“As humans, we can identify galaxies light-years away. We can study particles smaller than an atom,” President Barack Obama said in April 2013, “But we still haven’t unlocked the mystery of the three pounds of matter that sits between our ears.”
The observation was part of the president’s announcement of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, an effort to fast-track the development of new technology that will help scientists understand the workings of the human brain and its diseases.
With progress, though, comes a whole new set of ethical questions. Can drugs used to treat conditions like ADHD, for example, also be used to make healthy people into sharper, more focused versions of themselves—and should they? Can a person with Alzheimer’s truly consent to testing that may help scientists better understand their disease? Can brain scans submitted as courtroom evidence reveal anything about a defendant’s intent?
To address these questions, the Presidential Commission for the Study of Bioethical Issues, an independent advisory group, recently released the second volume of a report examining the issues that may arise as neuroscience advances. The commission outlined three areas it deemed particularly fraught: cognitive enhancement, consent, and the use of neuroscience in the legal system.
“The enormous promise of modern neuroscience research will only be realized if neuroscientists are able to direct and also fully participate in society’s critical conversations at the intersection of neuroscience and ethics,” Stephen Hauser, a neuroscientist at the University of California, San Francisco, and a member of the commission, wrote in editorial recently published in the journal Annals of Neurology.
I talked to Hauser about the problems in each of the commission’s three focus areas, the goals of the BRAIN Initiative, and the future of ethical neuroscience. Below is a lightly edited and condensed transcript of our conversation.
Cari Romm: What is “neurotechnology?” What technologies is the BRAIN initiative looking at?
Steven Hauser: The BRAIN Initiative is a very ambitious plan, to push the frontiers of neuroscience forward at a more accelerated path than otherwise would be possible. Essentially, the project has lasered in on mapping the 100 billion nerve cells in the human brain and [their] connections. Each neuron in the brain connects with between 10,000 and 50,000 other nerve cells. These connections are electrical, they’re use-dependent, they’re activity-dependent. You’ll hear the words “plasticity” or “modulation”: They’re words that are used to describe the flexibility of the system.
Obviously this is a difficult conceptual problem to address, and so the initiative will begin with lower organisms’ nervous systems, but the initiative is by its nature interested in human health and well-being. So even at Phase 1, as we are beginning the studies in simpler, lower organisms, we are hoping that major new opportunities to address human neurologic disease and human nervous-system understanding will be possible.
The other thing that is so exciting is that this is neurobiology, but it is extraordinarily multidisciplinary. Many of the advances that are needed to solve some of these horrific health problems that affect a billion people will require advances in engineering, in imaging, in informatics, in physics, in chemical biology. One of the magnificent features of the BRAIN Initiative is that it’s going to bring together people from different expertise and different walks of life.
Romm: When you say “mapping the brain,” does that mean the initiative is focused on developing new imaging technology?
Hauser: I think that the technologies are primarily two: imaging, and understanding activity, or function, of the structures that we’re imaging. So we want to see it, but we also want to watch it in action.
Our current means of looking at nerve cells, looking at our brain, is so dramatic—if you’ve seen 2015 MRI scans or PET scans, you know how amazingly informative these scans are in terms of teaching us about structure. But we need to look at higher resolution. A nerve cell is about eight or 10 microns, and the ability to visualize by imaging might be 200 microns. So we have a ways to go.
Also, how do we look at activity in cells? We do that traditionally through EEG techniques, where we can see the electrical activity of millions or hundreds of thousands of nerve cells together. We need to develop the electrical grids that can let us see activity at a much finer level than is currently possible. The brain is organized in a coordinated network of functions, where groups of cells speak to groups of other cells at a distance. Understanding how all of that works will require resolution tools for imaging, for monitoring electrical activity for single cells or single groups of cells, and also understanding the chemical processes within the cells that make this all happen.
Romm: Why was the Bioethics Commission brought on board for this?
Hauser: Another quality of neuroscience is that it attracts our interest in ways that few other areas of medicine or science do—how our nervous system enables us to be human, how it encodes our behaviors, our fears, our aspirations. Some of the highest and lowest human qualities are questions that not only scientists but philosophers and all of us have thought about for millennia. It is so exciting that for the first time in history, we now have the tools to imagine that we can understand some of these processes that underlie our behaviors, and also explain how these behaviors go terribly wrong with human disease.
At the same time, although the promise is great, there are also great fears that with a new understanding and an ability for science to reach deeper within each of our nervous systems, our mental privacy might be at risk. There’s nothing unique about the ethical issues underlying neuroscience, but I do believe that that many come into the sharpest focus in neuroscience. So in the report, we focused on three big areas that we think are key.
The first is modulating our neural capabilities. In the lay world, this is called “cognitive enhancement,” but we prefer to call this “neural modifiers.” We are dealing with cognitive enhancement as part of this, but we may also be dealing with modifying other functions of our nervous system—sensory function, vision or hearing. My children would be much more interested in enhancing their motor skills than their cognitive skills, so that they can hit a fastball better or sink a higher percentage of jump shots. One key point is that there exists, as we make advances, a continuum between the goals of maintaining health or improving health—[between] treating disease and then expanding or augmenting function above normal ranges. I thought what was really quite interesting and important was that the entire committee was comfortable with the concept that there is nothing inherently ethical or unethical about neural modification per se.
Romm: What are the concerns, then?
