Epigenetics and Child Psychiatry: Ethical and Legal Issues

Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues. Copyright © 2015 John Wiley & Sons, Ltd.     

Ethical Issues Raised by Epigenetic Testing for Alcohol,Tobacco, and Cannabis

Epigenetic testing is one of the most significant new technologies to provide insight into the behavioral and environmental factors that influence the development and reconfiguration of the human genetic code. This technology allows us to identify structural changes in the genome that occur due to exposure to a wide variety of substances including alcohol, tobacco, and cannabis. The information gained can be used to promote health but it also raises a variety of ethical, legal, and social issues. As society progresses in understanding the epigenetic mechanisms of substance use and addiction, there is an opportunity to use these use this knowledge to enable medical, behavioral, and environmental interventions to alleviate the burden of addiction. This article describes the ethical issues associated with use of epigenetic testing for alcohol, tobacco, and cannabis and the implications of this technology. A further review of the scientific basis for the relevance of epigenetics is found in the accompanying article by Philibert and Erwin in this issue. Copyright © 2015 John Wiley & Sons, Ltd.     

Child Welfare Versus Parental Autonomy: Medical Ethics,The Law,and Faith-Based Healing

Over the past three decades more than 200 children have died in the U.S. of treatable illnesses as a result of their parents relying on spiritual healing rather than conventional medical treatment. Thirty-nine states have laws that protect parents from criminal prosecution when their children die as a result of not receiving medical care. As physicians and citizens, we must choose between protecting the welfare of children and maintaining respect for the rights of parents to practice the religion of their choice and to make important decisions for their children. In order to make and defend such choices, it is essential that we as health care professionals understand the history and background of such practices and the legal aspects of previous cases, as well as formulate an ethical construct by which to begin a dialogue with the religious communities and others who share similar beliefs about spiritual healing. In this paper, we provide a framework for these requirements.     

Ethical and legal aspects in teaching students of medicine

Due to the rapid advances in medical technology, medical students are now being faced with increasingly complex and unparalleled ethical and practical dilemmas during their training. The new and future challenges of high-tech medicine demand improvements in current medical education, not only by meeting the needs of students through humanized training programs, but also by involving them in finding solutions to the ethical and legal quandaries they encounter. Today’s students of medical universities must acquire knowledge and understanding of the ethical and legal issues relevant to the practice of medicine, and we have to do everything possible to introduce these students to the current discussions on more or less controversial ethical and legal topics. Although final answers may not be found, the very discussion, argumentation, and awakening of students’ interest should become an essential part of the core curriculum of every doctor. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004. The author is a student and member of the Senate Committee on Teaching.     

Ethical Concepts and Future Challenges of Neuroimaging: An Islamic Perspective

Neuroscience is advancing at a rapid pace, with new technologies and approaches that are creating ethical challenges not easily addressed by current ethical frameworks and guidelines. One fascinating technology is neuroimaging, especially functional Magnetic Resonance Imaging (fMRI). Although still in its infancy, fMRI is breaking new ground in neuroscience, potentially offering increased understanding of brain function. Different populations and faith traditions will likely have different reactions to these new technologies and the ethical challenges they bring with them. Muslims are approximately one-fifth of world population and they have a specific and highly regulated ethical and moral code, which helps them deal with scientific advances and decision making processes in an Islamically ethical manner. From this ethical perspective, in light of the relevant tenets of Islam, neuroimaging poses various challenges. The privacy of spirituality and the thought process, the requirement to put community interest before individual interest, and emphasis on conscious confession in legal situations are Islamic concepts that can pose a challenge for the use of something intrusive such as an fMRI. Muslim moral concepts such as There shall be no harm inflicted or reciprocated in Islam and Necessities overrule prohibitions are some of the criteria that might appropriately be used to guide advancing neuroscience. Neuroscientists should be particularly prudent and well prepared in implementing neuroscience advances that are breaking new scientific and ethical ground. Neuroscientists should also be prepared to assist in setting the ethical frameworks in place in advance of what might be perceived as runaway applications of technology.     

