NSCI 301 Exam 1

What is bioethics?

Field of study that deals with the ethical implications of biological and medical practice, research, and technology

What is medical ethics?

NOT the same as bioethics, falls within it, specfically looking at how doctors and patients interact

What is the Hippocratic Oath?

Early example of code of ethics for medicine, focused on the patient-physician relationship and maintaining privacy

What is Cicero’s pronouncement?

“let the safety and welfare of the people be supreme law”

What makes up bioethics?

Biological knowledge and human values, both of which adapt over time

What were the doctors’ trials in Nuremberg?

First of the follow-up trials from International Military Tribunal after WWII, for war crimes against humanity committed by Nazi doctors

What is the Nuremberg Code? (DONT MEMORIZE)

Ten aspects:

1. The voluntary consent of the human subject is essential: legal capacity to give consent, free power of choice (no coercion), sufficient knowledge of subject matter, duty to ensure quality informed consent rests with experimenter

2. Experiment should be necessary and fruitful for good of society

3. Based on animal experimentation and prior knowledge

4. Should avoid unnecessary suffering/injury

5. No experiments where a priori risk of death/injury occurring (unless helps subject)

6. No risk which outweighs importance of problem being solved.

7. Adequate facilities

8. Qualified researchers ONLY, need skill and care throughout

9. Subject can stop at any time

10. the researcher must be prepared to terminate the experiment if necessary.

Why did Nuremberg Code not work?

Not accepted as law or official ethics guidelines by any nation, seen as an obvious response to brutal experimentations (no nuance)

What was the Declaration of Helsinki?

A wide breadth of ethical regulations made by the World Medical Association (includes protection of vulnerable groups, scientific protocols, research ethics, privacy, placebo, research registration/publication)

Why did the Declaration of Helsinki not work?

Controversies, arguments, people couldn’t decide what to accept, Beecher raised 22 examples of questionable science (Beecher’s fails)

What is the Belmont Report?

Response to Tuskegee syphilis study from the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research, prioritizes respect for persons, beneficence, justice (THIS ONE WORKED)

How did bioethics rise?

1. Conflicts between technology and human values

2. Simulating intellectual and moral challenges (people weren’t using religion to guide anymore)

3. Openness to multidisciplinary work

What are some example theories in bioethics?

Utilitarianism, deontology, descriptive natural law, justice, virtue ethics, ethics of care, principlism

Differentiate the ethics of neuroscience from the neuroscience of ethics

Ethics of neuroscience → ethical, legal and social impact of neuroscience research and the manipulation of the human brain

Neuroscience of ethics → neural underpinnings of morality, free will

What are the 4 pillars of neuroethics?

Brain science and the self, brain science and policy, ethics and practice of brain science, brain science and public discourse

Examples of neuroenhancement drugs?

• Purines and methyxanthine derivatives (caffeine, theophylline, theobromine)

• Phenylethylamine derivatives (stimulant, relevant to ADHD treatment)

• Modafinil (narcolepsy treatment)

What is cognitive neuroenhancement?

“improving the capacities of, or producing new capacities for, healthy individuals by means provided by neuroscience”

What are the issues with this definition of health? “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” - WHO (1946)

Unchanged to this day 

Issues

• Subjective

• What does complete mean?

• How are these terms defined?

• Underlying conditions?

• Vague

• Creates a binary of healthy/unhealthy rather than a continuum

• Other dimensions not included (spiritual wellbeing)

• Ableist 

Define health vs. disease

What are motivations for pharmacological neuroenhancement?

• Responses to increasing demands of society (work, school, private life)

• Individual - increased cognition, sleep reduction, mood enhancement, improved executive functions, job market advantages

• Society - Increased productivity and efficiency, competition, reduced resting periods

How can pharmacological enhancements be accessed?

• Diversion (stealing from friends, peers, family members, someone with prescription)

• “Independent suppliers” (dealers)

• Pharmacy (prescription OR over the counter medicines)

• E-commerce (sold online, rogue pharmacies)

Explain the debate between bioconservatives and technoprogressive optimists

Bioconservatives favour heavy-handed prohibition for pharmaceutical users who have no deficits (ex. okay to use drugs if you have ADHD but not if you’re neurotypical)

Technoprogressive optimists believe in widespread availability of all enhancement drugs, even for those who don’t need them/are neurotypical

What are ethical concerns involved in cognitive enhancement?

• Authenticity

  • Become a different person? Is there a “real/true” self?

• Coercion

  • Feeling unable to opt-out (what if job requires focus, are they harming people by not enhancing?)

• Distributive justice

  • Increase or decrease societal inequality

• Fairness (cheating)

  • Value of achievements

• Hubris

  • Morally defective attitude, ungrateful for what they have

• Cognitive liberty

  • Right to determine our own cognitive state

Intersectional considerations of enhancement?

