Neuroethics Exam 1

Psychological vs Neuroscientific levels of explanation

The Neuroscientific level of explanation deals with how neurochemical factors influence behavior. (e.g. Bill punched someone because his prefrontal cortex is underdeveloped)

The Psychological level of explanation deals with how patterns of thought, personality, or other psychological factors influence behavior. (e.g. Bill punched someone because he has poor inhibition)

Issue with Neuroscientific level of explanation

Is the neuroscientific level of explanation be considered superior to other levels, and should it be?

Deontology

An action is right if and only if it doesn’t violate certain moral laws

Utilitarianism

An action is right if and only if it leaves the most people the best off

Moral realism vs. moral anti-realism

Moral realism: there are objective, universal moral facts

Moral anti-realism: there are no objective, universal moral facts

Dualism vs. Materialism

Dualism: the mind is something non-physical, over

and above the brain

Materialism: the mind is just the brain

Adderall

Improves attention

Ritalin

Improves attention by acting on dopamine and norepinephrine

Ritalin affects activity in the prefrontal cortex (PFC)

• Increases the amount of dopamine and norepinephrine in PFC

The PFC is involved in executive function

• Direction and maintenance of attention

• Working memory

• Learning (building of stimulus-reward relationships)

• Action inhibition

Low doses only increase dopamine activity in the PFC

• Results in increased focus

Ritalin side effects

FDA gives it a “black box” rating

“A high potential for abuse and dependence and...risk of sudden death and serious cardiovascular adverse events” (Chatterjee 2009; see also Calzato & Arntz 2017)

Can cause excitability, insomnia, blurred vision, weight loss, other ill effects

Still not much known about long-term effects

Could change who we are? (Kass 2003)

What does Ritalin affect in healthy subjects?

Is shown to only sometimes enhance attention, and most reliably only affects working memory

Aricept

Enhances memory

Boosts memory by targeting enzymes that break down acetylcholine

Better communication in hippocampus and basal forebrain

Prozac

Stabilizes mood and personality

Affects mood by preventing the reuptake of serotonin

Better neurotrophy and neurogenesis

Parts of neuron

Dendrite

Soma

Axon

Terminal

• Vesicles with neurotransmitters

• Receptors

Therapy vs. Enhancement

Therapy: treating neurological problems

Enhancement: making a “normal” brain function better

“Moral equivalence” arguments

1. There is no moral difference between using neural enhancers and using other ways to boost cognitive abilities (e.g. better nutrition, more sleep)

2. There is no moral difference between using drugs to make up for reduced function and using it to enhance normal function

   1. What society considers as “normal” changes

“Precautionary Principle”

Leon Kass has argued that we should be particularly cautious when it comes to neural enhancements

Neural enhancers intervene in a complex and poorly understood system: the brain

• Alteration of this system could bring about disastrous

  results

The PCB likes this principle (“go slowly… you might ruin everything”)

Coercion with neural enhancers

If neurocognitive enhancers are legal and widely available, people will probably be coerced to use them (Greely et al 2008, 2010)

Explicit coercion: would arise if one were required to take cognitive enhancers in order to take a job, or to stay in school

• Some might think this a good idea in the case of some professions: air traffic controllers, soldiers (Sahakian & Morein-Zamir 2007) (they now do this in US military)

• Harris implies that it might be good for (some) schools to require use of cognitive enhancers (Harris & Chatterjee 2009)

Implicit coercion: Would arise if one were competing against enhanced co-workers or students

The “Red Queen Effect”

If some people in a profession use cognitive enhancers, those who don’t are at a disadvantage

Soon only those taking cognitive enhancers can be competitive, so everyone starts taking them

Now the playing field is again level, but everyone is taking cognitive enhancers

In their competition with one another, everyone is just as well-off as they were prior to the introduction of cognitive enhancers into the profession but now everyone stands the chance of suffering from whatever side effects the cognitive enhancers cause

Distributive justice and neural enhancers (Farah et al.)

Cost and social barriers to using enhancers will result in an uneven playing field (Kass 2003; Farah et al 2010)

This may already occur:

• Many college students, who are predominantly middle- or upper-class, use Ritalin

However, things like tutoring and cosmetic surgery are already not equally distributed

Moreover, distribution of enhancers might be not hard to do

• At least easier, e.g., than getting high-quality schools for children of lower socioeconomic status

“Lifestyle drugs” and “medicalization” (Flower)

Lifestyle drugs: drugs taken to satisfy a non-medical or non-health-related goal

• Encourages self-diagnosis and self-prescription (where possible)

• Should be available, but not paid for by public health insurance

Medicalization: When neurocognitive enhancers become increasingly available and potent, what was normal might come to be seen as pathological (Flower 2010)

Greely et al. policy suggestions

1. Presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs

2. An evidence-based approach to the evaluation of the risks and benefits of cognitive enhancement.

3. Enforceable policies concerning the use of cognitive-enhancing drugs to support fairness, protect individuals from coercion and minimize enhancement-related socioeconomic disparities

4. A program of research into the use and impacts of cognitive-enhancing drugs by healthy individuals

5. Physicians, educators, regulators and others to collaborate in developing policies that address the use of cognitive-enhancing drugs by healthy individuals

