Contributors.

In proportion to other serious illnesses, diseases of the brain and mind represent the greatest—and still increasing—public health burden that Western societies are facing. Consequently, scientists, governments, advocacy groups, and public health authorities are committed to research to tackle the causes and consequences of neurological and psychiatric diseases and to find cures for them. As neuroscience research progresses, ethicists and neuroscientists face numerous ethical challenges to the integration of frontier application of research—neurotechnology—with the delivery of high-quality healthcare. In this special neuroethics issue, we have invited distinguished scholars with diverse disciplinary backgrounds to present their reflections and research on the ethical dimensions of this crucial integration.

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by reviewing the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common?I thank Lisa Santer, Barry Schwartz, and Martha Farah for their thoughtful comments on earlier drafts of this paper.

The human mind strives to maintain equilibrium between memory and oblivion and rejects irrelevant or disruptive memories. However, extensive amounts of stress hormones released at the time of a traumatic event can give rise to such powerful memory formation that traumatic memories cannot be rejected and do not vanish or diminish with time: Post-traumatic stress disorder may then develop. Recent scientific studies suggest that beta-blockers stopping the action of these stress hormones may reduce the emotional impact of disturbing memories or prevent their consolidation. Using such an intervention could, in principle, help people who suffer from post-traumatic stress disorder, but the idea of doing so is controversial. I shall here discuss memory manipulation in this perspective.

Neuroimaging has provided insight into numerous neurological disorders in children, such as epilepsy and cerebral palsy. Many clinicians and investigators believe that neuroimaging holds great promise, especially in the areas of behavioral and cognitive disorders. However, concerns about the risks of various neuroimaging modalities and the potential for misinterpretation of imaging results are mounting. Imaging evaluations also raise questions about stigmatization, allocation of resources, and confidentiality. Children are particularly vulnerable in this milieu and require special attention with regards to safety guidelines and modality adaptations. This article examines pediatric neuroimaging practice through an ethics lens. Most authors in the field of neuroethics focus on the future concerns of neuroimaging. In contrast, our paper examines ethical matters surrounding current clinical applications in the pediatric population. We first provide a brief overview of the neuroimaging technologies most commonly used in a pediatric clinical context and then discuss a variety of ethical issues arising from the use of these technologies.

Persons who experience severe brain injury often suffer significant disorders of consciousness. Anoxic injuries from cardiac arrest or strokes and traumatic injuries from falls, vehicular crashes, or assaults can result in several conditions in which patients lose or have diminished consciousness for an extended period of time. Two such conditions that create considerable public confusion and controversy are the vegetative state (VS) and the minimally conscious state (MCS). Although these conditions have generated significant medical and academic research, the general public and policymakers are often confused about the nature of VS and MCS. The most recent evidence for this confusion is the acrimonious public debate, the extensive media coverage, the prolonged litigation, and the attempts of various governmental officials to intervene in dealing with the plight of Terri Schiavo.I thank my legal researcher, Tejal Banker, J.D., LL.M., for her assistance.

The 1990s “Decade of the Brain” stimulated research on many fronts and resulted in considerable advancement in neuroscience. Unfortunately, we have been slow to develop a policy dialogue to anticipate and deal with vast implications. Simply put, our political and social institutions have not kept pace with these advances. At the base, policy issues center on how we interpret the implications of these developments, especially given the complexity of the subject and the speculative nature of much of the evidence to date. The issues discussed here go to the heart of the major problems facing the world today and challenge basic assumptions on both the right and the left of the political/ideological spectrum as well as the standard social science model of behavior. As a result, the findings of neuroscience are open to ideological maneuvering designed to put the most expedient spin on their meaning.

Direct-to-consumer advertising (DTCA) of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians but DTCA is an increasing part of global promotional spending for prescription drugs. Latest estimates suggest that DTCA now represents an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion's share is going to the 20 most prescribed pharmaceuticals.We thank the Henry J. Kaiser Family Foundation (J.I.) for funding of this project and Dr. Patricia King for her support. Writing of this paper was supported by NIH/NINDS R01 #NS045831 (J.I.) and the Social Sciences and Humanities Research Council of Canada (E.R.). We also acknowledge Dr. Pamela Schraedley-Desmond, Shilpa Gulati, Neil Mukhopadhyay, and Sarah Waldman.