The Genetic Testing of Children for Cancer Susceptibility: Ethical,Legal, and Social Issues

Genetic testing for cancer susceptibility raises many ethical, legal, and social concerns, particularly when testing children is considered. The complexity of defining medical and psychosocial risks and benefits of genetic predisposition testing for multifactorial disorders, like cancer, is discussed. Presumed incompetence of children and adolescents and questionable ability of many adults to understand complex genetic information raise informed consent questions. Guidelines can aid professionals but there must also be a means of evaluating individual cases. Further research is needed to determine optimal methods of educating children and adults about genetic issues and to discriminate factors which contribute to satisfaction with decision-making about genetic testing. Legal issues and practical considerations are examined involving a duty to warn family members about genetic susceptibility and to re-contact previously-tested individuals as knowledge advances. Recommendations are offered concerning roles for social scientists and legal scholars in ethical integration of genetic testing into our medical and social framework.     

GLOBAL BIOETHICS: TRANSNATIONAL EXPERIENCES AND ISLAMIC BIOETHICS

In the 1970s “bioethics” emerged as a new interdisciplinary discourse on medicine, health care, and medical technologies, primarily in Western, developed countries. The main focus was on how individual patients could be empowered to cope with the challenges of science and technology. Since the 1990s, the main source of bioethical problems is the process of globalization, particularly neo‐liberal market ideology. Faced with new challenges such as poverty, inequality, environmental degradation, hunger, pandemics, and organ trafficking the bioethical discourse of empowering individuals is no longer sufficient. Global bioethics nowadays is concerned with applying and implementing a universal ethical framework. Islamic bioethics has contributed to creating such framework (exemplified in the UNESCO Universal Declaration on Bioethics and Human Rights) while at the same time it is continuously articulating and interpreting this framework in specific settings and contexts.     

Developments in Genetic and Epigenetic Data Protection in Behavioral and Mental Health Spaces

The legal system has been preparing for an explosion of epigenetic issues in public health, environmental regulation and litigation. So far, this explosion has been muted, and for now epigenetic data protection merely seems to be “enjoying” the same technological and legal challenges experienced by other clinical and research data. However, three areas of development suggest where epigenetic data protection may prove problematic. This article examines these three issues, noting the rapid expansion of research based on EMR-sourced clinical data, the large number of data protection models that can apply to genetic data (including point-of-use prohibitions on discrimination and confidentiality), and the increasing and controversial dangers of deidentified information being reidentified. Copyright © 2015 John Wiley & Sons, Ltd.     

Legal aspects of the risks raised by nanotechnologies in the field of medicine

The major breakthroughs achieved in nanotechnologies open new avenues in the field of healthcare--aid to diagnosis, upgrading medical treatment efficacy, development of regenerative medicine--but they are also associated with risks, hence the increasing need of legislation. So far very little research work has been conducted on this technology whose applications are still limited and whose potential hazards are not yet clearly apprehended. The more and more frequent uses of nanoparticles in medical imaging and in current research projects dealing with tissue engineering or RFID raises the following question: is the current legislative framework relevant in light of the specificities of nano-objects? The challenge is twofold: the legal approach must encompass the nanometric element itself as a "legal object" but it must include the use of nanotechnologies and their final aims. There is still some degree of uncertainty concerning the innocuity of nanoparticles so that the use of nanoelements in aid to medical diagnosis and in clinical trials must take into account and anticipate the potential harmful effects on patients and on biomedical research teams. But due to the fact that a clear understanding of nanoparticles as specific objects with new features is still missing, the existing regulations on chemical substances, medicinal products, medical devices or cosmetics do not seem to be appropriate. So considering nanoparticles as "singular" legal objects is a prerequisite requiring an approach based on the precautionary principle. Misusing nanotechnologies in the medical field is also a cause for great concern. Threats on individual freedom and on private life as well as on human identity are real and they raise recurring questions. The possible deviations in the use of these techniques, the temptations to "trespass the limits" are also common to info technologies and to biotechnologies but the threats triggered by the nanotechnologies are enhanced by the possibilities offered by the nanometric size and the expected convergence of these different technologies. One should refer to leading guiding principles in order to solve the future conflicts between the different sets of values, especially in the medical field by always remembering the Hippocratic oath "primum non nocere, deinde curare"     

