Neuroethics:The Repercussions of Neuroimaging

By Greg O’Keefe

Overview

Introduction to Neuroethics

Involved Technology

Ethical Considerations Law, Discrimination/Stigma, Incidental

Findings, Neuromarketing

Summary and Conclusion

Introduction to Neuroethics Emerging field

Introduction to Neuroethics Advanced understanding and

monitoring of human thought and behavior

Brings new ethical, social and legal issues forward

Enabled by modern neurotechnologies

Introduction to Neuroethics Can now quantify personal behaviors

Social attitude, value and moral agency

Akin to modern genetics Prediction of disease, privacy, identity

Must carefully and properly interpret relationship between brain findings and concept of self

Introduction to Neuroethics Must tackle practical questions in

neuroimaging Interpretation is fundamental

Ethics of genetics are not a sufficient guide

Not apart of traditional bioethical analysis

Introduction to NeuroethicsA Scary Trend

Introduction to Neuroethics The Good, the Bad and the Anterior

Cingulate (2002) Morals and the Human Brain: A Working

Model (2003) Strategizing the Human Brain (2003) The Medial Frontal Cortex and the Rapid

Processing of Monetary Gains and Losses (2002)

The Neural Basis of Economic Decision-Making in the Ultimatum Game (2003)

Introduction to Neuroethics How the Mind Reads other Minds

(2003) Tapping the Mind (2003) Why We’re So Nice: We’re Wired to

Cooperate (2002) There’s a Sucker Born in Every

Medial Prefrontal Cortex (2003)

Introduction to Neuroethics “Thought maps”

Quantitative profiles of brain function

“Thought maps” Not restricted to medical research and

clinical neuropsychiatry Natural relevance in our daily life

Introduction to Neuroethics Introduces many possibilities/desires

Assessing truth of statements and memory in law

Profiling prospective employees for professional and interpersonal skills

Evaluating students for learning potential

Selecting investment managers to handle financial portfolios

Choosing life partners based on compatible brain profiles

Introduction to Neuroethics Raises a number of epistemological issues

The study of knowledge What is knowledge, how can it be accessed, how

can it be used? Proper interpretation

Scientific level Complexity of neuroscience research – integration

and interpretation of neuroimaging data Social and cultural level

Social interpretations, bound by cultural and anthropological frameworks

Involved Technology

Most prominent tools: Electroencephalography (EEG) Magnetoencephalography (MEG) Positron emission tomography (PET) Single photon emission computed

tomography (SPECT) Functional Magnetic Resonance Imaging

(fMRI)

Involved Technology

1929, Hans Berger Invented electroencephalogram Relative signal strength and position of

electrical activity generated at level of cerebral cortex

Measured using electrodes placed on scalp

Evoked EEG response, “event related potential”

First tool used to reveal fundamental knowledge behind the operation of the human brain in real time

Involved Technology

Other imaging methods took advantage of brain signals Extracranial electromagnetic activity

(MEG) Metabolic activity and blood flow (PET

SPECT) Regional blood oxygenation (fMRI)

All imaging methods use comparison/subtraction between two controlled conditions

Involved Technology

All imaging methods use heavy statistical processing and computer intensive data reconstruction

Ultimately produce the familiar and colorful maps

Used for diagnosis/interventionof trauma, dementia, stroke, etc.

Involved Technology

fMRIs will have greatest impact Widespread availability of MR scanners Imaging approach is non-invasive Model for neuroethical discussions Relative difference between

experimental and control (baseline) task Surplus of oxygenated blood recruited to

relatively active brain regions produces effects measured by MR

Involved Technology fMRI used alone or in combo with previously

mentioned techniques in studies Lying and deception Human cooperation and competition Brain differences in violent people Genetic influences Variability in patterns of brain development

Investigation of unio mysticia using EEG, fMRI, and PET “Spiritual neuroscience”

Continuing on…

Personal neuroprofiles ripe for bioethical consideration

Neuroscience and philosophical questions Existence limits Meaning of free will Distinguishing truth from lies, false

memories from real ones Prediction of behavior

Ethical Considerations

Ethical Considerations - Law 1985 –Ake v. Oklahoma

Glen Burton Ake murdered a couple, wounded their two children

Acted bizarrely in court, prompted judge to order psychiatric competency evaluation

Report resulted in identifying Ake as delusional▪ Claimed to be ‘Sword of Vengeance’ and will sit at the

left hand of God in heaven Diagnosed as probable paranoid schizophrenic▪ Is he competent to stand trial?

Ethical Considerations- Law Ake’s attorney requested the court

appoint a psychiatrist to evaluate him for purpose of insanity defense Criminal defendants argue this should

include scans like PET and MRI

What do you guys think? Does Ake get evaluated?

Ethical Considerations - Law The court says, nope!

