Mahboobin 4:00
R05
EXPLORING BIOETHICS: SHOULD WE ENGINEER THE BRAIN?
Christine Heisler (cnh27@pitt.edu)
THE BREAKTHROUGH: BIOMARKER
RESEARCH
Before I knew that I wanted to pursue bioengineering, I
realized that the effects of mental disorders were significant
to me for several reasons. I have not personally experienced
the effects of a neurological disorder, but several of my close
friends live with depression and other mental disorders, and
these conditions are indescribable. One of my closest friends
has lived with depression for a few years and has recently
been diagnosed with bipolar disorder. This person is one of
the most brilliant, insightful, and inspiring people that I have
ever had the privilege to encounter, and yet, this person is
must live with the anxiety, loneliness, and mental pain of
depression. Often, no matter how hard we try, no amount of
encouraging words are able to bring a person out of his or her
own mind. This is one of the most difficult obstacles that
patients and their family and friends deal with- that they are
practically helpless to solve the problem. However, as an
aspiring bioengineer, I refused to believe that anyone should
have to live with the horrors of depression, anxiety or any
neurological
disorder.
Therefore,
throughout
my
undergraduate studies, I made it a goal of mine to be a part of
the solution to these neurological disorders.
Now, through extensive research of biomarkers, a possible
solution is within my reach, and I am inclined to seize this
opportunity. However, I know I must proceed with caution
and carefully analyze each code of ethics that govern
bioengineering as a whole, and neuroscience, which is my
current field of work. . Therefore, I will thoroughly consider
each aspect of this case, and further my understanding of the
implications of this solution.
BACKGROUND: THE ROAD TO THE
BREAKTHROUGH
I have recently earned my Ph.D. from Pitt. After
completing my undergraduate degree in bioengineering with
a neuroscience minor, I decided to pursue graduate school to
continue my neurological research and gain more in-depth
knowledge on different neurological disorders and the root
causes of these diseases. I am now working as the Research
Coordinator in the neurological research department of
UPMC. My team and I have been conducting research on
several biomarkers in the brain that are linked to depression.
My team is made up of four individuals: two who have an
undergraduate and graduate degree in bioengineering from
Pitt, and two who have an undergraduate and graduate degree
in neuroscience from Pitt. We all have neurological research
University of Pittsburgh, Swanson School of Engineering
Submission Date 2015-11-03
experience. We are working specifically with two patients,
Jane and John. Jane was diagnosed with depression one year
ago. Our second patient, John, has been living with depression
for over ten years. Both have similar symptoms commonly
associated with depression, which include chronic mental
pain, severe emotional highs and lows on a daily basis, and
increased anxiety in several social situations. The effects of
depression impair both of our patients greatly: they impair
Jane in her academic and social aspects of college life, and
they impair John in his marriage because even though he has
a solid relationship in which his wife constantly reassures
him, he lives in fear of losing connections with anyone who
is close to him. Both individuals have tried several
medications, simply hoping that they do not have an adverse
reaction to these new doses. They have also tried cognitive
behavior therapy, which has proven effective on certain
patients. However, these treatments have proven ineffective
for Jane and John.
My team and I, who are all bioengineers by trade with
extensive and varied knowledge in neuroscience, have done
extensive biomarker research on Jane and John. We have
discovered that the build-up of C-reactive proteins on the
frontal lobe of these patients’ brains has had a negative result
on the mental states of these two individuals. Even though
these patients have been affected for different lengths of time,
the amount of protein build up is similar and correlates to the
negative effects of depression that both patients experience.
Through extensive research and testing, my team has
developed an injectable enzyme treatment that will destroy
the C-reactive protein from this area of the brain. It is a
relatively inexpensive procedure to perform and could be
could be performed on several patients in the future.
