Virtual Mentor. June 2012, Volume 14, Number 6: 453-458.
Resources for Teaching Neuroethics
The rapidly evolving field of neuroethics is concerned with the ethical questions that new technologies will pose about autonomy, privacy, the definition of normal, and individuality.
David Elkin, MD, Erick Hung, MD, and Gilbert Villela, MD
Many of the ethical dilemmas that physicians confront are the result of the research and technological innovation of the last half century. Perhaps the most challenging ethical controversies that will result from scientific advances are expected in the field of brain science. News headlines from recent years demonstrate that this has already begun to happen: “More Students Turning Illegally to ‘Smart’ Drugs”  and “A Definitive fMRI Test For Narcissism” .
The rapidly evolving field of neuroethics—ethical issues involving neurologic and psychiatric conditions—is concerned with the great promise of newer technologies as well as the ethical questions that they will pose about autonomy, privacy, the definition of “normal,” and the nature of individuality.
The promise and danger of cognitive and emotional enhancement are now being considered. Listed below are some ethically controversial interventions that are either currently possible or are likely feasible in the near-future:
Educators should consider the specific dilemmas that arise in assessing and treating brain conditions and the special aspects of brain function that set controversies in neuroethics apart from those involving any other organ system. It is the brain that determines individuality and makes persons unique. Repairing damaged brain cells with stem cells is a very different proposition than fixing, for example, vascular tissue; replacing brain cells might lead identity to be altered. Similarly, the possibility of enhancing intelligence or mood beyond the normal range could change the social perception of what constitutes a normal or desirable state. If mental states or personality disorders are traced to specific DNA sequences, rapid genome sequencing may lead to a significant loss of privacy.
How will our society view these advances, and what role will physicians play in their implementation? Can scientists determine research agendas, or must society and social norms play a governing role? Considerations of autonomy, social pressure, access to care (another important issue in costly new treatment options) and the possibilities of neuroenhancement make for exciting discussion as trainees explore the social implications of potentially revolutionary innovations in medical care. We recommend several books, articles, and web sites that discuss these issues [3-9].
Critical Thinking and Psychiatry and Neurology Ethics
Critical thinking is reflective consideration leading to reasoned judgments. It can be characterized as a set of skills and habits of mind:
Critical thinking is often fostered through the Socratic method, in which instructors use questions to prompt reflection among students, empowering them as thinkers, and model open-mindedness and humility. We recommend several books on critical thinking in medicine and more generally [10-12].
The application of critical thinking to ethics offers numerous advantages and highlights the importance of techniques useful in teaching. Having trainees reflect on their process of ethical reasoning encourages practices that will be useful in the future. Highlighting the dangers of groupthink in ethical dilemmas, and the influence of emotions on supposedly rational analysis, offers important insights for trainees about psychological mechanisms that can influence ethical analysis. Asking trainees to explore their values explicitly, often as their idealism comes into conflict with real-life dilemmas, encourages self-knowledge and stresses the importance that each individual brings to such study.
Trainees can be asked to examine the basis for their beliefs by posing questions like: Where do you believe ethical authority originates? Do you believe in a religious or spiritual basis for morality or does society make rules that we must all follow? Can a decision be right or wrong on its own, or do individuals decide? How might beliefs that arise from these different bases conflict? How should conflicting beliefs and values be treated in a democracy?
The ability to tolerate ambiguity is key to discussions of ethical dilemmas. It is instructive for trainees to ponder how they will act under conditions of uncertainty. Many students and residents feel a strong desire to achieve closure on dilemmas by the end of a class or seminar, often prematurely.
Studies demonstrate the limited effectiveness of uninterrupted lectures. Most participants will be excited about discussing ethical issues; it is an instructor’s responsibility and charge to build on that enthusiasm, employing different pedagogical approaches such as didactic or informational presentations, Socratic discussion, case presentation and discussion, and other media including articles, advertisements , documentaries , film clips (see below), and nonacademic web sites [15, 16]. The University of Pennsylvania Center for Neuroscience and Society has online resources teachers may find useful in designing curricula and choosing assignments [17, 18].
The following scenarios can serve as the basis for small-group discussions:
Films that promote critical thinking about topics in brain-science-related ethics include:
David Elkin, MD, is a clinical professor of psychiatry at the University of California, San Francisco and an attending physician on the consultation-liaison service at San Francisco General Hospital, where he co-coordinates medical student education and teaches core didactics and a weekly humanities seminar on professionalism and ethics. He also directs physician wellness efforts and serves on the hospital ethics committee.
Erick Hung, MD, is an assistant clinical professor of psychiatry and the associate director of the Adult Psychiatry Residency Training Program at the University of California, San Francisco. He is the director of the Telemental Health Program at the San Francisco Veterans Administration Medical Center Downtown Clinic, where he has also been the mental health director and the associate chief of the mental health service.
Gilbert Villela, MD, is an associate clinical professor in psychiatry at the University of California, San Francisco and the unit chief of the jail psychiatry inpatient unit at San Francisco General Hospital, where he has also worked in psychiatric emergency services and the Outpatient Psychosocial Medicine Clinic. He is researching the efficacy of teaching critical thinking.
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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