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Goering S, Brown AI, Klein E. Brain Pioneers and Moral Entanglement: An Argument for Post-trial Responsibilities in Neural-Device Trials. Hastings Cent Rep 2024; 54:24-33. [PMID: 38390679 PMCID: PMC11060429 DOI: 10.1002/hast.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
We argue that in implanted neurotechnology research, participants and researchers experience what Henry Richardson has called "moral entanglement." Participants partially entrust researchers with access to their brains and thus to information that would otherwise be private, leading to created intimacies and special obligations of beneficence for researchers and research funding agencies. One of these obligations, we argue, is about continued access to beneficial technology once a trial ends. We make the case for moral entanglement in this context through exploration of participants' vulnerability, uncompensated risks and burdens, depth of relationship with the research team, and dependence on researchers in implanted neurotechnology trials.
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Klein E, Goering S. Can I Hold That Thought for You? Dementia and Shared Relational Agency. Hastings Cent Rep 2023; 53:17-29. [PMID: 37963132 PMCID: PMC10688267 DOI: 10.1002/hast.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Agency is talked about by many as something that people living with dementia lose, once they've lost much else-autonomy, identity, and privacy, among other things. While the language of loss may capture some of what transpires in dementia, it can obscure how people living with dementia and their loved ones share agency through sharing capacities for memory, language, and decision-making. We suggest that one consequence of adopting a framework of loss is that it makes the default response to changes in agency the substitution of a family member's agency for the purported lost agency of someone living with dementia. We argue for an alternative framework in which sharing agency is recognized as a central feature of living with dementia. Building on the work of relational theorists, we argue for the value of thinking about agency in dementia as fundamentally shared, and explore potential implications for treatment, caregiver support, and building dementia-friendly environments.
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Adsit-Morris C, Collins RN, Goering S, Karabin J, Lee SSJ, Reardon J. Unbounding ELSI: The Ongoing Work of Centering Equity and Justice. Am J Bioeth 2023; 23:103-105. [PMID: 37339305 PMCID: PMC11034805 DOI: 10.1080/15265161.2023.2214055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Goering S, Klein E. Why Taking Psychosocial Effects of Neurotechnology Seriously Matters. AJOB Neurosci 2023; 14:307-309. [PMID: 37682681 PMCID: PMC10503274 DOI: 10.1080/21507740.2023.2243886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
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Versalovic E, Klein E, Goering S, Ngo Q, Gliske K, Boulicault M, Sullivan LS, Thomas MJ, Widge AS. Deep Brain Stimulation for Substance Use Disorders? An Exploratory Qualitative Study of Perspectives of People Currently in Treatment. J Addict Med 2023; 17:e246-e254. [PMID: 37579102 PMCID: PMC10417220 DOI: 10.1097/adm.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Although previous studies have discussed the promise of deep brain stimulation (DBS) as a possible treatment for substance use disorders (SUDs) and collected researcher perspectives on possible ethical issues surrounding it, none have consulted people with SUDs themselves. We addressed this gap by interviewing people with SUDs. METHODS Participants viewed a short video introducing DBS, followed by a 1.5-hour semistructured interview on their experiences with SUDs and their perspective on DBS as a possible treatment option. Interviews were analyzed by multiple coders who iteratively identified salient themes. RESULTS We interviewed 20 people in 12-step-based, inpatient treatment programs (10 [50%] White/Caucasian, 7 Black/African American [35%], 2 Asian [10%], 1 Hispanic/Latino [5%], and 1 [5%] Alaska Native/American Indian; 9 women [45%], 11 men [55%]). Interviewees described a variety of barriers they currently faced through the course of their disease that mirrored barriers often associated with DBS (stigma, invasiveness, maintenance burdens, privacy risks) and thus made them more open to the possibility of DBS as a future treatment option. CONCLUSIONS Individuals with SUDs gave relatively less weight to surgical risks and clinical burdens associated with DBS than previous surveys of provider attitudes anticipated. These differences derived largely from their experiences living with an often-fatal disease and encountering limitations of current treatment options. These findings support the study of DBS as a treatment option for SUDs, with extensive input from people with SUDs and advocates.
