Craig McFarland

Surrogate decision-making is fraught with speculation. Amid fogs of uncertainty, surrogates must ascertain an incapacitated patient’s wishes. From this, they are entrusted to make life-altering or life-ending decisions based on limited information. This process of guesswork, however, is inevitably shaped by subjective interpretation and personal biases. In response, artificial intelligence (AI) tools like personalised patient preference predictors (P4) have been proposed as a means to safeguard the accuracy and reliability of surrogate decision-making.1 Yet, whether AI-driven preference predictors can uphold autonomy is a point of moral contention. Proponents like Earp et al. argue that AI tools offer a more systematic, data-driven approach to inferring patient wishes, thereby upholding autonomy by mitigating the human errors of traditional surrogates. Others challenge this assumption. Annoni, for instance, argues that AI-driven preference predictors categorically fail to respect patient autonomy, asserting that autonomy cannot be merely reduced to the satisfaction of patient preferences.2 What follows is an argument for reconsideration. This paper does not contend that AI tools definitively respect autonomy, but instead draws forth novel considerations that challenge the notion of their fundamental incompatibility. To this end, I first examine the case study of AI-powered psychotherapy, in which patients demonstrate a greater willingness to disclose personal information to AI systems. Then, I explore how these insights underscore the promise of …

With the growth of neuroscience research, new neuroscience and society (NeuroX) fields like neuroethics, neurolaw, neuroarchitecture, neuroeconomics, and many more have emerged. In this article we report on lessons learned about mentoring students in the interdisciplinary space of neuroscience and society. We draw on our experiences with the recently launched Dana Foundation Career Network in Neuroscience & Society. This resource supports educators and practitioners mentoring students aiming to apply neuroscience in diverse fields beyond medicine and biomedical science. Through our programming, we identified three key lessons: (1) students are interested in exploring a wide range of neuroscience and society intersections; (2) outreach to underserved institutions generates avenues for students to join NeuroX conversations; and (3) by offering free access to online NeuroX resources and a network of subject-matter experts, the Career Network joins many partners helping to bridge the gap between neuroscience and society.

Neuropsychiatric disorders introduce distinct challenges to clinical decision-making. Affected patients often experience impairments or absences in rationality, lucidity and cogni-emotional capacities, rendering it difficult for them to engage in the decision-making process. In turn, dynamics of the patient-physician relationship become strained, including when physicians employ bioethical principlism or moral case deliberation to arrive at ethically justified courses of action–both of which require sufficient communication and rationality that may be impaired or altogether absent in the presence of psychopathology. The complexity of neuropsychiatric conditions therefore compels interrogation towards how ethics consultations are currently constructed and conducted when full communication or rational decision-making cannot be assumed. Delany et al, for example, present a robust, methodical framework for ethical deliberation.1 Such methodologies for facilitating ethical decision-making, although valuable in predominant contexts, assume full participant engagement and decision-making capacities (eg, independent moral agency). Neuropsychiatric disorders complicate this assumption, making it difficult for patients with limited decision-making capacity to engage meaningfully in proposed ethics consultations.2 This paper will explore how neuropsychiatric disorders complicate the assumptions of full participant engagement underlying ethical frameworks. It will argue that, by adapting ethics consultations to function as a ‘mental prosthesis’, clinicians can better navigate the ethical challenges posed by neuropsychiatric disorders, helping to ensure that patient autonomy is upheld even in cases of impaired cognitive …

Neuropsychiatric disorders such as drug addiction, depression and schizophrenia are often centrally implicated in public health challenges. These conditions impact the individuals affected and have widespread implications, contributing to related crises such as opioid epidemic, rising suicide rates and homelessness. Despite their influence, public health interventions frequently emphasise individual responsibility, overlooking the complex interplay of neurobiological and systemic factors that underpin these disorders. Current public health frameworks, such as the Nuffield Council on Bioethics’ intervention ladder, prioritise efforts that encourage individual behaviour change. Paetkau critiques this emphasis on individual responsibility, emphasising the need to consider more systemic factors, such as social determinants of health, as targets of necessary intervention.1 We aim to reinforce Paetkau’s critique of the intervention ladder by introducing three neuropsychiatric case studies, each highlighting the limitations of an individual-based framework in addressing psychopathology-involved public health issues. We argue that conditions like addiction, depression and serious mental illness undermine the emphasis on individual responsibility in public health and policy interventions. To this end, neuroscience demonstrates that effective public health interventions necessitate a shift from the long-standing emphasis on individual responsibility towards more comprehensive, systems-level interventions. Opioid overdose deaths in the USA have sextupled since 1999, with over 100,000 deaths in 2023 alone.2 The opioid crisis has since remained one of the most pressing public …

Over 50% of the world population will develop a psychiatric disorder in their lifetime.1 In the realm of psychiatric treatment, two primary modalities have been established: pharmacotherapy and psychotherapy. Yet, pharmacological interventions often take precedence as the initial treatment choice despite their comparable outcomes, severe side effects and disputed evidence of their efficacy. This preference for medication foregrounds a vital re-examination of what it means to be invasive in medical treatments, namely in psychiatric care. De Marco et al challenge the standard account of invasiveness, presenting considerations that transcend the traditional criteria of physical intrusion.2 Through case studies centred on treatments for schizophrenia and depression, we aim to (1) reinforce De Marco et al ’s challenge to the standard account of invasiveness and (2) extend the dialogue to the moral imperative of redefining mental invasiveness. Our aims are to broaden the definition of mental invasiveness, aligning with De Marco et al ’s emphasis on context sensitivity, and to include the severity of side effects as a critical factor in this assessment. Redefining what is considered invasive in psychiatric treatment has profound implications for patient care and medical decision-making. Labelling treatments, namely medications, as invasive encourages both patients and healthcare providers to approach these options with a heightened level of scrutiny and care. This is …