Neuroethics & Law Blog

Nuffield Greenlights Fractional Parenthood

Researchers have been able to create fertilized human embryos containing nuclear DNA from a man and a woman and mitochondrial DNA from a second woman. Some women have difficulty becoming genetic parents due to mitochondrial DNA disorders, and the technology may allow these women to nevertheless become genetic parents by using the mitochondrial DNA of a donor. I have termed the arrangement fractional parenthood since a resulting child would have contributions from three genetic parents rather than two.

The UK's Nuffield Council on Bioethics says the procedure is ethically permissible in research contexts, but the Council would likely resist my description of the technology as creating fractional parenthood. According to an article in New Scientist, the Council "points out that just 0.1 per cent of the child's DNA would come from the donor. It would repair mitochondria but make a negligible contribution to the characteristics of the child, so it would be legally and biologically inaccurate to refer to such a donor as a 'third parent'."

There certainly are practical reasons for the Council to take that position. In reality, of course, "parent" is not a clearly defined term for biologists or lawyers, and the technology will surely raise issues that haven't been seen before (namely, having more than two genetic parents). I'm all in favor of the procedure when it becomes safe and effective, but there's no need to pretend that we have clear categories of parenthood when surely parenthood falls along a spectrum. For more of my thoughts on the topic, see here.

PEBS Neuroethics Roundup (JHU)

Last Edition's Most Popular Article: Flute’s Revised Age Dates the Sound of Music Earlier, New York Times In The Popular Press: Morals and the machine: As robots grow more autonomous, society needs to develop rules to manage them, The Economist  32 Innovations That Will Change Your Tomorrow, New York Times Electrical stimulation of the brain: the benefits of the short, sharp shock, The Guardian This Is Your Brain On No Self-Control, Science Daily Bionic cells can do basic arithmetic, New Scientist The Cognitive Behavioral Miracle--Controlling your Emotions, Brain Blogger Premature babies may have increased risk of psychosis, New Scientist Dictators Turn Strangely Benevolent in Online Game, Wired Science A case study by Lisa Bortolotti, Neuroethics & Law Blog Do Plants Think?, Scientific American Video From Sean Mackey On Using fMRI To Measure Pain, Stanford Center for Law and the Biosciences Video From Jack Gallant & Nita Farahany on fMRI-Enabled Mind-Reading, Stanford Center for Law and the Biosciences Is it reality? No, it's Truman Show delusion, The Guardian Lucid dreaming: Rise of a nocturnal hobby, BBC News Hitting the Court, With an Ear on the Ball, New York Times From the Academic Literature: Neuroscience: Sibling neurons bond to share sensations, Nature The Amygdala Central Nucleus: A New Region Implicated in Habit Learning, The Journal of Neuroscience Primary somatosensory cortex discriminates affective significance in social touch, PNAS Cineradiography of Monkey Lip-Smacking Reveals Putative Precursors of Speech Dynamics, Current Biology Forebrain GABAergic Neuron Precursors Integrate into Adult Spinal Cord and Reduce Injury-Induced Neuropathic Pain, Neuron Restoring Voluntary Control of Locomotion after Paralyzing Spinal Cord Injury, Science Identification of the Cortical Neurons that Mediate Antidepressant Responses, Cell Sex moderates the relationship between worry and performance monitoring brain activity in undergraduates, International Journal of Psychophysiology Evolution of a Vertebrate Social Decision-Making Network, Science Long-term soy isoflavone supplementation and cognition in women, Neurology The “Truman Show” delusion: Psychosis in the global village, Cogntive Neuropsychiatry

Subscribe to our mailing list The Program in Ethics and Brain Sciences (PEBS) is a collaborative effort of the Johns Hopkins Berman Institute of Bioethics and the  Johns Hopkins Brain Sciences Institute . The goal of PEBS is to ensure that research in brain science proceeds with an informed understanding of ethical issues, and that philosophical and empirical analyses of the advances in brain research proceed with an informed understanding of the science.

U.S. Secretary of Commerce Said to Have Had Seizure

See the bizarre story here. At least a few reports find no indication that intoxicating drugs were involved. Here's an excerpt:

The secretary was driving alone in a Lexus on a major street in San Gabriel when he struck the rear end of a vehicle that had been stopped for a passing train, authorities said.

Bryson spoke briefly with the occupants and then hit their car again as he departed, the officials said. The three occupants followed Bryson while calling police.

Bryson was cited for the hit-and-run, although he has not been formally charged.

Bryson then caused a second collision minutes later in the nearby city of Rosemead, striking a car occupied by a man and a woman, authorities said. Bryson was found alone and unconscious in his car.

Autonomy and mental illness [by lisa bortolotti]

In my posts so far, I have been asking questions about the relationship between mental illness and moral responsibility for action. Some may feel that one preliminary issue is whether mental illness adversely affects personal autonomy intended as the capacity to govern oneself.