• Gender, racial inequity

• Ableism

• Holistic definitions of enhancement

What is the inverted U?

Drugs affect different individuals in different ways (some individuals might improve while others may lose their original capabilities)

Could also cause benefits in one area (i.e. memory) while harming another (i.e. focus)

What are neurotechnologies used for neuroenhancements?

Transcranial magnetic stimulation (variable short-term effects)

Transcranial direct current stimulation (uncertain short-term effects)

Long-term effects are unknown for both, but risks include neurohype, adverse effects, and D2C

What is moral enhancement?

“an increase in the moral value of one’s actions or character”

Moral bioenhancement is when this is achieved using “medical, pharmacological, or biotechnological means”

Can be from increases in:

• Empathetic concern

• Personal responsibility

• Social norm compliance

• Respect for societal and global fairness

• Empathy and compassion for distant individuals

• Moral behaviours

What are 4 principles that bioethicists frequently use?

Autonomy (informed consent)

• Should have the freedom to choose

• Should not nudge (let people make autonomous judges)

Beneficence (best interests of the patient, can only give positive options for their benefit)

Nonmaleficence (Do no harm)

Justice (Distribute the harms and the benefits equally)

These fall under principilism (uphold as much as possible), NOT deontology (isn’t unethical to not follow one)

What is a contrastive vignette?

1. Minimally contrastive versions of a master vignette (a story/situation)

2. Randomly assigned to participants

3. Participants unaware of contrastive case

4. Answer identical questions

Between condition measurements

What is a robot, a social robot, and a socially assistive robot?

Robot - “cyber-physical system with sensors, actuators and mobility”

Social robot - a robot that interacts with people

Socially assistive robot - robots that support in care activities like healthcare, rehabilitation or special education through socially interacting with patients (coaching, motivation etc.)

How do social robots improve mental health outcomes for older adults and children?

Older adults:

• Decrease loneliness

• Decrease in anxiety

• Increased medication adherence

• Lower need for neuropsychiatric medication in people living with advanced dementia

• Improved quality of life

Children:

• Improved social and communication skills of children on the autism spectrum

• Relief of acute stress and anxiety

• Decrease in depressive symptoms

• Decrease in distress

Which robot is approved as a biofeedback medical device by the FDA?

PARO, my king <3

What are Asimov’s Laws of Robotics?

1. A robot may not injure a human being or, through inaction, allow a human being to come to harm

2. A robot must obey the orders given it by human beings except where such orders would conflict with the first law

3. A robot must protect its own existence as long as such protection does not conflict with the first or second law

What are some issues with Asimov’s laws of robotics?

• What about harming of human property?

• The use of the word “injury” is vague

• How will a robot know the outcome of every action?

• Difficult to instill nuanced rules into a fixed system

What are the “Principles of robotics” created by Margaret Boden?

1. Robots should not be designed as weapons except for national security reasons

2. Robots should be designed and operated to comply with existing law, including privacy

3. Robots are products, as with other products they should be designed to be safe and secure

4. Robots are manufactured artefacts: the illusion of emotions and intent should not be used to exploit vulnerable users

5. It should be possible to find out who is responsible for any robot

What are some issues with the “Principles of robotics” created by Margaret Boden?

• Language is still not very operable

• Says emotions shouldn’t be used, but this could be a reason why SARs work! (providing companionship)

• What counts as a vulnerable user? Is any SAR application in healthcare ethical then?

What are some categories of ethical issues related to social robot use?

Well-being

• Privacy/data control

• deception

• autonomy

Care

• Loss of human contact

• Legitimacy of the introduction of the SAR

• Quality of practice

Justice

• Distributive justice (is it ethical to distribute these devices knowing the ethical dilemmas?)

• Politics of SAR technology

• Responsibility

What are the dimensions of privacy?

Physical (personal space)

Psychological (privacy of values and thoughts)

Social (whether social conversations stay private)

Informational (user data)

What is the privacy paradox?

While many technology users report privacy concerns, not many take actions to protect said privacy.

• People feel like privacy is a price we pay for free services

• Lack of understanding of implications

• People are resigned

How are computers social actors?

Human-computer interactions are inherently social, many human-human interaction phenomena extend to interactions with computers (i.e. treating ChatGPT nicely when talking to it)

What is the definition of privacy?

the claim of individuals, groups, or institutions to determine for themselves when, how, and to what extent information about them is communicated to others

What are 7 design solutions for increasing SAR privacy?

1. Proactive not reactive; preventive not remedial

2. Privacy as the default setting

3. Privacy embedded into design

4. Full functionality - positive-sum, not zero-sum (not sacrificing privacy for functionality or vice versa)

5. End-to-end security - full lifecycle protection

6. Visibility and transparency - keep it open

7. Respect for user privacy - keep it user-centric

What are some informational privacy considerations?

