New in the Hastings Center Report

November 30, 2015

Engineering the Brain: Ethical Issues and the Introduction of Neural Devices Eran Klein, Tim Brown, Matthew Sample, Anjali R. Truitt, and Sara Goering

Neural engineering technologies such as implanted deep brain stimulators for Parkinson's disease and brain-computer interfaces represent exciting and potentially transformative tools for improving human health and well-being. But they raise ethical and philosophical concerns about identity, normality, authority, responsibility, privacy, and justice. If a device is stimulating my brain while I decide upon an action, am I still the author of the action? Does a device make my personal experience accessible to others? Will the device change the way I think of myself and others think of me? Devices currently under development--such as the BrainGate System of implanted brain sensors coupled to robotics in persons with paralysis and brain-to-brain interfacing--promise to extend and deepen these debates. The authors are part of a National Science Foundation-funded engineering research center tasked with investigating philosophical and social implications of neural engineering research and technologies. In the "Another Voice" column, Ronald M. Green, professor emeritus for the study of ethics and human values at Dartmouth College, examines the "ethical novelty" of deep brain stimulation compared with potent psychiatric drugs. He concludes, "It is not simply the fact that neural technologies pose questions of identity, privacy, and the like but that they do so with a degree of intensity that creates qualitatively new challenges."

The Ethics of Access: Who Is Offered a Cesarean Delivery, and Why? Steven J. Ralston and Ruth M. Farrell

Should pregnant women have the option of an elective caesarean delivery? In bioethics, much of the discourse on this question has focused on balancing respect for patient autonomy with attention to the risks of this procedure to the mother and her child. Much of the clinical and ethical analysis has concluded that, given the degree of risk to the mother and neonate from a primary or single repeat cesarean delivery, there is sufficient justification for pregnant women to request and obtain this procedure. However, the analyses often caution that physicians should not offer elective cesareans to all women, but only to those who initiate the request. This paper concludes that such a policy is ethically unjustifiable, as it treats women who do not make the request differently from those who do. Depriving appropriate candidates--for example, healthy women who are good surgical candidates and desire only one or two children--of information about elective cesarean delivery is a form of undue influence on women's decision-making. Steven J. Ralston teaches obstetrics, gynecology, and reproduction biology at Harvard Medical School, and Ruth M. Farrell is an obstetrician-gynecologist at the Cleveland Clinic. In a related piece, the Case Study discusses the request for an elective cesarean by a woman in labor whose fetus has a lethal abnormality: "Should the obstetrician proceed with a cesarean delivery despite knowing that it would expose the mother to surgical risks with little or no corresponding fetal or neonatal benefit?"

Also in this issue:

Policy and Politics: A Vaping Matter: E-cigarette Use in Health Care Organizations Sally Bean and Maxwell J. Smith

Although there is no federal legislation yet on e-cigarettes, the U.S. Food and Drug Administration proposed regulations in April 2014 that would prohibit sales of e-cigarettes to anyone under 18 and require that they be approved by the FDA as a tobacco product and carry warning labels for consumers on their packaging. Only three U.S. states have extended the same restrictions placed on tobacco products to e-cigarettes; however, 18 states restrict their use in venues such as schools, state property, or workplaces. Meanwhile, health care organizations will have to develop institutional policies if they wish to consistently address the use of e-cigarettes by patients and visitors on their property. Controversy regarding the use of e-cigarettes within health care organizations concerns their safety, their effectiveness for smoking cessation, and the risk of renormalizing smoking.

At Law: A Buyer's Market? Fixing the Price for Human Ova for Assisted Reproduction Sandra H. Johnson

The Wall Street Journal article "Putting a Price on a Human Egg" triggered extensive media coverage of a challenge to payments made to women providing ova for use in assisted reproduction. In Kamakahi v. American Society for Reproductive Medicine and Society for Assisted Reproductive Technologies, plaintiffs claim that ASRM and SART policies adopting limits on such payments violate the federal antitrust prohibition against price fixing. Ethicists debate whether payment for oocytes inappropriately commodifies the human body, and ASRM policy consistently refers to their procurement as the "donation process" and to women who participate as "donors." Nevertheless, in the context of antitrust law, the procurement of oocytes is a business and clearly falls within the reach of antitrust restrictions on business conduct.
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The Hastings Center

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