A blog from the Centre for Research Ethics & Bioethics (CRB)

Tag: philosophy (Page 12 of 19)

When “neuro” met “ethics”

Pär SegerdahlTwo short words increasingly often appear in combination with names of professional fields and scientific disciplines: neuro and ethics. Here are some examples: Neuromusicology, neurolaw, neuropedagogy. Bioethics, nursing ethics, business ethics.

Neuro… typically signifies that neuroscience sheds light on the subject matter of the discipline with which it combines. It can illuminate what happens in the brain when we listen to music (neuromusicology). What happens in the brain when witnesses recall events or when judges evaluate the evidence (neurolaw). What happens in children’s brains when they study mathematics (neuropedagogy).

…ethics (sometimes, ethics of…) typically signifies that the discipline it combines with gives rise to its own ethical problems, requiring ethical reflection and unique ethical guidelines. Even war is said to require its own ethics of war!

In the 1970s, these two words, neuro and ethics, finally met and formed neuroethics. The result is an ambiguous meeting between two short but very expansive words. Which of the two words made the advance? Where is the emphasis? What sheds light on what?

At first, ethics got the emphasis. Neuroethics was, simply, the ethics of neuroscience, just as nursing ethics is the ethics of nursing. Soon, however, neuro demonstrated its expansive power. Today, neuroethics is not only the “ethics of neuroscience,” but also the “neuroscience of ethics”: neuroscience can illuminate what happens in the brain when we face ethical dilemmas. The emphasis thus changes back and forth between neuroethics and neuroethics.

The advances of these two words, and their final meeting in neuroethics, reflects, of course, the expansive power of neuroscience and ethics. Why are these research areas so expansive? Partly because the brain is involved in everything we do. And because all we do can give rise to ethical issues. The meeting between neuro… and …ethics was almost inevitable.

What did the meeting result in? In a single discipline, neuroethics? Or in two distinct disciplines, neuroethics and neuroethics, which just happen to be spelt the same way, but should be kept separate?

As far as I understand, the aim is to keep neuroethics together as one interdisciplinary field, with a two-way dialogue between an “ethics of neuroscience” and a “neuroscience of ethics.” This seems wise. It would be difficult to keep apart what was almost predetermined to meet and combine. Neuroethics would immediately try to shed its neuroscientific light on neuroethics. And neuroethics would be just as quick to develop ethical views on neuroethics. The wisest option appears to be dialogue, accepting a meeting that appears inevitable.

An interesting article in Bioethics, authored by Eric Racine together with, among others, Michele Farisco at CRB, occasions my thoughts in this post. The subject matter of the article is neuroethics: the neuroscience of ethics. Neuroethics is associated with rather grandiose claims. It has been claimed that neuroscience can support a better theory of ethics. That it can provide the basis for a universal ethical theory that transcends political and cultural divides. That it can develop a brain-based ethics. That it can reveal the mechanisms underlying moral judgments. Perhaps neuroscience will soon solve moral dilemmas and transform ethics!

These pretentions have stimulated careless over-interpretation of neuroscientific experiments. They have also provoked rash dismissal of neuroethics and its relevance to ethics. The purpose of the article is to support a more moderate and deliberate approach, through a number of methodological guideposts for the neuroscience of ethics. These include conceptual and normative transparency, scientific validity, interdisciplinary methods, and balanced interpretation of results.

In view of this critical perspective on hyped neuroscientific claims, one could define the article as a neuroethical article on neuroethics. Following the linguistic pattern that I described above, the article is an example of neuroethics-ethics. No, this will not do! We cannot use these two expansive words to specify in neurotic detail who currently happens to advance into whose field.

I choose to describe the article, simply, as a neuroethical paper on neuroethics. I want to see it as an example of the dialogue that can unite neuroethics as an interdisciplinary field.

Pär Segerdahl

Racine, E., Dubljevic´, V., Jox, R. J., Baertschi, B., Christensen, J. F., Farisco, M., Jotterand, F., Kahane, G., Müller, S. (2017). “Can neuroscience contribute to practical ethics? A critical review and discussion of the methodological and translational challenges of the neuroscience of ethics.” Bioethics 31: 328-337.

