Neuroethics and Neuropsychology

  • Prelab questions:

    • How does the Belmont Report principle of Respect for Persons apply to the Bucharest Early Intervention Project (BEIP)? In what ways, if any, do you think the BEIP has satisfactorily met this principle? What are your concerns regarding this principle in the BEIP and how might the researchers respond in terms of addressing your concerns?

      • The Belmont Report’s principle of Respect for Persons applies to the Bucharest Early Intervention Project (BIEP), as the study revolved around the use of human subjects. This principle is broken down into two parts, neither of which the BEIP necessary complies with. The BEIP does not treat the children under 2 whom were the subjects as autonomous agents, as they justify the lack of informed consent with the future benefits it would bring to Romania. It also doesn’t meet the second principle of persons with diminished autonomy being entitled to protection. The participants fall into this category, and being institutionalized was shown to be worse off. The BEIP didn’t take into account that they waived the informed consent of a diminished group and subjected them to a condition shown to be worse off for their overall wellbeing. The researchers would have justified this, by stating how the vulnerable population would have been worse off without the study regardless of which group they were assigned to, due to the surrounding environmental conditions at the time.

    • How does the Belmont Report principle of Beneficence apply to the Bucharest Early Intervention Project (BEIP)? In what ways, if any, do you think the BEIP has satisfactorily met this principle? What are your concerns regarding this principle in the BEIP and how might the researchers respond in terms of addressing your concerns?

      • Beneficence within the Belmont Report applies to the BEIP’s treatment of children as human subjects in how they treated each participant. The BEIP meets this principle, as their study took children out of a potentially dangerous environment and, as they claim, bettered their cognitive development regardless of assigned foster/institution condition. One concern is with maximizing possible benefits to the participants. This isn’t possible for the children, as they had already gone through those crucial developmental years. Researchers would respond to this, as say that rather than benefiting the children themselves it was a benefit to future children. This particularly was in Romania, as the Romanian government was the one allowing this study to occur without informed consent from the children themselves who were too young without any definitive guardian to consent on their behalf.

    • How does the Belmont Report principle of Justice apply to the Bucharest Early Intervention Project (BEIP)? In what ways, if any, do you think the BEIP has satisfactorily met this principle? What are your concerns regarding this principle in the BEIP and how might the researchers respond in terms of addressing your concerns?

      • The principle of justice in the Belmont Report applies greatly to the BIEP, as there were many burdens and benefits to the study. The burdens were carried by the children who couldn’t necessarily provide informed consent but were still subject to the study. Depending on their assigned group, their cognitive development could have been sacrificed for the sake of research. The beneficiary is the outside world, countries can then benefit from the knowledge that being placed in foster care is better than institutionalization for cognitive development. According to the Belmont Report, this is unjust and does not satisfy the principle. The researchers would argue against this, citing how applying findings generally is too broad, arguing that the specific conditions in a developing country more so benefited countries such as Romania and thus returning some of the benefit. They would argue rather than the children being the burden, it was the country. Under this argument, the same body bearing the burden was reaping the benefits, therefore making it just and compliant with the principle of justice.

    • How are human subjects – including criminal suspects – placed at risk of harm in neuroimaging studies of lie detection? How might these risks be ameliorated or reduced?

      • Human subjects are placed at risk of harm in neuroimaging studies, particularly in the case of lie detection, as privatization of research makes regulation harder. This is especially true for criminal suspects, members of a group with less autonomy. Lie detector tests aren’t proven to be accurate, and a false positive on a suspected criminal could lead to an incorrect sentencing. With deregulated neuroimaging research, technology and findings can be sold to third parties who don’t have the consumer’s best interests in mind. For example, an unethical company who only hires people without children could subject job candidates to a lie detector test and unfairly discriminate against people who have children (regardless of how the question is illegal, as things quickly change politically). To reduce these risks, legislation could be put forward to regulate all forms of research, both private and at an institution.

