Dorothee Horstkötter

We are also normal humans, you know? Views and attitudes of juvenile delinquents on antisocial behavior, neurobiology and prevention

This paper presents and discusses the views and attitudes of juvenile delinquents regarding the implications of genomics and neurobiology research findings for the prevention and treatment of antisocial behavior. Scientific developments in these disciplines are considered to be of increasing importance for understanding the causes and the course of antisocial behavior and related mental disorders. High expectations exist with regard to the development of more effective prevention and intervention. Whether this is a desirable development does not only depend on science, but also on the ethical and social implications of potential applications of current and future research findings. As this pilot study points out, juvenile delinquents themselves have rather mixed views on the goals and means of early identification, prevention and treatment. Some welcome the potential support and help that could arise from biologically informed preventive and therapeutic measures. Others, however, reject the very goals of prevention and treatment and express worries concerning the risk of labeling and stigmatization and the possibility of false positives. Furthermore, interventions could aim at equalizing people and taking away socially disapproved capacities they themselves value. Moreover, most juvenile delinquents are hardly convinced that their crime could have been caused by some features of their brain or that a mental disorder has played a role. Instead, they provide social explanations such as living in a deprived neighborhood or having antisocial friends. We suggest that the hopes and expectations as well as the concerns and worries of juvenile delinquents are relevant not only for genomics and neurobiology of antisocial behavior, but also for prevention and intervention measures informed by social scientific and psychological research. The range of patterns of thought of juvenile delinquents is of great heuristic value and may lead to subsequent research that could further enhance our understanding of these patterns.

‘One Can Always Say No.’ Enriching the Bioethical Debate on Antisocial Behaviour, Neurobiology and Prevention: Views of Juvenile Delinquents

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications of current and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on ones identity are acknowledged too. Yet, a possible biological underpinning of ones antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering ones current self. Concerns regarding the refusal of responsibility and the blaming of ones genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed.

Self-control and normativity: Theories in social psychology revisited

The exercise of self-control is of great significance in people’s daily lives and in the organization of social institutions. The reasonableness of the self-control concept, however, has been challenged by recent developments in cognitive, behavioral, and neurosciences that identify human behavior as a result of complex automatic processes generated by people’s environments. Collating more data on self-control and developing new theoretical approaches is crucial to meeting this challenge. Still, this article argues that a conceptual analysis of the meaning of self-control is also needed. Reflecting on recent work in philosophy, it discusses how self-controlled behavior is characterized not only by distinct causal mechanisms, but also by fundamental normative evaluations. Four conceptualizations of self-control will be presented to highlight why the corresponding self-control failures are essentially also normative failures. Furthermore, it discusses how the normativity of self-controlled behavior can contribute to further theorizing in social psychology.

Moral Enhancement for Antisocial Behavior? An Uneasy Relationship

John Shook (2012) discusses the meaning and possibility of moral enhancement. He is concerned that neuroethicists yield to the temptation to discuss practical questions concerning the effectiveness...

The Importance of the Self for Autonomous Behavior

Neuroscientific findings have often been argued to undermine notions of free will and to require far-reaching changes of our political and legal systems. Making a difference between the metaphysical notion of free will and the political notion of autonomy, Dubljević (2013) argues this switchover to be mistaken. While we appreciate attention to the social limits of neuroscientific findings, we also have a twofold concern with his proposal. The first covers the nontransparent way in which he either rejects or embraces certain scientific findings, which renders the background and motivation of his argument unclear. The second revolves around his idea of a “rational life-plan,” which, while it covers a person’s capacity to conform to social and external factors, misses out what it means to act for a reason or be the source of one’s actions. Revisiting the example of former addict Tommy McHugh and invoking the example of a resigned addict, we present the idea of an “autonomous life-plan,” which is metaphysically sound and practically relevant.

