Around 2003, the discussion of neuroethics emerged as one part of applied ethics. In Japan, neuroethics has been discussed constantly since 2005. The ethical studies about enhancement and mind-reading has been accumulated, while neuroethical argument about BMI is not enough, compared with them. One of the reasons may be that it is easier for philosophers and moral philosophers to commit the former kinds of argument by using their research methods and concepts (such as authenticity, self identity). On the contrary, to study neuroethics about BMI, it is necessary to consider the technological aspects of BMI and thus it may refuse to apply the philosophical approach.
I believe that storing neuroethicl discussion about BMI is an important and original area for neuroethics which is different from former bioethics and philosophy of mind. The purposes of this presentation are construction and mapping the neuroethical arguments about BMI with two approaches: 1) the review of preceding technological researches of BMI; and 2) the preliminary hearing surveys for researchers engaging to the technological/medical development of BMI. Though there are few preceding researches about ethics of BMI, the amount of its technological researchers are huge. Reviewing some from them, I have extracted several ethical discussions about BMI. For instance, there is a demarcation problem how to apply BMI for patients who have congenital disorder like paralysis in the United States. That is because the present BMI treatment is based on invasive form, and it is difficult to decide whether we treat them or not with holding risk to consider cost and benefit. In addition, we can understand the overview of the present BMI technology may do. For example, it is hard for people with BMI to display each picture (paper, stone and scissors) on computer screen in the game of "paper, stone and scissors."
From the second approach, we can understand actual problems and raw data on the research place. I have opportunities to make preparatory survey to BMI researchers, and this makes it clear that part of problems which researchers have. Concretely speaking, there are few researchers who are not interested in ethical problems, but many of other researchers are quite anxious how and what their BMI technology would cause ethical problems. Thus, they strongly desire that neuroethicists make clear about ethical problems. This suggests that the researcher of neuroethics should be attached to the main body of the development team of BMI.
Recently, the phenomenon called "medicalization" has been discussed by several authors. The term "medicalization" includes multiple meanings. That represents basically a process in which the characters which was formerly regarded as a sin or a social deviance, has now come to be treated as medical "illness" and controlled by medical science. Whereas "medicalization" often used as the term which means "hospitalization" or the term which means the change of a socially accepted idea of "illness". In this report, I would use "medicalization" as a term which means a change process of a general idea about specific "illness" of people, in which a socially accepted idea about a specific character changes into "illness", and people with that character take some action to "cure" it. This change brings "patients" both positive and negative effects.
Alcoholism shows one of the examples of medicalization and its effect. A heavy drunker who lost the control of drinking was formerly regarded as a morally fallen person, but now as a "patient" addicted to alcohol in the medical context. This change of social treatment has made it possible to reduce moral criticism and to treat alcoholics by medical doctors. On the other hand, excess dependence on the doctor sometimes would cause negative effect. "Patient" often entrust their treatment thoroughly to their doctor and lose motivation to recover through their own efforts.
Medicalization processes have expanded its realm for recent years. Biological knowledge and technological progress has constantly contributed to expand the realm of medicalization by proposing scientific causes and medical solutions to several diseases. On one side, biological knowledge expands medicalization to more ambiguous "illness". Not only deviances but also some life events such as childbirth and menopause are turned to be medical subjects. On the other side, technology progress proposes a new method to treat some existing "illness", including more serious one, and open up a new awareness of issues.
One of the examples of new biological issues is a technology of Brain-Machine Interface. This technology will propose new possibility of medical treatment, and will press people to change the idea of "illness" and some disorders. On considering the influence of new technology including BMI on "illness" idea, it is meaningful to examine the change of socially accepted "illness" idea, as a result of medicalization.
This report examines the change of idea about some "illness" which medicalization brought, referring to some BMI problems.
Neuroethics has become rapidly widespread in North America, Europe, and Japan over these last several years. Neuroethics can be defined as "studies of ethical issues arising from using the results of the neurosciences." The results of the neurosciences are now considered to be used in various fields such as education, studies of developmental disorders, criminal investigation, economics, marketing, and psychopharmacology, as well as biomedical research and health care. Some issues in neuroethics are not new. They have been discussed in various fields of applied ethics, especially in bioethics. Now these issues are being reconsidered from the perspective of the mind-brain relation and this has been incorporated into neuroethics. The challenge now is to establish neuroethics as a discipline in the field of applied ethics.
In Japan, interest in neuroethics emerged around 2004, and since that time Japanese ethicists and philosophers have introduced discussions in North America and Europe. However, Japanese conditions surrounding neuroethics are different from those in the West. We should develop neuroethics from a Japanese perspective which could contribute to this discussion in the world. In my presentation I would like to offer a blueprint of neuroethics in a Japanese context taking up some specific topics. Topics to be discussed will include 1) problems of medicalization and enhancement concerning developmental disorders and dementia against the background of rapidly growing interest in developmental disorders and the aging of the population, 2) discussion of "game brain" of children and brain enhancement by electronic games, 3) impact of robotics and "android science" for neuroethics in Japan. The examination of these problems specific to Japan could provide new insights on neuroethics.
The future of neuroscience promises to bring a range of novel basic and applied research that could radically change our views of brain health and human nature. Already with research into the healthy and diseased brain, novel interventions on the brain are flourishing. These range from advances in neuroimaging research yielding insights into neurological disorders, behaviour and personality to developments in neurosurgical stimulation for motor and neuropsychiatric disorders. Given the importance of the brain in defining who we are and the vulnerability of neurological and psychiatric patients, neuroscience increasingly intersects with crucial ethical, legal, and social issues. We have never perhaps faced so directly the consequences and responsibilities that modern biomedical science bestows upon us as we will with the neuroscience revolution.
In the first part of my talk, I will provide a brief overview of the field of neuroethics and discuss some of the salient international controversies from a pragmatic standpoint. I will present a brief overview of a qualitative and quantitative review of the international neuroethics literature and identify common views of the field. I will then present salient controversies and discuss from a pragmatic standpoint (Racine 2008).
The second part of my talk will present some preliminary data from a qualitative study examining ethical issues created by the introduction of deep-brain stimulation in the Canadian healthcare systems. In our research, we have found that issues such as managing patient expectations and psychosocial outcomes in patients are amongst key concerns expressed by providers. In regard to the first issue, providers stated in interviews that, “There is an expectation, and management of expectation is quite important. …They [the patients] have to know that this is not a cure for the disease, this is something that you are improving their care but you are not actually going to cure them.” With respect to the second issue, providers informed that, “One thing that has been said about movement disorders is that people have been used to a certain type of role, the sick role. And you more or less remove this from them and that could cause problem adapting to this new role”. Other major issues identified and further characterized are challenges related to resource allocation and the public understanding of neurostimulation.
I will conclude this talk by providing a one-slide snapshot of current and future Canadian activities in neuroethics