Laura Cabrera

Brain matters: from environmental ethics to environmental neuroethics.

The ways in which humans affect and are affected by their environments have been studied from many different perspectives over the past decades. However, it was not until the 1970s that the discussion of the ethical relationship between humankind and the environment formalized as an academic discipline with the emergence of environmental ethics. A few decades later, environmental health emerged as a discipline focused on the assessment and regulation of environmental factors that affect living beings. Our goal here is to begin a discussion specifically about the impact of modern environmental change on biomedical and social understandings of brain and mental health, and to align this with ethical considerations. We refer to this focus as Environmental Neuroethics, offer a case study to illustrate key themes and issues, and conclude by offering a five-tier framework as a starting point of analysis.

Teaching Bioethics to a Large Number of Biology and Pharma Students: Lessons Learned

To be made aware of bioethical issues related to their disciplines, undergraduate students in biology and pharmaceutical sciences at the University of Basel are required to enroll in the bioethics course called “Introduction to Bioethics”. This article describes the chances and challenges faced when teaching a large number of undergraduate biology and pharmaceutical sciences students. Attention is drawn to the relevance and specific ethical issues that biology and pharmaceutical sciences students may be confronted with and to how these could be integrated into ethics curricula. Results from a survey addressing the knowledge and opinion of students taking the course in spring semester 2012, 2013, and 2014 are presented and discussed. Finally, we describe the lessons learned and how we have improved the course based on students’ feedback throughout the following years.

Reframing Human Enhancement: A Population Health Perspective

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.

Memory Interventions in the Criminal Justice System: Some Practical Ethical Considerations

In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical purposes, but that in the future could be used in the forensic setting to modify criminal offenders’ memories. In this section we contrast the cases of (1) dampening and (2) enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders’ memories.

Converging approaches to understanding early onset familial Alzheimer disease: A First Nation study.

Objectives: In 2007, a novel pathogenic genetic mutation associated with early onset familial Alzheimer disease was identified in a large First Nation family living in communities across British Columbia, Canada. Building on a community-based participatory study with members of the Nation, we sought to explore the impact and interplay of medicalization with the Nation’s knowledge and approaches to wellness in relation to early onset familial Alzheimer disease. Methods: We performed a secondary content analysis of focus group discussions and interviews with 48 members of the Nation between 2012 and 2013. The analysis focused specifically on geneticization, medicalization, and traditional knowledge of early onset familial Alzheimer disease, as these themes were prominent in the primary analysis. Results: We found that while biomedical explanations of disease permeate the knowledge and understanding of early onset familial Alzheimer disease, traditional concepts about wellness are upheld simultaneously. Conclusion: The analysis brings the theoretical framework of “two-eyed seeing” to the case of early onset familial Alzheimer disease for which the contributions of different ways of knowing are embraced, and in which traditional and western ways complement each other on the path of maintaining wellness in the face of progressive neurologic disease.

They Might Retain Capacities to Consent But Do They Even Care

in particular, throughout the trial and at every follow-up after surgery. We have previously attempted to establish the minimum criteria that psychiatric neurosurgery clinical trials need to satisfy prior to their publication and dissemination (Lipsman, Bernstein, and Lozano 2010). Among them was a clear and transparent discussion of the risks of the trial as well as the patients’ and caregivers’ expectations and goals. DBS research continues globally, with several centers involved in randomized double-blind trials for psychiatric indications. As both academic and public attention is focused on neuromodulation in psychiatry, due attention needs to be paid to patient management and expecations. This will become even more important in the future, as neurosurgical procedures become safer, with the therapeutic dosage amenable to adjustment, and as their consequences become more and more reversible, as is the intention for DBS therapy, and as the risk/benefit assessment of DBS moves asymptotically toward that of medications. The necessary involvement of a multidisciplinary research team will address the competency issue surrounding the ability to give consent. In addition, a dynamic, interviewtype, consent process is needed to ensure that patients understand the objectives of a clinical trial in general, and of the trial in question specifically. Standard informed consent comprehension measures and questionnaires exist, but these may not be suitable for surgical interventions in a psychologically vulnerable and “desperate” population. These issues can, and should, be developed both conceptually and empirically, as it is clear that unrealistic goals and expectations could lead to misleading trial results as well as unhappy, and increasingly desperate, patients.