Nanopatents and their impact on the medical environment

The nano-medical field is seen, by governments as well as the business sector as a very promising one. The process of converting basic research in nanomedecine into commercially viable products has already begun, even if it might be long and difficult. Part of the difficulties that could occur comes from regulatory and safety issues. Some of them are also coming from patent uncertainty in the global nanotechnology field. Indeed, the rush towards patents in the nanotechnology arena has already begun. Nanopatents are about to alter the legal landscape of the innovation economy, of research and development, and of industry--no doubt to an unprecedented extent because of the scope covered by these technologies. From a global point of view, the very delineation of the scope of nanotechnologies confronts patent law with complex problems of definition. The emergence and characteristics of this technology are also giving rise to a reassessment of the criteria for patentability that could be prejudicial to innovation. In the medical environment, this issue is even exacerbated in the real challenges which pharmaceutical companies are running up against.     

Schizophrenia: An Update and Review

Schizophrenia is a common complex disorder characterized by psychosis, cognitive dysfunction and negative symptoms, whose etiology involves interactions between both genetic and environmental vulnerability factors. Recently, ongoing research attempting to elucidate the nature of these vulnerability factors has been generating exciting findings. The advances in understanding of environmental risk factors for mental illnesses and in genetic research into mental illnesses will be reviewed. Limitations of the findings and implications of these advances for genetic counseling practice will also be discussed.     

Imagining the Future of Photoacoustic Mammography

How can a realistic ethical imagination about the future of a technology take shape? This article contains a reflection which is based on the experiences of an embedded ethicist in the context of biophysical research conducive to the development of photoacoustic mammography, which is intended for the non-invasive detection of breast cancer. Imagination in this context already informs the activities of the biophysical researchers, but its role is limited: biophysical future scenarios concentrate on the technological advances that photoacoustics could bring about. In this article it is argued that it is advisable to also consider the medical practice and the ways in which this practice is likely to change as an effect of the introduction of photoacoustic mammography into it. On the basis of this more encompassing imaginative endeavor it is possible to get a clearer idea about how new technologies are able to contribute to human well being, which is informative for the setting of research-goals/priorities and a responsible implementation of new technologies into the world.     

Nanomedicine: Building a Bridge Between Science and Law

This article aims to address challenges of translating emerging scientific technologies into legal terms and incorporate them into the existing North American regulatory regimes. A lack of full scientific knowledge about nanomedicine technologies results in the lack of development in legal discourse to describe products and to clearly set legal standards on their safety and efficacy. The increasing complexity and hybrid nature of technologies negatively impact the functionality of “law in action” leading to a legal uncertainty and ultimately to a public distrust. Nanomedicine is an illustrative example of how law lags behind increasingly fast-paced scientific technologies making it difficult to find a balance between innovation and safety. This article argues that the boundary crossing nature of nanomedicine through different domains of science triggers a methodological and epistemological debate within science and law, suggesting that a critical revision is required in our traditional methods to learn, create, and categorize knowledge from breakthrough scientific advances. The highly disruptive nature of nanomedicine places stress on traditional conceptual frameworks, classifications of knowledge, and existing regulations. The legal challenge to identify definitions or to classify nanoapplications brings to light a conceptual vacuum surrounding nanomedicine. Moving away from confusing policies and obsolete classificatory models, this article suggests to undertake changes that are only the first steps of a more in-depth “epistemological transformation” that addresses knowledge as the process of not only gathering data, but also, as the process of elaborating new conceptual bases to better fulfill the legal language and facilitate the legal task of finding definitions and formulating criteria more adherent with scientific advances. This should compel regulators to explore new paradigms and develop new methodologies to evaluate data on nanomedicine applications in order to provide sustainable bases for a responsible development of nanomedicine.     