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We transgress disciplinary borders - the Ethics Blog

Research is not a magical practice

Pär SegerdahlWhy does hearing about research sometimes scare us in a vertiginous way? I mean the feeling that researchers sometimes dig too deeply, that they see through what should not be seen through, that they manipulate the fundamental conditions of life.

It does not have to concern GMOs or embryonic stem cell research. During a period, I wrote about studies of human conversation. When I told people that I was working on conversation analysis, I could get the reaction: “Oh no, now I dare not talk to you, because you’ll probably see through everything I say and judge how well I’m actually talking.”

Why do we react in such a way? As if researchers saw through the surface of life, as through a thin veil, and gained power over life by mastering its hidden mechanisms.

My impression is that we, in these reactions, interpret research as a form of magic. Magic is a cross-border activity. The magician is in contact with “the other side”: with the powers that control life. By communicating with these hidden powers, the magician can achieve power over life. That is at least often the attitude in magical practices.

Is this how we view research when it scares us in a dizzying way? We think in terms of a boundary between life and its hidden conditions; a boundary that researchers transgress to gain power over life. Research then appears transgressive in a vertiginous way. We interpret it as a magical practice, as a digging into the most basic conditions of life.

The farmer who wants to control the water level in the field by digging ditches, however, is not a magician who communicates with hidden forces. Digging ditches gives you ordinary power in life: it gives control of the water level. I would like to say that research is more like digging ditches to control the water level than like engaging in magic to control life itself. Certainly, research gives power and control – but in life, not over “life itself.”

This does not mean that research does not need to be regulated; digging ditches probably needs regulation too.

The magical aura of charismatic researchers sometimes seduces us. We think they are close to the solution of “the riddle” and give them a free hand… We must be careful not to give research work a magical interpretation.

Pär Segerdahl

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Fear of the unknown produces ghosts

Pär SegerdahlWhat really can start feverish thought activity is facing an unclear threat. We do not really see what it is, so we fill the contours ourselves. At the seminar this week, we discussed what I think was such a case. A woman decided to test if she possibly had calcium deficiency. To her surprise, the doctor informed her that she suffered from a disease, osteoporosis, characterized by increased risk of bone fractures.

She already had experienced the problem. A hug could hurt her ribs and she had broken a shoulder when pushing the car. However, she felt no fear until she was informed that she suffered from a disease that meant increased risk of bone fracture.

I do not mean she had no reason to be worried. However, her worries seem to have become nightmarish.

Presumably, she already understood that she had to be careful in some situations. However, she interpreted the “risk factor” that she was informed about as an invisible threat. It is like a ghost, she says. She began to compare her body with a house where the foundation dissolves; a house which might therefore collapse. She began to experience great danger in every activity.

Many who are diagnosed with osteoporosis do not get fractures. If you get fractures, they do not have to be serious. However, the risk of fractures is greater in this group and if you get a hip fracture, that is a big problem. The woman in the example, however, imagined her “risk factor” as a ghost that constantly haunted her.

I now wonder: Are ethical debates sometimes are about similar ghost images? Most of us do not really know what embryo research is, for example, it seems vaguely uncanny. When we hear about it, we fill the contours: the embryo is a small human. Immediately, the research appears nightmarish and absolute limits must be drawn. Otherwise, we end up on a slippery slope where human life might degenerate, as the woman imagined her body might collapse.

I also wonder: If debates sometimes are about feverishly produced ghost images, how should we handle these ghosts? With information? But it was information that produced the ghosts. With persistent logical counter arguments? But the ghosts are in the feverish reasoning. Should we really continue to fill the contours of these images, as if we corrected bad sketches? Is it not taking ghosts too seriously? Is it not like trying to wake up yourself in a dream?

Everything started with the unclear threat. The rest were dreamlike consequences. We probably need to reflect more cautiously on the original situation where we experienced the first vague threat. Why did we react as did? We need to treat the problem in its more moderate beginning, before it developed its nightmarish dimensions.