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Boulicault M, Goering S, Klein E, Dougherty D, Widge AS. The Role of Family Members in Psychiatric Deep Brain Stimulation Trials: More Than Psychosocial Support. NEUROETHICS-NETH 2023; 16:14. [PMID: 37250273 PMCID: PMC10212803 DOI: 10.1007/s12152-023-09520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/08/2023] [Indexed: 05/31/2023]
Abstract
Family members can provide crucial support to individuals participating in clinical trials. In research on the "newest frontier" of Deep Brain Stimulation (DBS)-the use of DBS for psychiatric conditions-family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their family members as interview participants. Using dyadic thematic analysis-an approach that takes both the individuals and the relationship as units of analyses-this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s12152-023-09520-7.
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Affiliation(s)
- Marion Boulicault
- Department of Philosophy, University of Edinburgh, Edinburgh, UK
- Center for Neurotechnology, University of Washington, Seattle, WA USA
| | - Sara Goering
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Philosophy, University of Washington, Seattle, WA USA
| | - Eran Klein
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Neurology, Oregon Health & Science University School of Medicine, Portland, OR USA
| | - Darin Dougherty
- Neurotherapeutics Division, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alik S. Widge
- Medical Discovery Team on Addiction, University of Minnesota, Minneapolis, MN USA
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN USA
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Ligthart S, Ienca M, Meynen G, Molnar-Gabor F, Andorno R, Bublitz C, Catley P, Claydon L, Douglas T, Farahany N, Fins JJ, Goering S, Haselager P, Jotterand F, Lavazza A, McCay A, Wajnerman Paz A, Rainey S, Ryberg J, Kellmeyer P. Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'. Camb Q Healthc Ethics 2023:1-21. [PMID: 37183686 DOI: 10.1017/s0963180123000245] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.
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Affiliation(s)
- Sjors Ligthart
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Criminal Law, Tilburg University, Tilberg, The Netherlands
| | - Marcello Ienca
- School of Medicine, Technical University of Munich (TUM), Germany & College of Humanities, Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland
| | - Gerben Meynen
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Roberto Andorno
- Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | | | - Paul Catley
- School of Law, The Open University, Milton Keynes, UK
| | - Lisa Claydon
- School of Law, The Open University, Milton Keynes, UK
| | | | | | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Pim Haselager
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Fabrice Jotterand
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Allan McCay
- The University of Sydney Law School, Sydney, NSW, Australia
| | - Abel Wajnerman Paz
- Instituto de Éticas Aplicadas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephen Rainey
- Ethics and Philosophy of Technology Section, Delft University, Delft, The Netherlands
| | - Jesper Ryberg
- Department of Philosophy, Roskilde University, Roskilde, Denmark
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany
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Klein E, Montes Daza N, Dasgupta I, MacDuffie K, Schönau A, Flynn G, Song D, Goering S. Views of stakeholders at risk for dementia about deep brain stimulation for cognition. Brain Stimul 2023; 16:742-747. [PMID: 37076043 PMCID: PMC10576447 DOI: 10.1016/j.brs.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, United States; Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States.
| | - Natalia Montes Daza
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
| | - Ishan Dasgupta
- The Dana Foundation, 1270 Avenue of the Americas, 12th Floor, New York, NY, 10020, United States
| | - Kate MacDuffie
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 Ninth Ave. Seattle, WA, 98101, United States; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, PO Box 5371, Seattle, WA, 98105, United States
| | - Andreas Schönau
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
| | - Garrett Flynn
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Denney Research Center (DRB) 140, Los Angeles, CA, 90089-1111, United States
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Denney Research Center (DRB) 140, Los Angeles, CA, 90089-1111, United States
| | - Sara Goering
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
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Reardon J, Lee SSJ, Goering S, Fullerton SM, Cho MK, Panofsky A, Hammonds EM. Trustworthiness matters: Building equitable and ethical science. Cell 2023; 186:894-898. [PMID: 36724788 PMCID: PMC10580253 DOI: 10.1016/j.cell.2023.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
Trustworthy science requires research practices that center issues of ethics, equity, and inclusion. We announce the Leadership in the Equitable and Ethical Design (LEED) of Science, Technology, Mathematics, and Medicine (STEM) initiative to create best practices for integrating ethical expertise and fostering equitable collaboration.
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Affiliation(s)
- Jenny Reardon
- Department of Sociology, University of California, Santa Cruz, Santa Cruz, CA 95064, USA.