In a paper co-authored with Matthew Broome, Rochelle Cox and Matteo Mameli, which appeared in Autonomy and Mental Disorder, edited by Lubomira Radoilska, we investigated the relationship between having delusions and governing oneself. We proposed a distinction between the capacity to govern oneself and being successful at governing oneself. We argued that the capacity for self-governance depends on the capacity to develop a self-narrative, and that success in self-governance depends on the coherence of self-narratives and on their correspondence to real life events.

Our thesis was that in most of the relevant cases, people with delusions retain the basic capacity for self-governance, because they can develop self-narratives, but are unlikely to be successful at governing themselves due to failures of rationality and self-knowledge. This is in no way hinting at a discontinuity between people with mental illness and people without. Failures of rationality and self-knowledge are present in all of us and they interfere with the way in which we exercise our capacity for self-governance.

In this post, let me start by describing those failures of rationality and self-knowledge that are typical of people with delusions. Then, in the next few posts, I shall introduce and discuss the notion of self-narrative and its role in enabling self-governance. Finally, I shall make a proposal about what it takes to be successful at governing oneself.

Delusions are classified and diagnosed on the basis of their surface features, that is, on the basis of their manifestations. These manifestations are normally described by reference to epistemic notions such as truth, rationality, justification and belief (see DSM definition of delusion as an example).

Delusions may violate norms of rationality and compromise self-knowledge to a higher degree and across more dimensions than non-pathological beliefs. This might be due to their aetiology, which involves neurobiological deficits giving rise to abnormal experiences, as well as deficits in the evaluation of the hypotheses aimed at explaining those experiences (see research by psychologists at Macquarie University on delusion formation).

These are the main epistemic faults of delusions:

• People with delusions can endorse mutually conflicting or even inconsistent attitudes (failure of procedural rationality).
• Delusions are typically formed in the absence of sufficient evidential support, are very resistant to counterevidence, and are rejected by other members of the community to which the person belongs (failures of epistemic rationality).
• Although people with delusions are often disposed to act on their reports, and to defend their reports with sensible reasons, there are circumstances in which their actions do not match their reports, and no reasons are offered in support of their beliefs (failures of agential rationality). 
• People with delusions may claim that an external force is responsible for moving their limbs or that a third person is inserting thoughts into their minds (distortion of personal boundaries).

If people with delusions cannot typically satisfy the conditions for rationality and self-knowledge, at least with respect to the content of their delusional reports, what are the implications for their capacity to exercise autonomy?

Apes, Chickens, and Moral Standing

Here are two recent additions to SSRN on the rights and interests of non-human animals. The first is just an abstract (unless you have a subscription to HCR and download it there), the other a draft version:

"A Status Elevation for Great Apes" 
HASTINGS CENTER REPORT, Mar.-Apr. 2012

REBECCA DRESSER, Washington University in Saint Louis - School of Law
The ethical case for changing the way we treat nonhuman animals is gaining ground. Two federal policy developments last year are evidence that United States officials are responding to arguments for elevating the moral and legal status of certain species: chimpanzees, gorillas, and other great apes. The policy actions show that society is beginning to see these species, our closest nonhuman relatives, as less like property and more like beings entitled to respect and protection. The key question is whether these steps are the beginning of a more general trend. Will humans move toward conferring higher moral status on other nonhuman species?

"Primitive Self-Consciousness and Avian Cognition" 
The Monist, Volume 95, Issue 3, July 2012.

ANDY LAMEY, Monash University
This is an uncorrected author's draft of a paper published in The Monist issue on neuroethics, Volume 95, Issue 3 (July 2012). For citation and quoting purposes, please use the published version.

Recent work in moral theory has seen the refinement of theories of moral standing, which increasingly recognize a position of intermediate standing between fully self-conscious entities and those which are merely conscious. Among the most sophisticated concepts now used to denote such intermediate standing is that of primitive self-consciousness, which has been used to more precisely elucidate the moral standing of human newborns. New research into the structure of the avian brain offers a revised view of the cognitive abilities of birds. When this research is approached with a species-specific focus, it appears likely that one familiar species, the chicken (Gallus gallus domesticus), also exhibits primitive self-consciousness. Given the likelihood that they are primitively self-consciousness, chickens warrant a degree of moral standing that falls short of that enjoyed by persons, but which exceeds the minimal standing of merely conscious entities.

A case study, revisited [by lisa bortolotti]

Remember the case of Bill who attacked his neighbour and received a less severe sentence than he might have done because he had a diagnosis of schizophrenia. This case has been presented in my last post with a brief description of the known details of Bill’s condition at the time of the attack. But we can imagine that further information about Bill becomes available and ask what role his having mental illness should play in establishing whether he was morally responsible for his action in these possible scenarios.

