HONS 182 Neuroethics – Spring 2006

April 25, 2006

SCHEDULE

1.         The new field of neuroethics

            a.         William Safire is credited with coining the term neuroethics.

            b.         Kennedy D. Neuroscience and neuroethics. Science. 2004 Oct 15;306(5695):373.

            c.         Farah MJ. Emerging ethical issues in neuroscience. Nat Neurosci. 2002 Nov;5(11):1123-9.

            d.         Moreno JD. Neuroethics: an agenda for neuroscience and society. Nat Rev Neurosci. 2003 Feb;4(2):149-53.

            e.         Dana Foundation

                        i.         http://www.dana.org/books/press/neuroethics/

            f.         University of Pennsylvania

                        i.         http://www.neuroethics.upenn.edu/ [Great listing]

            g.         President's Council on Bioethics

                        i.          http://www.bioethics.gov/topics/neuro_index.html

            h.         Center for Cognitive Liberty & Ethics

                        i.         http://www.cognitiveliberty.org/index.html

            i.         Stanford University

                        i.         http://scbe.stanford.edu/research/programs/neuroethics.html

            j.           NIH's Bioethics Resources on the Web

2.         Scientific method

            a.         Strong inference and method of multiple hypotheses

                        i.         Platt, J.R. 1964: Strong inference. Science 146,347-353

                        ii.         Chamberlain, T.C. 1965: The method of multiple workinghypotheses. Science, 148, 754-759

            b.         Side effects & unexpected consequences

                        i.         Edward Tenner, WHY THINGS BITE BACK: Technology and the Revenge of Unintended Consequences
(346 pp. Alfred A. Knopf, 0-679-42563-2)

3.         Mind-brain relations

            a.         Basics of brain function

                        Neuroscience. by Purves, Dale; Augustine, George J.; Fitzpatrick, David; Katz, Lawrence C.; LaMantia, Anthony-Samuel; McNamara, James O.; Williams, S. Mark Sunderland (MA): Sinauer Associates, Inc.; 2001.

            b.         Linking mental and neural function
i.          Outline on the brain and volition

                        ii.         Tom Wolfe, Sorry, But Your Soul Just Died

                        iii.        Schall JD. On building a bridge between brain and behavior. Annu Rev Psychol. 2004;55:23-50.

                        iv.        Where am I?  From Brainstorms:  Philosophical Essays on Mind and Psychology, Daniel C. Dennett, © Bradford Books (1978)

            c.         Decision making

                        i.         Schall JD. Decision making. Current Biology  2005. 15:R9-R11.

                        ii.        Schall JD. Neural basis of deciding, choosing and acting. Nat Rev Neurosci. 2001 Jan;2(1):33-42.

                        iii.       Anderson SW, Bechara A, Damasio H, Tranel D, Damasio AR. Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nat Neurosci. 1999 Nov;2(11):1032-7.

                        iv.       Greene JD, Sommerville RB, Nystrom LE, Darley JM, Cohen JD. An fMRI investigation of emotional engagement in moral judgment. Science. 2001 Sep 14;293(5537):2105-8.

            c.         Free will
i.         Is God a Taoist By Raymond Smullyan, 1977

                        ii.        Free will on Wikipedia

4.         Neuroenhancement

Neurocognitive enhancement: what can we do and what should we do? Martha J. Farah, Judy Illes, Robert Cook-Deegan, Howard Gardner, Eric Kandel, Patricia King, Eric Parens, Barbara Sahakian and Paul Root Wolpe.  Nat Rev Neurosci. 2004 May;5(5):421-5.

U.S. Constitution, Amendment V

No person shall be [...] compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

Amendment XIV

[...] No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. [...]

1.  Washington v. Harper (1990)

Respondent Harper has been a ward of the Washington state penal system since his 1976 robbery conviction. Both as an inmate and while temporarily on parole, he received psychiatric treatment, including the consensual administration of antipsychotic drugs. He has engaged in violent conduct, and his condition has deteriorated when he did not take the drugs. On two occasions, he was transferred to the Special Offender Center, a state institute for convicted felons with serious mental illness, where he was diagnosed as suffering from a manic-depressive disorder. While at the Center, he was required to take antipsychotic drugs against his will pursuant to an SOC Policy.  The Policy provides:

- that, if a psychiatrist orders such medication, an inmate may be involuntarily treated only if he

(1) suffers from a "mental disorder" and (2) is "gravely disabled" or poses a "likelihood of serious

harm" to himself or others;

- that, after a hearing and upon a finding that the above conditions are met, a special committee

consisting of a psychiatrist, a psychologist, and a Center official, none of whom may be currently

involved in the inmate's diagnosis or treatment, may order involuntary medication if the

psychiatrist is in the majority;

- and that the inmate has the right to notice of the hearing, the right to attend, present evidence,

and cross-examine witnesses, the right to representation by a disinterested lay adviser versed in

the psychological issues, the right to appeal to the Center's Superintendent, and the right to

periodic review of any involuntary medication ordered. In addition, state law gives him the right to

state-court review of the committee's decision.