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY 10032, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA 98195, USA
| | - Stephanie M Fullerton
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, USA
| | - Aaron Panofsky
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Evelynn M Hammonds
- Department of the History of Science, Harvard University, Cambridge, MA 02138, USA; Department of Comparative Women's Studies, Spelman College, Atlanta, GA 30314, USA
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Goering S, Versalovic E, Brown T. Ambiguous Agency as a Frame on Neural Device User Experience. AJOB Neurosci 2023; 14:50-52. [PMID: 36524954 DOI: 10.1080/21507740.2022.2150716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Schönau A, Goering S, Versalovic E, Montes N, Brown T, Dasgupta I, Klein E. Asking questions that matter – Question prompt lists as tools for improving the consent process for neurotechnology clinical trials. Front Hum Neurosci 2022; 16:983226. [PMID: 35966997 PMCID: PMC9372354 DOI: 10.3389/fnhum.2022.983226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
Implantable neurotechnology devices such as Brain Computer Interfaces (BCIs) and Deep Brain Stimulators (DBS) are an increasing part of treating or exploring potential treatments for neurological and psychiatric disorders. While only a few devices are approved, many promising prospects for future devices are under investigation. The decision to participate in a clinical trial can be challenging, given a variety of risks to be taken into consideration. During the consent process, prospective participants might lack the language to consider those risks, feel unprepared, or simply not know what questions to ask. One tool to help empower participants to play a more active role during the consent process is a Question Prompt List (QPL). QPLs are communication tools that can prompt participants and patients to articulate potential concerns. They offer a structured list of disease, treatment, or research intervention-specific questions that research participants can use as support for question asking. While QPLs have been studied as tools for improving the consent process during cancer treatment, in this paper, we suggest they would be helpful in neurotechnology research, and offer an example of a QPL as a template for an informed consent tool in neurotechnology device trials.
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Affiliation(s)
- Andreas Schönau
- Department of Philosophy, University of Washington, Seattle, WA, United States
- *Correspondence: Andreas Schönau,
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Erika Versalovic
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Natalia Montes
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Tim Brown
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | | | - Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Goering S. Resisting Transhumanist Fantasies. Hastings Cent Rep 2022. [DOI: 10.1002/hast.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wexler A, Choi RJ, Ramayya AG, Sharma N, McShane BJ, Buch LY, Donley-Fletcher MP, Gold JI, Baltuch GH, Goering S, Klein E. Ethical Issues in Intraoperative Neuroscience Research: Assessing Subjects' Recall of Informed Consent and Motivations for Participation. AJOB Empir Bioeth 2022; 13:57-66. [PMID: 34227925 PMCID: PMC9188847 DOI: 10.1080/23294515.2021.1941415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BackgroundAn increasing number of studies utilize intracranial electrophysiology in human subjects to advance basic neuroscience knowledge. However, the use of neurosurgical patients as human research subjects raises important ethical considerations, particularly regarding informed consent and undue influence, as well as subjects' motivations for participation. Yet a thorough empirical examination of these issues in a participant population has been lacking. The present study therefore aimed to empirically investigate ethical concerns regarding informed consent and voluntariness in Parkinson's disease patients undergoing deep brain stimulator (DBS) placement who participated in an intraoperative neuroscience study.MethodsTwo semi-structured 30-minute interviews were conducted preoperatively and postoperatively via telephone. Interviews assessed participants' motivations for participation in the parent intraoperative study, recall of information presented during the informed consent process, and participants' postoperative reflections on the research study.ResultsTwenty-two participants (mean age = 60.9) completed preoperative interviews at a mean of 7.8 days following informed consent and a mean of 5.2 days prior to DBS surgery. Twenty participants completed postoperative interviews at a mean of 5 weeks following surgery. All participants cited altruism or advancing medical science as "very important" or "important" in their decision to participate in the study. Only 22.7% (n = 5) correctly recalled one of the two risks of the study. Correct recall of other aspects of the informed consent was poor (36.4% for study purpose; 50.0% for study protocol; 36.4% for study benefits). All correctly understood that the study would not confer a direct therapeutic benefit to them.ConclusionEven though research coordinators were properly trained and the informed consent was administered according to protocol, participants demonstrated poor retention of study information. While intraoperative studies that aim to advance neuroscience knowledge represent a unique opportunity to gain fundamental scientific knowledge, improved standards for the informed consent process can help facilitate their ethical implementation.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebekah J. Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwin G. Ramayya
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhil Sharma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J. McShane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Love Y. Buch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Joshua I. Gold
- Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H. Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sara Goering
- Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Philosophy, University of Washington, Seattle, Washington, USA
| | - Eran Klein
- Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Philosophy, University of Washington, Seattle, Washington, USA,Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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Abstract
The BRAIN 2.0 roadmap lauds the neuroscientific advances made in the first decade of the BRAIN Initiative, but also calls attention to the need to carefully consider how these advances will inform and perhaps alter our understanding of "those deepest behaviors that, as humans we hold dear" (Roadmap, Executive Summary). In this short statement, we briefly consider several features of the BRAIN Neuroethics subgroup's roadmap that lie within our area of expertise, including the recommendations to (1) enhance integration of neuroscience and neuroethics, and (2) provide additional tools and resources for neuroscientists to recognize neuroethics issues and opportunities for neuroethics research.