THE ETHICAL DEBATE
Even though this is the breakthrough that my team and I
have all been working for, we are currently faced with a few
ethical dilemmas. The questions I must ask myself are:
Should we go through with this procedure, taking into account
all the possible consequences? Should it be repeated on other
patients? Is this a viable option, or would engineering these
patients’ brains alter their emotional state of being, not only
their mental condition? Here is the overarching question that
weighs heavily on my mind: Should we engineer the brain?
As Brey asks in the article “Biomedical Engineering Ethics”,
“Can humans still be held morally responsible for their
behavior when their brain has been engineered by others to
function in a certain way?” [1]. My job now is to consider all
of these questions, weigh the options at hand, and decide if
our procedure is viable to implement.
Christine Heisler
people affected by depression worldwide. Here, when we
consider this BMES canon and consider all the people it will
impact, we are faced with a vital question: Does the benefit of
the relatively few amount of people who will gain use from
our procedure outweigh the potential harm that it could cause
many others? I believe that the potential help definitely
outweighs the potential harm. Our procedure is indeed a step
in the right direction, and if it can help even just a few people
in a clinical setting, it has the potential to help several others,
and therefore it should be implemented. I will continue to
consult a variety of sources as I develop this initial opinion
and contemplate the potential impacts of this procedure.
WEIGHING THE OPTIONS
There are several reasons that support the validity of our
research and prove that we can ethically go through with this
procedure. To start, as the Rules of Practice in the National
Society of Professional Engineers ethical code states,
“Engineers may express publicly technical opinions that are
founded upon knowledge of the facts and competence in the
subject matter” [2]. This canon is vital to the development of
a new product or the implementation of a new procedure
because there must be an extensive amount of information and
research to back up the claims made by the product or
procedure. If we predict that our procedure would completely
eradicate all traces of the C-reactive protein and cure the
patient of all symptoms of depression, this would be an
invalid statement because we do not have the factual
information required to prove it. However, through our
extensive research and background knowledge in both
bioengineering and neuroscience, my team has proven its
competence in this subject matter. In addition, we have
consulted with neurosurgeons and have performed repeated
experiments to test the enzyme treatment. Therefore, we have
fully acknowledged this canon and we can be confident that
this procedure will lead to a significant decrease in the
negative side effects associated with depression in patients
with a similar concentration of C-reactive proteins.
The NSPE code of ethics goes on to state that engineers
have a professional obligation to “acknowledge their errors”
and “not distort or alter the facts.” [2] As previously stated,
my team and I do not assume that this treatment will work on
every individual, because each brain is unique and complex.
No single test will be able to predict the specific treatment of
an individual, and no single procedure will be a ‘cure-all’.
Also, there is no accurate way to predict how any patient
would react to this procedure. In a similar way, because
neuroimaging results may have a different meaning for each
patient, there is no way that tests can determine potential for
violence, as in the scenario called "Neuroimaging and
Violence in the Educational Setting" [3]. For these reasons,
we have tailored our treatment to specific individuals and
biomarkers within these individuals.
However, since this is such a target-specific procedure, it
is not easily tested, nor is it easily applicable to many patients.
As bioengineers, we must “consider the larger consequences
of their work in regard to cost, availability, and delivery of
health care”, as stated by the BMES code of ethics. [4]. Even
though our procedure is inexpensive to implement, there is no
true way to test its effectiveness until the procedure has taken
place. Therefore, we can only accurately determine how this
procedure works on patients that have a similar concentration
of the C-reactive protein as our patients. So, when considering
the availability and delivery of this product, we realized that
it is not as easily marketable as we first thought. Indeed, this
procedure would still have a positive effect on several people,
but would be only a small portion of the total amount of
POTENTIAL IMPACT
The decision to implement this procedure will impact
several people, including the patients that receive the
treatment and their families, the personnel in the neurological
department at the UPMC, and the field of bioengineering
itself.
I am fully aware that my team must adhere to the ASPE
and BMES codes of ethics, and that we must also consider all
the ramifications associated with these codes and the codes of
neuroethics. One of the most crucial canons of both the ASPE
and BMES ethical code is that “Engineers shall at all times
strive to serve the public interest” [2] [4]. Within the context
of my ethical dilemma, this is a crucial canon to consider.
