the term ‘neuroethics’ suggests a tension. Consider the variety of research methodologies employed in the field. For instance, a scholar trained in philosophy might approach neuroscience from a conceptual and purely analytical basis, and yet a social scientist might research the same question by collecting empirical interview data. The interplay between empirical and theoretical work was a theme that defined the discussion.

A psychiatrist by training, Dr. Applebaum spoke on the medical approach to the field. He argued that a focus on ethical issues in clinical psychiatry and neurology should be viewed as a part (but only a part) of neuroethics. Furthermore, medicine’s empirical approach to neuroethics is one (but not the only) way to advance thinking on neuroethical issues.

To demonstrate this approach to neuroethics, Dr. Applebaum offered a two-staged example from his own work assessing a patient’s capacity to give informed consent. He explained the first stage of his work was to conceptualize decisional capacity. Here, he and colleagues identified four criteria that seemed central from a multidisciplinary perspective (in particular legal, ethical, and clinical approaches to capacity). These were; understanding, appreciation, reasoning, and evidencing a choice. The second stage was to operationalize the construct. Towards this end, he helped develop the MacCAT-T, a survey tool to reliably evaluate competence. “The existence of tools often drives the development of a field,” he said, as standardized tools like this allow for comparative studies (so far over 60 have been published). These provide a sense of the prevalence of incompetence, and is in the early stages of spurring work on the neurophysiological mechanism of incompetence in the brain.

Professor Chandler spoke on the approach to neuroethics in the law (‘neurolaw’). She laid out three broad divisions of scholarship within neurolaw. First, there is the neuroscience of the law. This includes technologies like detecting and predicting mental states such as pain, can has implications for legal concepts or categories (e.g. disability), and for how we make legal decisions (e.g. understanding bias). The second division is the law of neuroscience. Example might include legal recognition of brain injury, or legal response to the use of a brain intervention. She calls the third division one of cross-cutting introspective legal issues. This includes problems such as how one might introduce neuroscientific evidence to legal proceedings, or when neuroscience triggers professional obligations of judges or lawyers to apply new insights.

Professor Buller discussed the speculative nature of neuroethics from a philosophical viewpoint. He started by comparing the Brain 2025 initiative to the Apollo space program. “We’re looking at something that would have utterly profound implications.” He argued that there are two general forms of speculative neuroethics. The first, internal speculation, is by far more common. This viewpoint grounded in our current ethical framework, accepted practices, and societal values. Frequently one will look at the ethical issues from a developing technology. For instance, one might apply our moral principles to cognitive enhancement, or neuroimaging. Professor Buller called this a, “static moral framework.” On the contrary, the second type, external speculation, considers the implications of neuroscience from outside our broad-based normative frameworks. This need not hold morality or societal values as a given. “The level of speculation we might be involved in could be extraordinarily bold.”

The last panelist, Professor Singh, presented a pragmatic and empirical approach to neuroethics. She defined pragmatism as a “protest” against the, “idea that knowledge can be grounded in a priori methods of inquiry (such as appeal to abstract duties, obligations, etc).” One might, however, employ a variety of methods from the social sciences to inform neuroethics. “Moral truth is not absolute, but we can approach asymptotically, if you will.” Professor Singh likened the pragmatic approach to the scientific method—one expresses a moral thought in the form of hypotheses, and then one subjects these hypotheses to empirical investigation. The nature of this work might include structured interviews, validated surveys, census data, or other tools from the social sciences.

Listening to the panelists, I was struck by both the similarities and differences in each approach to the field. For instance, Professor Singh’s empirical rigor in approaching issues in neuroethics was, on the surface, highly analogous to Dr. Applebaum’s use of the MacCAT-T to assess capacity among his patients. But while Dr. Applebaum’s goal was—in a medical context—to reliably assess patients for an ethically-important entity, the pragmatic approach might instead be aimed at disproving the entity’s underlying normative presumptions. Nonetheless, disparate fields seem to benefit from the varying ends of each approach. Scholars in neurolaw, for example, gain from the MacCAT-T an application of neuroscience in the law with given its reliable assessment of capacity. Or one can imagine how the tool might be used to ground the proper direction and scope of speculative efforts.

One of the key themes to arise in the discussion was that each approach brings its own limitations to the field. Professor Chandler, for instance, emphasized two central notes of caution in neurolaw. First, reductionism tempts one to characterize everything at the descriptive level of the brain, but instead, we must look beyond the brain to the environment to understanding and prevent criminal behavior. Second, neurolaw can encourage essentialism (where people are presumed to have some immutable essence as result of their neurobiology). However, the threat of this in the setting of criminal rehabilitation, this improperly sends the message that defendants are broken or mad, which can become a self-fulfilling prophecy without adequate prudence. Professor Buller highlighted how conceptual “internal” speculation—e.g. looking at how we might use cognitive enhancement—presupposes that such advances will not alter society’s ethical norms. Thirdly, Professor Singh emphasized a limitation to empirical work in the field. She highlighted that her approach requires rigor in one’s methodology. “I think this is something we don’t talk about enough in neuroethics,” she says. Instead, she urged scholars to be more cognizant of the epistemic limits of their particular methodologic approach.

Dr. Applebaum suggested a few conclusions to draw from the medical/empirical approach neuroethics, but his remarks tapped into something more general. First, he concluded that ethical problems raised in the practice of clinical psychiatry and neurology are a legitimate focus of neuroethical inquiry. I would claim that the same is true for the law, social sciences, and traditional philosophy as well. Second, empirical approaches depend on—and can help to advance—conceptual clarity. My intuition is that, again, these conclusions are true for other non-speculative approaches to neuroethics as well—and perhaps is also true in the field of bioethics more broadly.

Interestingly, Dr. Applebaum sees the empirical and theoretical work as going hand-in-hand. He noted that, “Better concepts lead to better data, and better data lead to better concepts.” Lacking from the discussion was limitations to speculative work on the value of our current ethical views. Better delineated, however, was prudence in one’s empirical approach towards ethical advancement.  I feel that here, Professor Singh urged well-needed prudence for such work. She advised, “The ethics has to be close to the science, which means people have to understand the science.”

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