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2018 Annual Meeting
San Diego, CA, USA
November 1-2

Meeting Highlights

Themed 'Cutting Edge Neuroscience, Cutting Edge Neuroethics,' the 2018 Annual Meeting of the International Neuroethics Society gathered a diverse group of scholars, scientists, clinicians, and professionals dedicated to the responsible use of advances in brain science. Attendees came together for an intellectually stimulating and dynamic conference that explored technologies challenging and advancing our understanding of the brain.

Photo collection – Courtesy of Gillian Hue, Emory University / AJOB Neuroscience

photo array

Recognitions / News

Student/Postdoc Essay Contest Winners

Plenary Speakers

Tom Insel

Mindstrong Health

Emily Postan

University of Edinburgh

Keith Humphreys

Stanford University

Public Program

My Brain Made Me Buy It? The Neuroethics of Advertising

In partnership with the Center for Ethics in Science and Technology

Panels / Discussions

Digitally Decoding Brain & Behavior

In the past decade, the development of devices that collect information passively has given behavioral scientists a new window into human behavior. This opening lecture and panel will explore the potential unintended consequences with this exciting new opportunity.

DBS: Continuity of Self?

There is disagreement about whether deep brain stimulation (DBS) causes personality changes, and if so whether such changes generate any cause for concern. This panel will clarify concepts and uncover where there is genuine disagreement regarding facts and values.

Genetics, Behavior, and Society

Panelists will describe recent discoveries in sociogenomics, discuss their implications for policy and social action, and contextualize the field of sociogenomics within the broader history of genomics and society.

Brain Surrogates: Perceptions and Reality

Various models are now being developed with human brain tissue. This panel will discuss the types of models being developed, the difficult questions raised as advances continue, and the ethical tools needed.

Meeting Program

Summaries

Ethics and Compassion, Key Elements for Addressing Opioid Use Disorder 

Keith Humphreys began his Keynote Lecture by announcing his envy for people who work on diseases like cholera. If you eliminate cholera, everyone is happy; nobody is left asking for “just a little bit” of cholera on the weekends. The problem with drugs—opioids in particular—is that they are neither simple nor wholly good or bad; we cannot just eliminate them. He contrasts a patient describing the suffering of withdrawal with his own hospice patient describing his fear of the pain of dying, not death itself, a pain that could be relieved by opioids. This dichotomy of patient experiences underlies one of the fundamental contradictions of opioid medications: for one person they may bring despair and misery, while for another person they provide comfort and dignity. This nuance means that no matter what policies are implemented, not everyone will be satisfied. 

He speaks about 3 initial policy changes that would help those with Opioid Use Disorder (OUD) without hurting those who need opioid prescriptions:

  • Removing the “bad apples”—the very few bad doctors who behave badly
  • Normalizing prescription recycling programs
  • Expanding access to naloxone

Many policies aimed to prevent anyone else from developing an OUD may initially cause increased harm to people who already have OUD. Reformulated opioid medications were developed to prevent misuse; however, for the first 5 years after their implementation there is an overall increase in overdose deaths as many people with OUD shift from prescription opioids to heroin. Although the reformulation initially harms those who already have OUD, it may be necessary to prevent more people developing OUD and we need to focus on prevention.

So how can we help people who already have OUD? There are now long-term implantable opiate agonist medications. These implants remove the need to make a daily decision about whether or not to use drugs and address the fluctuating motivation that is seen in addiction. There are complicated ethical issues associated with these longer-lasting treatments: can we make these decisions for our future selves? What should the physician do if a patient changes their mind and requests the physician remove the implant due to a desire to use heroin again?