Hauser: The devil is in the details. As the details are addressed for any specific application [of neural modification], we’re going to reach areas where reasonable people will disagree. And there will also be unexpected applications arising, that may have to do with possibly extending life span, or enhancing capabilities through what some would call artificial or cheap means that will degrade the authenticity of accomplishments.
[One part of neural modification] is drugs, like Ritalin, Adderall … There are drugs that are very useful for some neurologic disorders, and in some cases, widespread use of these drugs to improve focus, energy, to enhance cognition. But one point that we made about all of these drugs is that their benefit, in terms of improving function in normal people, is really quite modest if present at all. The results in the literature are mixed. We need better results. What we have now are not game-changers.
[Another part] is brain stimulation for cognitive enhancement. The lead technologies here are things like deep-brain stimulation for movement disorders, and there is now quite a bit of research using deep-brain stimulation—which means that you implant electrodes into the brain—for depression, experiments for schizophrenia, for other conditions. In addition to this, there are other technologies, such as transcranial magnetic stimulation and transcranial direct-current stimulation, that have the huge advantages of not requiring any implants. It’s just electrical activity that can be delivered on the surface of the scalp, non-invasively.
So we’ve proposed that we need to find ways for all of us to consider the ethical implications of neural modifiers on a case-by-case basis, considering the interventions, their purpose, who is choosing it, who might benefit, and who could be harmed. Along with this, we have to have the research so that we know not only the short-term benefits and risks, but what happens over the long term. And then finally, we need to make sure that if these advances are deployed—when they are deployed, because some certainly will be—that there’s equitable access, so that existing social inequities are not exacerbated. And the other principle that we made is that these safe, simple, non-invasive approaches to maintaining health should take priority over dangerous, invasive, more ethically challenging approaches. And approaches that potentially could help improve the health of the billion people globally with neurologic disease need to take priority.
Romm: The report also talks about problems regarding consent.
Hauser: So the second issue is related to the capacity for consent for human research. This is so important because neurologic diseases often rob us of fundamental human characteristics that permit us to function normally, understand what is happening to us, and communicate with the world. When these disorders strike, it can become difficult or impossible for people to consent to participating in research, and yet without this research, progress can never happen. As exciting as basic science is, rubber hits the road when the ideas from the scientific community are tested in real people with real health problems. So I see no way to avoid the step of human clinical research testing if we are going to find answers. And yet to do this, people who may not be able to consent to the research in a traditional way need to participate.
Romm: And what were the report’s recommendations?
Hauser: I think we were quite surprised that despite the work that has been done in the past, including the work of previous bioethics commissions, we really don’t have specific regulations or uniform guidance. Many of our institutions and scientists and human-studies committees are left to decide for themselves how to proceed ethically. So we have suggested that research in this area be carried out, that clarity be given to investigators, and that we define the role of a legally authorized representative [like a family member or friend] who can give permission for an individual with impaired consent capacity to participate in research. Clear requirements are needed for who can serve as a legally authorized representative and what level of confidence we should have that they are acting not only in the best interest of the patient, but also in tune with the patient’s likely wishes.
Also, the loss of language is just a part of the loss of communication. In some individuals, verbal communication is lost, but it is still possible for them to understand and demonstrate their consent. So the kinds of neuroscience-based research that would be enormously helpful would be to better define the neurologic conditions under which consent would be reasonable, even in a cognitively impaired individual, as well as those situations where a legally authorized representative would be required.
Romm: The third area the report covered is the relationship between neuroscience and the law. What are the issues there?
Hauser: There are a number of neuro-imaging and electrical-activity tools that have been introduced in the courts to bolster claims of neural incapacity underlying criminal behavior. Judges, lawyers, jurors, and the general public really need guidance and education on how to apply and interpret neuroscience evidence in the legal system. This is important today, but it will become even more important as the neuroscience tools expand. So the commission recommended that the relevant organizations develop training resources to help judges, lawyers, and jurors understand neuroscience and its applications. And also, we need education of neuroscientists to help them understand the different ways that science and the courts approximate truth, and the challenging gaps between scientific jargon and legal jargon.
The other issue that has often been raised is this fascinating question of free will. For example, if there is a group of neurons that fire electrically before we make a motor activity, or before we say something, does that mean that when we do it, it is no longer free will, but we are being run by our neural pathway? And one really important point that we make is that although neuroscience is certainly going to contribute to knowledge about the goals of punishment and rehabilitation, there is no way that neuroscience can fundamentally change [the answer to] questions like: Why do we punish criminals? Is it because they deserve to be punished? Is it to rehabilitate them? Are we incarcerating them to protect society? Some of these questions are not going to be in the neuroscientist’s toolbox. They are ethical, societal questions that require broad discussion. The key issue here is that a sophisticated knowledge of science, its strengths and limitations, is entered into the deliberative process during court proceedings. And this will require a back and forth interaction between sophisticated neuroscientists and sophisticated legal minds.
Romm: As new technologies develop, is the role of neuroscience in court something that will be clarified, or do you think it will be muddled further?
Hauser: They have to be clarified. The legitimacy of the system demands it. So we proposed research and mutual education. … In science, the funding is more difficult than ever. This is an incredibly exciting but competitive and hard-driving world, and we need to make sure that as neuroscience moves forward, that experts have the incentive to think about the ethical implications of these discoveries. And especially to help translate them to the public at large, so that we all can make the most reasonable conclusions as to how they should be applied.