THURSDAY, April 1, 2004

Session 4: Neuroscience, Brain, and Behavior III: Council Discussion

 

CHAIRMAN KASS:  Could we get started, Dean?  This last session, it will be abbreviated, and it will have to be followed up by some staff work with your advice to take us to the next stage.  This last session, abbreviated because we've been behind for most of the day, is supposed to be devoted to council discussion in which we are to take stock of what we might have learned today, about what new kinds of knowledge and inquiry we would like ourselves to pursue and how to formulate any implicit ethical or social issues that are here, and also to raise for ourselves other kinds of topics in this large area, not only deserving of our attention, but in a way ripe for our attention. 

I mean, there was some discussion at the very end of Dr. Jessell's presentation about how soon one might be able to move between these neuroscientific findings and our interests in behavior, and we got a rather, an answer which says not for awhile, and that means that somehow we're trying to move rapidly from that to some kind of issue worthy of our attention.  Important though those studies were, if one's looking for somehow the secret of preventing abnormal behavior or mental illness, we've got a little time to go.

This is a large and inchoate area.  We are attempting to find out whether this is a topic for us or not, even as we are learning some very interesting things.  I've asked Mike Gazzaniga if he wouldn't mind too, and if you want to wait, I'll sing a song, to offer something in this discussion. 

It was partly, indeed, on the basis of suggestions that you made last time, and Janet and Dan Foster, where the question was well, we really ought to learn something about what people know about normal brain development and early childhood development before we wander off into some more esoteric topics.  The suggestion was well, if you want to—there was a discussion whether we should read these things and treat them as background, or whether we ought to hear them in the flesh from people who are working in the field. 

Speaking specifically for myself, it was very, very good to have the live presentations of people who are in the forefront of these neuroscientific and psychological studies.

Mike, would you be prepared to say something about what have we learned today that's relevant to our own ongoing work, and can we begin to formulate certain kinds of questions for further investigation?   By the way, I'll set a limit on this discussion for today of 5:15, 5:20, so we're not going to go over.  This will be a start, and we will continue with staff prepared papers and the like.  We're not going to cheat on your free time.

DR. GAZZANIGA:  Well, don't worry about my taking the time.  As I reconstruct this in my mind, we were having a conversation last time about possible issues in neuroscience that might bubble up to the level of an ethical concern.  A conversation was starting on those various issues, and some of them are fascinating issues in neuroscience, and they moved all the way from looking at issues of consciousness to issues of determinism and all the like, down to issues of, perhaps, intervention in early education, and what was the nature of what we know about neurodevelopment that might make that rise to the level of ethical concern.

Now, oddly, even though I love all those topics, I'm not really pushing this because I don't know that, given the mandate of this council, that those issues are appropriate for the council in the sense that if we are supposed to be looking at biotech advancements that impact society at large, I think these issues of neuroscience are very active, very fascinating, very interesting, but I don't see any huge issue around the corner that is being provoked by our knowledge of neuroscience.  I may get a lot of pushback on that from my fellow neuroscientists, but that is sort of my take on things.

I think there are things to be discussed, but I don't think there's urgency to it in a sense like there has been with the cloning issue and all that is associated with it.

On this particular issue that we examined today, the point was to sort of bring everybody up to speed on how one thinks about how much comes with the baby, with the child, how much conceptual work is already done by the process that finds us all being humans.  Then in that context, if you understand that, what you might mean about a deeper learning experience, deeper educational experience.

So, here we had today a wonderful discussion on the richness of the concepts that the young child comes with, basically, and the limits on those and then how those are developed and how they're sometimes not met in this critical period and so forth and so on.  So, those are general interests, and unless we want to get into the social policy questions that were raised indirectly or directly by Dr. Spelke, I'm not sure where the ethical question is.  So, I really yield to how you want to think about this.

I don't know—I'm not pushing an agenda here.  I'm just trying to think out loud about where ethics meets the advancements in neuroscience in the context of this council.

CHAIRMAN KASS:  Let me make a small comment on that, and I'm sure others would like to get in on this as well.  I read from the mission as stated in the Executive Order.  "To undertake fundamental inquiry to the human and moral significance of developments in biomedical and behavioral science and technology, to explore specific ethical and policy questions related to these developments."

Ethical questions need not be conundra.  They need not be things that are highly changed, and policy questions need not only be those things about which we are divided.  There seems to be at least a certain human significance to the kinds of work that's being done here insofar as it bears upon early childhood education and the prospects for rearing well the next generation in a world in which we don't do that all that well.

