Drs. Stahl and Tomlinson: “Is there a right not to know?”

Devan Stahl photoTom Tomlinson photoCenter Assistant Professor Dr. Devan Stahl and Center Director Dr. Tom Tomlinson are the co-authors of a new article in Nature Reviews Clinical Oncology, titled “Is there a right not to know?”

Published online on April 4, the article addresses whether a patient with advanced illness or incurable disease has a right not to “hear the bad news.” Drs. Stahl and Tomlinson write that this question “raises fundamental questions concerning patient autonomy and the duties of health-care professionals.”

The full text is available on the Nature Reviews Clinical Oncology website.

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Dr. Stahl published in ‘NanoEthics’

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl has a new book review published in NanoEthics, titled “Building Better Humans? Refocusing the Debate on Transhumanism.”

Building Better Humans? Refocusing the Debate on Transhumanism [Hava Tirosh-Samuelson and Kenneth L. Mossman (eds) 2012 (Peter Lang, Frankfurt) ISBN 9783631635131 520 pp.] is the third volume of the Peter Lang series Beyond Humanism: Trans- and Posthumanism.

The full text is available online ahead of print on the Springer website (MSU Library or other institutional access may be required to view this article).

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Can brain scans spot criminal intent?

This post is a part of our Bioethics in the News seriesBioethics-in-the-News-logo

By Laura Cabrera, PhD

Imagine that you are returning from your holidays and suddenly you are detained in the airport for carrying drugs in your suitcase. You remember that your friend asked you to bring a small package back with you to deliver to his family. Was it reckless of you to have accepted the request to help your friend? A different situation would have been if your friend had told you that the package contained drugs and you still had accepted it. In the first situation, you didn’t intend to cross the border with drugs; in the second you knew what you were doing.

A crucial factor influencing prison sentences is connected to criminal intent: whether you carried out an action in a state of knowledge compared to a state of recklessness. Knowing actors are considered guilty to a greater degree and thus punished more harshly than reckless actors, yet for the most part we rely on human ability (jurors) to infer the real intentions behind a person’s actions or words. But are there more “objective” ways to distinguish between different criminal intentions? A recent news article in The Guardian discussed a neuroimaging study (Vilares et al, 2017) looking at the tantalizing possibility of using a brain scan to distinguish between these two types of criminal intent.

The prospect of using brain scans to bypass the peripheral nervous system and get at the seat of thoughts, intention, and knowledge is not new (Haynes and Rees, 2005). The media often portrays the use of brain imaging for getting at the neural correlates of preferences, morals, or intentions as “mind reading.” But should we be worried about the use of neurotechnologies for this purpose? A focus of neuroethics is to determine the real nature of the threats involved and to evaluate the ethical implications, many of which could have wide-ranging legal and social ramifications. Neurolaw is another field at the intersection of neuroscience and law that aims to better understand human behavior through new developments in neuroscience, or insights from neuroscientific research, and incorporate those insights into legal studies.

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Image description: a chainmail tapestry with brain image inlay. Image source: CNgoXkde/Flickr Creative Commons

In the study covered in The Guardian’s article, researchers scanned the brains of forty subjects using functional magnetic resonance imaging (fMRI). The participant’s task was to decide whether to carry a suitcase with “valuable content” across a border. Researchers varied both the probability that the suitcase had contraband, as well as the level of information available to participants regarding the risk of being searched at customs (e.g. how many checkpoints they might have to go through). Using a new machine learning method, the researchers looked for multiregional brain activity patterns that could collectively predict “culpable” mental states. They reported that with the machine learning method they could predict with “high accuracy” those participants who knowingly broke the law vs. those who simply took a risk. However, the high predictive ability was strongly dependent on the amount of risk information available to the individuals. This raises a number of questions such as what is involved in criminal intent? Intention involves complex mental activity, including an interpersonal relation and often a moral dimension. For practical purposes the law has a number of categories to classify different degrees of intent (Shen et al.2011), but to what extent is the difference between knowledge and recklessness reflected in unique brain activity? It is one thing to say that brain scanners can correlate certain behaviors with a certain neural basis, and another to interpret such a correlation as the cause of the behavior.

Moreover, in the study intent was only measured when a potential criminal activity was being committed, thus it is uncertain that a person’s mental state when they committed a past crime could be recreated. In addition, these were mock crimes, so one can question the validity of assessing the criminal intentions of someone who is lying in a brain scanner. For a more reliable and ecologically valid reading we will need devices that can monitor our brain 24/7, so that the brains of those individuals suspected of committing an offense could be measured while they commit the act. This takes us to a key issue: mental privacy. The mere thought of someone accessing our minds with the purpose of disclosing attributes we might not want others to know is very troublesome. Imagine then the privacy issues that would arise from having a device that could monitor a wider range of our daily mental lives. In this regard, proponents of cognitive liberty (Sententia 2013) argue that the right of a person to liberty, autonomy, and privacy over their own intellect is situated at the core of what it means to be a free person. Yet for others, the thought of having a device monitoring and perhaps even recording our mental lives is not such a disturbing possibility. For those of you who watch the British television series Black Mirror (Episode 3), you might recall the episode with the memory implant, portraying some of the issues that could arise if such a device were to be available.

