A four-part working bibliography of neuroethics: Part 4 - Ethical issues in clinical and social applications of neuroscience

Background

As a discipline, neuroethics addresses a range of questions and issues generated by basic neuroscientific research (inclusive of studies of putative neurobiological processes involved in moral and ethical cognition and behavior), and its use and meanings in the clinical and social spheres. Here, we present Part 4 of a four-part bibliography of the neuroethics literature focusing on clinical and social applications of neuroscience, to include: the treatment-enhancement discourse; issues arising in neurology, psychiatry, and pain care; neuroethics education and training; neuroethics and the law; neuroethics and policy and political issues; international neuroethics; and discourses addressing "trans-" and "post-" humanity.

Methods

To complete a systematic survey of the literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine (NLM). A Python code was used to eliminate duplications in the final bibliography.

Results

When taken with Parts 1-3, this bibliography aims to provide a listing of international peerreviewed papers, books, and book chapters published from 2002 through 2016. While seeking to be as comprehensive as possible, it may be that some works were inadvertently and unintentionally not included. We therefore invite commentary from the field to afford completeness and contribute to this bibliography as a participatory work-in-progress.

     

A social neuroscience approach to self and social categorisation: A new look at an old issue

We take a social neuroscience approach to self and social categorisation in which the current self-categorisation(s) is constructed from relatively stable identity representations stored in memory (such as the significance of one's social identity) through iterative and interactive perceptual and evaluative processing. This approach describes these processes across multiple levels of analysis, linking the effects of self-categorisation and social identity on perception and evaluation to brain function. We review several studies showing that self-categorisation with an arbitrary group can override the effects of more visually salient, cross-cutting social categories on social perception and evaluation. The top-down influence of self-categorisation represents a powerful antecedent-focused strategy for suppressing racial bias without many of the limitations of a more response-focused strategy. Finally we discuss the implications of this approach for our understanding of social perception and evaluation and the neural substrates of these processes.     

Ethical,and practical issues in applying functional imaging to the clinical management of Alzheimer's disease

This review outlines ethical, legal, and practical issues related to conducting functional imaging research with Alzheimer's disease (AD) patients. Imaging techniques, with an emphasis on functional MRI and positron emission tomography, are compared and contrasted with respect to the manner in which they can be applied to issues of clinical relevance to AD. Methodological difficulties are raised to assist with critical evaluation of current imaging results. Various potential clinical applications of functional imaging are briefly reviewed and discussed with respect to associated ethical conflicts.     

Feedback in dynamic psychotherapy: Notes on selected clinical issues and practical applications

Conclusion In this presentation of selected clinical issues and applications of feedback in dynamic psychotherapy, I have ranged from metaphor to paradox and the sharing of the therapist’s wisdom; from feedback of silence, empathy, and memories to working through alienation from self; from feedback of the therapist’s psychophysiologic reactions during a session to feedback of the fear of separation and mortality. Believing that all too often the therapeutic process is based on linear feedback, I have focused on the circularity of interactive, interpersonal systems, suprasystems, and subsystems as well as their simultaneous, mutually influencing perception through many equally important channels of communication and levels of awareness. These serve as the ground, frame, and context for constructive feedback between therapist and patient that can promote personality reconstruction and development of human potentials. Revised from a paper presented at a scientific meeting of the Association for the Advancement of Psychoanalysis of the Karen Horney Psychoanalytic Institute and Center on April 22, 1993. Immediate Past-President of the Association for the Advancement of Psychoanalysis; author of many publications on verbal and nonverbal communications.     

A systems neuroscience approach to autism: biological,cognitive, and clinical perspectives

Autism is a behaviorally defined disorder characterized by a broad constellation of symptoms. Numerous studies directed to the biological substrate demonstrate clear effects of neurodevelopmental differences that will likely point to the etiology, course, and long-term outcomes of the disorder. Consistently replicated research on the neural underpinnings of autism is reviewed. In general, results suggest several main conclusions: First, autism is a heterogeneous disorder and is likely to have multiple possible etiologies; second, structural brain studies have indicated a variety of diffuse anatomical differences, reflective of an early developmental change in the growth or pruning of neural tissue, rather than localized lesions; similarly, neurochemical studies suggest early, neuromodulatory discrepancies rather than gross or localized abnormalities; and finally, there are a number of limitations on studies of brain activity that to date preclude definitive answers to questions of how the brain functions differently in autism. The large number of active research programs investigating the cognitive neuroscience of autism spectrum disorders, in combination with the exciting development of new methodologies and tools in this area, indicates the drama and excitement of work in this area.     

