Neuroethics & Law Blog

The Pope's Living Will

Reuters reports here that, based on a speech he delivered last year, Pope John Paul wants life support to the very end of his life.  Here's a brief excerpt from the story:

The ailing Pontiff sharply narrowed Catholic guidelines for treating patients nearing death in March 2004 when he described tube-feeding as a normal treatment rather than an extraordinary measure that can be stopped if all hope of recovery fades.

This indicates he would want to be kept alive by artificial means even if he fell into a coma or a persistent vegetative state, such as the brain-damaged Terri Schiavo in the United States whose feeding tubes have been removed after 15 years.

"The Pope's statement would have to be considered the equivalent of his living will," said Father Thomas Reese S.J., editor of the Jesuit weekly America in New York. "It would be very difficult to unplug him if it came to that."

The article describes some disagreement, however, over the scope and effect of the statements that were made.

Terri Schiavo Has Died

Details from Reuters are available here.  Of course, the controversy will live on.  In addition to federal legislation under consideration, the New York Times reports that many states are considering new legislation, as well.  See here for the full story.  On the more extreme end, the NYT notes a couple of proposals:

Among them is the Alabama Starvation and Dehydration Prevention Act, which would forbid the removal of a feeding tube without express written instructions from the patient. And a legislator in Michigan is writing a bill that would bar adulterers from making decisions for an incapacitated spouse.

However:

Polls indicating broad public opposition to government involvement in the Schiavo case may be giving some politicians second thoughts. With many legislatures approaching the end of their sessions, some bills, including those in Hawaii, Kansas and Kentucky, have already stalled.

False Claims Testimony in Michael Jackson Case

Stan Katz, a psychologist in the Michael Jackson trial, offered testimony today that pertains to the reliability of the alleged victim.  According to an AP story, Katz testified that it would be "extremely rare" for a child who was the alleged victim's age to make a false allegation.  Here's an excerpt (the last paragraph may seem counterintuitive):

Stan Katz, one of the prosecution's key witnesses, was prohibited by Judge Rodney Melville from testifying directly about the credibility of Jackson's accuser or whether he believes the molestation occurred.

However, Katz said that children over 5 rarely fabricate claims of molestation.

He said that accusers who appear to be truthful sometimes change their stories and embellish or exaggerate, while "children who make false allegations are usually consistent, almost scripted."

Aptronyms

A great deal of research in behavioral economics has shown how our preferences may be altered by seemingly irrelevant facts.  How far might this extend? Might one choose a life's profession based on something as arbitrary as one's last name? Ask my colleague at the University of San Diego, Prof. Law.  Or, ask Mrs. Cook, my middle school home economics teacher.  Or, ask the English teacher who taught at my high school, Mr. Shakespeare.

A recent article in the New York Times discusses such "aptronyms" (a term coined by the columnist Franklin P. Adams).  Here are some of the more famous examples it mentions:

Think of baseball's Cecil Fielder and Rollie Fingers, the news executive Bill Headline, the artist Rembrandt Peale, the poet William Wordsworth, the pathologist (not gynecologist) Zoltan Ovary, the novelist Francine Prose, the poker champion Chris Moneymaker, the musicians Paul Horn and Mickey Bass, the TV weatherman Storm Field, Judge Wisdom, the spokesman Larry Speakes, the dancer Benjamin Millepied, the opera singer Peter Schreier, the British neurologist Lord Brain, the entertainer Tommy Tune, the CBS Television ratings maven David Poltrack.

I would have thought that most such occurrences were just coincidences.  The lesson here is likely that we tend to find correlations where none exist.  The article suggests (without much analysis) that there may be more to it than that:

Cleveland Kent Evans, a psychologist at Bellevue University in Nebraska, said: "It is certainly possible that when someone's name corresponds with a word which is associated with a particular interest or profession in their culture, it might make them somewhat more likely to go into that profession. But the people involved themselves wouldn't necessarily consciously know that or consciously want to admit it when it would happen."

Dr. Lewis P. Lipsitt, professor emeritus of psychology at Brown, agrees that the influence of a name is often subliminal.

"You wouldn't expect people to reply that they had a strong awareness of moving toward a profession or occupation or a preoccupation just because their name signified that they should," he said, "but I think there is a real process at work to gravitate people toward occupations and preoccupations suggested by their names.

