Nada Gligorov

Neuroethics is an emerging interdisciplinary field with unsettled boundaries. Many of the ethical issues within the purview of neuroethics could be described as resulting from the clash between the scientific perspective on concepts such as free will, personal identity, consciousness, etc., and the putatively commonsense conceptions of those terms. The assumption that undergirds the framing of the conflict between these two approaches is that advances in neuroscience, psychiatry, and psychology can be used to explain phenomena covered by commonsense concepts and in some cases undermine them entirely. This book is focused on the examination of the particular relationship between developments in neuroscience and commonsense moral concepts. Common sense, I argue, has been misinterpreted as a static, either foundational or degenerative, basis of our morality, when it is an ever shifting repository of theories from many domains. Within this discussion, I focus on the application of neuroscience to human beings, i.e., the ethics of neuroscience. But I also cover issues within the purview of the neuroscience of ethics, and attempt to address the infiltration of neuroscientific knowledge into everyday parlance and the impact of that on our commonsense morality and psychology.

Confidentiality of health information is increasingly relevant in the era of electronic medical records. We discuss the case of a hospitalized patient who requested a neurology consultation for an episode he described as an “LSD-like” flashback. The patient expressed concern that the episode was a residual effect of past drug use, but subsequently requested that his drug use not be documented. Involved in a custody battle, he feared that if his records were released to the court he could lose custody of his children. Ethical concerns arose with regards to the physician’s competing obligations with a duty to record information accurately and honestly, respect patient autonomy, and maintain patient confidentiality. We discuss the decision of the team to document the patient’s drug use by arguing that the obligation to maintain confidentiality did not supersede the primary role of the medical record as a complete and accurate account, which cannot be altered at a patient’s behest.

The purpose of this essay is to examine some of the ethical concerns raised regarding the use of neuroenhancers. Authors such as Fukuyama and Sandel argue that medical intervention should be limited to treatment of disease, and that enhancement should be outside of the scope of medicine. This commentary will examine the distinction between treatment and enhancement. I shall conclude that it is not a well-drawn distinction and should not be used to provide guidance with regards to the use of psychopharmacological agents for the purpose of cognitive enhancement. I shall further examine whether concepts such as disability and normality could provide a criterion for determining whether enhancement is a permissible use of medical intervention. I conclude that as those concepts are contextually defined, they cannot be used to make principled arguments against enhancement. Finally, I shall review the charge that medicalization of cognitive performance enhancers is not morally permissible. I shall argue that medicalization might have both negative and positive consequences, and decisions about the moral permissibility of medicalization should be made on a case-by-case basis.