Finally, Humphreys addresses the uncomfortable question: how should we feel about people with addiction? As scientists, we may subscribe to the disease model. Implicit in this description is the claim that people with OUD have a disease ergo cannot be blamed. No one finds this deeply compelling. The disease model is flawed in that it overlooks that fact that the person with OUD is not the only one who has no control over the situation; their family and friends also suffer. The disease model suggests that we should feel sorry for the person with the addiction, but it does not address the people they hurt. Humphreys argues that changing the narrative of how we discuss addiction and blame may help improve empathy and decrease stigma. He reminds us that we are all flawed and that perfection and blamelessness are not required to qualify for compassion. 

Summary by Tabitha Moses

Examining the Ethical Use of Brain Surrogates in Research 

At the 2018 INS Annual Meeting, an array of neuroscientists, physicians, philosophers, industry leaders, and lawyers , gathered to discuss the potential ethical implications of utilizing organoids as brain surrogates in the neuroscientific research contexts. The panel included Dr. Giorgia Quadrato, Dr. Nenad Sestan, Dr. Laurie Zoloth, and Dr. Khara Ramos, moderated by Dr. Nita Farahany.

Dr. Farahany set the tone of the discussion by expanding the ethical discussion to include a number of human brain surrogates—including human brain organoids, ex vivo brain tissue, and chimeras—to help neuroscientist better understand the human brain in certain pathological states. While each model may seem distinct, what these brain organoid models entail philosophically is still shrouded in what is myth versus fact. To address these possible confusions, this panel brought together scholars from the neuroscientific, governmental, and philosophical communities to sort out these differences and define their implications.

Dr. Quadrato started the presentations off by diving into the scientific understanding of human brain organoids as they resemble human brains in both aspects of both functionality and structure. Structurally human brain organoids can develop into specific brain regions with varying tissue cell types. She described that there are currently several kinds human organoids that are created through the differentiation of pluripotent stem cells. These organoids can then be induced into certain pathological states to obtain a pragmatic model for research. For example, as the human brain organoids develop, their synaptic connections between neurons will develop at random similar to the pathology of human developmental diseases. This is also unique, because it shows a limitation in human brain organoids being unable to be produced as each will produce different connection, unlike the orderly arrangement of human neural tissue. In practice these organoids have been useful in culture for up to nine months and overtime develop cells responsible for cognitive and sensory function. She highlighted how currently, human brain organoids have developed photoreceptors that after being stimulated by light, will have an increased neural response. However, she parsed, while these cells are “responding” to light they are do not yet have the neural anatomy required to then interpret this sensory information. However, this will be a concern as human brain organoids develop for having this ability will result in differing moral status. Until then, she finished by stating that the current risks seem to outweigh the benefits since these models are important for the future development of treatments for neurodevelopmental diseases due to their genetic components that animal model do not have the ability to resemble. 

Dr. Sestan expanded on the science by explaining other methods utilized to understand human brain tissue. He explained that the use of organoids as well as other ex vivo tissue where neural cell cultures and slices of fetal and human brains are used to understand pathology. He gave his own experience with the practical use of these various ex vivo techniques when trying to understand the development and causes of microencephaly within fetal brains affected by the Zika virus. He stressed that it is because of the analogous architecture of human brain organoids that within months they were able to understand the mechanism of action of this virus. Interestingly, this architecture not only saved time, but it allowed medications to be tested. They found during testing medications that one pharmacological treatment accelerated the zika pathology without having to involve any patients in this process. Similarly, using these models, he and his colleagues were able to better understand the mechanisms associated with the viability with ischemic cell death over a course of four minutes to hours. They demonstrated the use of genetic expression in these cells and stressed the neuroethical concern of better understanding cell death with ischemic tissue that could help shed light of ethical debates around traumatic brain cases. He, like Dr. Quadrato, emphasized the importance these models, and the lack of empirical harms they have been finding with their use.