Neuroeconomics vs. Behavioral Economics

An article in Business Week provides a good overview of issues emerging in neuroeconomics.  The article begins by noting that everyone lost this season in the National Hockey League and then asks "What went wrong?":

According to the new science of neuroeconomics, the explanation might lie inside the brains of the negotiators. Not in the prefrontal cortex, where people rationally weigh pros and cons, but deep inside, where powerful emotions arise. Brain scans show that when people feel they're being treated unfairly, a small area called the anterior insula lights up, engendering the same disgust that people get from, say, smelling a skunk. That overwhelms the deliberations of the prefrontal cortex. With primitive brain functions so powerful, it's no wonder that economic transactions often go awry. "In some ways, modern economic life for humans is like a monkey driving a car," says Colin F. Camerer, an economist at California Institute of Technology.

The article suggests that discoveries in neuroeconomics may provide a stronger challenge to traditional economic assumptions than do the more psychological findings of behavioral economics:

Since the early 1900s, economists have mainly assumed that people have a stable and consistent set of preferences that they try to satisfy. When faced with an apparently illogical outcome -- such as the cancellation of the hockey season -- they try to explain it as the result of a reasoned decision process. Such top economists as Gary S. Becker, Milton Friedman, and Robert E. Lucas Jr., all Nobel prize winners, have argued that discrimination, unemployment, and stock market gyrations can have rational origins.

In recent years, the assumption of rationality has taken some hard shots as economists have shown that people often lack self-control, are shortsighted, and overreact to the fear of losses. But to date, these attacks on rationality -- under the broad heading of "behavioral economics" -- have seemed more like a grab bag of anomalies than a consistent alternative theory. So the assumption of rationality survives.

By linking economic behavior to brain activity, however, neuroeconomics may finally supply the model that knocks mainstream economics off its throne. The new theory should fit better with reality, but it won't be as mathematically clean -- because the brain is a confusing place, with different parts handling different jobs. Says Camerer: "You are forced to think about a brain which has many somewhat modular circuits."

Thanks to Mind Hacks for the pointer.

Neuroethics Conference Update

Updated schedule and speaker information on the AAAS neuroethics conference at MIT (April 17- April 19) is now available here.

Another Aspect of Art and the Brain

I have recently posted articles on creativity and psychatric disorder. (See here and here).  In a different light, here is an interesting article in Nature about how visual art can inform neuroscience.  A sample is below (Thanks to Mind Hacks for the pointer):

The rules of physics that apply in a real scene are optional in a painting; they can be obeyed or ignored at the discretion of the artist to further the painting's intended effect. Some deviations, such as Picasso's skewed faces or the wildly coloured shadows in the works of Matisse and other Impressionists of the Fauvist school, are meant to be noticed as part of the style and message of the painting. There is, however, an 'alternative physics' operating in many paintings that few of us ever notice but which is just as improbable. These transgressions of standard physics — impossible shadows, colours, reflections or contours — often pass unnoticed by the viewer and do not interfere with the viewer's understanding of the scene. This is what makes them discoveries of neuroscience. Because we do not notice them, they reveal that our visual brain uses a simpler, reduced physics to understand the world. Artists use this alternative physics because these particular deviations from true physics do not matter to the viewer: the artist can take shortcuts, presenting cues more economically, and arranging surfaces and lights to suit the message of the piece rather than the requirements of the physical world.

In discovering these shortcuts artists act as research neuroscientists, and there is a great deal to be learned from tracking down their discoveries. The goal is not to expose the 'slip-ups' of the masters, entertaining as that might be, but to understand the human brain. Art in this sense is a type of found science — science we can do simply by looking.

Body Integrity Identity Disorder

The New York Times has an interesting article (registration required) on what has been termed body integrity identity disorder.  Those with the disorder seek to have healthy limbs amputated.  It is yet one more instance where society must determine the extent to which individuals should control their own bodies, particularly when the exercise of such control requires the assistance of health care professionals.  Here's a sample:

Dr. First is among a small group of psychologists and psychiatrists who are trying to define the disorder, understand its origins and decide whether to include it in the encyclopedic bible of psychiatry, the Diagnostic and Statistical Manual, or D.S.M., as a full-fledged disease. At the same time, the disorder is turning up as a plot device or documentary subject in a handful of films, plays and television shows.

The idea of having extreme elective surgery, even when it involves mutilation or removal of healthy tissue, has met at least some acceptance in cases like sex reassignment, or cosmetic surgery for those who hate their noses or breasts even when those body parts are objectively fine.