I'm not proposing that that be our focus, but I don't think it would be outside the mandate of this body to think about, and this was the force really of Ben Carson's question and the way of Janet's questions.  How does this somehow translate into education.  Is it too early to offer certain kinds of suggestions there, or is there some kind of social significance of the things that these people are showing us, and should we find out more?

Again, I'm not pushing that either, but I wouldn't say that this is off the table and irrelevant to our mission, at least insofar as the mission is described.

DR. GAZZANIGA:  Just to finish my little—there certainly are large social issues and implications to this.  I think it's a shift in what the council has been considering if we go there.  I just leave it for the council to advise and consent on that.

CHAIRMAN KASS:  Yes, I'm not proposing it as a shift.  I'm not proposing that shift, but I'm saying that it would fall under the larger umbrella that we have. 

Let's see, I had Rebecca and Jim Wilson, and Robbie and Alfonso, and Ben.

PROFESSOR DRESSER:  Well, I wanted to push my—first, one hopes that policy decisions rest on some ethical views or judgments.  So, if you're talking about policy implications, it seems to me underneath there would be policies putting into play some sort of views that about right and wrong or what's good and what's bad. 

You said that some of your colleagues would disagree with you that, you know, it's premature to start talking about applications, but I wondered, what would your colleagues who disagreed with you say are issues that are social issues with ethical implications?

DR. GAZZANIGA:  Well, I say that in the context that we have put out this book called "Beyond Therapy," which addressed a lot of the issues that are currently being discussed within the neuroscience community of enhancements, the memory issues, and all the rest that were reviewed in that book.  So, we're trying to get beyond those.  We've done those, and move forward.

So, if the "Beyond Therapy" effort had not been completed, then we could go through that whole list of things that we discussed for six months.

PROFESSOR DRESSER:  What about free will and criminal responsibility and education?  You can't think of anything?

DR. GAZZANIGA:  I mean, those are all issues.  I'm not sure that the neuroscience twist on it, though, is that tight at this point.  Those are issues that can come out more out of the sort of work that Liz Spelke talked about and then any deep understanding of the neurocircuits involved in learning.

CHAIRMAN KASS:  Jim?

PROFESSOR WILSON:  In order to sharpen the discussion, let me make two different kinds of proposals for what we might do next.  I'm sorry I was not here at our last meeting.  I was traveling on a trip that I much preferred to being with all of you people, much as I admire you.

I think that there are two issues which have policy significance which have deeply involved medical and biological implications.  One we will talk about tomorrow, and that's the problem of aging.  We will hear from Rebecca and Gil and others about how you manage an increasingly aging population when people are trying to assert for themselves some degree of authority over how they shall end their lives or what kind of treatment will be provided.  I think this is a terribly important subject. 

Allied to it is a second subject that is also related to aging, and that is organ transplants.  Medical science has become extraordinarily skilled at transplanting organs.  We're getting older.  The demand for transplanted organs will get greater.

I do not believe personally, without having made a deep examination of this, that we necessarily have a very good system whereby we either collect or distribute organs.  The ethical questions that arise about how you collect them and how you distribute them and indeed what you do with them, it seems to me are very important.

Now, this is a lot different from talking about criminality and free will.  If you're going to talk about criminality and free will, about which I've written a great deal, tell me when you're going to do it because I don't plan to attend that session because I can assure you that there is nothing to say on this topic, having gone through countless seminars about it.

If you want to talk about something where there is a clear bioethical problem, these two aspects of aging strike me as being quite deserving.

CHAIRMAN KASS:  Robbie?

DR. GEORGE:  Well, if everybody's in the mood for another rumble, I can think of a good topic that we could generate a lot of divisiveness about, which is the topic that was suggested in the one area in which our guests made some suggestions towards social policy, and that is education.  Of course, we begin with a shared conviction.  I'm sure everybody believes that it's better for children to be placed in circumstances and given opportunities and resources to fulfill their abilities.  We all want that for our children and for everyone's children.

But it would be interesting to know what the best science had to say about the desirability of putting children between ages two and five in schools or daycare centers or having them in homes, having in mind what Janet said about the inability to completely generalize here and imagine that the answer is going to be the same for everybody.  There are special circumstances.

Even trying to decide that question, I'm sure, would be very controversial, and we would probably divide over it, but gee, I'd like to know the answer to it, and I'd like to know what's out there by way of research that would lead us to be able to at least form some tentative conclusions.

