Report on the Workshop in NEUROETHICS, Milano, May 2016

At a time when ethical issues are no longer envisaged as a hindrance to the ‘pure’ scientific character of the academic disciplines, but rather considered as an epistemic vector, neurosciences follow well this laudable trend.
As reference in this field within the European Research Area the ERA-NET Neuron proved attentive to this academic tendency/movement. By incorporating in its work program ethical-related actions NEURON launched in 2015 the Neuroethics Call for Proposals for “European Research Projects on Ethical, Legal, and Social Aspects (ELSA) of Neuroscience". A new edition of this call (2017) is under discussion.

The Milan Neuroethics workshop hosted by Prof. Fabrizio Tagliavini (IRCCS, Milano, Italy) provided the possibility to further discuss among the experts, Neuron partners and the scientific community ethical approaches that apply to the topics of NEURON’s Joint Transnational Calls.

The workshop was the second of a series of thematic focused activities embedded in NEURON’s working agenda addressing the «Interaction with the general public and stakeholders».

As Carlos Pereira (FCT, Portugal), the workshop organizer pointed out: 'NEUROETHICS is a relatively new interdisciplinary field that focuses on ethical issues posed by new technologies emerging from neuroscientific research and its findings' such as:

• psycho-pharmaceuticals and other ways of intervening in the mind;
• the practice of neuroscience itself, including problems posed by incidental findings in imaging work on research subjects;
• regulation of neuroscientific technologies, and
• ways in which the sciences of the mind illustrate traditional moral and philosophical problems, as the nature of free will and moral responsibility, self-deception, weakness of the will and the nature of personhood.

Along these lines the two major dimensions of neuroethics are thought as:

- the «Ethics of Neurosciences»: the ethical implications of the knowledge obtained in the neuroscientific areas and of the supporting technologies (brain imaging, enhancement of the neurological functions through neuro drugs, neuro-stimulation and neuro-genetic techniques), and
- the «Neurosciences of Ethics» - the neurological correlates of morality, in its adjacency to the philosophical reflection and to the meta-ethics (discussion on the new forms of imputation of the moral responsibility in view of the new assumptions of the cognitive neurosciences).

The workshop speakers addressed the following topics within the above mentioned dimensions:

- Prof. António Jácomo (PT), from the Portuguese Catholic University, made a general overview on Neuroethics;
- Prof. Andrea Lavazza (IT), from the Centro Universitario Internazionale, Arezzo, talked about the ethical issues of Brain Interventions and Brain Imaging;
- Doctor Hannah Maslen (UK), from the Oxford Uehiro Centre for Practical Ethics (University of Oxford), discussed the topic of Neuroethics of Neurological Treatments, and
- Prof. Manuel Curado (PT), from the University of Minho, expounded on the Neurological correlates of ethicity: the cognitive biases of moral thinking and moral behavior.

All presentations revealed an epistemic and philosophical density. Therefore, the discussion among speakers and audience was intense, witnessing a remarkable interest in the field.
The summaries of the presentations are provided below:

António Jácomo - «From the Ethics of the Brain, to the Brain of the Ethics»
Recent advances in neurosciences promote a neuroethical debate, often shrouded in skepticism and lack of concern. The nature of the brain has attracted philosophers and scientists for thousands of years. But can modern neuroscience ever hope to crack this mysterious phenomenon?
The purpose of this reflection is to reveal how neuroscience advances could improve the ethical reflection. The link that we attempt is to make a synthesis of the “brain of the ethics” and the “ethics of the brain”.
Inspired by Block (2009), we propose a vision and a summary of four theoretical perspectives: Neuroreductionist; Neurofunctional; Neurodualistic; Neuropheno-menological.
Faced with the brain complexity, neuroscience leads us to a kind of humility. The real triumph of neuroscience would be to make us aware of “how” we can discover: using correct methods, and relying on the structure of science as a basis of knowledge, we can understand not only the world but also the experience of ourselves. This is the framework within which we could fit Neuroethics; which is not knowledge, but gives "meaning to learn" through a set of proposals for the integration of scientific advances in the context of a genuine humanity.
What accounts for this change? Part of the shift reflects the deepening neuroscience expertise of many neuroethicists and the migration of neuroscientists to the field of neuroethics. 

Andrea Lavazza – «Ethics of Brain Imaging and Brain Interventions»
Brain imaging techniques are clinical and scientific tools that have allowed a giant leap in recent decades. But there are many ethical issues related to them.
(1) Brain imaging might heavily interfere with brain privacy, when a person is requested to undergo a brain scan for whatever reason.
(2) Incidental findings, undiagnosed medical or psychiatric conditions that are discovered unintentionally, need to be carefully considered and sometimes can create moral dilemmas. (3) Brain Evidence vs. Brain Functioning: what we see in the brain is not always what the brain can and cannot do. So there are risks of hyper-valuing brain imaging as a direct access to mind/brain, which is not true.
(4) Predictive Neuroimaging: for example, psychotic disorders, such as schizophrenia, are associated with neuroanatomical abnormalities. Some of the grey-matter abnormalities associated with psychotic disorders predate the onset of overt symptoms: when and what should the patient be told?
(5) Non-Clinical Uses: Assessing Offenders and Skills Evaluation. Specific profiles of activation of specific brain areas as well as specific architecture and connectivity can be good predictors of impulsive and/or aggressive behaviour. Markers similar to those used in criminal contexts can be good predictors of a person’s specific skills. And brain scans could take the place of job interviews. All of that raises relevant political and social issues.
As to brain interventions, there are many ethical issues related to: (1) Psychopharmacology (therapeutic and novel treatments); (2) Neurosurgery; (3) Psychosurgery; (4) Neurostimulation; (5) Cognitive and affective enhancement; (6) Brain-machine interfaces; (7) Gene-editing. For example, regarding, psychopharmacology, beyond safety and effectiveness, a strong social pressure to adapt and be productive exists. And patients undergoing pharmacological treatment adapt themselves to situations which they might otherwise try to change. Pills can discourage people from seeking political solutions to social problems, which turn into medical problems treated individually.