Ethical issues in the clinical application of fMRI: factors affecting the validity and interpretation of activations

The ability of functional magnetic resonance imaging (fMRI) to localize activations in a single patient, along with the safety and widespread availability of this methodology, has lead to an increasing use of fMRI for clinical purposes such as pre-surgical planning. As methodology continues to improve and more experience with fMRI in the clinical setting is acquired, clinical functional neuroimaging will likely have an increasing influence over patient care. Therefore, ethical use of fMRI, as with other medical techniques, requires understanding the factors impacting the interpretation of the methodology. Issues affecting the validity and interpretation of clinical functional neuroimaging, including effects of altered hemodynamic response function, head motion, and structural changes in the brain, are reviewed. The distinction between correlated and necessary activation in a clinical context is discussed. Different types of statistical errors in fMRI analysis are described, along with their consequences to the patient. Finally, for the future of clinical fMRI development, the need for normative patient data, as well as standardized tasks, scan protocols, and data analyses, is discussed.     

Amnesia and competency to stand trial: A review of legal and clinical issues

Recent case law is discussed regarding the role of amnesia in determining competency to stand trial. Clinical issues are examined for a range of amnestic conditions on a spectrum of organic and functional disorders. Clinical methods are explored for establishing the extent of amnesia and its relevance to competency.     

Ethical issues and approaches in stem cell research: from international insights to a proposal

In recent years and months, human stem cell research has dominated many scientists' interests, the media, public debate, and social policy. This paper aims to consider, first, the major scientific data on stem cell research that are available. Second, I reflect on them by examining how they shaped policies in Europe and the United States. I also point to current changes in policy-making concerning the creation of ad hoc committees to address this novel issue and how, in a few instances, different ethical positions are part of the documents produced. In other words, diverse approaches are not solved but kept in tension. Finally, I suggest that the current state of research on human stem cell will benefit from an ethics of risk.     

Ethical issues in biomedical research: Perceptions and practices of postdoctoral research fellows responding to a survey

We surveyed 1005 postdoctoral fellows by questionnaire about ethical matters related to biomedical research and publishing; 33% responded. About 18% of respondents said they had taken a course in research ethics, and about 31% said they had had a course that devoted some time to research ethics. A substantial majority stated willingness to grant other investigators, except competitors, access to their data before publication and to share research materials. Respondents’ opinions about contributions justifying authorship of research papers were mainly consistent but at variance with those of many biomedical journal editors. More than half said they had observed what they considered unethical research practices. To increase the chances of getting a grant funded, 27% said they were willing to select or omit data to improve their results; to make publication of their work more likely or to benefit their career, 15% would select or omit data and 32% would list an undeserving author. Of respondents who thought they had been unfairly denied authorship on a paper, or been listed with or asked to list an undeserving author, 75% said they would be willing to list an undeserving author (P<0.001). Having taken a course dealing with research ethics had no effect on stated willingness to select or omit data or to fabricate data in the future, but was positively associated with willingness to grant undeserved authorship (P<0.04). Although these results do not controvert research demonstrating the effectiveness of ethics courses during professional education, they indicate that the research environment is a powerful component of a trainee’s experience and ethical development. Preliminary results of this work were presented in part as a poster at the forumEthics, Values, and the Promise of Science, presented by Sigma Xi, The Scientific Research Society, 25–26 February 1993 in San Francisco, California, USA.     