The first question we should ask is whether the mere fact that Bill had hallucinations is sufficient to make him less than fully responsible for his action. You might remember that Bill could hear persistent noise, shouting and banging, and believed that his neighbour was causing such noise. It may well be true that if Bill hadn't had those auditory hallucinations, he wouldn’t have felt resentment towards his neighbour and wouldn’t have attacked him. These considerations do not seem sufficient to excuse what Bill did. Had Bill’s auditory experiences been veridical, the fact that his neighbour was being noisy wouldn’t have justified Bill’s violent reaction. Bill should have tried to talk to his neighbour first, and failing that, he should have called the police, instead of taking matters into his own hands. Bill’s hallucinations don’t morally justify his reaction, but they make it more understandable. 

Suppose that Bill’s hallucinations had been accompanied by delusional beliefs about his neighbour that made the attack less morally objectionable. If Bill had believed at the time that his neighbour was a robot not amenable to reason and if he had also been genuinely worried about his own safety, some peaceful resolutions of the noise problem would have ceased to make sense. Going to the police to report that a neighbour-robot is making too much noise is not such a good idea - the report wouldn't be taken seriously. This is a point that would deserve to be discussed at greater length. It isn't surprising that people with delusions often fail to act on their delusions. First, schizophrenia negatively impacts on motivation. Second, some actions are not genuinely open to people with bizarre delusions, because the world around them doesn't present them with opportunities for acting on their delusions. Third, some actions are open, but become less attractive because they would require the person to persuade others of the truth of her delusion. (If you want to know more about this phenomenon, see this.)

Let me consider one further option. What if Bill’s hallucinatory experiences had just been the tip of the iceberg and Bill’s decision making capacities had also been affected by his mental illness? His ability to act in morally and legally acceptable ways might have been compromised. Maybe Bill was not able to form intentions in the standard way or was not able to resist strong desires which he himself wouldn’t have approved of on reflection. Impairments of this type could have been correlated to his symptoms without being a direct effect of them. In this hypothetical case, if evidence of malfunctioning in the decision making machinery had been available, attributing to Bill less than full responsibility would have seemed entirely legitimate.

The complexity of attributions of moral responsibility to people with a diagnosis of mental illness is apparent. By changing some details of Bill’s story, and hypothesising scenarios that are perfectly realistic, his action becomes more or less understandable and he becomes more or less morally responsible for it. Suppose we agreed that attributions of moral responsibility at least partially depend on whether the agent's decision-making machinery functions properly, and suppose we could establish in what way and to what extent a psychiatric disorder affects one’s capacity for decision making, both in general terms and by reference to specific clinical cases. Would this be sufficient ground to change our moral and legal practices?

Gallant and Farahany on fMRI-Enabled Mind Reading

Stanford Law School's Center for Law and the Biosciences has posted video of a talk by Jack Gallant on fMRI-enabled mind reading, along with commentary from Nita Farahany: 

A Step Toward the Experiential Future

This Sunday's NYT Magazine ran an interesting article entitled 32 Innovations That Will Change Your Tomorrow. I particularly appreciated #25 called, "A Blood Test for Depression." I read it as a step toward what I call our experiential future. Here's the pertinent blurb by Elizabeth Weil:

This year, Eva Redei, a professor at Northwestern’s Feinberg School of Medicine, published a paper that identified molecules in the blood that correlated to major depression in a small group of teenagers. Ridge Diagnostics has also started to roll out a test analyzing 10 biomarkers linked to depression in adults. “Part of the reason there’s a stigma for mental illness, including depression, is that people think it’s only in their heads,” Redei says. “As long as there’s no measurable, objective sign, we’re going to stay in that mind-set of ‘Just snap out of it.’ ” Blood tests will take mental illness out of the squishy realm of feelings. And as Lonna Williams, C.E.O. of Ridge Diagnostics, says, they’ll help people understand “it’s not their fault.”

A case study [by lisa bortolotti]

Here is the case Matthew Broome, Matteo Mameli and I considered in our 2010 paper. A young man was convicted for assault on a neighbour and his sentence was affected by a previous diagnosis of schizophrenia.

Bill had been admitted to a psychiatric unit because he contacted the police, worried that he was acting weird and that he might test his invincibility by jumping off the balcony of his apartment. He reported that people he could not see were talking to him, that his upstairs neighbour had been banging and shouting, and that thoughts were being taken out of his head. After six weeks he was discharged, and initially cooperated with the community mental health team, but then refused to participate in the rehabilitation activities and was no longer compliant with medication. Bill claimed to have no symptoms, but reported feeling low and complained that his neighbour was making a lot of noise, keeping him awake at night. One week later, Bill was charged with burglary and grievous bodily harm with intent.