Both of the involuntary treatment proceedings were conducted in accordance with the SOC Policy.  During his second stay at the Center, but before his transfer to a state penitentiary, Harper filed suit...

i.  On what grounds can psychiatric medication be involuntarily administered to a prisoner?

ii.  Was this policy sufficient to protect Harper’s rights?  (The decision to medicate in this case was

made by a committee hearing, not by a state court.)

2.  Riggins v. Nevada (1992)

When petitioner Riggins, while awaiting a Nevada trial on murder and robbery charges, complained of hearing voices and having sleep problems, a psychiatrist prescribed the antipsychotic drug Mellaril. After he was found competent to stand trial, Riggins made a motion to suspend the Mellaril's administration until after his trial, arguing that its use infringed upon his freedom, that its effect on his demeanor and mental state during trial would deny him due process, and that he had the right to show jurors his true mental state when he offered an insanity defense. After hearing the testimony of doctors who had examined Riggins, the trial court denied the motion with a one page order giving no indication of its rationale. At Riggins' trial, he presented his insanity defense and testified, was convicted, and was sentenced to death.

i.  Did the forced administration of medication infringe on Riggins’s rights?

ii.  What is the distinction here between insanity and incompetence?

caused by antipsychotic medication, and how can these affect court proceedings?

    Where is Riggins today?

3.  Sell v. United States (2003)

Charles Sell, once a practicing dentist, has a long and unfortunate history of mental illness.  In September 1982, after telling doctors that the gold he used for fillings had been contaminated by communists, Sell was hospitalized, treated with antipsychotic medication, and subsequently discharged.  In June 1984, Sell called the police to say that a leopard was outside his office boarding a bus, and then he asked the police to shoot him.  Sell was again hospitalized and subsequently released.  On various occasions, he complained that public officials... were trying to kill him.  In April 1997, he told law enforcement personnel that he “spoke to God last night,” and that “God told me every [FBI] person I kill, a soul will be saved.”

In May 1997, the Government charged Sell with submitting fictitious insurance claims for payment.  A Federal Magistrate Judge, after ordering a psychiatric examination found Sell “currently competent,” but noted that Sell might experience “a psychotic episode” in the future.  The judge released Sell on bail.  A grand jury later produced a superseding indictment charging Sell and his wife with 56 counts of mail fraud, 6 counts of Medicaid fraud, and 1 count of money laundering.

In early 1998, the Government claimed that Sell had sought to intimidate a witness. The Magistrate held a bail revocation hearing. Sell’s behavior at his initial appearance was, in the judge’s words, “totally out of control,” involving “screaming and shouting,” the use of “personal insults” and “racial epithets,” and spitting “in the judge’s face.”  A psychiatrist reported that Sell could not sleep because he expected the FBI to “come busting through the door,” and concluded that Sell’s condition had worsened.  After considering that report and other testimony, the Magistrate revoked Sell’s bail.

In April 1998, the grand jury issued a new indictment charging Sell with attempting to murder the FBI agent who had arrested him and a former employee who planned to testify against him in the fraud case. The attempted murder and fraud cases were joined for trial.

In early 1999, Sell asked the Magistrate to reconsider his competence to stand trial. The Magistrate sent Sell to the United States Medical Center for Federal Prisoners at Springfield, Missouri, for examination. Subsequently the Magistrate found that Sell was “mentally incompetent to stand trial.”  He ordered Sell to “be hospitalized for treatment” at the Medical Center for up to four months, “to determine whether there was a substantial probability that [Sell] would attain the capacity to allow his trial to proceed.”

Two months later, Medical Center staff recommended that Sell take antipsychotic medication. Sell refused to do so. The staff sought permission to administer the medication against Sell’s will. That effort is the subject of the present proceedings.

i.  When can the government forcibly administer antipsychotic drugs?  What criteria should be applied?

Being Human: Readings from the President's Council on Bioethics Chapter 3: To Heal Sometimes, To Comfort Always

Neuroethics in the arts

Books (in no particular order)

Flowers for Algernon by Daniel Keyes

Movies (in no particular order)      

Gattaca

Eternal Sunshine of the Spotless Mind