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UCL IGEM ETHICS REPORT

The Neuroethics and Feasibility of Genetic Engineering on the Nervous System

The Core of the Neuroethical Debate

Neuroethics is, as defined by Gazzaninga, ‘the examination of how we want to deal with the social issues of disease, normality, mortality, lifestyle and the philosophy of living informed by our understanding of underlying brain mechanisms’, (Gazzaninga 2005).

When it comes to considering any medical practice that is going to affect the brain, especially NGE, there are many ethical issues to consider. For example, with uncertainties surrounding NGE to do with un-desired consequences on the brain, it may be difficult to ever reach a position where all parties in a procedure can give fully informed consent. This may be due to an underlying misunderstanding, ignorance or confusion about what synthetic biology is amongst doctors delivering a treatment and patients receiving it, as well as varying opinions amongst the general public as to what constitutes a person, and what exactly is, if there is indeed, ‘selfhood’.

NGE would, in many of its applications, have both short-term and long-term effects on a person’s character. This does not represent a physiological concern, and may even be the by-product of returning the brain to a healthy physiological state. Whether or not this changes the intrinsic nature of a person will likely be the driving question that divides proponents and opponents of NGE generally. The philosophy of self is a large field, and this is not the place to examine in detail its theses and anti-theses in an NGE context, though a brief examination is required.

The modern conception of the self has its roots in the philosophies of Rene Descartes and David Hume. Hume observes and error on Descartes’ part; his famous realisation ‘I think therefore I am’ (cogito ergo sum) does not necessarily entail a metaphysical substance, the ‘self’, only the momentary selves developed by thought. Descartes’ view was informed by his dualism, a philosophy completely at odds with modern neuroscience (Damasio 2005). Hume’s empiricist view demanded that all knowledge of the world and ideas derived from that knowledge (or lack of it) are the result of sense impressions; thus nothing can be known of a ‘self’, ergo there is no self. Hume concluded that we are a conglomerate of remembered experiences that perhaps allude to a fictional selfhood that is effectively, utterly mutable. Immanuel Kant proposed instead that the self is not fictional, though neither is it truly detectable, it is the focal point of our subjective emotions, experiences and cognition – and so again, must be mutable.

Many modern philosophers, with a more neuroscientific context in mind, see the ‘self’ as accompanying experience as a somewhat superficial ‘awareness tone’ that lacks ‘ontic depth’ (Strawson 2009). The focal point of the self shifts between experiences, potentially occupying multiple sensations at once, seemingly located at, say, the neocortical reaches in an A-level student puzzling over calculus, and the hunger centre of the hypothalamus as that same student longs for a sandwich whilst in the exam hall. In the modern view of the brain as reducible, a sense of agency is likely an emergent property of activity across the nervous system, rather than being centralised or localised to a specific area. We perhaps constantly experience, or experience upon reflection, an autobiographical self that is made from memory and encodes (in a non-neuroscientific sense), for example, our personality (Damasio 2000). Our own self-identity and that of others is narrated to us through language, through linguistic tags that we associate with stored concepts, and it is at this level in our brain that perhaps we interact with an idea of ourselves and others, and this is where we perceive change. Some see a rendition of the ‘self’ even in the motor-mapping system of the ancient midbrain (Panksepp 1998). However, without appealing to (other) metaphysical agencies, such as an insoluble soul, the notion of selfhood is vague to say the least.

What does this mean for NGE? If we see the self as, as many theists do, a metaphysical derivative of an immutable soul, NGE is not really a threat to one’s ‘inner’ identity, only outward manifestations of that identity. Therefore, seemingly counter intuitively, basic theistic philosophy should have less to fear from NGE than other philosophies of self. Following Hume’s brand of empiricism, NGE could change the nature of information received by the brain and in so doing reformulate a new self – but the information is unlikely to change so drastically as to lead to a complete overhaul of self, and one’s autobiographical self will remain unchanged (unless the NGE’s purpose is to alter memory or memory access), though the nature of subsequent memory recording could change. Hume’s selfhood is ultimately fictional, and so NGE cannot really threaten it. If it helps AD patients hold on to their memories, NGE may even enhance their perception of self. Following the ideas of Strawson, Damasio, Panksepp and others, NGE could have a minimal or a dramatic impact on the transient self that flits across the brain, depending on the purpose of the NGE in question. The self may change because the neurological nodes between which the self flits change due to NGE, and so the nature of information or information processing changes. If the NGE increases attention, for example, we may be aware of things for longer and with greater intensity, and such a small thing as this could eventually have on impact on our personality and our transient experiences. If the NGE simply tried to stall disease progress its effect would be more to maintain oneself. Essentially, this discussion becomes too fragmented over the exact application of NGE and so it is more usefully related in specific circumstances.