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Affiliation(s)
| | - Eran Klein
- University of Washington.,Oregon Health And Science University
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Abstract
Novel neurotechnologies, like deep brain stimulation and brain-computer interface, offer great hope for treating, curing, and preventing disease, but raise important questions about effects these devices may have on human identity, authenticity, and autonomy. After briefly assessing recent narrative work in these areas, we show that agency is a phenomenon key to all three goods and highlight the ways in which neural devices can help to draw attention to the relational nature of our agency. Drawing on insights from disability theory, we argue that neural devices provide a kind of agential assistance, similar to that provided by caregivers, family, and others. As such, users and devices participate in a kind of co-agency. We conclude by suggesting the need for developing relational agency-competencies-skills for reflecting on the influence of devices on agency, for adapting to novel circumstances ushered in by devices, and for incorporating the feedback of loved ones and others about device effects on agency.
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Affiliation(s)
- Sara Goering
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, Washington, USA
| | - Timothy Brown
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, Washington, USA
| | - Eran Klein
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, Washington, USA
- Department of Neurology, Oregon Health and Sciences University, Portland, Oregon, USA
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Abstract
Neural devices have the capacity to enable users to regain abilities lost due to disease or injury - for instance, a deep brain stimulator (DBS) that allows a person with Parkinson's disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies' capacity to maintain or restore their capabilities, the neuroethics literature is replete with examples of concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person's brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issue - responsibility, privacy, authenticity, or trust - selectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an "Agency Map" which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual's experience of agency.
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Affiliation(s)
| | | | | | | | - Eran Klein
- University of Washington
- Oregon Health and Science University
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Dasgupta I, Versalovic E, Schönau A, Klein E, Goering S. BCI Mediated Action and Responsibility: Questioning the Distinction Between Recreation and Necessity. AJOB Neurosci 2020; 11:63-65. [PMID: 32043933 DOI: 10.1080/21507740.2019.1704932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | - Eran Klein
- University of Washington.,Oregon Health Sciences University
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Hendriks S, Grady C, Chiong W, Fins JJ, Ford P, Goering S, Greely HT, Hutchison K, Kelly ML, Kim SY, Klein E, Lisanby SH, Mayberg H, Maslen H, Miller FG, Ramos KM, Rommelfanger K, Sheth SA, Wexler A. Ethical Challenges of Risk, Informed Consent, and Posttrial Responsibilities in Human Research With Neural Devices: A Review. JAMA Neurol 2019; 76:1506-1514. [PMID: 31621797 PMCID: PMC9395156 DOI: 10.1001/jamaneurol.2019.3523] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Developing more and better diagnostic and therapeutic tools for central nervous system disorders is an ethical imperative. Human research with neural devices is important to this effort and a critical focus of the National Institutes of Health Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative. Despite regulations and standard practices for conducting ethical research, researchers and others seek more guidance on how to ethically conduct neural device studies. This article draws on, reviews, specifies, and interprets existing ethical frameworks, literature, and subject matter expertise to address 3 specific ethical challenges in neural devices research: analysis of risk, informed consent, and posttrial responsibilities to research participants. Observations Research with humans proceeds after careful assessment of the risks and benefits. In assessing whether risks are justified by potential benefits in both invasive and noninvasive neural device research, the following categories of potential risks should be considered: those related to surgery, hardware, stimulation, research itself, privacy and security, and financial burdens. All 3 of the standard pillars of informed consent-disclosure, capacity, and voluntariness-raise challenges in neural device research. Among these challenges are the need to plan for appropriate disclosure of information about atypical and emerging risks of neural devices, a structured evaluation of capacity when that is in doubt, and preventing patients from feeling unduly pressured to participate. Researchers and funders should anticipate participants' posttrial needs linked to study participation and take reasonable steps to facilitate continued access to neural devices that benefit participants. Possible mechanisms for doing so are explored here. Depending on the study, researchers and funders may have further posttrial responsibilities. Conclusions and Relevance This ethical analysis and points to consider may assist researchers, institutional review boards, funders, and others engaged in human neural device research.