Neuroimaging in the Courtroom: Normative Frameworks and Consensual Practices

Neuroimaging is increasingly playing a role in courtrooms where judges take into account representations of the suspect’s brain as evidence to determine their accountability and the sentence. Berlin (in press) presents an intriguing and timely overview of relevant developments and challenges in this regard. Focusing on issues related to criminal behaviour and criminal prosecution, we, however, have a twofold concern with his arguments. First, after having pointed out current controversies concerning the use of neuroimaging techniques, Berlin concludes that future scientific discoveries will solve current conflicts (p. 13). To our opinion, however, the mere accumulation of scientific findings will not suffice. normative framework that guides decision making is needed. Second, Berlin assumes that in the upcoming decades “the neurobiological and legal communities will continue to struggle with issues bearing on accountability and punishment” (p.6). Unfortunately, it remains open how this struggle might evolve and under what circumstances it could lead to more satisfactory applications. Addressing this challenge, we will present a plan to structure and approach this struggle. NORMATIVE GUIDANCE OF SCIENTIFIC APPLICATIONS The past decades have been characterized by an overwhelming interest in the biomedical foundations of criminal behavior in general and the genetic, neurobiological and neurophysiologic aspects of juvenile delinquency and youth violence in particular (van Goozen et al. 2007). It has been shown that groups of offenders differ from non-offenders regarding genetic polymorphisms, structure and function of the brain, psycho-physiological response to stress, and in gene-brain-environment interactions. Even though much is still unknown and scientific evidence is far from conclusive, these developments trigger high hopes and expectations concerning the development of more accurate methods both for early detection of children at-risk and for more effective forms of early prevention and treatment.

The Prevention of Psychopathy: What We Owe to Young People

Neuroscientific research points toward neurobiological deficits in the causation of psychopathy. Gillett and Huang (2013) argue that this deficit model is inapt and inappropriate for two reasons: It would present psychopaths as being inherently different from “decent” people and it would neglect the interaction between genetic and (adverse) environmental cofactors. The presence of adverse environmental factors, however, is also a social failure, and for that reason we, society, owe psychopaths a caring ethos, not mere imprisonment. While we appreciate the renewed attention for social factors, we have a twofold concern with their proposal. First, unlike their own assertion, Gillett and Huang do not get over the medical model, but rather expand it and present a nuanced version. By also including deficits in the (former) social environment of psychopaths, their approach might intensify rather than alleviate the perceived “abnormality” or “moral insanity” of psychopaths and therefore be counterproductive. Second, in line with their focus on the environmental context, the authors point toward the great significance of the childhood period for developing psychopathic behaviour. For this reason, one could argue that early childhood interventions that take effect before or during the “critical period” would be the best way to prevent psychopathy. While child welfare and child protection are obviously valuable, there are some serious ethical concerns with regard to early prevention of antisocial behavior. We explicate these concerns and point out that and why they hold likewise for biomedical–psychological approaches and those that primarily take environmental factors into account.

Ethics of Deep Brain Stimulation in Adolescent Patients with Refractory Tourette Syndrome: a Systematic Review and Two Case Discussions

IntroductionTourette Syndrome (TS) is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation (DBS) may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals.

Ethical issues in research on substance-dependent parents: The risk of implicit normative judgements by researchers

Abstract When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents’ problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers’ own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them.

Raising Self-Controlled Children. A Philosophical Analysis of Neuroscience and Social Psychology Perspectives

In recent decades, self-control has received increasing attention as it can safeguard child-development and human wellbeing. Researchers from various disciplines – philosophy, neuroscience and social psychology – have investigated what self-control is, how it is generated and how it can be stimulated. This chapter critically reflects on recent discussions of the concept and the science of self-control while investigating their bearings on the question of whether parents have a responsibility to raise self-controlled children and what that would entail. The argument put forth is that current social psychology and neuroscience largely investigates controlled behaviour but ignores the prefix self. Consequently, a more comprehensive understanding of the term that does justice to both aspects is provided. This gives rise to two different sets of educational goals. Firstly, raising self-controlled children entails teaching them strategies to overcome temptation. Secondly, it requires that parents support children to develop a self that sets its own goals, reflects on these goals and considers them as reasons for action.