The basic idea of selfhood and the fear of change is not just constrained to the individual level. If the use of NGE in medicine, therapy and enhancement technology were to become widely used in the future, we may find ourselves increasingly confronted with the question of what we consider neuro-typical and how far should and individual be from its guide posts to warrant medical NGE treatment, and how far away can we let people get following NGE therapy and enhancement. Especially in the latter two applications, we may well find the guide posts defining what is normal shifting in sync with social changes brought about in those societies willing to make NGE therapy and enhancement widely available.

There is, even now, a growing concern in the medical community that appropriate human emotion is being ‘pathologised’ (Parker 2007). Unpleasant affective states are a fact of human life and important not just in a cultural sense but also in terms of personal development, a basic example being heightening our ability to empathise. Thresholds for diagnosis of depression, for example, have slipped down in the last few years. Misdiagnosis with an NGE treatment could have negative physiological, as well as psychological effects, the latter not just for the patient, but also for the family. As a result, a new problem may be created and the other, underlying issue, medical or otherwise, never sorted out.

If medical NGE treatments become as an effective and long-lasting cure as hoped, we may face and entirely different ethical issue of increased attempts at diagnosis for neurological problems and increased societal pressure on those and the families of those diagnosed, to undergo NGE treatment. Diagnosis and being pushed towards even an effective treatment can, especially with affective disorders, exacerbate the condition and put strain on an individual’s personal moral views about synthetic neurobiology without being educational or informative. A good example of an analogous situation is the law suit brought against the U.S. national mental health screening programme, which diagnosed a (supposedly previously perfectly contented) fifteen-year-old with obsessive compulsive disorder (OCD) and anxiety (Lenzer 2005). Her parents claimed that the screening was a breach of parental and privacy rights. Societal paternalism and the way it can countermand moral individuality, privacy and parenting on such a contentious issue as NGE represents an even more ethically hazardous situation, even if the treatment suggested is an effective, complete cure. Diagnosis and subsequent medication, NGE or otherwise, also suggests to the concerned party, explicitly or implicitly, that they are the source of a pathology that the medical treatment will fix. If this mentally broadens to NGE therapy and enhancement technology, people who are low achievers at school, hopeless at art, socially awkward, etc., may feel that it is due to biochemical factors out of their control and opt for NGE treatment, instead of making the effort to improve in these areas conventionally. This is of special concern with children and young adolescents, who are more vulnerable to suggestion and often more willing to conform to practices they see encouraged around them. They are often also harder to diagnose, be that in a medical sense or in terms of say, intellect. An NGE course of action encouraged by the child or their parents may preclude further natural development in the areas modified as well as the personal development associated with becoming an adult. This means that treatment should be context-rich and well contextually informed, not according to society’s generalised perceptions, whichever way they may lean, but the situation of the NGE recipient.

Privacy has always been a premier issue in neuroethics, mostly in regards to brain scanning, but it also could play a major role in NGE neuroethical discussions down the road. This is because if NGE brain enhancement technology becomes a social practice with the same profile as plastic surgery, people may try to model their psyche on others’ and we may, though it seems farfetched, see the introduction of patents for specific brain profiles, neuronal networks, brain area development schemes, etc. Perhaps not the sort of thing that seems appealing in the current social landscape, but people already make comments about wanting Stephen Hawking’s intelligence, Ronaldo’s motor control, David Mitchell’s wit, etc., so if a future society already desensitised to the ethics of neuro-enhancements finds itself able to create these abilities in others through NGE to commercial gain, we arrive at a suggestion that is not impossible, if implausible, and instinctively uncomfortable for the current social mind-set.

NGE technology may result in the degradation of cognitive, intellectual and emotional faculties by acting as a crutch, and may compromise the natural psychology and personal development that we associate with being human. People are born with certain biological tendencies and propensities that can make them vulnerable to certain life events, both positive and negative, but where this vulnerability applies to cognitive, intellectual and emotional challenges people adapt, develop and overcome these obstacles in a manner that develops them as an individual in the social machine. What NGE therapy, enhancement and inappropriate medicine may result in, is a situation where the social machine crafts its own parts instead of being an emergent phenomenon. The removal of mental troubles that are social or mildly medical with ease, assuming NGE offers efficient and complete corrective procedures, could remove the struggle that crafts ‘the human spirit’, or at least that makes us different from one another. A psychologist may argue that such a future would be characteristic of neuroscience’s willingness to intervene at the level of the neuron, and not at the holistic level of the person in question.

Overview