Gray Matters: Neuroethics in the Twenty-First Century
From its nineteenth century beginning until the late twentieth century, the advancing medical science of neurology strove to understand the brain and central nervous system and help those with often irreversible neuropathology. In the last 3 or 4 decades, neurology’s scope has widened to comprise the many clinical and ethical questions associated with neuroenhancement, neurodiversity, and the nature of creativity. Contributors to November’s issue grapple with prognosticating for severely impaired newborns, standardizing criteria for declaring brain death, the advent of “smart” pills, parents who decline treatment for a child with autism, and more.
Forcing parents to participate in treatment is unlikely to succeed. Seeking to optimize the therapeutic alliance between family and pediatrician is more likely to achieve the desired outcome—the child’s short- and long-term well-being.
Within the patient-physician relationship, the request for neuroenhancement becomes a chief concern, and the physician has a duty to take a history and perform a physical exam to determine whether the patient’s current level of function represents significant change.
James F. Bartscher, MD and Panayiotis N. Varelas, MD, PhD
Variability in the determination of brain death from state to state, hospital to hospital, and, most likely, physician to physician undermines the validity of the concept in the minds of practitioners and the public.