Upheld that he had no such right to assistance

Ake was then tried Convicted of 2 counts of murder Sentenced to death

Ethical Considerations - Law Conviction overturned!

Ake was not provided a psychiatrist Deemed unfair trial

Found guilty again, this time just life in prison

Ethical Considerations - Law Should neuroimaging be used regardless

of offences? Do they ‘deserve’ it? Burden of the state? Unfair advantage?

Keep in mind: PET previously has shown poor functioning in prefrontal cortex of criminals Locus of impulse control

Ethical Considerations - Law PET images have been used to argue

that defendant was biologically predisposed to committing a crime

Further argued they should be spared conviction or death sentence

Ethical Considerations - Law 1994 – People v. Jones

Homicide conviction overturned State failed to provide brain scans

1992 – People v. Weinstein Accused of strangling his wife to death,

throwing her body from 12th floor PET, MRI showed arachnoid cyst, used

for insanity defense

Ethical Considerations - Law 1992 – People v. Weinstein

PET scan showed juxtaposition between black cyst and red/green colored “normal” areas

Juxtaposition was apparently “profound”, apparent his brain was not functioning normally

Convicted of manslaughter

Thoughts?

Ethical Considerations - Law 2001 – Langleben et al.

fMRI study Approach to truth verification, “brain fingerprinting” Participants with/without playing cards Boils down to “lying takes more energy” Results consistent with studies done in 1997 and

2003 Can also determine if deception is premeditated

Thoughts? Is brain fingerprinting legitimate? Should it be used in court?

Ethical Considerations - Law Brain fingerprinting

Terry Harrington, convicted of murder of retired police officer in 1977▪ Underwent brain fingerprinting in 2000▪ EEG patterns suggested he was innocent▪ Original prosecution witness recanted

statement when presented with this evidence

Ethical Considerations – Discrimination/Stigma

Ethical Considerations – Discrimination/Stigma Health information is not entirely

private

This can lead to denial of Health insurance Employment Education Financial loans

Ethical Considerations – Discrimination/Stigma Neuroimaging provides insights into

range of higher cognitive functions Many do not have good animal models Studies touch on areas of profound societal

importance and controversy

Race relations, economic justice, perceived trustworthiness, moral reasoning, economic cooperation, social rejection, consumer brand attachment

Ethical Considerations – Discrimination/Stigma Ability to predict behavior raises

many concerns Mind-reading Social control

Novelty and extent of neuroimaging data gives info on human health, behavior and cognitive fitness Raises concern

Ethical Considerations – Discrimination/Stigma How much of this info will be used to

benefit mankind?

Can the info be used for harm or purposes with ill-intent?

How will neuroimaging affect our daily life? Work, education, financial, social

interactions

Ethical Considerations – Discrimination/Stigma Prediction of future

behavior/pathology

Screening for team players and weak decision-makers in the workplace?

Post-Columbine era Screening students for predisposition to

unruly or violent behavior?

Ethical Considerations – Discrimination/Stigma Post 9/11 era

Screening for terrorists? Perhaps a brain scan at the airport?

Detention of individuals who have not yet committed a crime DSPD – Dangerous Severe Personality Disorder Type I and II errors – statistical threshold Cost vs. detaining past sentence (which can

be legal)

Ethical Considerations – Discrimination/Stigma Pedophiles

January 22nd, 2002 – US Supreme Court states:▪ Can confine violent sexual offenders beyond their

prison term▪ Only if shown they have mental/personality disorder

making it difficult to control behavior

Very likely future imaging studies will be used to determine felon’s ability to control behavior More effective than behavioral test

Ethical Considerations – Discrimination/Stigma So, back to pedophiles!

Megan’s Law Information on sex offenders available to public

What if brain scans can be used to identify potential pedophiles among non-criminal persons Who should scan? How should the data be used?

Should identified persons be registered? Should it be made available to employers?

Ethical Considerations- Incidental Findings

Ethical Considerations- Incidental Findings Incidental findings

“Observations of potential clinical significance and unexpectedly discovered and unrelated to the purpose of variables of the study”

Found in up to 10% of neuroimaging research

How should they be handled? In what way? What should be done? Abide by legal and ethical principles in

research/medicine

Ethical Considerations- Incidental Findings Risks

Emotional burden, possible unnecessary procedures

Benefits Early detection of something that can be

treated/prevented

How about opportunity to waive right to receive info on incidental findings?

Ethical Considerations- Incidental Findings Case Study!

FE is 65 yo female fMRI volunteer Study is for osteoarthritic knee pain Found to have ischemic changes in left

temporal lobe during brain scan She had no neurological deficit, did not

complain of discomfort

What would you do?