In an interview two months after the offence, Bill admitted to have stopped taking medication after the first week of discharge and reported that soon after he had started hearing banging and shouting from the apartment above. When he saw the door open in the apartment where he thought the noise was coming from, he went in and removed a set of keys, an axe and a hammer. He said he had removed the last two items because he didn’t want them to be used against him, and he had taken the keys in case he needed to access the flat at a later stage. In the following days, as he continued to hear noises, his anger and frustration increased and one night he got dressed and went upstairs. Bill said that he entered the flat with the intention to confront the neighbour verbally, but he lost his temper and ended up seriously injuring his neighbour.

At the time of his assessment, Bill was fit to plead. He understood the indictment, was capable of following the evidence submitted in his case, could instruct his legal team, could follow court proceedings, and could understand the role of the jurors and witnesses. Further, from what Bill can recall, it seems that, at the time of the offense, he was able to form specific intentions and he was aware that his actions may lead to violence and harm. At the time of assessment, though, he denied any formal plans to harm the tenant of the apartment above and was surprised at how events had escalated. Bill was able to realize that the actions he had committed were wrong and unlawful.

The opinion of his clinical team was that at the time of the offense he was relapsing from his psychotic illness. He had poorly engaged with his clinical team, and had been noncompliant with medication for several weeks prior to the offense. Further, he reported a recurrence of (probably hallucinatory) auditory experiences (e.g., banging, shouting) that had previously abated. In the end, Bill was found guilty and was sentenced to 2 years’ probation and a suspended custodial sentence. Because of his diagnosis of mental illness, the sentence was less severe than otherwise would be expected.

In the next post, I shall explore different ways in which a diagnosis of schizophrenia can impact on attributions of moral responsibility in a case like Bill's. Watch this space!

Moral responsibility: an incremental view? [by lisa bortolotti]

When Simon Wessely commented upon the case of the Norwegian mass killer Anders Breivik in the Lancet, he exposed two common misconceptions about psychiatry. The first is that “outrageous crimes must mean mental illness”. The second is that “the purpose of psychiatry is to get people off”. He showed that both assumptions are misguided. Breivik has committed an outrageous crime in name of beliefs that are not delusional, because they are (unfortunately) shared by others. But if a mental illness defence applied to his case, that wouldn’t necessarily mean that he would walk free. Wessely's commentary caused reactions in newspapers and blogs worldwide.

When people commit ominous crimes, debates tend to polarise. One position is that the perpetrator is fully responsible for the consequences of her actions and deserves punishment. The alternative position is that she is not responsible at all and deserves treatment instead. Commonsense suggests that between these two extremes there is a range of intermediate positions. Agents can be responsible for the consequences of their actions to some extent, not fully, and punishment can be proportionate to the extent to which agents are responsible. I have asked Matthew Broome, a clinical and academic psychiatrist at the University of Warwick, what he thinks about the possibility of having an incremental view of moral responsibility. Here is what he told me:

“An incremental view of responsibility, common in philosophy and psychiatry, is not one that is seen in the law where typically categorical, dichotomous judgments are made.  For example, in English law guilt requires both actus reus and mens rea, the former being acts of omission, commission or possession, and the latter including intention to commit the act but also the act being committed by recklessness and negligence. In English Law, the McNaughten Rules specify when an individual is not responsible for his or her actions due to mental illness and rely on the individual not knowing the quality or nature of the act, not knowing that it was wrong, and being under an 'insane delusion' that prevents the appreciation of the true nature or quality of the act. This is a fairly high threshold and more commonly, in homicide cases, the diminished responsibility defence is used instead. For this to work, it is not sufficient to demonstrate that there is an abnormality of mind. This abnormality must be due to development, injury or illness, and must impair responsibility for actions 'substantially', as judged by individual medical experts and juries.

In schizophrenia, for example, we know that there are cognitive and neuropsychological impairments, even when patients are remitted and taking medication, but what we don't know is how these impairments interface with local, particular, and context-specific decisions in terms of responsibility. Further, we don’t know whether such an interaction amounts to a ‘substantial’ impact. If we assume that it always does, then we lower the threshold to the point that a person with schizophrenia, however well, can never be criminally responsible.”

Broome’s comments raise important questions. Should the law take into account what psychiatrists and philosophers have to say about moral responsibility? Can we establish whether a psychiatric condition impairs the making of a specific decision substantially? In 2010 Broome, the philosopher Matteo Mameli and I published a paper on the relationship between mental illness and moral responsibility which appeared in the Cambridge Quarterly of Healthcare Ethics. It was an attempt to raise similar questions for debate. For instance, a key issue in the assessment of moral responsibility seems to be whether we can establish a causal link between mental illness and behaviour. In the paper we chose to discuss a case study featuring a young man who committed a crime having a diagnosis of schizophrenia.

More details about the case in the next post!