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Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Christine Grady
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Winston Chiong
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph J. Fins
- Division of Medical Ethics and CASBI, Weill Cornell Medical College, New York, NY, USA
| | - Paul Ford
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, USA
| | - Sara Goering
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | | | - Katrina Hutchison
- Department of Philosophy, Macquarie University, Sydney, NSW, Australia
- Australian Research Council (ARC) Centre of Excellence for Electromaterials Science, Australia
| | - Michael L. Kelly
- Department of Neurosurgery, Case Western Reserve University School of Medicine, MetroHeath Medical Center, Cleveland, OH, USA
| | - Scott Y.H. Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Eran Klein
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, WA, USA
- Department of Neurology, Oregon Health and Sciences, University Portland, Portland, OR, USA
| | - Sarah H. Lisanby
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Helen Mayberg
- Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hannah Maslen
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Franklin G. Miller
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| | - Khara M. Ramos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Sameer A. Sheth
- Cognitive Science and Neuromodulation Program, Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anna Wexler
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, USA
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MacDuffie KE, Goering S. Neurotechnologies Cannot Seize Thoughts: A Call for Caution in Nomenclature. AJOB Neurosci 2019; 10:23-25. [PMID: 31070564 PMCID: PMC7250465 DOI: 10.1080/21507740.2019.1595779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | - Sara Goering
- University of Washington
- Center for Neurotechnology
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Pham M, Goering S, Sample M, Huggins JE, Klein E. Asilomar survey: researcher perspectives on ethical principles and guidelines for BCI research. Brain-Computer Interfaces 2018. [DOI: 10.1080/2326263x.2018.1530010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michelle Pham
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Sara Goering
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Matthew Sample
- Department of Philosophy and Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Jane E. Huggins
- Department of Physical Medicine and Rehabilitation and Department of Biomedical Engineering and Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA
| | - Eran Klein
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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Yuste R, Goering S, Arcas BAY, Bi G, Carmena JM, Carter A, Fins JJ, Friesen P, Gallant J, Huggins JE, Illes J, Kellmeyer P, Klein E, Marblestone A, Mitchell C, Parens E, Pham M, Rubel A, Sadato N, Sullivan LS, Teicher M, Wasserman D, Wexler A, Whittaker M, Wolpaw J. Four ethical priorities for neurotechnologies and AI. Nature 2017; 551:159-163. [PMID: 29120438 PMCID: PMC8021272 DOI: 10.1038/551159a] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Artificial intelligence and brain-computer interfaces must respect and preserve people’s privacy, identity, agency and equality, say Rafael Yuste, Sara Goering and colleagues.
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Affiliation(s)
- Rafael Yuste
- Columbia University, New York City, New York, USA
| | | | | | - Guoqiang Bi
- University of Science and Technology of China, Hefei, China
| | | | | | | | | | | | | | - Judy Illes
- University of British Columbia, Vancouver, Canada
| | | | - Eran Klein
- University of Washington, Seattle; and Oregon Health & Science University, Portland, USA
| | - Adam Marblestone
- Kernel, Los Angeles, California; and Massachusetts Institute of Technology Media Lab, Cambridge, Massachusetts, USA
| | | | - Erik Parens
- The Hastings Center, Garrison, New York, USA
| | | | - Alan Rubel
- University of Wisconsin-Madison, Wisconsin, USA
| | - Norihiro Sadato
- the National Institute for Physiological Sciences, Okazaki, Aichi, Japan
| | | | | | | | - Anna Wexler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jonathan Wolpaw
- the National Center for Adaptive Neurotechnologies, Albany, New York
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Abstract
Because novel neurotechnologies may alter human identity and society in profound ways, we advocate for the early integration of ethics into neurotechnology. We recommend developing and adopting a set of guidelines, like the Belmont Report on human subject research, as a framework for development and use of brain-related technologies.
