When the UK Xenotransplantation Authority approached the possibility of using organs from animals to save human lives there were three kinds of questions. Is it safe? Will it work? Is it right? These seem highly relevant questions as we hear of the tremendous advances of neuroscience, which will transform our understanding of the human mind and our very humanity, our behavior and our health and well being.
Whenever we are confronted with a new, medical technology we musk ask whether or not there will be the benefits promised or the actual reality will be undesirable effects. This is straight risk vs. benefit analysis. But behind that is the moral view that we should do no harm and that we should do what is good for people. Beneficence and non-maleficence are keystones in the Georgetown mantra of Childress and Beauchamp[1] and their four principles, which are the received moral wisdom taught in most medical and nursing schools. Are the harmful effects and risks of neuro-scientific techniques so great that they overcome the possible benefits of using these new techniques?
The problem with much of the hype of genetic and stem cell research is that far more was and is promised than has been delivered. In an age of funding shortfalls it is no surprise that hard-pressed scientists tend to gild the lily and put the most positive spin on what their research will achieve. This raises all kinds of hopes and expectations in patients, families, and society. Such high expectations are almost inevitably disappointed, but the question of efficacy is a practical and scientific one. Scientists and regulators ranging from Institutional Review Boards (or IRBs) to FDA levels are in place to ensure that any new medicine or medical procedure is rigorously tested before it is available for common use. There is in fact a moral underpinning to efficacy, which is about stewardship and efficiency. We ought not to be wasting time, money, and effort on things that will not work or make a genuine difference.
Broader questions of morality depend on the starting point. We have already seen how the principles of beneficence and non-maleficence are at work in judging the safety and efficacy of the neurosciences, but there are two other principles and many other approaches to morality. Justice and autonomy complete the Georgetown mantra.
Will the application of neuroscience lead to more or less justice in the world? The fear here is that money not just talks but controls. It controls who produces the new neuro-scientific applications and, more significantly, who actually gets help. As we have seen in the whole cosmetic surgery business, if you have enough money then almost all things are available and possible. The affluent will be the first to benefit from applications that enhance memory, prevent intellectual and motor degeneration, and even enhance mental powers. What parent would not sacrifice to help their child have an advantage in the costly world of education and employment? So what then happens to the poor and disadvantaged? The danger in medicine is that the wealthy are treated well and the poor almost ignored. Any of the stars of stage and screen can afford the various cosmetic surgeries which supposedly enhance what nature has provided, while those who are damaged in terrible accidents and have no medical insurance may be struggling to obtain basic, restorative surgery or treatment. This is a key distinction which lies behind the moral stress that medicine and neuroscience should be in the business of putting right what has gone wrong rather than merely enhancing what may be working perfectly well.
There are at least two aspects that under gird autonomy. One is the absence of force and coercion. You make the choice and you pay for the consequences. If we can affect parts of the brain that might have some link to sexual behavior, past or future criminal activity, anti-social expressions of rage and the like, then how long will it be before people are forced into having preventative treatment whether they like it or not. Coercion is lurking at the door both in the sense of what will serve the greater good and the greatest happiness of the greatest number and how we feel forced into a competition not just to keep up but to surpass our neighbors.
The other aspect of autonomy is a stress on the individual who makes the free choice. But what is that individual? The question of our identity is closely related to our brains, personalities and how our mental life is expressed in public behavior and relationships. As neuroscience begins to be applied to our brains and the various centers of sensation, emotion, will and personality, it is all too easy to see how we literally could be manipulated in order to fit in and conform to whatever model of being a well-adjusted human being is currently in vogue. Instead of magazines of well shaped men and women, we may have a new form of voyeurism in watching enhanced humanity perform in the neuro-excellent Olympics.
If the application of neuroscience undermines not just the freedom of the individual but also the very identity and fundamental nature of each unique individual human being, then it seems that is too high a price to pay for the ability to think better, longer, and more quickly.
The four principles seem to raise pretty fundamental moral questions about the projected applications of neuroscience. Christians will not be content to stop there. Human dignity founded on being image bearers of God Himself and God-created, unique individuals has been at the heart of medicine and ethical theory and behavior. From Declarations of Human Rights to the Hippocratic and a host of other medical oaths and declarations, human dignity in terms of preserving the health, well being and essential features of what it means to flourish personally and in community is a key basis of our human society and medical activities. New scientific advances and medical techniques and procedures cannot escape from the moral questions which are essentially posed. Until and unless we have satisfactory responses to these fundamental questions, we ought to proceed with great care and careful supervision.
[1] Beauchamp, Tom and Childress, James. Principles of Biomedical Ethics 6th Rev ed. Oxford University Press (2008).