Having said that, let's just say for the sake of argument, and I'm not trying to prejudice the case.  Let's say for the sake of argument that all things considered in most cases, it's rational to conclude based on the science that we would look at that it's better for kids to be between ages two and five, to be at home with a parent, or someone who is functioning very much like a parent rather than being in a school or a daycare center or something like that.

Well, then of course there would be a profound division about how you create social circumstances or what social policies would facilitate that.  I've heard this argued at completely polar extremes.  Some people say that well, what that puts into place is the predicate for the establishment of a true form of socialism where through a heavy taxation system, we would put the government in a position to be able to provide resources that would enable people to keep kids at home who would otherwise have to be in the work force.

Then there are other people who say at the opposite extreme that what created the need for the two earner family was the Constitutional amendment that authorized the income tax and what we should do is abolish the income tax and solve the problem that way.

I can imagine us usefully discussing, although it would be extremely controversial, usefully discussing and having our staff look into and having us read studies about what's best for kids between ages two and five.  I can't imagine us usefully debating then the policy question, should we abolish the income tax, should we establish some form of socialism or something like that.

So, if when we went down this road, I think we could only go down so far, not toward any concrete policy conclusions about how to make it possible for people to have a parent at home, but only looking at the question whether all things considered, our society is heading in the right direction by having an awful lot of kids, perhaps most kids today between two and five, in some sort of daycare situation.

CHAIRMAN KASS:  Yes, thank you.  Let me make a procedural suggestion.  Jim Wilson has added non-neuroscience questions to our agenda.  One of them we will take up tomorrow, and he has put forth the business of organ transplantation.  Let's keep the rest of this discussion still on where we might be on this topic.  We are free to abandon it if it turns out that we cannot make it tractable or focused.  This does not preclude adding other topics, at least for provisional consideration as we go along.  Jim?

PROFESSOR WILSON:  Early childhood education, as you may know, currently involves a major study effort by the National Institutes of Health that involves several dozen scholars around the country.  They regularly produce reports.  The reports are filled with conflicting interpretations about what the data mean, and conflicting ethical arguments about what they ought to mean.

If we're going to look at this, I suggest it will take some deep staff work into what the National Institute has done in this area to see if there's anything left over.  I say this, urging us to bear in mind that in our second reincarnation, we have roughly seven meetings left.

CHAIRMAN KASS:  I have Alfonso, Ben, Peter, and Michael.

DR. GÓMEZ-LOBO: I'm going to contribute to the rambling I guess in a way, but I'm going to go back to the question of neuroscience, just to give you my personal thoughts. 

First of all, I've enjoyed these two meetings, the meeting today and the last meeting tremendously.  I mean, it's really fascinating to hear people who really know a lot about these things, and always initially divided in my mind in the following way.

On the one hand, it seems to me that any ethical concerns would have to do with actions, with what people do.  There I really don't see that there's much going on.  In other words, no one seems to be proposing sort of radical interventions into the brain so as to make people, you know, different or something like that.  I mean, Mike has shown that rather clearly.

So, that concern on my part has faded away.  I just don't see that there are ethical issues along those lines.

My second concern had to do more with questions in ethical theory.  Now, one of them was to what an extent progress in neurology was driving us away from ethics and from the replies we heard today from Professor Kagan, et cetera.  I'm reassured that there's a big gap there and that in no way are we giving up issues of freedom of the will or that.

Now, the last thing about which I was concerned, and it's connected to this, were issues connected with the presentation by Professor Jonathan Cohen last time.  I thought they were quite fascinating, and I tried to think about them, not necessarily because they were new.  I think that the emotional reaction to certain kinds of actions is known for a long time.

It became clear to me later on that his field is really a field very different from ethics, in fact, because even if a PET scan tells you what the reaction of certain agents are to certain kinds of actions, that, unfortunately, does not tell us anything about whether it's true that those actions are morally right or morally wrong.  That, in a way, put me to rest because it means that we are really in a world of multiple dimensions in which we have to think about certain domains in certain ways and about other domains in other ways.

So, in a way, I'm at peace, if I should say so, with everything that I've heard right now.  Now, that said, it seems to me that Jim is pointing in a very promising direction.  As far as I can see, aging and connected with that the questions of justice related to organ transplantation are really going to be pressing issues, and I think issues that will demand public policy and therefore will demand some kind of ethical advice.