First, we must acknowledge that the public interest includes
all of the people previously mentioned, and that each of these
groups of people influence the total positive or negative
impact of this procedure.
Impact on Patients and Families
The procedure will most directly impact the patients and
their families. If the procedure is unsuccessful in depleting the
C-reactive proteins, the patient will have no improvement in
their emotional health and their families may lose hope in our
hospital, and in this procedure. In addition, since we have
been working specifically with Jane and John, then if we fail,
they may lose hope in any other procedure. This procedure is
specifically geared toward them and therefore it is of extreme
importance that it is successful.
We must also consider what the consequences are if the
procedure is successful. If the procedure helps decrease the
symptoms associated with depression and improves their
mental health, then this is a positive result. However, there
may be other significant changes within their mental state that
would require an adjustment. Often, when altering or
engineering any part of the brain, people think that a
procedure may have an effect on the individual’s personality,
which could cause emotional pain and a difficult adjustment
for their friends and family as well as the individual. I have
strongly considered and debated this, through my knowledge
of psychology, neuroscience, and the consultation of outside
sources. I learned that there is not one single cognitive
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Christine Heisler
the biomedical engineering profession” [4]. In accordance
with these factors, I must make my decision on this case. So,
I plan to also consult a code of neuroethics and a variety of
other sources that have value to me personally so I can make
the most informed and unbiased decision as possible.
function that directly affects personality and behavior; it is a
combination of several complex and intertwined cognitive
functions. Therefore, it is not completely correct to assume
that the alteration of one part of the brain will definitely
change an individual’s sense of self. As stated in the article
“Ethical Issues in Neuroscience”, even though there is a close
relation between neurological state of an individual and
personality, there is not a “definitive neural basis of morality
or consciousness”, because this is such a complex aspect of a
person [5]. I believe that our personality and sense of self is
malleable, because the way we interpret who we are and what
we feel changes quite often. Also, I believe that this procedure
may have an effect on the neurological function of the
individuals treated, but it will not drastically alter their
personality or sense of self.
I analyzed this issue further by reading alternative sources
on the subject. An article on Quartz discusses the link between
neuroscience and the sense of self. It discuss that the view of
the self is ever-changing, not constant, as was previously
believed. The article quotes from a neuroscience paper
published in “Trends and Cognitive Sciences”. This paper
states that “self-processing in the brain is not instantiated in a
particular region or network, but rather extends to a broad
range of fluctuating neural processes that do not appear to be
self-specific” [6]. This further proves that personality and
sense of self is determined by more than one area of the brain,
by several complex processes. My team and I acknowledge
that there have been several instances where different
procedures have altered the personality of the patient, and we
know that this is always a risk associated with surgical
procedures on the frontal lobe of the brain, but we are
confident that our procedure will be carefully performed and
will have little to no impact on their sense of self or identity.
CONSULTING NEUROETHICS
The NSPE code of ethics and BMES code of ethics are
helpful to reference when discussing any engineering issue.
The NSPE code would be especially relevant in cases such as
Case 1042, an example case I examined in my research
process, because it explores the relationship between the
workers and bosses and how information should be reported
[7]. In my specific scenario, however, this case is not as
applicable, so it is necessary to consider aspects of
neuroethics as well. In Fuchs’ research article “Ethical Issues
in Neuroscience”, these aspects are thoroughly examined. To
start, Fuchs points out several cases where healthy individuals
have used neurological drugs to enhance their cognitive
function. [8]. Drugs targeted for patients with Alzheimer’s
disease have been used to enhance the memory of healthy
individuals, and drugs targeted for patients with PTSD are
accessible to anyone who wishes to forget any remotely
unpleasant event [8].These cases provide proof that any
medication or procedure has the ability to be severely abused,
and this leads to a substantial concern that our procedure
could be misused by the general population. We could not
feasibly account for every action of outside consumers, but if
we applied our procedure in a clinical setting and to only a
defined set of patients, then we could control its use. Once
these initial procedures occur, we would take many
precautionary measures to assure that this procedure would
only be available to patients with diagnosed depression. Since
it is such a specific surgical procedure, it is less likely to be as
easily accessed and misused as an over-the-counter
medication, but to protect against potential problems, we
would need to take all necessary precautionary measures.