• Capacity of social robots for data collection (including emotions, mental states, personality)

• Third-party access to data

• Hacking

• Collecting information about third parties

• Lack of user understanding

What are some psychological privacy considerations in SARs?

• Psychological dependence on robots

• Reduced self-reflection and autonomy

• Vulnerable user groups

What did conceptual vs empirical scoping reviews of SARs show?

Conceptual came up with more privacy concerns, empirically, people did not care that much and focused more on benefits of SARs

What are some real-world privacy failures?

• Hello Barbie

  • Was recording everything a child ever said (which parents coul access)

  • Info was used to collect marketing information for Mattel

• CloudPets

  • Non-encrypted, information and voice recordings were leaked

What were some initial concerns of structural neuroimaging (MRI)?

• Scared of nuclear explosions (was initially called nuclear magnetic resonance)

  • Even more wary of this during the Cold war

• Cost

  • Economically inaccessible, a service only given to the rich

• Cancer

  • Used to identify cancerWh

• Competency

  • Loud, scary to be in, patients thought it would explode

  • Healthcare professionals were confused by machine’s output

What is an incidental finding?

Unexpected discovery unrelated to original purpose of examination (specific to imaging)

ex. unexpected masses, evidence of trauma to the brain, aneurysms bleed/stroke

What is the prevalence of different types of IFs?

Depends on IF definition, study population, methods/analysis tools used, etc.

What are some ethical considerations of incidental findings?

Team 1: Obligation to participant

• Researchers must look for and disclose information about participant wellbeing

• Participants should have patient autonomy

• Beneficence

Team 2: Obligation to research

• Responsibility of IF burdens researchers and the healthcare system

• Consistency between participants

• Potential for unwarranted harm to participants from disclosure

  • Most affected by the ambiguity of the post-disclosure period

Explain the Netherlands Epidemiology of Obesity study and its incidental findings issues?

• Study investigating obesity-related diseases/pathophysiology

• 56 incidental findings found (including malignancy suspects, aneurysms, subdural hematoma and more)

Participants reportedly felt pain in the areas of:

• Informed consent

  • Assumed IFs were disclosed

  • Unsure if info was shared with medical team

• Disclosure

  • Took too long

  • Didn’t get to choose method (phone/email etc.)

  • Information of health info was confusing/misleading

• Medical follow up

  • Period between disclosure and follow-up was worrying

  • Participants expected GP to support/follow up

• Transition from participant to patient

  • Expected researcher (who they were “doing a favour for by participating”) to give them rapid access to medical care

  • Assumed all IF info was being given to medical specialist

What are some initial concerns of functional neuroimaginng (fMRI)?

• Informed consent (do people know what they’re getting into?)

• Incidental findings

• Self-evaluation (people can make inaccurate generalized conclusions about themselves following an MRI)

• Legal

• Educational (could fMRIs diagnose learning disabilities? Only one point in time, inaccurate measure of intelligence)

• Economic (neuromarketing, is it ok for businesses to use your brain data for marketing?)

This is just a snapshot of function/connectivity at a particular point in time, does not show full picture

What is consciousness and its relation to imaging?

Consciousness - awareness of surroundings, subjective experience of existence

fMRI can be used in disorders of consciousness, impaired consciousness, vegetative states and more.

Explain false positives and ghost fish

There is a very large sample of voxels in the fish fMRI, which amplifies random correlations, making the dead fish seem like they are still showing brain activity.

Shows that there are

• large statistical challenges to keep in mind with fMRI analysis

• large rate of false positives

• proceed with caution and skepticism

Explain benefits and cons of the portable MRI

Portable MRI uses cloud-based imaging to create a cheap, quick, and convenient alternative to typical MRIs

PROS

• Access to healthcare increases

• Cheaper and quicker, more accessible in remote regions and rural areas

CONS

• Can people in remote areas meaningfully consent? How to communicate in culturally appropriate ways?

• What are ethical frameworks of incorporating cloud-based AI into brain scan analysis? Biased?

• How will IFs be reported?

• How will participants access their brain data?

What are some current privacy concerns in neuroimaging technology?

• Concern that Amazon and similar health platforms will harvest consumer health data from patients

• Concern about large data breaches occurring in healthcare organizations

What do surveys capture in neuroethics?

• Public attitudes

• Factors in decision-making

• Patient experience

Why is collecting patient experience data important?

Quality improvement, accreditation, improving practices, research, actual caring

What are important questions to think about when surveying?

What is active data capture?

What is passive data capture?

What are the elements of a good vs bad survey?

• Validated or custom?

• Has someone done it before? (build on what exists)

• Pilot

• Buzzfeed (short, punchy, pictures)

• Question order and wording