Neuroethics

Three examples illustrate the medical, ethical, legal and social importance of neuroethics.  When I was a clinical ethicist in a Montreal hospital, a person with schizophrenia admitted himself because of headaches.  The doctors wanted to do a CT scan of his brain to determine whether he had an aneurysm.  But he refused, only to agree, and then refuse again.  The question was whether he had the mental capacity to give informed consent and the autonomy to refuse the procedure.  His admission was voluntary and autonomous.  The patient’s capacity seemed to wax and wane.  Based on a series of questions and their responses, it was determined that the patient had capacity and agreed to have the scan, which showed a small, low-risk aneurysm.  The recommendation was to monitor it without any surgery.  If the patient had refused and was deemed competent, then the doctors would have been obligated to respect his decision.  This case shows how the ethics of neuroscience (to benefit and not harm patients) overlaps with the neuroscience of ethics ( the capacity to make informed decisions that affect ourselves and others). 

In another case, a healthy volunteer in the control group of a study about a neurological disease was told that he had an abnormality in a particular region of his brain. These are incidental fundings which may warrant referral to neurologist or neurosurgeon for further assessment. This information was accessed without authorization from the patient or their physicians by third parties.  It resulted in his being denied medical insurance based on a false assumption about the risk of developing a neurological disease from the incidental finding.  In addition to underscoring the need to protect information about the brains of patients and research subjects, this case underscored the need for physicians and researchers to inform patients and subjects of the potential for incidental findings before they participate in research studying the brain.

A third case shows how deep brain stimulation can benefit patients with Parkinson’s disease by restoring motor function and identity impaired and disrupted by the disease.  It can restore some degree of the life they had before disease onset and re-establish their identity. Commenting on their experience with deep brain stimulation, they said:

I am standing still and walking normally.  I still have Parkinson’s. Symptoms may return   . . .  But for now, and possibly years to come, I get this sweet return to some of what I was. Who I was...

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