Ethical Considerations- Incidental Findings What actually happened

PI was clinician, decided to disclose findings With her permission contacted physician for follow up

FE developed neurological deficits 24 hours later, underwent repeat neuroimaging and treatment

Diagnosis of ischemic temporal lobe Survived after treatment

Ethical Considerations- Incidental Findings Afterwards, PI and team felt

distressed and unequipped in dealing with incidental findings Wished for clear documentation of

whether patient wanted to be informed Addressed lack of standard guidelines,

protocol, training, knowledge regarding legal and ethical principles

Ethical Considerations- Incidental Findings Canada – all known foreseeable risks (even

rare and remote) must be disclosed to research participants or surrogate decision-maker Guided by Halushka v. University of Saskatchewan

and Weiss v. Solomon No mention of whether foreseeable incidental

findings should be regarded as potential risks/harms No clear guidelines as to when and what to disclose

in best interests of the patient

Thoughts?

Ethical Considerations - Neuromarketing

Ethical Considerations - Neuromarketing Goal of marketing is to match

products with people Guide design and presentation of

products to increase compatibility with consumers

Facilitating choice process of customer

Neuroeconomics – incorporating neuroimaging into decision-making sciences

Ethical Considerations - Neuromarketing Hope among marketers

neuroimaging will streamline marketing processes while saving money

Obtain customer information that cannot be acquired using conventional methods

Some companies market neuromarketing itself

Ethical Considerations - Neuromarketing More accurately indicate underlying

preferences than standard market data Remains insensitive to biases

Efficiently allocate resources Product concepts tested rapidly Unpromising concepts eliminated early Can now focus on promising products

Ethical Considerations - Neuromarketing Banned in France

Eye-tracking, galvanic skin response still legal

Misinterpretation and over-interpretation an issue

Video: http://www.youtube.com/watch?v=Ajg0ypDD7i0

Ethical Considerations - Neuromarketing Unsettling? Creepy?

Is it ethical? Need to respect autonomy,

confidentiality, privacy Informed consent? Full disclosure of risk

or harm▪ How invasive are the procedures?

What exactly can the data be used for?

Ethical Considerations - Neuromarketing Protecting the vulnerable

Children, psychiatric patients, prisoners Can be easily influenced▪ Easily deceived and/or experience negative

affected

Commercial use of data from these groups Is it justified? Can it be defended?

Ethical Considerations - Neuromarketing Baylor College of Medicine

Pepsi vs. Coca-Cola fMRI showed consumers prefer Pepsi▪ 5x the response in ventral putamen

When repeated unblind…▪ Nearly all participants prefer Coca-Cola▪ Medial prefrontal cortex was activated –

linked to sense of self▪ Brand is so attractive its overriding our taste

buds?

Ethical Considerations - Neuromarketing Are you comfortable with

neuromarketing? Should lines be drawn? Where? What can the information be used for? Do the risks outweigh the benefits? Do we care that much about finding

products that suit us?

Summary Neuroethics is still young

Many unaddressed situations Neuroscience “boomed” in early 21st century

Utilizes neuroimaging EEG, MEG, PET, SPECT, fMRI

Massive impact on bioethics Law, Discrimination/Stigma, Incidental findings,

Neureconomics/Neuromarketing, etc.

Summary

However, brain imaging is extremely useful Understanding how our brain functions,

diagnosis of disease, detecting abnormalities

Interpretation is the key issue Scientific and social level

Should lines be drawn? Where do we draw the line?

References Illes, J., & Racine, E. (2005). Imaging or Imagining? A

Neuroethics Challenge Informed by Genetics. The American Journal of Bioethics : AJOB, 5(2), 5–18. doi:10.1080/15265160590923358

Illes, J., & Bird, S. (2006, July 21). Neuroethics: A modern context for ethics in neuroscience. Retrieved February 12, 2015, from http://neuroethics.stanford.edu/documents/TINSarticle.pdf

Scanning the social brain. (n.d.). Retrieved February 12, 2015, from http://www.nature.com/neuro/journal/v6/n12/full/nn1203-1239.html

Canli, T., & Amin, Z. (2002, December 3). Neuroimaging of emotion and personality: Scientific evidence and ethical considerations. Retrieved February 12, 2015, from http://www.sciencedirect.com.ezpxy.fanshawec.ca/science/article/pii/S0278262602005171

References Lawrence Leung, “Incidental Findings in Neuroimaging:

Ethical and Medicolegal Considerations,”Neuroscience Journal, vol. 2013, Article ID 439145, 7 pages, 2013. doi:10.1155/2013/439145

Ariely, D., & Berns, G. S. (2010). Neuromarketing: the hope and hype of neuroimaging in business. Nature Reviews. Neuroscience, 11(4), 284–292. doi:10.1038/nrn2795

Yesim Isil Ulman, Tuna Cakar & Gokcen Yildiz, Ethical Issues in Neuromarketing: “I Consume, Therefore I am!”, Science and Engineering Ethics, ISSN 1353-3452, Sci Eng Ethics, DOI 10.1007/s11948-014-9581-5