This is not to say that we have no reason to be concerned.

Pär Segerdahl

Reventlow, S., Hvas, A. C., Tulinius, C. 2001. “In really great danger.” The concept of risk in general practice. Scandinavian Journal of Primary Health Care 19: 71-75

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Trusting yourself

Pär SegerdahlTrusting yourself, what does it mean? It can of course mean thinking that you always know best, trusting your strength to prevail over whoever and whatever you may meet in life.

There is another form of trust in yourself, where you trust your uncertainty rather than your certainty. You respond to your uncertainty not by accusing yourself, but by taking a deep breath and saying: this is difficult. I would not be so uncertain if it was not for the fact that I have come across something that truly requires caution, reflection, and long-term investigation.

It sounds humble when Socrates says that the only thing he knows is that he knows nothing. Or when it is said that wisdom lies in the recognition that one is not wise. In a sense, it is humble. However, this form of humility also exhibits self-reliance. One is uncertain not because one is unusually stupid but because some things are unusually difficult. Life sometimes surpasses the intellect.

People who trust their uncertainty express it as honest questions, instead of hiding it behind clever arguments and theses. When they express their uncertainty as questions, their work can begin. The uncertainty is then their only certainty. It shows them there is something worthy of investigation. It shows them the way, through sincere questions and rejections of premature solutions.

Sometimes weakness is a strength. Socrates relied on it. Researching persons do.

Pär Segerdahl

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The Ethics Blog - Thinking about thinking

Sliding down along the slippery slope

Pär SegerdahlDebates on euthanasia, abortion or embryonic stem cell research frequently invoke slippery slope arguments. Here is an example of such reasoning:

Legalizing physician-assisted suicide (PAS) at the end of life pushes healthcare morality in a dangerous direction. Soon, PAS may be practiced even on people who are not at the end of life and who do not request it. Even if this does not happen, the general population’s trust in healthcare will erode. Therefore, PAS must be forbidden.

Reasoning about the future is important. We need to assess consequences of allowing new practices. However, how do we assess the future in a credible way?

In an article in Medicine, Health Care and Philosophy, Gert Helgesson, Niels Lynøe and Niklas Juth argue that many slippery slope arguments are not empirically substantiated, but are based on value-impregnated factual assumptions. Anyone who considers PAS absolutely wrong considers it as a fatal step in a dangerous direction. Therefore, it is assumed that taking such a step will be followed by further steps in the same dangerous direction. If you chose the wrong path, you end up further and further away in the wrong direction. It seems inevitable that a first step is followed by a second step…

The problem is that this prophesying is based on the original moral interpretation. Anyone who is not convinced of the fatality of a “first” step does not have a tendency to see it as a “first step” with an inherent tendency to lead to a “second step” and finally to disaster.

Thinking in terms of the slippery slope can sometimes be experienced as if you yourself were on the slippery slope. Your thoughts slide toward the daunting precipice. Perhaps the article by Helgesson, Lynøe and Juth contains an analysis of this phenomenon. The slippery slope has become a vicious circle where the prophesying of disastrous consequences is steered by the moral interpretation that one defends with reference to the slippery slope.

Slippery slope arguments are not wrong in themselves. Sometimes development is on a slippery slope. However, this form of reasoning requires caution, for sometimes it is our thoughts that slide down along the slippery slope.

And that can have consequences.

Pär Segerdahl

Helgesson, G., Lynøe, N., Juth, N. 2017. Value-impregnated factual Claims and slippery slope arguments. Medicine, Health Care and Philosophy 20: 147-150.

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Approaching future issues - the Ethics Blog

Stem cells: unique biobank material?

Pär SegerdahlStem cells are perhaps not what first springs to mind as biobank material. Yet, even stem cells can be biobank material and there are biobanks that focus on stem cells. The use of this biobank material, however, has some unique features.

Stem cell researchers process not only data from human material. The material itself is “processed” and sometimes transplanted to research participants. Commercializing stem cell research moreover implies that cells derived from donated human tissue appear in products on a market. This gives rise to ethical and legal questions.