There are also various technology issues to consider, such as sensitivity, spatial precision, and false positives (Roskies, 2015). A high accuracy rate for scientific purposes is not always similarly applicable to forensic or civil purposes, in particular in cases where an individual’s civil liberties, and as such their autonomy, might be at stake.

Finally, while the study appeared to support current legal classifications, it is far from certain how different brain states influence people’s behavior. That is, how do we separate intentions from actual actions? We might have an intention to do something that is not according to the law, but we never act on the intention.

Considering all these points, it is clear that brain scans will not be replacing juries anytime soon. Of course, future advances might make worries about mind-reading and constant monitoring of our mental lives more pressing. For now, it is not a bad idea to start engaging in the discussion of the broader ethical and societal impact of neuroscientific research and neurotechnologies on the law and beyond.


Laura Cabrera photo
Laura Cabrera, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Science & Molecular Medicine at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, April 20, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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More from Dr. Cabrera: Forgetting about fear: A neuroethics perspective

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Dr. Cabrera published in ‘Frontiers in Sociology’

Laura Cabrera photoCenter Assistant Professor Dr. Laura Cabrera has a new article in the open-access journal Frontiers in Sociology, titled “Reframing human enhancement: a population health perspective.”

The article is part of the research topic ELSI in Human Enhancement—ELSI stands for “ethical, legal and social implications.” Dr. Cabrera is a topic editor for ELSI in Human Enhancement, along with Dov Greenbaum of Yale University.

Abstract
The dominant understandings on human enhancement, such as those based on the therapy-enhancement distinction or transhumanist views, have been focused on high technological interventions directly changing biological and physical features of individuals. The individual-based orientation and reductionist approach that dominant views of human enhancement take have undermined the exploration of more inclusive ways to think about human enhancement. In this perspective, I argue that we need to expand our understanding of human enhancement and open a more serious discussion on the type of enhancement interventions that can foster practical improvements for populations. In doing so, lessons from a population health perspective can be incorporated. Under such a perspective, human enhancement focus shifts from changing the biological reality of individuals, to addressing environmental factors that undermine the optimal performance of individuals or that can foster wellness. Such a human enhancement perspective would be consistent with a population health approach, as it pursues more equitable and accessible interventions, on the path to addressing social inequality. Human enhancement does not need to be only about high-technological interventions for a selected group of individuals; rather it should be a continuous project aiming to include everyone and maximize the public benefit.

The full article text is available on the Frontiers in Sociology website.

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Correlates of Patient Intent and Preference on Colorectal Cancer Screening

Karen Kelly-Blake photoCenter Assistant Professor Dr. Karen Kelly-Blake is a co-author of an article in the April 2017 issue of the American Journal of Preventive Medicine. The article, “Correlates of Patient Intent and Preference on Colorectal Cancer Screening,” is co-authored by Masahito Jimbo, MD, PhD, MPH, Ananda Sen, PhD, Melissa A. Plegue, MA, Sarah T. Hawley, PhD, MPH, Karen Kelly-Blake, PhD, Mary Rapai, MA, Minling Zhang, BS, Yuhong Zhang, BS, and Mack T. Ruffin IV, MD, MPH.

From 2012 to 2014, a total of 570 adults aged 50–75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for colorectal cancer screening. The article discusses the results of that trial. The full article text is available on the ScienceDirect website (MSU Library or other institutional access may be required to view this article).

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How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?

Leonard Fleck photoAn ethics case by Center Professor Dr. Leonard Fleck and co-author Marion Danis, MD, was published in the February 2017 issue of the AMA Journal of Ethics. Their commentary is titled “How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?”

Abstract
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties—medical scientists, reviewing agencies, insurers, and accountable care organizations—can and should contribute to optimizing the development, approval, funding, and prescription of therapies—particularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care.

Visit the AMA Journal of Ethics website to read the full article.

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Dr. Eijkholt published in ‘Journal of Emergency Medicine’

CMarleen Eijkholt photoenter Assistant Professor Dr. Marleen Eijkholt is the co-author of an article in the April 2017 issue of the Journal of Emergency Medicine. The article, “Enabling Donation after Cardiac Death in the Emergency Department: Overcoming Clinical, Legal, and Ethical Concerns,” is co-authored by Michael Dailey, MD, Sean P. Geary, MD, Stefan Merrill, MD, and Marleen Eijkholt, PhD.

Abstract
Background: In light of the growing gap between candidates for organ donation and the actual number of organs available, we present a unique case of organ donation after cardiac death. We hope to open a discussion regarding organ procurement from eligible donors in the prehospital and emergency department setting.

Case: This case study, involving an otherwise healthy man who, after suffering an untimely death, was able to successfully donate his organs, highlights the need to develop an infrastructure to make this type of donation a viable and streamlined option for the future.

Discussion: Given the departure from traditional practice in United States transplantation medicine, we bring forth legal and ethical considerations regarding organ donation in the emergency department. We hope that this case discussion inspires action and development in the realm of transplant medicine, with the aim of honoring the wishes of donors and the families of those who wish to donate in a respectful way, while using our medical skills and technologies to afford candidates who are waiting for organs a second chance.

Conclusions: We believe that this case shows that donation after cardiac death from the emergency department, while resource-intensive is feasible. We recognize that in order for this to become a more attainable goal, additional resources and systems development is required.

The full article text is available on the ScienceDirect website (MSU Library or other institutional access may be required to view this article).

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