Bioethics and the Brain

Microelectronics and medical imaging are bringing us closer to a world where mind reading is possible and blindness banished - but we may not want to live there. New ways of imaging the human brain and new developments in microelectronics are providing unprecedented capabilities for monitoring the brain in real time and even for controlling brain function. The technologies are novel, but some of the questions that they will raise are not. Electrical activity in the brain can reveal the contents of a person\u27s memory. New imaging techniques might allow physician to detect devastating diseases long before those diseases become clinically apparent. And researchers may one day find brain activity that correlates with behavior patterns such as tendencies toward alcoholism, aggression, pedophilia, or racism. But how reliable will the information be, how should it be used, and what will it do to our notion of privacy? Meanwhile, microelectronics is making access to the brain a two-way street. The same electrical stimulation technologies that allow some deaf people to hear could be fashioned to control behavior as well. What are the appropriate limits to the use of this technology? Ethicists are only now beginning to take note of these developments in neuroscience

Re-examining ethical obligations in the intensive care unit: HIV disclosure to surrogates

Physicians treating newly incapacitated patients often must help navigate surrogate decision-makers through a difficult course of treatment decisions, while safeguarding the patient's autonomy. We offer guidance for intensive care physicians who must frequently address the difficult questions concerning disclosure of confidential information to surrogates. Three clinical vignettes will highlight the ethical challenges to physician disclosure of a critically ill patient's HIV status. Two key distinctions are offered that influence the propriety of disclosure: first, whether HIV infection represents a 'primary cause' for the patient's critical illness; and second, whether the surrogate may be harmed by failure to disclose HIV status. This balanced consideration of the direct duties of physicians to patients, and their indirect duties to surrogates and third-party contacts, may be used as a framework for considering other ethical obligations in the intensive care unit. We also provide a tabulation of individual US state laws relevant to disclosure of HIV status

International variation in ethics committee requirements: comparisons across five Westernised nations

BACKGROUND: Ethics committees typically apply the common principles of autonomy, nonmaleficence, beneficence and justice to research proposals but with variable weighting and interpretation. This paper reports a comparison of ethical requirements in an international cross-cultural study and discusses their implications. DISCUSSION: The study was run concurrently in New Zealand, UK, Israel, Canada and USA and involved testing hypotheses about believability of testimonies regarding alleged child sexual abuse. Ethics committee requirements to conduct this study ranged from nil in Israel to considerable amendments designed to minimise participant harm in New Zealand. Assessment of minimal risk is a complex and unreliable estimation further compounded by insufficient information on probabilities of particular individuals suffering harm. Estimating potential benefits/ risks ratio and protecting participants' autonomy similarly are not straightforward exercises. SUMMARY: Safeguarding moral/humane principles should be balanced with promotion of ethical research which does not impede research posing minimal risk to participants. In ensuring that ethical standards are met and research has scientific merit, ethics committees have obligations to participants (to meet their rights and protect them from harm); to society (to ensure good quality research is conducted); and to researchers (to treat their proposals with just consideration and respect). To facilitate meeting all these obligations, the preferable focus should be promotion of ethical research, rather than the prevention of unethical research, which inevitably results in the impediment of researchers from doing their work. How the ethical principles should be applied and balanced requires further consideration

Expert Bioethics as Professional Discourse and the Case of Embryonic Stem Cells

This article reviews the history of discourse on research using human embryonic stem cells (hES cells). Reports of the hES controversy in major scientific journals show how the terminology and conceptual framing of the debate by experts are narrow and reflect the concerns of a small, professionally invested elite. The hES ceils in all their complexity provide an obvious opportunity to test a new model for the role of bioethics in public debate. Bioethicists must master the tools of public debate, exert influence over the words used in framing the debate and lead the way in making the debate more inclusive of broader audiences