Does the law allow patenting cell lines derived from human donated material? Is buying and selling such material lawful? Another issue concerns research participants’ right to withdraw their consent at any time. Human embryonic stem cell research uses stem cells from donated spare embryos from IVF treatment. How far does embryo donors’ right to withdraw consent stretch? Must transplanted devices with matured cells be removed from research participants, if the embryo donor withdraws consent? Moreover, assuming that researchers share stem cell lines with companies, are these companies willing to invest in the development of stem cell products if embryo donors may withdraw their consent at any time?

Another difficulty is the purpose to which embryo donors are asked to consent. According to the law, human embryos can be donated only for research purposes (or to other IVF patients). Yet, medical research loses its meaning if results cannot be commercialized. It cannot then reach patients. It is important to inform donors about this broader context of embryo donation. Does that information imply that the consent becomes broader than has support in the law? Or is there support since embryos are not used in product development, only derived material?

The answers to these questions probably depend on whether one can distinguish between donated embryos and cell material derived from embryos (using various inventions). This raises also more philosophical questions about how to view embryos, stem cell lines, matured cells, and human tissue.

Pär Segerdahl

An earlier version of this text was published in Biobank perspectives.

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Approaching future issues - the Ethics Blog

Not just facts, ideas are also needed

Pär SegerdahlWhen fraudulent “academic” journals publish articles without proper peer review. When websites online spread fake information. When politicians talk about alternative facts. Then undeniably, one feels a need for a general tightening up.

A possible problem in this reaction is that we castrate ourselves. That we don’t dare to propose and discuss ideas about the situation we are in. That we don’t dare to think, interpret and analyze. Because we fear being found guilty of error and of contributing to the scandalous inflation of facts and truths.

We hide ourselves in a gray armor of objectivity. In order not to resemble what we react to.

But why do these tendencies occur now? Is it about the internet? Is it about neglected groups of citizens? Is it about economic and political shifts in power?

In order to understand this complex situation and act wisely, we need not just facts but also good questions, thoughts, interpretations and analyses of the situation. If we take that task seriously, we also take relevant facts seriously when we discuss the ideas.

If we react with hypercorrection, with an armor of correctness, we risk repressing our questions about how we should think about our situation. We repress our uncertainty: the motive for thinking, interpreting and analyzing.

Pär Segerdahl

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We care about communication - the Ethics Blog

How should we think about it?

Pär SegerdahlMuch debated issues tend to be about how we should view important matters that are also multi-faceted. The school system is important. But there are many ways of thinking about the importance of education; many ways of reasoning about how it should be designed to carry out the important tasks that we think it has.

So how should we think about it?

The question is reflexive. It is about the matter, but also about how the matter should be described. How should we reflect important things in our ways of reasoning about them? It is in this reflexive dimension that we are debating school, health care, freedom of speech, or the ethics of stem cell research. It is a difficult to navigate dimension. We easily go astray in it, but we can also try to find our way in it and become wiser.

Philosophers have felt particularly responsible for this reflexive dimension. They have been thinking about how we think about things, if I may put it that way. They have been thinking about thinking. I do it now, by trying to understand debated issues in terms of a difficult to navigate reflexive dimension. I do not know how successful my attempt is. The risk is that what I call a reflexive dimension appears like a separate realm of pure ideas about things (absolute principles for how we should think).

I do not want to reinvent Platonism. I just want to point out that when we debate something, we reason not only about the matter, but also about how we reason about it. We work on ourselves. Debates that lack such self-awareness tend to be dogmatic and less fruitful.

A name for work on self-awareness could be self-criticism, or thinking. I believe it makes a difference if conversations in a society are marked by the attitude that “the matter” also includes ourselves. Responsibility has its origin in that attitude.

Pär Segerdahl

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The Ethics Blog - Thinking about thinking

The pharmaceutical industry and altruism

Pär SegerdahlI am currently thinking about a common gut reaction to the pharmaceutical industry. I sometimes have this reaction too, so this is an examination of my own reaction.

The reaction is a feeling of discomfort, when a central actor in the management of something as important as human health and disease is a multibillion-dollar industry with profit as overall goal.