Neuroethics: A New Way to Do Ethics or a New Understanding of Ethics?

Levy’s (2011) article makes some interesting and provocative points about neuroethics. Not only does he claim that neuroethics is more than just another branch of applied ethics, he also argues further that neuroethics offers us the opportunity to dramatically alter, the tools we use as applied ethicists. He describes two sets of evidence that he thinks are relevant to assessing the reliability of our intuitions, based on neuroimaging and psychological evidence respectively. The first set of evidence he considers consists of a study on functional magnetic resonance imaging (fMRI) by Greene and colleagues (2001) in which they examine the way the brains of subjects respond to moral dilemmas. Levy argues that by using neuroimaging to distinguish between intuitions driven by emotion and those that are not we can distinguish between morally relevant intuitions and irrelevant ones. The second set of evidence he examines consists of work done by Joshua Knobe. He uses this evidence to argue that the intuitions to which the doctrine of double effect appeals are not reliable. He concludes his article with the suggestion that by using neuroscientific evidence, neuroethicists could produce better ethical theories and reach better justified normative conclusions. Let us start with the sets of evidence he uses. In the case of the neuroimaging evidence, Greene and colleagues’ (2001) fMRI study has been used to separate between consequentialism and deontological judgements. Levy then suggests that neuroethicists could use the knowledge that deontological intuitions involve brain areas more associated with emotion than with rationality, to consider deontological judgements less reliable than consequentialist ones. However, it can be argued that using neuroimaging as a form of evidence for proving the reliability of our intuitions is not as objective as the author claims. Neuroimaging studies when used uncritically and taken out of context can be used to reinforce certain predominant scientific biases (Farah 2010; Gray and Thompson 2004; Wolpe et al. 2005; Phelps and Thomas 2003). Levy’s suggested interpretation of the evidence rests on the assumption that reason-based intuitions, which he associates with consequentialist thinking, are the only ones we can rely on because they are not blurred by emotions. However, if we embrace a normative ethical theory in which emotion is no less relevant to morality than reason (Haidt 2001), the same neuroimaging study would issue the opposite conclusion. We can wonder, then, whether neuroimaging is really more objective than a firstperson account. And as Phelps and Thomson (2003) have

Recognition of Vowel Segments in Spanish Esophageal Speech Using Hidden Markov Models

This paper presents a system for recognition of voiced segments in Spanish esophageal speech. It exposes different algorithms for the feature extraction of speech segment like formant analysis, linear prediction coefficients (LPC) and mel frequency cepstral coefficients (MFCC), as well as, the recognition stage through the hidden Markov models. Simulation results are presented for normal and esophageal speech. The system was implemented in a real time processing platform based on a digital signal processor TMS320C5416 of Texas Instruments

The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage

BackgroundSurgical approaches to treat psychiatric disorders have made a comeback. News media plays an essential role in exposing the public to trends in health care such as the re-emergence of therapeutic interventions in psychiatric neurosurgery that were set aside for decades, and in shaping attitudes and acceptance to them.MethodWe conducted an analysis of media articles covering all types of psychiatric neurosurgery published in Canada, USA, Germany, and Spain between the years 1960 and 2015. We applied both quantitative and qualitative methods to elucidate patterns of reporting for conditions, themes and tone, across geographic regions, time, and for type of intervention.ResultsCoverage of psychiatric neurosurgery has surged since 2001 and is largely consistent across the countries examined. It focuses on depression and deep brain stimulation, and is explicit about historical context. The tone of coverage becomes more positive for Canada, USA and Spain over time; the tone of coverage from Germany remains cautious. Identity and privacy are among the few ethical and philosophical issues raised, notably in the German press.ConclusionsThe focused and optimistic attention to contemporary psychiatric neurosurgery in the media, but inattention to ethical issues, places an extra burden on functional neurosurgeons, psychiatrists, and other frontline health professionals to attend to queries from patients and policy makers about the full range of relevant emergent and emerging interventions and the mental health issues to which they may beneficially apply.

Inductive Risks, Inferences, and the Role of Values in Disorders of Consciousness

Johnsons (2016) article begins by considering various inferences regarding patients with disorders of consciousness (DoC)—from inferences in diagnosing, including those involved by the use of neur...