CHAIRMAN KASS:  Ben?

DR. CARSON:  If, in fact, there is scientific evidence, as was suggested this morning, that the intrauterine environment can have a positive effect on the potential of a child, and if in fact it is true that a caring and nurturing environment can improve their subsequent intellectual performance, I guess an ethical question becomes do we as a society have a responsibility to at least disseminate this information in a wide fashion and try to facilitate both the pre-natal and post-natal environments for all of our citizens.

CHAIRMAN KASS:  Thank you.  Peter, Michael, and Gil, and then we will halt, just arbitrarily.

DR. LAWLER:  I would like to agree with Jim Wilson that our main focus probably should be on questions concerning an aging society, but I'm not a scientist, but I do think science is a very high human good, and I do want to become more rational.

With this in mind, I was really fascinated by the presentations today.  I agree with Alfonso.  I'm at peace with them.  I don't see any lurking danger to anything that we need to deal with immediately or anything like that.  It does seem like in many respects, neuroscience is in the early stages of development and so forth, but it does seem to me it's really important.

One breakthrough I noticed in the materials we read and what we heard is that basically behaviorism is dead.  Basically in a certain way, sociobiology is dead because we're now getting solid scientific evidence that many of our distinctively human qualities, like for example, language, have a natural foundation, that they're innate in some sense.

So, it might be, from a theoretical point of view, good to reflect on this, but I'm not quite sure what public policy implications would derive from this, and it might be as interesting and as futile as free will versus determinism finally.

Nonetheless, in my project to become more rational, if someone could conceive a way of studying this with public policy implications, I'd be all for it.

CHAIRMAN KASS:  Michael Sandel?

PROFESSOR SANDEL:  Well, Leon, after the lunch break, you addressed some rumbling doubts around the table about the practical and ethical public policy implications of the kinds of presentations we were hearing today, and I for one was greatly heartened and relieved when you tried to address those doubts by saying well, it would take us back to Lucretius, these issues.  We have an expansive executive order that would encompass Lucretius, and that's good enough for me.

CHAIRMAN KASS:  I said we were going to bracket the Lucretian question, and we were going to learn something about the science, but never mind.

DR. GEORGE:  But we also heard about studies described as classical studies from the 1970's.

PROFESSOR SANDEL:  So, Lucretius would please me, but thinking about what really will sustain a project for this council.  I think that in the neuroscience area, what worked, what was stimulating, what educated us, and Alfonso says he's at peace now, which worries me because I like Alfonso when he's agitated.  That's what makes things interesting.  So, I would oppose any topic that would leave Alfonso at peace.

I think that what agitated all of us and excited and intrigued all of us about the neuroscience topic were the two provocative presentations of Pinker and Cohen.  That's what got this group interested in neuroscience.  The thing about brain imaging and cognitive mapping and what were the implications for free will versus mechanism and what were the implications for responsibility and maybe ultimately for criminal responsibility.  So, people got all excited about that, and we were in a combat, some of us, with Pinker and Cohen.  That was interesting.  That was the part of neuroscience that seemed to be sort of rich with implications for ethics.

But as we delve into sort of the main lines of work and research in these sessions today, it turns out that that's more, if we're framing a project, it's not easy to frame a project around the topics that excited us and interested us with the Pinker and the Cohen.  The mundane state of the discipline doesn't really lend itself, I don't think, to a project that we can really usefully undertake.

So, my suggestion would be that we shouldn't take up the neuroscience thing after all.

CHAIRMAN KASS:  That we should not?

PROFESSOR SANDEL:  Should not, and instead maybe the aging and the elderly thing will have something useful.  I would go back to Jim's idea.  Organ transplants not necessarily by itself is a topic but is one way of getting at the broader question that we've toyed with taking up before, the issue of commodification of the body, organ transplants being one practical question that's looming on the horizon that would enable us to take up the commodification question.  Listening to the presentations today, I think we'd be better off with that than we would with the neuroscience.

CHAIRMAN KASS:  Mike, did you want a quick comment to this?

DR. GAZZANIGA:  Well, at the risk of being inconsistent.  So, let's take Jim's concern about aging, and let me raise a question that neuroscience has a lot to speak about, death of the person versus death of the brain.  Now, that will get you all going.

