Novelneurotechnologies: intervening in the brain

Foreword During the last 50 years life expectancy in the UK has increased by about 10 years, so that the average age at death is now 85 for men and 89 for women. While this is good news, one result has been that the incidence of neurological disorders such as Alzheimer’s disease has increased disproportionally, since this affects about one person in six over the age of 80 (as compared with only one in fourteen among those over 65). And while the increase in life expectancy is partly due to medical advances, treatments for disorders like Alzheimer’s have not advanced at the same rate as those for other common diseases. Nonetheless our understanding of the brain has improved dramatically in recent years, in part because of the development of fMRI scanners which produce the familiar striking images of brain activity and provide suggestive hints concerning the basis of neurological disorders. Neuroscience has thus become a central area for biomedical research, and with it there are now new methods of treating neurological disorders and new lines of research which, it is hoped, will lead to further treatments. In this report we focus on the new methods which involve interventions in the brain, some requiring invasive physical intrusions into the brain, others relying on methods of interacting with the brain from outside, typically by exposing the brain to electromagnetic fields. Some of these ‘novel neurotechnologies’, as we call them, are still at an early experimental stage (such as the introduction of human neural stem cells into the brain), while others build on existing techniques (such as deep brain stimulation) to provide treatments of further neurological and psychiatric disorders, which at present lack safe and effective treatments. It is not the aim of this report to provide a detailed clinical assessment of the safety and efficacy of these novel technologies; instead we aim to provide a reflective assessment of the ethical and social issues that are raised by their development and use. The reason for undertaking this task is that because these technologies involve interventions in the brain, the organ which furnishes us with the capacities that underpin our existence, personal and social, interventions here are liable to affect our lives in the most intimate and fundamental ways. So while the aim of these interventions is to meet the need for neurological and psychiatric therapies, there is always the risk of damaging side-effects, as the troubled history of lobotomy indicates. And despite recent advances in neuroscience, this risk has to be taken seriously because of the limited knowledge of the ways in which these new technologies affect the brain. Thus the situation here is one in which great needs are matched by great uncertainty, and in our report we take this situation as the starting point for our ethical assessment of these technologies. We then identify certain fundamental interests at stake here, such as safety, autonomy, trust and equity, and also discuss the complex social and economic circumstances which affect the development of these technologies, where promising research needs substantial support before devices can be brought into use in the clinic. To bring all these points together we suggest that the social and ethical issues here are best organised by identifying the key values, the ‘virtues’, that one would ideally like to see exemplified in the practices and institutions of those who develop, regulate and use these technologies. We suggest that these virtues are inventiveness in the research and development of technologies that meet the needs of patients; responsibility in early trials and applications of them; and humility in acknowledging the uncertainties that accompany their use, especially when dealing with patients and carers. Thus among other things we recommend that the procedure for gaining consent from patients should include an opportunity for counselling about the risks and benefits inherent in a proposed treatment; that there should be better ways of gathering systematic data from trials and experimental treatments than appears to be the case at present; and that within the present regulatory system there should be a greater effort to ensure that regulations address patients’ needs by supporting innovation that provides access to safe and effective therapies. At the end of the report we turn to two further topics, - non-therapeutic applications of these neurotechnologies for the purpose of gaming, cognitive enhancement and military uses; and the representation in the media of biomedical research, including in particular the representation of these viii novel neurotechnologies. These topics raise rather different issues from those considered so far. Although the non-therapeutic uses appear exciting at first, we suggest that the truth is, so far, rather more mundane; but that this is a field which nonetheless merits continuing attention, particularly because of the lack of knowledge about the long-term effects of regular use of the relevant neural devices. When considering the role of the media we feel that we can draw on two of our fundamental values, responsibility and humility. Despite the nexus of commercial, institutional and personal interests which tempt journalists and media agencies to add a pinch of hype to their reports of these new technologies, exaggeration of their potential benefits and under-reporting of risks do not contribute to a public culture in which there can be a responsible understanding of these technologies. It has been a challenge and a privilege to work on this report for the Nuffield Council on Bioethics. We have had the benefit of advice from those who responded to our consultation and from others who have come forward to help us; and I have learnt a great deal from my expert colleagues on the working party who have all contributed enormously to this report. I would like also to thank the Secretariat of the Nuffield Council on Bioethics, including Alena Buyx and Varsha Jagadesham, who assisted us so ably in the early stages of our work. But most of all, thanks are owed to our project leader, Emily Postan, who kept us going and provided important drafting and intellectual input, and our research officer, Rosie Beauchamp, without whom the report could never have been completed. Thomas Baldwin Chair of the Working Part