Child witnesses to violence between parents: Critical issues in Behavioral and social adjustment

This study examined the impact of exposure to family violence on children's adjustment. Two groups of residents of shelters for battered women (current and former residents) were compared to a nonviolent control group. All three groups of mothers completed interviews and selfreport questionnaires related to both their own and their children's adjustment. Children recently witnessing violence tended to have the lowest levels of social competence ratings, and their mothers reported the most health and emotional difficulties. Former residents of shelters experienced the highest level of family/social disadvantage. The results are discussed in the context of previous research findings, and implications for intervention programs are outlined.This research was supported by a grant from the Ontario Ministry of Community and Social Service and the Ontario Mental Health Foundation. The authors wish to thank the staff of transition houses in Cambridge, Catham, Guelph, Kitchener, Sarnia, and Woodstock for their generous support of this project.     

Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar scenarios, allowing for effective comparisons. M.S. counselors were more willing than M.D. and Ph.D. counselors to maintain patient confidentiality when screening for Huntington's Disease and occupational diseases, and a greater number would agree to counsel patients pursuing prenatal testing for sex selection. A majority of M.S. counselors would disclose an XY karyotype to a phenotypically female patient. M.S. counselors reasoned that respect for patient autonomy and patient confidentiality justified their decisions in many cases. The importance of these principles is discussed and questioned.     

Social outcomes in childhood brain disorder: a heuristic integration of social neuroscience and developmental psychology

The authors propose a heuristic model of the social outcomes of childhood brain disorder that draws on models and methods from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. The heuristic model characterizes the relationships between social adjustment, peer interactions and relationships, social problem solving and communication, social-affective and cognitive-executive processes, and their neural substrates. The model is illustrated by research on a specific form of childhood brain disorder, traumatic brain injury. The heuristic model may promote research regarding the neural and cognitive-affective substrates of children's social development. It also may engender more precise methods of measuring impairments and disabilities in children with brain disorder and suggest ways to promote their social adaptation.     

A bibliography of articles of interest to teachers of psychology appearing in psychological reports 1955-2010

Abibliography is presented of articles related to various aspects of the teaching of psychology that have appeared in Psychological Reports from 1955-2010. The 605 articles are classified into 21 sections including those devoted to history, psychology of the scientist, teaching tips, textbook evaluation, and evaluation of students and professors.     

Epistemological and ontological issues in counseling: Implications of social systems theory

Philosophical issues related to theoretical and methodological developments in counseling are addressed, especially related to epistemology (theory of knowledge) and ontology (theory of reality). Social systems theory is described as an epistemologically and ontologically significant challenger to psychological theory, which has traditionally predominated as a foundation for counseling approaches. Recent developments from cognitive biology are used to demonstrate how systems theory may be metatheoretical to the psychological point of view, accounting for all that psychological theory can account for, and more.     

Ethical issues in the application of medical technology to paediatric intensive care: two views of the newborn

Recent advances in medical technology have led to a marked improvement in the chances of survival of sick or preterm infants, thereby stimulating renewed ethical debate on the status of the newborn. Two contradictory attitudes to the medical care of preterm or congenitally malformed newborn infants can be discerned in our pluralistic society. The two attitudes have their historical roots in the classical Graeco-Roman and Judaeo-Christian ethical traditions respectively. The former views newborn infants as of potential value only whereas the latter emphasises the intrinsic worth and dignity of the individual made in God's image. Recent secular philosophical reflection has provided a rationale for infanticide of the sick or abnormal newborn. A Christian approach to the care of the newborn prohibits intentional killing yet may encompass the withdrawal of treatment that is inappropriate or unduly burdensome. Medical care should be based upon respect for the value of the individual, protection of the defenceless from abuse or exploitation, and wise stewardship of limited health-care resources.     

Ethical issues in pediatric life-threatening illness: dilemmas of consent, assent, and communication

The treatment of life-threatening illnesses in childhood is replete with ethical issues and with clinical issues that have ethical implications. The central issues are those involved with a child's participation in the decision-making process and with communication of information about the illness and treatments to children. This article examines the questions of patient autonomy and of parental responsibility and prerogative in the context of pediatric oncology. Included in this examination of the ethical dimensions of pediatric life-threatening illness is a discussion of the many related aspects involved, including medical, cultural, psychosocial, legal, and developmental. A multidimensional approach that considers the ways in which these multiple aspects interact with one another, and which focuses on establishing a strong working alliance between the health care team and the pediatric patient's family, can help to avoid or resolve potential ethical and clinical conflicts.