There are many, many current brain imaging studies that touch on what we know about the parts of the brain that are involved in self and parts of the brain that have to be active in various states of conscious experience and so forth and so on.   The model is that right now, Dr. Carson would know about this more than I do, that in cardiology, the current cardiologist is faced very commonly now with the ethical question, a patient comes in who has a pacemaker in them and it's working fine and it's sustained their life, and now other diseases have caught up with them, and they want the pacemaker turned off.  It's a tough decision. 

Some doctors won't turn it off, some will.  They want it reprogrammed.  They want to check out.  They've had enough.

It's easy to imagine down the pike that they're going to be—there's already deep brain stimulators that have this wonderful effect on some Parkinson's cases.  There could be similar critical implants in the brain that are life sustaining, and then the question is if other things catch up with the patient, some form of cancer, heart disease, and if it's the brain, does the medical community have the right to turn this off after they've turned it on, and how do you think through that moral issue.

So, one could get back into it real quickly.

PROFESSOR SANDEL:  Then that would be one subset under the general heading of end of life issues, which would be fine.  That wouldn't be neuroscience as a broad category as we've been thinking of it here.

CHAIRMAN KASS:  Gil, please?

PROFESSOR MEILAENDER:  My first and last view on this is also doubt whether I really see a way forward for us.  Having said that, I mean, I do think there is a project here.  I just don't know whether we're the people to do it, or we're up for it.

I think that what Professor Spelke gave us this afternoon was in some ways a bunch of empirical evidence in support of what, if I'm remembering correctly, Kant called something like the transcendental unity of apperception.  So, there are profound questions about the relation between behavior and biology that were raised here, and questions, Alfonso, that aren't so clear to me.

In other words, if there are structures that are really given, what does that—does that have any implications for morality or not?  I mean, there are very deep questions that could be raised there, and I think we could do something interesting, or someone could do something interesting on that.

It would not be the kind of project that had immediate public policy implications.  It would be more like Beyond Therapy in the sense that it would simply seek to educate the public about some very deep issues which are never going to go away, which are very old and are just raised in different contexts now but are still always worth thinking about.

So, I would have no objection in doing that.  I think it could be very useful and provocative in various ways.  Having said all that, I'm not sure I see a way forward for us to do it or whether we're the body that's up to it in a way.

So, I do want to go on record as saying I think there's a serious project actually here of deep philosophical import, but I'm not confident that it's wise for us to really try it.

CHAIRMAN KASS:  Good.  Let me make a procedural suggestion here.  Speaking simply for myself, I'm not ready to toss in the towel on this, partly because, as I said at the beginning of the day, the background here today, the purpose of the day was to give us some fundamental background and to see whether on the basis of this foundation we could then develop the kind of project that would suit this body, focused with some kind of practical implications, not without some theoretical or deep human significance, but not to have a simply philosophical project like "Beyond Therapy."  I would agree with Gil.  That's not for this group.

There were topics tossed out before about neural imaging, its promise, its perils.  However primitive it is, people are making use of it for all kinds of purposes, and we could do a service simply to call attention to how much is known and what the possible misuses or good uses of that would be.  That would be one thing.

There are other people who are talking about the re-emergence of deep brain stimulation and various other kinds of interventions in which the question is not whether you just turned the machine off, but what actually does this mean for questions of autonomy and control and the like.  We could begin to at least explore some of the sub-areas, both of a technical sort that does raise ethical and social questions.  It's not for today.

What this discussion shows me at least is that if this project is to go forward, I and the staff have to do some hard work with your advice, to put together a working paper to try to focus this somewhat before we bring anything back to you for the next meeting, and we'll take that as our assignment, mindful of the fact that there's at least some skepticism around the table as to whether there is a clear enough focus in this neuroscience area.

The importance of this stuff is, I think, clear.  There's no sense that there's anything ominous here about which we have to go ring the alarm bell, but this is science coming home to work on certain fundamental things of our humanity, and we would be foolish, I think, if we simply turned away our eye, especially when no one else has bothered to take it up, and neuroethics is a growing field, and the train shouldn't leave the station without our at least paying some attention as to whether there's something here ripe for our attention—weighty, ripe, and doable.

We have to go to an ethics class across the hall in the break room.  Someone is waiting for us there.  The formal session is adjourned until tomorrow morning, 8:30 we will convene.  I'm happy to say that our colleague, Bill May, will be with us.  He is the senior consultant on this aging project, and will be joining us at the table.

(Whereupon, the above-referenced matter was adjourned at 5:23 p.m., to reconvene the next day at 8:30 a.m.)