But an obsessive desire for a limb amputation - one that drives people to cut off healthy arms and legs - tests the tolerance of even the most open-minded. . . .

No one knows for sure what causes the integrity disorder or how it can be treated. Dr. J. Mike Bensler and Dr. Douglas S. Paauw of the University of Washington Medical Center in Seattle, writing in the Southern Medical Journal in 2003, said it was probably both sexual and emotional in nature. The condition is at its heart an "erotic fantasy," they wrote, with two components: "undergoing amputation of a limb, and subsequently overachieving despite a handicap."

Schiavo Order

Here's a link to Judge Whittemore's order denying the request of the parents of Terri Schiavo for preliminary injunctive relief.  According to reports here and here, an appeal has been filed in the 11th Circuit.

The Upside of Mild Disorders: Hypomania and Exuberance

A recent post here concerned the possible decline of creative genuis in society as a result of improved treatment for psychiatric disorders.  Along those lines, the New York Times has an article today about "Hypomania" (registration required).  Here's a sample:

In recent decades, scientists have found that bipolar disorder is widely variable, and that its milder forms are marked by hypomanias, currents of mental energy and concentration that are less reckless than full-blown manic frenzies, and unspoiled, in many cases, by subsequent gloom.

New research helps explain how people with manic or hypomanic tendencies navigate the small triumphs and humiliations of daily life, and provides clues to how some of them quickly shake off the emotional troughs that their ambitious natures should make inevitable.

"It kind of goes against the common assumption, but many people who are inclined to hypomanic or manic symptoms have an underlying resilience," said Dr. Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University. "They may get trashed by their peers, laid low, but they respond very strongly."

In a new book, "Exuberance," Dr. Jamison argues that flights of joyous energy similar to hypomanic states frequently accompany scientific and literary inspiration.Psychiatrists have known for more than a century that bipolar disorder, unlike any other mental illness, is often associated with some financial and professional accomplishment. Mania can inspire destructive shopping or gambling sprees, but it can also generate bursts of creative and focused work.

Technology Wars

Gregory Mandel (Law, Albany) has posted "Technology Wars: Mending the Failure of Democratic Discourse" on SSRN.  You can download it here.  Here's the abstract:

Controversies over the use and regulation of various technologies pervade public discourse and have serious implications for the public interest. Conflicts over the regulation of genetically modified food, nuclear power, and nanotechnology, among others, fuel some of the most socially and politically explosive debates of our time. These technology conflicts extract a substantial cost from society - they create costly inefficiencies, prevent society from optimally managing new technologies, consume vast resources, and retard technological growth.

Existing scholarship does not explain or adequately address the teleology of conflict over technology. This Article examines the nature of legal and regulatory technology conflict, diagnoses the sources of that conflict, and proposes innovative solutions to the conflicts. This analysis integrates original empirical research and a multi-disciplinary body of scholarship from the fields of law, behavioral economics, psychology, and political science, to develop a descriptive and prescriptive framework for understanding and resolving legal and regulatory technology controversies.

The proposed framework sheds light on the inefficiency, paralysis, and polarization produced by technology conflict, and on democratic and market failures that inhibit resolution of these conflicts. As a result, the framework reconceptualizes our understanding of technology controversies, revealing new ways to improve social welfare by resolving seemingly intractable legal and regulatory standoffs. These teachings have potentially far-reaching consequences for conflict resolution in non-technology areas as well.

Art and Neuropharmacology

An interesting post at Kuro5hin, entitled "Pharmaceuticals and the Death of Art" argues that new treatments for psychiatric disorders impair society's creative, artistic output.  Here's a sample from the post (Thanks MindHacks for the link):

With the drug companies and commercialism, it is becoming more and more accepted (and culturally enforced, and reinforced) to treat individuals with drugs for any problem they might have that causes then to step (even temporarily, or insignificantly) away from the norm. We can see this in the increasing rates that drugs for treating mental illnesses are prescribed. (We can see this across the board, actually, and not just for psychiatric drugs) It is not because there are more mentally ill, or that we are better at diagnosing people as such, it is because our standards for medicating are lowering. "Better living through chemistry" is indeed becoming our cultural motto.