6. Information to be broadly disseminated concerning the risks, benefits and alternatives to pharmaceutical cognitive enhancement

7. Careful and limited legislative action to channel cognitive-enhancement technologies into useful paths

PTSD definition and symptoms

Posttraumatic stress disorder (PTSD)

Brought on by a traumatic event that threatened death or serious injury

Can involve flashbacks, hallucinations, nightmares

PTSD sufferer avoids thinking or talking about the event

Memory and emotion

Emotionally-charged memories are stored more effectively and with more detail

Very significant events thought to cause “flashbulb memories” (Brown & Kulik 1977)

• The existence of flashbulb memory is controversial (Neisser & Harsch 1992)

It is well-established that emotion produces more vivid and resilient memories in some fashion (Phelps 2006)

• Emotion “promotes memory [even]...for peripheral detail” (Heuer & Reisberg 1990)

There are good evolutionary reasons for this

Cahill and McGaugh study —> 2 stories, one emotional and one not

The increased ability to remember in emotional situations is thought to be due to an increase in stress hormones

• Stress hormones: Catecholamines such as epinephrine and norepinephrine

• Increase in stress hormones causes the amygdala to influence activity in the hippocampus, causing more resilient memories to be created

  • Amygdala: involved with emotions such as fear

  • Hippocampus: involved in the formation of memories

Propanolol

“Beta-blocker” previously used just to treat hypertension, social anxiety, stage fright

Blocks the ß-adrenergic receptor (receptor for epinephrine)

Study by Cahill et al (1994) showed that administering propranolol decreases the boost emotional memories usually get (also used a two-stories setup similar to Cahill and McGaugh)

Propranolol has shown promise for the treatment of PTSD (Pitman 2002; see also Vaiva et al 2003). Questionable results, though

Limitations and drawbacks:

• Appears to work only if administered within 6 hours of the event

• Has possible side effects: sedation, difficulty focusing (no studies on the long-term cognitive effects of chronic use)

Treating PTSD

The traumatic memory is thought to be “consolidated,” and therefore difficult to get rid of

Old method of treatment is “exposure therapy”

• Exposure to fearful stimulus with no bad consequences weakens the fear response

• Inhibits but does not weaken the memory

New treatment: give “amnestic” agent (e.g., propranolol) during fear memory reactivation

• When a memory is activated, it becomes unstable (“labile”)

• The amnestic agent prevents its reconsolidation

• Effectiveness: shows a reduction of PTSD symptom ratings

  • 19% from just one session (Brunet et al 2008; but see Wood et al. 2015)

  • 42-52% from multiple (five) sessions (Brunet et al 2011; see also 2018)

PCB concerns about memory dampeners

To edit one’s memories is to live inauthentically

• It divorces one from reality

• One loses the chance to make sense of the bad experience

  • To be a person “who can live well with the whole truth”

• It is to “pursue a happiness that is less than human” (91)

  • A truly human happiness comes from both trials and triumphs

Problems with recognizing the moral significance of events

• An immoral action might seem less immoral if not in the company of the proper emotional reaction

  • In some sense, the person who remembers the act is not a “genuine witness”

• Such drugs could be used to prevent one from feeling shame or pangs of conscience even when a deed is something someone should feel badly about

Lost value as witnesses

• In many cases, we need someone who witnessed something (e.g., a crime) to remember as many details as possible

Developing resilience

• The way in which one learns how to deal with pain and suffering is through practice

• If one takes a drug instead, one never learns this skill

Kolber’s criticisms of the PCB position on memory dampeners

Inauthenticity and Character/Resilience Development:

• Kolber says there are two ways to understand this:

• Allows us to relieve distress in a “false or undeserved way”

  • Many experiences have no redeeming aspect, and not everyone is capable of such assimilation

• Those who take memory dampeners will not learn how to deal with suffering

  • If it is addictive in this way, then we won’t prescribe it

  • Many have good coping skills without experiencing trauma

A Genuine Life

• What does being genuine mean here?

  • Being genuine, in the sense of under no illusions

  • Living a genuine human life

• These two views seem in tension:

  • e.g., a medication that cured people’s tendency to overestimate their importance and abilities would be more genuine in the first sense, but not the other...

• Why is having a genuine life more important than ridding oneself of truly painful memories?

Prudential Concerns

• PCB have a bias for humans using whatever mechanisms they naturally have to deal with traumatic memories

• Two possible justifications for this bias:

  • It is doubtful we could improve upon natural mechanisms

  • We can, and should, live the kind of life that is distinctively human

    • Giving us too much control over what happens dehumanizes us

• Kolber’s responses:

  • It seems unlikely our memories are optimized for our individual needs

    • Many aspects of our “design” seem ill-suited to our modern day environment

  • What, really, is “the given” for human beings?

    • Which of the given is to be respected?

    • Why isn’t our ability to improve ourselves a given?

    • The “Dearthling” thought experiment

      • Dearthlings are exactly like humans but have a much lower chance of getting PTSD

      • If a dearthling wouldn’t be compelled to take a pill that increases his chances of PTSD, why would an earthling be compelled to not take the pill?