    • Pose at least one methodological question that you have after reading the human neuropsychology case study (Murre et al., 2001, p. 647-653)

      • One methodological question I have regarding the neuropsychology case study conducted by Murre et al. is researchers chose to test A.M. every 6 months. Was there something about that frequency that they thought would lead to evident differences in MRI scans or neuropsychological test scores? Was there a previous reference that used the same time frame? Would later degeneration patterns be more evident if tests and scans were more frequent later on?

  • Vocabulary:

    • Bucharest Early Intervention Project (BIEP): A randomized trial of the effects of moving institutionalized young children to foster care. Occurred in Romania, and was deemed unethical because of how it treated informed consent with children. There was no one to consult for consent and so it was ignored, though researchers justified it by saying their research stopped the government from institutionalizing children under 2 due to developmental effects. Study found cognitive development before 2 was significantly improved by foster parents as opposed to institutionalizations. Results only benefited future children, not those who had participated if they were in the institutionalized group. No studies in other cultures, like those in non-developing countries, have been conducted

    • Belmont report: A set of ethical principles for research practice, not just guidelines. 3 principles include respect for persons, beneficence, and justice. Applied via informed consent, risks v benefits, and enrollment (in order)

      • Respect for persons: Emphasized via informed consent. Established by the Belmont Report, subjects must understand the risks and benefits of the protocol and that they can choose what does or does not happen to them, unable to be provided by children but rather their legal guardians can on their behalf. Some argue it cannot be obtained in developing countries due to lack of education and understanding of risks (but some say this is patronizing). Done voluntarily, not under coercion. There are additional protections for those with limited autonomy (like with dementia, children, or in prison). Debriefing should occur, and deception should be revealed afterward. Respect privacy of participants and confidentiality

      • Beneficence: Risks vs. benefits. Minimize unnecessary risks, use least risky methods (some risk is still allowed, hence informed consent). Risks must be balanced by benefits. Direct like money, indirect towards society/public knowledge

      • Justice: Do not preferentially assign conditions, everyone should be treated equitably (not equally). Do no exploit vulnerable populations or convenient samples.

  • Academic institutions have to follow strict ethics codes, but recent neuro research is private and not subject to the same codes of conduct, raising ethical questions

  • Bioethicists fear that neuroscience will increasingly focus on commercial transaction and become weaponized with potential ability to determine things like political stances and used to sway voters unethically

  • There is experimental evidence for fMRI lie detection, which could lead to terrible consequences if those in power use it wrong. It is currently unregulated

  • Research with human subjects has the goal of creating generalizable knowledge that benefits future patients, but risks sacrificing the interests of research participants for the greater good of society, which is why ethical guidelines were made

  • 4 main ethical issues:

    • Standards of care: On the issue of giving a known to work drug on a shorter timeline in a trial (AZT), critics argue placebo trials lead to the double standard where the wealthy avoid the trials to avoid the risks, while supporters for the trials argued giving worse treatments in developing countries was ethical so long as it was scientifically necessary, didn’t deny anyone treatment they would already receive, and was intended to benefit the developing country

    • Informed consent: See vocabulary definition

    • Ancillary care obligations: The medical treatments provided by researchers during trials above and beyond what is minimally required for safety/scientific validity. Those in developing countries may require more of this, though obligations are not well defined

    • Posttrial benefits: These exist to prevent exploitation, with a developing country this is to minimize burden and reap benefits of the associated study risks. This typically involves research results and benefits of trials are made reasonably accessible, but also sometimes includes ancillary care

  • Neuropsychological methods can only be used with natural causes due to ethical concerns. Lesioned areas hint to what certain regions may be responsible for. This used to be done via autopsy, but can now be done with neural imaging. It can only be correlational, damage → damage located → tests → associations made between impaired behavior and damaged area

  • Neuropsychological tests evaluate cognitive tasks

    • Block tapping order for spatial learning/memory

    • Mirror drawing for perceptual motor skill learning

    • Memory cards for episodic memory