Neuroimaging as a New Tool in the Toolbox of Psychological Science

ABSTRACT— During the past quarter century, advances in imaging technology have helped transform scientific fields. As important as the data made available by these new technologies have been, equally important have been the guides provided by existing theories and the converging evidence provided by other methodologies. The field of psychological science is no exception. Neuroimaging is an important new tool in the toolbox of psychological science, but it is most productive when its use is guided by psychological theories and complemented by converging methodologies including (but not limited to) lesion, electrophysiological, computational, and behavioral studies. Based on this approach, the articles in this special issue specify neural mechanisms involved in perception, attention, categorization, memory, recognition, attitudes, social cognition, language, motor coordination, emotional regulation, executive function, decision making, and depression. Understanding the contributions of individual and functionally connected brain regions to these processes benefits psychological theory by suggesting functional representations and processes, constraining these processes, producing means of falsifying hypotheses, and generating new hypotheses. From this work, a view is emerging in which psychological processes represent emergent properties of a widely distributed set of component processes.     

APPLIED BEHAVIOR ANALYSIS: AUTISM AND BEYOND

Over the past 60 years, applied behavior analysis (ABA) has made notable contributions to the literature involving populations with developmental disabilities. Practitioners and researchers have made impressive advances in addressing challenges posed by autism spectrum disorder (ASD), in particular. The focus on autism has resulted in an improved public image of ABA and, in turn, has helped highlight the need for increased awareness surrounding ASD. A summary of relevant research contributions is provided, and although the advances in autism are impressive, individuals with ASD constitute a minority portion of the educational system. A review of the existing literature, as well as a novel literature search, supports the suggestion that ABA has narrowed its focus to issues affecting populations with ASD, while concurrently being less attentive to problems faced by society as a whole, particularly general education. Copyright © 2012 John Wiley & Sons, Ltd.     

Determining the status of non-transferred embryos in Ireland: a conspectus of case law and implications for clinical IVF practice

The development of in vitro fertilisation (IVF) as a treatment for human infertilty was among the most controversial medical achievements of the modern era. In Ireland, the fate and status of supranumary (non-transferred) embryos derived from IVF brings challenges both for clinical practice and public health policy because there is no judicial or legislative framework in place to address the medical, scientific, or ethical uncertainties. Complex legal issues exist regarding informed consent and ownership of embryos, particularly the use of non-transferred embryos if a couple separates or divorces. But since case law is only beginning to emerge from outside Ireland and because legislation on IVF and human embryo status is entirely absent here, this matter is poised to raise contractual, constitutional and property law issues at the highest level. Our analysis examines this medico-legal challenge in an Irish context, and summarises key decisions on this issue rendered from other jurisdictions. The contractual issues raised by the Roche case regarding informed consent and the implications the initial judgment may have for future disputes over embryos are also discussed. Our research also considers a putative Constitutional 'right to procreate' and the implications EU law may have for an Irish case concerning the fate of frozen embryos. Since current Medical Council guidelines are insufficient to ensure appropriate regulation of the advanced reproductive technologies in Ireland, the report of the Commission on Assisted Human Reproduction is most likely to influence embryo custody disputes. Public policy requires the establishment and implementation of a more comprehensive legislative framework within which assisted reproductive medical services are offered.     

Against the iDoctor: why artificial intelligence should not replace physician judgment

Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an “iDoctor,” a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger’s critique of technology to show how an algorithmic approach to medicine distorts the physician–patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient’s needs. In response to the objection that AI could develop this capacity, I use Hubert Dreyfus’s analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient’s history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology.     

Enhancement and ethics

Now suppose we could use genetic engineering, regenerative medicine or drugs --chemical enhancers, or reproductive technology or nanotechnology to produce healthier, fitter and more intelligent individuals, what should our reaction be? Would it be unethical to do so? Would it be ethical not to do so? Our question is this: If the goal of enhanced intelligence, increased powers and capacities and better health is something that we might strive to produce through education, including of course the more general health education of the community; why should we not produce these goals, if we can do so safely, through enhancement technologies or procedures? If these are legitimate aims of education could they be illegitimate as the aims of medical or life science, as opposed to educational science?     

Biotechnologies that empower transgender persons to self-actualize as individuals,partners, spouses,and parents are defining new ways to conceive a child: psychological considerations and ethical issues

Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.