Hannah Maslen – «Neuroethics of Neurological Treatments: DBS for the treatment of anorexia nervosa and chronic pain»
Deep Brain Stimulation (DBS) involves surgically implanting a battery-operated neurostimulator to deliver electrical stimulation to targeted areas in the brain via electrodes implanted in the brain.
To date, DBS has most routinely been used to treat the debilitating motor symptoms associated with Parkinson’s disease. However, DBS is now being trialled as a treatment for a range of other disorders. Treatments are still in early, investigational stages and raise a number of ethical issues. Two potential indications for DBS include the psychiatric disorder, anorexia nervosa (AN), and medically refractory chronic pain. In this talk the ethical issues associated with using DBS to treat these very different conditions are examined.
Anorexia nervosa
In relation to AN, I distinguish three potential mechanisms alluded to in the neuroscientific literature, relating to desire, control, and emotion, respectively. I explain why the precise nature of the mechanism has important implications for the patient’s autonomy and personal identity. I then consider practical dimensions of offering DBS to patients with AN, identifying some limited circumstances where the mere offering of the intervention might be perceived as exerting a degree of coercive pressure that could serve to undermine the validity of the patient’s consent.
Chronic pain
In relation to chronic pain, I discuss the significant ethical issues raised by the high risk of recurrent seizure and even the development of de novo epilepsy. Some patients expressed a preference to continue with stimulation despite the experience of seizures. This raises questions about whether patients should be allowed to choose to undergo such a risky intervention given that it is not indisputably in their best interests. Understanding how the patient’s autonomy can be promoted in these cases will be essential. Further ethical challenges are raised by the apparent side effect of increased apathy. Close attention must be paid to any implications of DBS-induced apathy for the patient’s treatment-related decision-making and, indeed, her broader wellbeing.

Manuel Curado – «Neurological correlates of ethicity: the cognitive biases of moral thinking and moral behavior»
Ethics is the systematic investigation of voluntary human behavior that aims at the pursuit of happiness. There are many constraints that greatly limit the scope of human action. The ethics is the systematic exploration of those constraints. Aristotle is perhaps the philosopher who presented in a more comprehensive way the field of ethical reflection, and Hegel the philosopher who launched the novel field of ethicity. This communication seeks to show that contemporary neuroscientific research is changing radically what was known about the way ethicity influences ethics. Moral categories such as poor decision, reward, influence of beliefs in action, behavior motivated by fear, suicidal ideation, painful memories, honesty, responsibility, addictions and dependencies, and many others, are being significantly altered. Although these investigations are very important for ethics, this communication argues the case that the assessment of this importance depends on a deliberate conceptual limitation of the most difficult theoretical problems linked to the relationship between the brain and the human mind. We are far from understanding the whole connection between mental states and behavior and, above all, what determines a particular behavior.
Saying this another way: the real impact of neuroscience has been rhetorically inflated. The public perception of neuroscientific results was oversimplified by a theoretical model that considers mental life a byproduct of brain activity. There is still room for doubt. In any case, the theoretical debate about ethics and ethicity does not diminish the importance neuroscience has for health. This communication proposes that should be sought a balance between excessive enthusiasm for the promises of neuroscience and a fair assessment of its actual results in the context of intellectual debate. Ethical monitoring of neuroscientific research should be constant.

Curricular notes:

● Prof. António Jácomo (PT), from the Portuguese Catholic University, is a teacher and a researcher in the Bioethics Research Office. His research areas are
philosophy of mind, moral psychology, ethics and cognitive science.
● Prof. Andrea Lavazza, (IT), from the Centro Universitario Internazionale, Arezzo, is a scholar of cognitive sciences and a philosopher. His main field of research is neuroethics, namely the areas of moral philosophy, free will, and law at the intersection with cognitive sciences.
● Doctor Hannah Maslen (UK), from the Oxford Uehiro Centre of Practical Ethics, is a Postdoctoral Research Fellow in Ethics, working on the Oxford Martin Programme on Mind and Machine. Her current research focuses on the ethical, legal and social implications of various brain intervention technologies.
● Prof. Manuel Curado (PT) is professor at Universidade do Minho, Portugal. His research activity is directed to the Biomedical Ethics, the Philosophy of Mind, the History of Ideas, and the problem of human consciousness and its relationship to the brain.