Is it really possible to combine such a businesslike aim with a genuine desire to cure the sick?

Let us compare with another industry that radiates more compassionate desire to cure, namely, alternative medicine. Here too products are sold to people with various ailments. There is clearly a market and a business mindset. Yet the actors on this market radiate more love of mankind. It can sometimes even appear as if the products were manufactured and sold out of pure goodness!

What makes these business practices seem imbued with good will to cure? I suggest that it depends on the strong belief in the healing effects of the products. I do not deny that many of the products have beneficial effects. My point is only that beliefs about good effects are at the forefront and can make the provision of the products appear like an ethical act of noble actors.

The pharmaceutical industry is different from alternative medicine partly through being prohibited from being permeated with beliefs about the healing effects of the products. It is actually illegal for the pharmaceutical industry to act as nobly and compassionately as the actors within alternative medicine. It could invite quackery.

The pharmaceutical industry operates on a highly regulated market. There is specific legislation for pharmaceutical products and special authorities supervising the industry. Satisfying the quality and safety demands often requires decades of research and development. This means huge investment costs, which presupposes profits.

This is how we have solved the problem of providing safe and effective treatments through the health care system. By having a pharmaceutical industry that is not permeated with good faith and good intentions, but instead is highly regulated and supervised. The products must satisfy the quality requirements, period. Beliefs and good intentions are irrelevant.

Research, industry and healthcare together constitute a regulated system for managing health and disease. Within this system, researchers can be driven by curiosity, and industry by profit, while doctors want to cure their patients, and research participants want to support research that could lead to more effective treatments.

The point I am trying to make is that the gut reaction probably overlooks just this division of motives: In order for a whole system to work for the good, not every actor in the system needs to place good intentions first. It can rather pose a risk for the entire system.

There is no reason to glorify the pharmaceutical industry. Rather there are reasons to question it, for example, the marketing of products, which sometimes tries to create the faith that is prohibited in the development and approval of the products.

The industry is not altruistic. It is driven by profit. But through its place within the system it can make altruism and good will possible.

Pär Segerdahl

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Ethics and law of stem cell treatment of diabetes

Pär SegerdahlMany people support in various ways medical research, which they perceive as urgent in view of the needs of various patient groups. But patients typically won’t benefit from research unless the results are translated into development of medical products.

Type 1 diabetes is an incurable disease that requires daily life-sustaining treatment and strict dietary rules. Disease onset usually occurs at an early age.

In Sweden, about 50 000 people have this form of diabetes and of these around 8 000 are children. In type 1 diabetes, the immune system attacks the insulin-producing cells. Without insulin the body cells cannot use glucose for energy, and the sugar level in the blood rises. Energy is recovered instead from fat and protein, which causes waste products that can cause diabetic coma and attacks on vital organs.

Today, diabetes is treated with daily insulin injections, or by using an insulin pump. This requires continuous measurement of blood sugar levels, as incorrect doses of insulin entails risks and can be life-threatening. It is not easy to live with diabetes.

An alternative treatment, which is still at the research stage, is to generate new insulin-producing cells using human embryonic stem cells. The insulin-producing cells detect blood sugar levels and regulate the secretion of insulin. In order not to be attacked by the immune system, the transplanted cells are encapsulated in a protective material. It may become easier to live with diabetes.

But research alone doesn’t treat diabetes. Encapsulated insulin-producing cells need to be produced and made available also to patients; not only to research participants. But this is a big step and a host of ethical and legal issues, including embryo donation, patentability and consent, need to be examined and discussed.

The Swedish Research Council recently granted funding for a project to examine these issues. The project is led by Mats G. Hansson at CRB and is a collaboration with Olle Korsgren, professor of transplantation immunology, as well as with lawyers Anna-Sara Lind and Bengt Domeij, and philosophers and ethicists Jessica Nihlén Fahlquist and Pär Segerdahl.

The step from stem cell research to available treatments requires reflection. I look forward to start thinking about the ethical and philosophical questions.

Pär Segerdahl

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Approaching future issues - the Ethics Blog

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