Thus, many people who previously (pre-60's) would not have gotten psychiatric chemical interventions have now. This means that many of the disorders that we, classically, associated with genius and creativity are being eradicated by psychiatric treatment. If there is a causal correlation between insanity, and greatness, then we to some extent also eradicating greatness. Through our push for conformity, and so-called mental fitness, we lose something more socially important, great works of creativity, the baring of human soul, the sense of awe that genius can bring.

Of course, even if the comments in the post are accurate, one might still think that we can afford some loss of creative genius if it spares many the agony of a psychiatric disorder. 

Schiavo Discussion

I am sure that many of you are following the Schiavo case in the mainstream media.  Some very recent news is here and here.  A reader who is a neurologist in Houston writes:

I am glad to find a site devoted to the legal and ethical issues related to neuroscience. Watching the Schiavo case unfold, I have become quite concerned: I had thought that the ethics of withholding nutrition and fluids from a person in a persistent vegetative state was a debate the country had already settled. Also, it seems as though the prominent involvement of government, particularly on a federal level, involves serious and intrusive overreaching. Might this be a topic for discussion on your page?

Comments are enabled!

Manopause (aka Menoporsche)

Menopause--it's no longer just for women.  It appears that many middle-aged men are proudly proclaiming the benefits of testosterone therapy to combat "change-of-life malaise."  Here's a sample from an interesting article by Shari Rudavsky (Thanks to MemCheck for the link):

Nine years ago, Scott Simmons, now 54, felt he had run out of steam. The Fort Wayne man sold his advertising business and decided to get back in shape. No matter how much time he spent at the gym, however, his body retained its less-than-taut middle-aged shape.

He read an article about testosterone and asked his internist to check his level of the hormone. Sure enough, he fell in the lower range. After his doctor prescribed testosterone, his problems melted away. Not only did his muscles pop out, his attitude did a 180. "I felt so much better, I felt good," Simmons says. "All I remember was, suddenly now I wasn't tired as much. I just felt younger and more energetic again."

Male menopause is not as much a foregone conclusion as female menopause, which every woman who lives past a certain age will experience. While men lose about 1 percent of testosterone each year after age 30 or so, not every man will drop into the low range. . . .

Some doctors believe that midlife crises often stem from men's waning testosterone levels. Dr. Harry Fisch, a New York physician and author of the "Male Biological Clock," drolly refers to the phenomenon as "menoporsche," noting that testosterone treatment may prove a better antidote for the condition than the purchase of a new sports car.

In addition to the big questions such treatment raises about human therapy/enhancement, there are, not surprisingly, some safety concerns:

Not everyone endorses the widespread use of testosterone therapy -- at least not at this point. A 2003 Institute of Medicine report on the treatment urged caution, noting that not enough was known about testosterone therapy to assure users that it's 100 percent safe.

[Editor's Note: Some paragraphs in the original text were condensed here.]

Capitalism and Two Kinds of Happiness

My colleague at the University of San Diego, Chris Wonnell, has posted "Capitalism and Happiness," at the Right Coast blog.  In it, he challenges a  particular critique of capitalism.  Here's a small sample:

We should distinguish between immediate sensory experience and the retrospective intellectualization of that experience. I am from Chicago originally, and now live in San Diego. My observation is that people complain about the weather roughly the same amount in the two cities. That doesn't mean it wasn't genuinely painful to walk the streets of Chicago in the winter and feel like you were being stuck by needles. In intellectualizing the experience, however, Chicagoans simply took it stoically and could honestly state that the weather did not make them especially unhappy. There was the pain, but hey, it is winter time. Of course, when given the choice, a lot of Chicagoans moved to San Diego, and not that many have moved back.

Progress may consist more of improvements in immediate sensory experience than in changes in reflective intellectualization of one's condition. Surely our nature wires us to detect when it is too cold for us out there, so that we will tend to the problem when we can. The feeling of pain is genuine, but it doesn't translate into existential suffering because that would not be good for us. I think that this is largely the kind of progress that capitalism has achieved. It has made our lives as they are pre-intellectually experienced much more pleasurable and less painful than they were before capitalism, not only in terms of mitigating bodily pain but also in terms of immediate experiences of cognitive or aesthetic pleasure. But when we are in the mood for assessing our condition reflectively we are not going to see ourselves as especially happy or unhappy. The normative claim is that it is better to live lives that are pleasurable rather than painful even if one will, at the end of the day, answer a question "how happy are you on a scale of 1 to 10?" the same in either state.