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Affiliation(s)
- Sara Goering
- Department of Philosophy, and Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Rafael Yuste
- Neurotechnology Center, Kavli Institute of Brain Science, Department of Biological Sciences and Neuroscience, Columbia University, New York, NY 10027, USA.
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Brown T, Thompson MC, Herron J, Ko A, Chizeck H, Goering S. Controlling our brains – a case study on the implications of brain-computer interface-triggered deep brain stimulation for essential tremor. Brain-Computer Interfaces 2016. [DOI: 10.1080/2326263x.2016.1207494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Timothy Brown
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Margaret C. Thompson
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Jeffrey Herron
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Howard Chizeck
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
- Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, USA
- Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA
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Klein E, Goering S, Gagne J, Shea CV, Franklin R, Zorowitz S, Dougherty DD, Widge AS. Brain-computer interface-based control of closed-loop brain stimulation: attitudes and ethical considerations. Brain-Computer Interfaces 2016. [DOI: 10.1080/2326263x.2016.1207497] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Eran Klein
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sara Goering
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Josh Gagne
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Conor V. Shea
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Franklin
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Samuel Zorowitz
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Darin D. Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alik S. Widge
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Boston, MA, USA
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Moritz CT, Ruther P, Goering S, Stett A, Ball T, Burgard W, Chudler EH, Rao RPN. New Perspectives on Neuroengineering and Neurotechnologies: NSF-DFG Workshop Report. IEEE Trans Biomed Eng 2016; 63:1354-67. [PMID: 27008657 DOI: 10.1109/tbme.2016.2543662] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
GOAL To identify and overcome barriers to creating new neurotechnologies capable of restoring both motor and sensory function in individuals with neurological conditions. METHODS This report builds upon the outcomes of a joint workshop between the US National Science Foundation and the German Research Foundation on New Perspectives in Neuroengineering and Neurotechnology convened in Arlington, VA, USA, November 13-14, 2014. RESULTS The participants identified key technological challenges for recording and manipulating neural activity, decoding, and interpreting brain data in the presence of plasticity, and early considerations of ethical and social issues pertinent to the adoption of neurotechnologies. CONCLUSIONS The envisaged progress in neuroengineering requires tightly integrated hardware and signal processing efforts, advances in understanding of physiological adaptations to closed-loop interactions with neural devices, and an open dialog with stakeholders and potential end-users of neurotechnology. SIGNIFICANCE The development of new neurotechnologies (e.g., bidirectional brain-computer interfaces) could significantly improve the quality of life of people living with the effects of brain or spinal cord injury, or other neurodegenerative diseases. Focused efforts aimed at overcoming the remaining barriers at the electrode tissue interface, developing implantable hardware with on-board computation, and refining stimulation methods to precisely activate neural tissue will advance both our understanding of brain function and our ability to treat currently intractable disorders of the nervous system.
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Klein E, Brown T, Sample M, Truitt AR, Goering S. Engineering the Brain: Ethical Issues and the Introduction of Neural Devices. Hastings Cent Rep 2015; 45:26-35. [DOI: 10.1002/hast.515] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kelley M, Edwards K, Starks H, Fullerton SM, James R, Goering S, Holland S, Disis ML, Burke W. Values in translation: how asking the right questions can move translational science toward greater health impact. Clin Transl Sci 2012; 5:445-51. [PMID: 23253665 PMCID: PMC3561695 DOI: 10.1111/j.1752-8062.2012.00441.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The speed and effectiveness of current approaches to research translation are widely viewed as disappointing given small gains in real population health outcomes despite huge investments in basic and translational science. We identify critical value questions-ethical, social, economic, and cultural-that arise at moments throughout the research pathway. By making these questions visible, and promoting discussion of them with diverse stakeholders, we can facilitate handoffs along the translational pathway and increase uptake of effective interventions. Who is involved with those discussions will determine which research projects, populations, and methods get prioritized. We argue that some upfront investment in community and interdisciplinary engagement, shaped by familiar questions in ethics, social justice, and cultural knowledge, can save time and resources in the long run because interventions and strategies will be aimed in the right direction, that is, toward health improvements for all.
