[Ethical principles in psychiatric action]. / Ethische Prinzipien psychiatrischen Handelns.

There is no specific psychiatric ethic. The ethical principles for practical actions in psychiatry have to be adapted on the basis of the generally accepted ethical principles, which are based on psychobiologically developed ethic of love: honesty, discretion, empathy, patience, distance, consistency, accountability, tolerance, economic neutrality.

The Human Brain Project: social and ethical challenges.

Focusing on the Human Brain Project, I discuss some social and ethical challenges raised by such programs of research: the possibility of a unified knowledge of "the brain," balancing privacy and the public good, dilemmas of "dual use," brain-computer interfaces, and "responsible research and innovation" in governance of emerging technologies.

Ethics of facial transplantation revisited.

PURPOSE OF REVIEW: There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation. RECENT FINDINGS: Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse. SUMMARY: Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.

Neuroscience, ethics and legal responsibility: the problem of the insanity defense. Commentary on "The ethics of neuroscience and the neuroscience of ethics: a phenomenological-existential approach".

The insanity defense presents many difficult questions for the legal system. It attracts attention beyond its practical significance (it is seldom used successfully) because it goes to the heart of the concept of legal responsibility. "Not guilty by reason of insanity" generally requires that as a result of mental illness the defendant was unable to distinguish right from wrong at the time of the crime. The many difficult and complex questions presented by the insanity defense have led some in the legal community to hope that neuroscience might help resolve some of these problems, but that hope is not likely to be realized.

The ethics of neuroscience and the neuroscience of ethics: a phenomenological-existential approach.

Advances in the neurosciences have many implications for a collective understanding of what it means to be human, in particular, notions of the self, the concept of volition or agency, questions of individual responsibility, and the phenomenology of consciousness. As the ability to peer directly into the brain is scientifically honed, and conscious states can be correlated with patterns of neural processing, an easy--but premature--leap is to postulate a one-way, brain-based determinism. That leap is problematic, however, and emerging findings in neuroscience can even be seen as compatible with some of the basic tenets of existentialism. Given the compelling authority of modern "science," it is especially important to question how the findings of neuroscience are framed, and how the articulation of research results challenge or change individuals' perceptions of themselves. Context plays an essential role in the emergence of human identity and in the sculpting of the human brain; for example, even a lack of stimuli ("nothing") can lead to substantial consequences for brain, behavior, and experience. Conversely, advances in understanding the brain might contribute to more precise definitions of what it means to be human, including definitions of appropriate social and moral behavior. Put another way, the issue is not simply the ethics involved in framing neurotechnology, but also the incorporation of neuroscientific findings into a richer understanding of human ethical (and existential) functioning.

Haunted by the ghost in the machine. Commentary on "The spirituality of human consciousness: a Catholic evaluation of some current neuro-scientific interpretations".

Metaphysical and epistemological dualism informs much contemporary discussion of the relationships of science and religion, in particular in relation to the neurosciences and the religious understanding of the human person. This dualism is a foundational artifact of modern culture; however, contemporary scientific research and historical theological scholarship encourage a more holistic view wherein human personhood is most fittingly understood as an emergent phenomenon of, but not simply reducible to, evolutionary and developmental neurobiology.

What if? The farther shores of neuroethics: commentary on "Neuroscience may supersede ethics and law".

Neuroscience is clearly making enormous progress toward understanding how human brains work. The implications of this progress for ethics, law, society, and culture are much less clear. Some have argued that neuroscience will lead to vast changes, superseding much of law and ethics. The likely limits to the explanatory power of neuroscience argue against that position, as do the limits to the social relevance of what neuroscience will be able to explain. At the same time neuroscience is likely to change societies through increasing their abilities to predict future behavior, to infer subjective mental states by observing physical brain states ("read minds"), to provide evidence in some cases relevant to criminal responsibility, to provide new ways to intervene to "treat antisocial brains," and to enhance healthy brains. Neuroscience should make important cultural changes in our special, and specially negative, views of "mental" versus "physical" illness by showing that mental illness is a dysfunction of a physical organ. It will not likely change our beliefs, implicit or explicit, in free will, or spark a new conflict between science and religion akin to the creationism controversy.