Dr. Zoloth took the direction of the conversation back into the philosophical domain by presenting on the historically debate around the moral status of this tissue through trying to understand what the tissue represents and what normative values are used to judge them. She cited historical debates around children needing the face of a human in order to obtain the moral status associated with one. She then transitioned to Aristotle and his quest to understand how parts relate to the whole—that is, how a hand relates and is part of the whole human but yet not the human itself. This study of mereology strives to understand how parts relate to a whole being and vise versa. In understanding this relationship in different ways, Dr. Zoloth stressed, the brain can be seen to have different moral statuses. As it is in Buddhism, the brain is just one part of a whole, while in understandings of the human brain as the center of rationality, it now becomes the part that is the whole. This allowed her to then move into the moral status concerns of human brain organoids as parts. She articulated that depending on which parts of the whole we prioritize at the beginning and end of beinghood we will have different entities obtaining moral status. Thus, if we are a brain-centric society where our brains hold the majority of our personhood, how can we begin to treat this tissue ethically? This extends to now, as these tissues are in their basic stages and in the future as they develop to have similar capacities as our current brains. However, in then answering these questions, we run into limitations like the challenges in using deep brain stimulation: how do you measure the intangible notions of identity and personality. She pointed to the challenges in confirming a first-person experience in these tissues and accounting for changes in the neuroanatomy at this small of a level using our understanding of a larger human brain model. She ended in the middle ground of skepticism with these tissues, concluding that until the capacities of these tissues can be confirmed or expanded, there might be duties and responsibilities with having these tissues such as anesthetizing them until proven that they such care is not needed.

Finally, Dr. Ramos provided insight into how the National Institutes of Health are overseeing neuroscientific research. It has recently invested $7 million in governmental funds into neuroscientific research. This funding hopes to contribute to the alleviation of suffering from neurological diseases in the world through the development of fundamental knowledge about the nervous system. Included in this mission are also workshops to encourage interdisciplinary discussion between neuroscientists and neuroethicists and funding for neuroethicists specifically. Neuroethics therefore is fundamental part of the BRAIN initiative to help with the development of neuroscientific policies. The Neuroethics Division has recently contributed to the initiative by developing ethical principles that will be published soon in the Journal of Neuroscience. She focused on two principle of these guidelines in her presentation. They were the need to incorporate the public’s concerns about the brain and, secondly, moving novel neuro-innovations into the medical and public sphere with caution. The former this will strive to better understand which aspects of the mind the public is are concerned about as human brain organoids develop, such as memory, self-awareness, or sensation. For there is something about the brain that we identify with and want to protect more than other organs of the body. Allowing the public to engage could result in more transparent and trusted implementation of these tissues. The latter principle will allow growth as each new technology will likely result in different and new ethical principles in which to accommodate for. One example is as deep brain stimulation devices become more autonomous in our brains with the use of artificial intelligence, there may be different ethical considerations that need to be addressed. Dr. Ramos used the example of how human brain organoids also have none uniform ethical oversight around the country. She listed several concerns that the IRB may address daily, without uniform guidance, related to autonomy and stewardship of human brain organoids and ex vivo tissue in the research and clinical spectrums. They could benefit from a clear overarching guide through these ethical principles. She finished her discussion by highlighting the need to balance the risks and benefits that using these surrogates may present. While there may be several scientific benefits in the use of these tissues, there could be other risks and benefits from the societal and personal communities to weight and consider that could alter the further use and development of these surrogates. 

As the panel reached a conclusion, the discussion focused around not just what these tissues are now, but what they may become in the future. The overall sentiment is that there is relatively little concern about using brain surrogates in research today as they exhibit little similarity with our own brains and researchers are already using animals with comparatively complex nervous systems. The pressing concern seemed to be around what this technology could become and how these types of tissues represent our scientific ability to manipulate the human body. This may concern us since now that we have the power to ‘make’ brains, what is stopping these tissues from fulfilling the tales we thought were only science-fiction over the next twenty years? Similarly, it may be difficult, given the status brains have as bearers of identity, to take a piece of brains without feeling like we are taking a portion of ourselves. Regardless, the science and the ethics will need to develop side by side to gather the information necessary to understand the how best to utilize brain surrogates in future research.

Summary by Ian Stevens