Attention Deficit Hyperactivity Disorder: Defining A Spectrum Disorder and Considering Neuroethical Implications
James M. Swanson, Timothy Wigal, Kimberley Lakes, and Nora D. Volkow
Prospective follow-up studies have shown that even though some children outgrow the disorder, a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) is clearly a risk factor for a broad range of adverse outcomes, with extremes including drug abuse and juvenile delinquency. This article considers the use of several spectrum concepts and some neuroethical issues. It provides a list of criterion symptoms with a threshold set for the number of symptoms required for categorical diagnoses of disorders. It gives a brief review of some brain imaging and pharmacological treatment studies of ADHD to set the stage for a consideration of brain-specific issues related to neuroethics. Studies using reaction time (RT) tasks of cognitive control, response inhibition, and conflict have identified interindividual variance in task performance as one of the most prominent aspects of cognitive deficits related to ADHD.
Lynn C. Robertson
Balint’s syndrome is the most severe neuropsychological disorder affecting spatial attention that has been observed. In humans, it can be observed after bilateral occipital-parietal damage. The signs and symptoms of this syndrome are first described and then discussed in terms of how research with patients with Balint’s syndrome has helped and/or limited our understanding of object-based attention, visual search, and feature binding in visual perception. The findings have also supported the existence of implicit spatial maps that are available in the face of severely limited conscious spatial awareness. The results of such studies have led to advancements in attentional theory, especially as related to spatial attention and its interaction with object perception.
New brain imaging technology has emerged that might make it possible to read a person's thoughts directly from their brain activity. This novel approach is referred to as “brain reading” or the “decoding of mental states.” This article provides a general outline of the field and discusses its limitations, potential applications, and also certain ethical issues that brain reading raises. The measurement of brain activity and brain structure has made considerable progress in recent decades. The mapping from brain activity patterns to thoughts is learned for each specific subject using brute force statistical pattern recognition techniques. It discusses the degree to which polygraphy and brain-based lie detection can be manipulated by trained subjects. A future application of brain reading technology, “neuromarketing,” has received tremendous interest and there are repeated attempts to optimize marketing campaigns by adding brain-based sources of information.
Jonathan D. Moreno
Bioethics literature on national security issues is surprisingly sparse and the implications of neuroscience for national security are of increasing public and scholarly interest. This article elaborates one important source of evidence that can be found in reports by US government advisory committees over the past few years. It demonstrates that the growing interest in neuroscience on the part of national security agencies can be discerned in part by reviewing recent reports from the US National Academies. The relationship between national security concerns and neuroscience is complex. Primary questions are discussed in the anthropomorphic terms of concerns and goals, and there is no inference to any particular sort of deliberations within these systems that leads ineluctably to a certain science policy agenda. This article also assesses the cultural underpinnings of neuroscience and ethical implications of evolving neurotechnologic capacity.
Chemical Cognitive Enhancement: Is it Unfair, Unjust, Discriminatory, or Cheating for Healthy Adults to Use Smart Drugs?
This article states that drugs could be used to produce, if not more intelligent individuals, at least individuals with better cognitive functioning. Cognitive functioning is something that we might strive to produce through education, including of course the more general health education of the community. Enhancements are good if and only if they make people better at doing some of the things they want to do including experiencing the world through all of the senses, assimilating and processing what is experienced, remembering and understanding things better, becoming more competent, and experiencing more. Beneficial neural changes have been reported for such familiar technologies as reading, education, physical exercise, and diet. Smart drugs create irresistible competitive pressures such that once they are used everyone is forced to follow in order to keep up, and this is coercive and corrosive.
Research is crucial to improve medicine's ability to care for the sick, and this includes research on conditions affecting cognition. This article focuses on whether persons suffering from diseases affecting cognition can be enrolled in research when the purpose is to investigate the condition leading to this impairment. It also discusses when they may be enrolled and on the precautions which are necessary if they are. Protections for vulnerable persons in research have two components: fair subject selection, and the specific care required to minimize wrongs to vulnerable persons once they are enrolled in research. Finally, the article examines, and rejects, the idea that there could be circumstances in which persons suffering from diseases affecting cognition could have an obligation to participate in research addressing these disorders.
Thomas Metzinger and Elisabeth Hildt
Cognitive enhancement aims at optimizing a specific class of information-processing functions: cognitive functions, physically realized by the human brain. This article deals with ethical issues in cognitive enhancement (CE). It discusses some standard conceptual issues related to the notion of “cognitive enhancement” and then continues from a purely descriptive point of view by briefly reviewing some empirical aspects and sketching the current situation. Several enhancement strategies are being tested and used. Then the chapter offers some reflections on the treatment or enhancement distinction. It turns to normative issues by describing standard topics in current debates, then highlighting three examples of relevant novel questions under an ethical perspective. It is of central importance to be able to draw on long-term studies yielding data on the benefits, risks, and side-effects involved in the use of such substances over months and years. It concludes by making some general proposals for policy makers.
Anders Sandberg, Walter Sinnott-Armstrong, and Julian Savulescu
Human cognitive performance has crucial significance for legal process, often creating the difference between fair and unfair imprisonment. Lawyers, judges, and jurors need to follow long and complex arguments. They need to understand technical language. Jurors need to remember what happens during a long trial. The demands imposed on jurors in particular are sizeable and the cognitive challenges are discussed in this chapter. Jurors are often subjected to both tremendous decision complexity and tremendous evidence complexity. Some of these problems could be ameliorated if we can somehow enhance the cognitive capacities, including attention and memory, of various players in trials. There are multiple ways in which cognition can be improved either by external tools or by an increasing number of biomedical interventions that act directly on the brain. The article surveys a range of beneficial and detrimental effects that substances can have on cognition.
Debra J.H. Mathews, Peter V. Rabins, and Benjamin D. Greenberg
This article reviews some of the ethical issues raised by the emergence and use of deep brain stimulation (DBS) as a treatment for neuropsychiatric disorders. Issues include concerns about the capacity of persons with severe mental illness to give authentic informed consent, protecting vulnerable individuals from being exposed to unproven and potentially irreversible therapies, the use of DBS for psychiatric disorders in minors, the necessary organization of the interdisciplinary teams required to deliver these demanding treatments, and the degree and quality of oversight. DBS may be seen as the most recent on a continuum of surgical intervention for psychiatric disease and also represents an adaptation of the first implantable brain-interfacing device (IBID) in clinical use. Consideration of the ethical issues raised by such therapies will protect individuals with neurologic and psychiatric diseases from the abuses of the past.
Development of the Adolescent Brain: Neuroethical Implications for the Understanding of Executive Function and Social Cognition
Brain research has informed many recent studies of adolescent development either through direct measures of brain structure and activity in neuroimaging studies or through behavioral studies where laboratory tasks are selected on the basis of their links to brain function. This body of work has led to a popular understanding of adolescence as a time period when risk-taking behavior escalates to extreme levels due to brain-based immaturities. This article considers neurobehavioral studies that allow us to conclude about executive functions in adolescence, studies of brain development that indicate about the status of the adolescent brain, and then, importantly, if these research domains cohere. The article analyses that brain-based substrates clearly underlie the immaturities in executive function observed in adolescence. The practical and ethical implications of these findings are discussed using legal decisions as a prominent example.