Fuchs’ article then addresses another controversial topic;
the topic of changing the human condition. He states that
“mind enhancement threatens to devalue human life in all its
imperfection.” [8]. I have considered this fact as well, and
often questioned how I can morally attempt to change the
human condition. It is certainly a question that all
bioengineers must consider. If humans take a medication or
undergo a procedure to become ‘perfect’ in any way, then
how can we continue to call ourselves human? At what point
does enhancement cross a line, and who has the jurisdiction
to define this? These are questions that I will still be asking
myself for years to come, because they require an amount of
research and contemplation far beyond this essay. However, I
can make a few observations about this at the present time.
First, if any substance or product is used for a different
purpose than it was intended, or if it is abused in an extreme
case, then it has the potential to negate everything that human
Impact on UPMC and Field of Bioengineering
The result of the enzyme injection procedure will also
impact my other team members and the entire neurological
department of UPMC at the University of Pittsburgh. My
team and I have spent a great deal of time developing a
procedure that could treat depression, through our past
research, education, and current work. Therefore, we would
all be understandably upset if this procedure failed. Further,
each individual in the department serves as a representative of
the entire department in each aspect of our work, so if our
team fails, it is also a failure for our department. Several law
suits could arise as a result of our procedure and this would
be a large detriment to the progress of our department, or any
department in the UPMC, so we must make this decision
carefully.
Moreover, our decision on the implementation of this
procedure will impact the entire field of bioengineering. Each
bioengineer represents the profession as a whole, so we must
hold each other accountable. As the BMES code of ethics
states, bioengineers must “strive by action, example, and
influence to increase the competence, prestige, and honor of
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Christine Heisler
beings are. In a similar way, if the procedure that my team and
I have developed is used to augment human happiness and
cognition in individuals who do not have any diagnosable
need for this procedure, then this intervention is not only
unnecessary, but extremely dangerous. But if this procedure
allows an individual who has been living with depression to
regain a relatively pain-free mental process and allows them
to perform daily tasks to their full potential, then I absolutely
support the implementation of it. I believe that an
improvement in a patient’s current condition is definitely
worth supporting, especially if it provides relief from the
terrible grip of depression. This procedure would not
dehumanize the patient in any way; they would still be the
same person after the procedure, but now with the ability to
live a more mentally stable life.
Another issue that Fuchs addresses is free will, and this
part of the article provides some insight into my overarching
question: should we engineer the brain, and can people be
held responsible for actions they take when their brain has
been engineered? [1]. Several people, both in the medical
field and in the general population, have the predetermined
notion that a surgical procedure such as ours could not only
affect personality but also have an effect on the free will of an
individual. Fuchs addresses this and shows that free will is not
solely determined by the finite neurological condition of the
individual. It is “not concerned with neurons, muscles, or
bodily movements that we act upon but with meaningful
actions that we plan and intend in the context of our goals”
[8]. Therefore, engineering the brain does not entail
completely altering an individual, and this means that
individuals can be held responsible even if a part of their brain
has been engineered. I believe that, for the most part,
procedures that are performed carefully and with minimally
invasive techniques will not lead to a drastic change in the
decision-making process of the individual. Therefore, they
can still be held accountable for their own decisions.
only be implemented within the realm of the clinical setting,
and only administered to our patients and other patients with
a similar C-reactive protein concentration. In this way, this
procedure will help Jane, John, and other patients with a
similar protein concentration, which was our original goal.
