Insiders and Outsiders: Lessons for Neuroethics from the History of Bioethics

Abstract

Recent disputes over the NIH Neuroethics Roadmap have revealed underlying tensions between neuroethics and the broader neuroscience community. These controversies should spur neuroethicists to more clearly articulate an oft-cited ideal of "integrating" neuroethics in neuroscience. In this, it is useful to consider the integration of bioethics in medical practice as both historical precedent and context for integration in neuroethics. Bioethics began as interdisciplinary scholars joined biomedical institutions to serve on newly-created IRBs and hospital ethics committees. These early bioethicists identified as outsiders and their presence was initially resisted by some in the medical establishment, but over time they became integrated into the very institutions that many had originally come to critique. This work has transformed medical practice, but also required compromises and intellectual costs. Also, the successful integration of bioethics relied in part on structural features of postwar medicine with no clear analogue in contemporary neuroscience; for neuroethics, imaginative new approaches will also be needed. While neuroethics to date has focused somewhat narrowly on questions in neurotechnology, I argue that successful integration in neuroethics will likely require a broader vision, encompassing the clinical neurosciences as well as questions at the interface of neuroscience and society.

Emerging Subspecialties in Neurology: Neuroethics

“…As neurologist and neuroethics researcher Winston Chiong (UCSF) presciently remarked, "…an integrated neuroethics must engage with ethical and social controversies that are direct working concerns of those in neuroscience, including the clinical neurosciences… a more inclusive conception of neuroethics would cohere with neuroscience's own self-conception as an interdisciplinary field… A more broadly engaged neuroethics would not only be a more useful partner to neuroscientists-particularly to those working with clinical populations." 14 Neuroethics may also be successfully combined with other neurology subspecialty training, particularly synergistic subspecialties include neurocritical care, cognitive behavioral neurology, stroke, neurorecovery, neurogenetics, global neurology, neurophysiology, and neuropalliative care. I began collaborating with philosopher Bernard Gert and psychiatrist-bioethicist Charles Culver at Dartmouth.…”

“…Over the past 2 decades, neuroethics has matured as a discipline with its own professional society (International Neuroethics Society), conferences, journals, faculty positions, textbooks, National Institutes of Health (NIH) Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative committee, and scholarship. 14,15 Most of this disciplinary organization has centered on research neuroethics. Neurologists should partner with research neuroethics scholars to advance clinical neuroethics.…”