Neuroethics 101: A student’s guide to ethics of modern neuroscience

Neuroethics at UBC is a world-leading program, established in the early 2000s and pioneered by UBC Faculty of Medicine and the School of Population and Public Health professor Dr. Judy Illes.

The Ubyssey sat down with Illes to discuss the purpose of neuroethics and learn more about the questions at the heart of the field, from the role of technology in healthcare to the ethics of medically-assisted dying, and consent.

The basics of neuroethics

Neuroethics aims to align “ethical and social and legal issues with advances in neuroscience,” according to Illes. It raises and anticipates pertinent questions about current and forthcoming practices in neuroscience while taking an evidence-based and nuanced approach.

“[Unlike] people who do a more philosophical kind of neuroethics, ours is always grounded in research methods,” she said. “So it’s a scientific approach to a question or results, and then an interpretation very rigorously of the results that we receive.”

Much of this evidence is gathered through interviews, focus groups and workshops with various groups including students, professors, policy-makers, patients and their families.

Topics approached by neuroethicists are diverse and complex. They range from assessing the invasiveness of tools and technology used in neuroscience research to exploring how to “bring together different cultural understandings of brain diseases” when designing treatment plans.

For example, Illes and her team worked with Indigenous peoples to understand perspectives on individuals diagnosed with Alzheimer’s and those with genetic predispositions to the disorder. They aim to understand how “biomedical understandings of a disease like Alzheimer’s can coexist with traditional beliefs and approaches to wellness,” said Illes.

Technology drives neuroethical questions

Neuroscience can rely on technology such as robots, virtual reality programs, wearable headgear and many other devices. Neuroethics stops to consider how research tools may be physically invasive or skew results, and aims to proactively ensure that the introduction of technology does not cause more harm than good.

Modern neuroscience relies heavily on a technique called functional magnetic resonance imaging (fMRI), which recognizes brain activity by measuring oxygen used across the brain. This technique has applications in neuroscience research, while also being applicable in ethical discussions surrounding disorders of consciousness.

In a 2016 article co-authored by Illes, fMRI was presented as a means to assess brain activity and consciousness in people suffering from severe brain injury and in a seemingly unconscious state. In an interview, Illes said that despite their physical state, brain scans have revealed up to one in five patients may demonstrate signs of “wakefulness” or a “minimally conscious state.” For these individuals, it is possible that “they are able to process information and maybe even understand it,” she said.

The question for neuroethicists is whether this information could be used to understand patient wishes, including possibly a preference to die. In the health care industry, if a patient is incapable of making their own decisions due to physical or psychological reasons, a medical proxy consents on their behalf.

Neuroethics considers how medical professionals can ethically inform proxies and advocate for patients who are physically or psychologically unable to consent. However, Illes emphasized the “dicey” nature of this ethical problem and the dilemmas it raises surrounding will and consent.

‘Tremendous impact’

Neuroethics can also inform health care policy. The Office of Economic Cooperation and Development, as well as Health Canada, hope to promote safe and ethical uptake of new medical technologies and practices.

Illes said the heart of her neuroethics work lies in supporting people and patients.

“Our work at Neuroethics Canada informs health care and policy, as well as research,” she said. “We think that we’ve had a tremendous impact.”