In April 2005, the U.S. National Academy of Sciences (NAS) published its Guidelines for Human Embryonic Stem Cell Research. These voluntary guidelines are among the most permissive in the world—in a country that prohibits federal funding of research to derive human embryonic stem (hES) cells (cells that can self-renew or differentiate into most cells in the human body). One of the few research prohibitions in the NAS guidelines concerns the creation of certain kinds of human–nonhuman chimeras. A chimera is an organism with a mixture of cells from two different organisms, from the same or different species. Figure 1 provides a useful overview of different types of chimeras.This work was supported, in part, by a Stem Cell Network grant to Françoise Baylis and Jason Scott Robert and a CIHR grant to Françoise Baylis. We sincerely thank Alan Fine, Rich Campbell, Cynthia Cohen, and Tim Krahn for helpful comments on an earlier draft of this paper. Thanks are also owed to Tim Krahn for his research assistance. An earlier version of this paper was presented to the Department of Bioethics and the Novel Tech Ethics research team (www.noveltechethics.ca). We thank the participants at each of these meetings for their helpful comments.

Neuroethics to date has tended to focus on social and ethical implications of developments in brain science, especially in functional neuroimaging. Within clinical neuroethics, the emphasis has been on ethical issues in clinical neuroscience practice, including informed consent to neuroimaging; the development of ethical research protocols for functional magnetic resonance imaging especially, and especially in children; and the ethical clinical management of incidental findings. Within normative neuroethics, we have witnessed the more philosophical and/or social scientific study of the meanings of developments in neuroscience, including concerns about the impact of neuroimaging on privacy, freedom of thought, moral culpability, and sense of self. In this piece, I argue for an expansion of neuroethical attention to the interface of neuroscience and psychiatry, where brain science meets the clinical sciences of the mind. My particular focus is the development of psychiatric classification systems.I am grateful to Jenny Brian, Carl Craver, Thane Plantikow, Claire Pouncey, and Ken Schaffner for discussion of many of the themes presented here. Early research on which portions of this article are based was funded by the Canadian Institutes of Health Research in the form of an operating grant and salary award. My current research is supported by the Institute for Humanities Research, the Center for Biology and Society, and the School of Life Sciences, Arizona State University.

The Nobel Laureate Illya Prigogine compares the recent breakthroughs in human biology to the major changes that occurred when the Neolithic period succeeded the Paleolithic, 12,000 years ago. Although there is disagreement about the meaning of these changes, most opposing views recognize that a “major transformation” took place. Some interpret the recent breakthroughs in neuroscience as the first step toward “our posthuman future” whereas others see the consequences of these achievements as the end of humankind. Genomics and neuroscience are the main fields that, at this point, give rise to such a debate, some authors stating that neuroscience raises even greater anthropological and ethical challenges than does genomics. This article focuses on neuroscience. Its main object is to critically assess these diverging opinions on the impact of neuroscience and to determine whether both sides are not telling us something important about ourselves and how neuroscience could enlighten healthcare ethics.I acknowledge the help of Dr. Nancy Burbidge and Dr. Béatrice Godard in the preparation of this manuscript.

CQ sources/bibliography.

A substantial portion of the developed world's population is increasingly dependent on machines to make their way in the everyday world. For certain privileged groups, computers, cell phones, PDAs, Blackberries, and IPODs, all permitting the faster processing of information, are commonplace. In these populations, even exercise can be automated as persons try to achieve good physical fitness by riding stationary bikes, running on treadmills, and working out on cross-trainers that send information about performance and heart rate.This essay is drawn from collaborative research conducted under the auspices of the “Altering Nature: How Religious Traditions Assess the New Biotechnologies” project at Rice University from 2002 to 2004 through the financial support of The Ford Foundation (Grant #1010-1601). The paper is submitted with the permission and acknowledgement of the project coordinators and The Ford Foundation. The authors also acknowledge the research and editorial assistance of Dr. Siobhan Baggot and Ms. Sarah Gehrke.

“Dissecting Bioethics,” a column edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].Many thanks have to go to several people: first to my patient proofreader, my mum (who else!), my even more patient sounding board Tanvi Shah, and finally, for the comments and criticisms, to Tuija Takala and Matti Häyry.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.