Further, I believe that although the impact of this procedure
may seem small in the context of the entire population that
lives with depression, this would initiate progress that has
much value in the development of a more effective treatment
of this detrimental disease. Eventually, the procedure and our
further research has the potential to eventually help a variety
of patients living with depression, and this would be
absolutely incredible.
This ethical dilemma posed several questions. Although I
may not be able to fully answer each question, I used a variety
of information to make an initial decision: I searched for new
information on the topic, relied on information I have already
learned, and tried to analyze the dilemma from every angle
possible. I reached this decision after carefully reading
through each source and reflecting on it; so, for future
engineers who face a similar dilemma, I would advise them
to conduct their own careful analysis and to determine the
steps of action accordingly.
REFERENCES
[1] Brey, P. ‘Biomedical Engineering Ethics.’ (2009). A
Companion to Philosophy of Technology. Blackwell.
[2] (2014). “Code of Ethics for Engineers.” National Society
of
Professional
Engineers.
(website).
http://www.nspe.org/resources/ethics/code-ethics
[3] Beckford, G.H. (2013). "Neuroimaging and Violence in
the
Education
Setting." Online
Ethics.
Web.
http://www.onlineethics.org/Resources/Cases/27564.aspx.
[4] (2004). “Biomedical Engineering Society Code of Ethics.”
Biomedical
Engineering
Society.
(website).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[5] J. Illes, S. J. Bird. (2006). “Neuroethics: a modern context
for ethics in neuroscience”, Trends in Neurosciences, Volume
29, Issue 9, September 2006, Pages 511-517, ISSN 01662236, http://dx.doi.org/10.1016/j.tins.2006.07.002.
[6] Goldhill, O. (2015). "Neuroscience Backs up the Buddhist
Belief that "the Self" Isn't Constant but Everchanging." Quartz.
http://qz.com/506229/neurosciencebacks-up-the-buddhist-belief-that-the-self-isnt-constant-butever-changing/.
[7] (2014). "Case 1042-Roman Holiday”. Ethics Cases. Texas
Tech
University:
http://www.depts.ttu.edu/murdoughcenter/products/cases.ph
p.
[8] Fuchs, Thomas. (2006). “Ethical Issues in Neuroscience.”
Springer, 2014. Web.
[9] Orwell, George. 1984. New York: Signet, 1977. Print.
CONCLUSION AND
RECOMMENDATION FOR FUTURE
ENGINEERS
As Orwell states in his novel “1984”, “Nothing [is] your
own except the few cubic centimeters inside your skull” [9].
When I read this brilliant novel in high school, I realized how
precious the inner workings of our brain are, and how changes
in these features can be severely detrimental. This novel is
extremely poignant and applicable in several situations.
Among other lessons, it taught me that protecting the intrinsic
part of ourselves is vital, and throughout all of my research, I
have kept this in mind. Through the consideration and
analysis of different codes of ethics, several other sources, and
this brilliant novel, I have been able to come to a conclusion
about my ethical dilemma. I believe that our procedure should
be implemented, with the following restrictions: it should
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Christine Heisler
ADDITIONAL SOURCES
McGrath CL, Kelley ME, Holtzheimer PE, III, et al. Toward
a Neuroimaging Treatment Selection Biomarker for Major
Depressive Disorder. JAMA Psychiatry. 2013;70(8):821-829.
doi:10.1001/jamapsychiatry.2013.143.
ACKNOWLEDGEMENTS
Many people were involved in the process of writing this
essay. I would like to thank my writing instructor, Josh
Zelesnick, for answering all of my questions about this
assignment. I also want to thank my former classmate, Alex
Cipriano, for taking the time to read my paper. She helped
bring life to my paper and brought an outside view that I
greatly needed. I would also like to thank my roommate who
dealt with my stressful rants about this paper all week, and
who took time to read parts of my paper. My paper greatly
benefitted from all of their perspectives, and I am very
grateful for their help.
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Christine Heisler
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