Fall 2007
In this Issue:
Focus On Biomaterials
Therapy vs. Enhancement: The Ethics of Neural Engineering
What are the risks and what are the benefits of placing electrodes into the brain? Where does therapy stop and enhancement begin? Given the expense of neural engineering, how are the costs and benefits of neurosurgery shared by society?
These were some of the issues debated at what some billed as the first international conference on the ethics of neural engineering – Implanting Change: The Ethics of Neural Prosthetics – held at Penn State in September 2007. If none of the answers was entirely conclusive, that may be because the debate is just beginning. The ability to make truly revolutionary improvements in the functioning of the brain has only recently been proven.
“We decided several decades ago that psychosurgery was immoral in many ways,” says Penn State neurosurgeon Steven Schiff. “We shut down whole areas of destructive neurological surgery trying to alter the minds of people. We had no effective treatment for those we felt needed treatment or institutional care. We’ve stopped doing lobotomies, and now we’re about to revive it under the guise of the technological capability of being able to stimulate almost any place in the brain with what are ‘probably’ acceptable risks. We really need to define very carefully for any of these treatments what are the risks and what are the potential benefits.”
By the early 1950s, according to Joseph Fins of Weil Cornell Medical College, a noted medical ethicist and one of the conference speakers, 50,000 psychosurgery procedures had been performed, many of them on shell shocked and depressed veterans returning from World War II. Lobotomies dwindled in popularity in the late fifties and early sixties with the advent of Thorazine, the first nonsedating tranquilizer. However, longterm studies of the harmful effects of lobotomies left a lingering anti-psychosurgery legacy with the public. Dr. Fins noted that the public is largely unaware of the differences between the deliberately destructive psychosurgery of fifty years ago, and the far more localized and minimally destructive deep brain stimulation (DBS) practiced today. He predicts that in the future nanotechnology and new materials will further reduce the side effects of implantation.
With the proper safeguards, neural engineering for therapeutic purposes should develop with little opposition, the participants concluded. The public seems to be in favor of implants for the control of Parkinson’s tremors and epileptic seizures. Where the controversy begins is when therapy edges over into human enhancement. For instance, placing computer interfaces inside the skull raises the question of what is strictly human and what is artificial. Are the risks of a neural implant worth the potential benefits of increased attention and wakefulness, or a 20-point gain in IQ? It may come down to individual cases. The benefits to a person with much below normal intelligence might be greater than for someone who is already functioning capably in society. We might decide that an airline pilot has greater need for concentration and wakefulness than a student studying for an exam.
Neural engineering is especially problematic in the context of the military. Here there may be special risk versus benefit balances that are uncommon in civilian life. Is it justified to improve a soldier’s capabilities to enable his or her survival in circumstances that would otherwise carry a high risk of death? Customary medical ethics would want the risk of the device to be significantly less than the risk without it. On the other hand, if the neural prosthetic were intended to largely increase the effectiveness of creating injury to others, is this beyond the acceptable scope of medical care?
The technologies of neural engineering now place us at the threshold of the abilities to increase human intelligence, control moods with stimulation, ameliorate depression, increase wakefulness, and enhance concentration. This means that the challenges for the Penn State Center for Neural Engineering will extend well beyond the technical arena at which Penn State excels, and into the domain of the personal and societal implications of brain research where scientists are often reluctant to tread. Clearly, the researchers in this new Center are eager for the challenge, both ethical and scientific, that the emerging field of brain engineering creates. Soon we will find out if we are able and willing to improve on the hand that Nature has dealt us.
