Neuroethics Exam 2

DSM Definition of Addiction

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time within the same 12-month period.

1. tolerance

2. withdrawal

3. using more than was intended

4. persistent desire or unsuccessful efforts to control use

5. a great deal of time spend obtaining, using, or recovering

6. reduction in other important activities because of use

7. continued use despite knowledge of its causing a persistent or recurrent physical or psychological problem

Class Definition of Addiction

Addiction is a strong and habitual want that significantly reduces control and leads to significant harm. Control and harm come in degrees. Addicts have some control over their choices and actions, but they do not have full or normal control; and hence they have less control than non-addicts (including non-addicted drug users).

Aversion therapy does not work because:

Dopamine is released even with negative associations with taking drug

Biological basis of addiction based on:

Animals can be addicted too

What does dopamine release do?

• Produces intense euphoria

• Powerfully reinforces the connection between consumption of the drug, resulting pleasure, and all external cues linked to the experience

• Large amounts teach the brain to seek drugs at the expense of other things

• Becomes stronger over time; control and motivation diminish as drug signals increase and amplify - which leads to subconscious decision-making in re-taking the drug

What makes addiction hard to overcome

• 70% of treatment programs are abstinence-based. Thus, it is considered a moral failing.

  Environmental influences (nurture) can impact addiction (parents, friends, peers)

• To avoid withdrawal

• External cues

• Dopamine changes the brain

Causes of addiction

• 60% genetics, 40% psychosocial

When the cure is worse than the disease

read bout this

Different types of neurological evidence

• Medical history

• Neuropsychological testing

• Brain scanning

  • Claims of brain or head injury

Uses of neurological evidence

• mitigation of sentencing or crime charged

• whether person has competency to stand trial

• improve accuracy and decrease errors in the criminal justice system

• help us understand the general predispositions and behavioral proclivities of a person

Limits of neuroscientific evidence

• Usually not used to argue that a defendant does not have requisite mens rea

  • neuroscience cannot answer difficult questions of what someone was thinking, feeling, intending, or experiencing at the time of the crime

• Usually raised on appeal (improper counsel)

• neuroscientific data is simply more data

Requirements of legal, criminal responsibility

• Actus reus (THE ACT)

  • Requires a voluntary action

    • A bodily movement performed while conscious as a result of effort or determination, or (an omission to perform an act of which the actor is physically capable)

    • Includes a conscious but accidental act

• Mens rea (THE MENTAL STATE)

  • Different levels of intention required

Conviction requires both elements be proven beyond reasonable doubt

1. Consciously will to x

2. Know that x is wrong

3. Do x

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Example: Theft

• Actus reus: Taking property

• Mens rea: Knowledge the property belongs to someone else and the intention to deprive that person of it

Mental states of intention

1. Purposefully (intends to bring about a result)

2. Knowingly (practically certain the result will occur)

3. Recklessly (consciously disregards a substantial or unjustifiable risk)

4. Negligently (should be aware of a substantial or unjustifiable risk, but is not)

Purposefully

intends to bring about a result

Knowingly

practically certain the result will occurR

Recklessly

consciously disregards a substantial or unjustifiable risk

Negligently

should be aware of a substantial or unjustifiable risk, but is not

4 defenses of impairment

1. insanity defense

2. involuntary intoxication (voluntary or reckless intoxication is not a defense)

3. diminished capacity

4. duress

Duress

1. requires actual or threatened physical force or harm and

2. reasonable belief of harm if act not taken

Diminished capacity

1. negates required mental state; changes knowingly to recklessly or premeditated to spontaneous

insanity defense

Majority rule: an actor is excused for their conduct constituting an offense if, as a result of:

1. a mental disease or defect AND

2. the actor

   1. does not perceive the physical nature or consequences of his conduct; OR

   2. does not know how conduct is wrong or criminal; OR

   3. is not sufficiently able to control his conduct as to be held accountable

Normative question

should we do this (asking about a norm)

Descriptive question

this is what we currently do (describing what is done)

Legal question

this is what is legal (which can differ from normative)

4 steps of organ donation

1. patient’s physician refers patient to an organ transplant center (OTC)

2. OTC evaluates patient’s eligibility for an organ transplant

3. If OTC determines that patient is eligible, OTC places them on the national waiting list

4. If a match is found, OTC carries out organ transplant

4 general concerns for list prioritization

1. medical compatibility between donor and organ recipient

2. how long patient has been on the waiting list

3. distance between the donated organ or living donor and the recipient

4. how urgently the transplant is needed

Criteria for organ transplant

1. no cancer outside of organ that needs transplant

2. no infections

3. no documented medical non-compliance

4. adequate social support

5. adequate insurance or other financial means

Moss and Siegler’s arguments

Thesis: ARESLD should be lower than ESLD because of scarcity

1. Liver disease is different because of 3 things

   1. nonrenewable resource

   2. comparison with heart transplant (h/o alcoholism is rejected in heart transplants)

   3. expensive technology

2. Fairness

   1. ESLD through no own fault should have higher priority than those whose liver disease is due to failure to obtain treatment for alcoholism

   2. ARESLD was preventable, thus they should be treated differently

   3. tradeoffs between basic health care for the many and expensive but life saving for the few

Van Theil’s arguments

Thesis: Alcoholics should have liver transplants because they can survive it and use it to return to work.

1. Refuting medical grounds

   1. liver transplant increases the 2-year survival rates of patients with severe alcoholic cirrhosis compared to same patients who haven't received the transplant

   2. low rate of returning to drinking post-transplant

2. Arguments against Moss & Siegler

   1. no other disease that includes voluntary choices (lung disease & smoking) change rules for organ donation

   2. important to give an alcoholic a better matched liver than a non-alcoholic a worse-matched liver

   3. ensure things that lead to a successful recovery - support of significant other, pt’s acceptance of alcoholism as cause of liver disease, job

opposite of addiction is:

community and relationship

Legal responsibility

mens rea and actus rea (for a crime)

Moral responsibility

acts or states of affairs for which you can be praised or blamed

it attributes actions to an agent, holding the agent accountable for those actions, and being liable for something or someone. The dominant themes are having a sense of obligation or duty, being accountable to others in fulfilling obligations, and having a concern for others

Addiction according to Levy

• autonomy impaired by addiction is not the same kind which is necessary in informed consent

• thus, addicts can still give informed consent to a study or treatment program because it relies on decisional capacity instead of executive autonomy (which is impacted by addiction)