The spirituality of human consciousness: a Catholic evaluation of some current neuro-scientific interpretations.

Catholic theology's traditional understanding of the spiritual nature of the human person begins with the idea of a rational soul and human mind that is made manifest in free will--the spiritual experience of the act of consciousness and cause of all human arts. The rationale for this religion-based idea of personhood is key to understanding ethical dilemmas posed by modern research that applies a more empirical methodology in its interpretations about the cause of human consciousness. Applications of these beliefs about the body/soul composite to the theory of evolution and to discoveries in neuroscience, paleoanthropology, as well as to recent animal intelligence studies, can be interpreted from this religious and philosophical perspective, which argues for the human soul as the unifying cause of the person's unique abilities. Free will and consciousness are at the nexus of the mutual influence of body and soul upon one another in the traditional Catholic view, that argues for a spiritual dimension to personality that is on a par with the physical metabolic processes at play. Therapies that affect consciousness are ethically problematic, because of their implications for free will and human dignity. Studies of resilience, as an example, argue for the greater, albeit limited, role of the soul's conscious choices in healing as opposed to metabolic or physical changes to the brain alone.

Biological indeterminacy.

Reductionist explanations in biology generally assume that biological mechanisms are highly deterministic and basically similar between individuals. A contrasting view has emerged recently that takes into account the degeneracy of biological processes--the ability to arrive at a given endpoint by a variety of available paths, even within the same individual. This perspective casts significant doubt on the prospects for the ability to predict behavior accurately based on brain imaging or genotyping, and on the ability of neuroscience to stipulate ethics.

Reductionism, brain imaging, and social identity. Commentary on "Biological indeterminacy".

The practice of reductionism in science and philosophy includes attempts to essentialize human persons, which can lead to serious social problems. Reductionism is not necessary, as comparative philosophers and alternative-thinking scientists have shown.

Neuroscience may supersede ethics and law.

Advances in technology now make it possible to monitor the activity of the human brain in action, however crudely. As this emerging science continues to offer correlations between neural activity and mental functions, mind and brain may eventually prove to be one. If so, such a full comprehension of the electrochemical bases of mind may render current concepts of ethics, law, and even free will irrelevant.

Applications of transcranial magnetic stimulation (TMS) in child and adolescent psychiatry.

Transcranial magnetic stimulation (TMS) is emerging as a new treatment and neurophysiological research tool for psychiatric disorders. Recent publications suggest that this modality will also serve as a treatment and research tool in child and adolescent psychiatry. Current reports on therapeutic trials of repetitive transcranial magnetic stimulation (rTMS) in adolescents have primarily focused on depression. However, other pilot work involves the treatment of attention-deficit/hyperactivity disorder (ADHD), autism and schizophrenia. Neurophysiological studies typically utilize single and paired-pulse TMS paradigms which index cortical excitability and inhibition. Initial studies have focused on ADHD, autism, and depression. General knowledge regarding TMS among child and adolescent psychiatrists is lacking. The aim of this review is to provide an overview of TMS in the context of child and adolescent psychiatry, discuss recent therapeutic and neurophysiological studies, and examine relevant ethical considerations.

Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice.

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.

DSM diagnosis and beyond: on the need for a hermeneutically-informed biopsychosocial framework.

While often dubbed "the bible of contemporary psychiatry" and widely hailed as providing "a benchmark" for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM's diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework.

Our brains are not us.

Many neuroscientists have claimed that our minds are just a function of and thus reducible to our brains. I challenge neuroreductionism by arguing that the mind emerges from and is shaped by interaction among the brain, body, and environment. The mind is not located in the brain but is distributed among these three entities. I then explore the implications of the distributed mind for neuroethics.