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Affiliation(s)
- Maureen Kelley
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Washington, USA.
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Wilfond BS, Miller PS, Korfiatis C, Diekema DS, Dudzinski DM, Goering S. Navigating growth attenuation in children with profound disabilities. Children's interests, family decision-making, and community concerns. Hastings Cent Rep 2011; 40:27-40. [PMID: 21155109 DOI: 10.1002/j.1552-146x.2010.tb00075.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- Sara Goering
- University of Washington, Department of Philosophy, 345 Savery, Box 353350, Seattle, WA 98195, USA.
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Abstract
New parents suddenly come face to face with myriad issues that demand careful attention but appear in a context unlikely to provide opportunities for extended or clear-headed critical reflection, whether at home with a new baby or in the neonatal intensive care unit. As such, their capacity for autonomy may be compromised. Attending to new parental autonomy as an extension of reproductive autonomy, and as a complicated phenomenon in its own right rather than simply as a matter to be balanced against other autonomy rights, can help us to see how new parents might be aided in their quest for competency and good decision making. In this paper I show how a relational view of autonomy--attentive to the coercive effects of oppressive social norms and to the importance of developing autonomy competency, especially as related to self-trust--can improve our understanding of the situation of new parents and signal ways to cultivate and to better respect their autonomy.
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Affiliation(s)
- Sara Goering
- Department of Philosophy and Program on Values in Society, Box 3533501, University of Washington, Seattle, WA 98195, USA.
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Goering S. The ethics of making the body beautiful: what cosmetic genetics can learn from cosmetic surgery. Philos Public Policy Q 2004; 21:21-7. [PMID: 12705249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- S Goering
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840-2408, USA.
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40
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Abstract
The formal justice model proposed by Anita Silvers in Disability, Discrimination, and Difference emphasizes the social model of disability and the need for full equality of opportunity, and it suggests that a distributive model of justice that gives special benefits to individuals with disabilities is self-defeating. Yet in that work, Silvers allows an exception for the "profoundly impaired." In this paper, I show how the formal justice theory falls short when it comes to defining and dealing with "profoundly impaired" individuals and explore the ways in which making the exception raises serious theoretical concerns for the grounding of the formal justice model.
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Affiliation(s)
- Sara Goering
- Department of Philosophy, California State University, Long Beach, CA, USA
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Abstract
As a philosopher interested in biomedical ethics, I
find recent advances in genetic technologies both fascinating
and frightening. Future technologies for genetic therapies
and elimination of clearly deleterious genes offer us the
ability to get rid of the cause of much human suffering,
seemingly at its physiological root. But memories of past
eugenics programs gone horribly awry (whether we speak
of Hitler's program, California sterilization laws
and practices of the 1920s, or even contemporary practices,
such as attempts to work out deals that exchange sterilization
for early prison release) must make cautious our initial
optimism for these generally well-intentioned programs.
Most often the scientist proceeds in research with the
best of intentions, but that does not make all scientific
investigation worth pursuing.
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Affiliation(s)
- S Goering
- California State University at Long Beach, USA
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Goering S. Patient consumerism and health care reform: compromise without commodification. Health Care Anal 1996; 4:324-8. [PMID: 10164004 DOI: 10.1007/bf02249321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shannon IR, Dula A, Goering S. "It Just Ain't Fair": The Ethics of Health Care for African Americans. J Public Health Policy 1995. [DOI: 10.2307/3342626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Inter- and intrahemispheric processing for left- and right-handers were compared in two experiments. In one, subjects performed a digit-matching task and in the other they decided if two letters were part of a previously presented word. On some trials the matching items were presented initially only to one hemisphere (within-hemisphere trials), and hence the match decision could be reached by a hemisphere in isolation. On other trials, one item of the match pair was presented to each hemisphere (across-hemisphere trials), requiring interhemispheric interaction for the match decision. Patterns of performance on within-as compared to across-hemisphere trials were identical for the two handedness groups in both experiments. Furthermore, individual characteristics of subjects such as their hand posture, sex and family history of left-handedness did not affect the pattern of performance. These results suggest that interhemispheric processing may not differ between right- and left-handers.
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Affiliation(s)
- M T Banich
- Department of Psychology, University of Illinois, Champaign 61820
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