key: cord-0938147-n1dleax0 authors: Moreno, Jonathan title: Society and the reception of imaging technology: The American experience date: 2011-05-06 journal: Cortex DOI: 10.1016/j.cortex.2011.04.024 sha: 1f48d16c1a0e58f62f936d1b009296a8b0307d5b doc_id: 938147 cord_uid: n1dleax0 nan Ethical issues in neuroimaging overlap with some familiar issues in medical ethics and bioethics. Familiar bioethical issues have to do with regulation around existing or emerging research methods and include consideration of the risks as well as the benefits to people of participating in research. One such source of risk is incidental findings that are revealed in the course of the research. These are discussed in depth elsewhere in this Forum but are worth commenting on here. In the USA, it is not uncommon for University students to participate in neuroimaging research, for example by acting as a subject for their friend's psychology research project. Participating in neuroimaging research may be perceived as novel, 'cool' even, they may be paid for their time and they might be given a picture of their brain to use as a screen saver or Christmas card. The downside is the 1e5% chance of unexpected incidental findings in their brain, some of which have health implications (Morris et al., 2009) . Most of the researchers conducting these studies are not neurologists or neuroradiologists, nor medically qualified, many do not yet even have their PhD, but there is the obvious and uncomfortable question of "what do you do"? The 'fun' experiment has become a potentially (very) scary nightmare. The person is your research subject, is may be 19 or 20 years old, is not your patient, and you are not a physician, but their participation in your neuroimaging research has turned them into a patient. In many respects this is the "easiest" of the ethical issues that the recent rapid advances in neuroimaging technology are now forcing us to consider. More profound and challenging are the ethical issues, especially acute in neuroimaging, that depend on what exactly one thinks is going on from a philosophical standpoint when one has access to images of brain activity. What is the mindebrain relation and what does this do to current concepts of personhood? If one believes that such data really provide insight into the person, or that it could, then thought privacy becomes a uniquely neuroethical issue, as is detection of deception. Questions about personhood and moral agency have legal, as well as philosophical, implications: -To what extent am I simply the product of what is going on in my brain? -If another person could be omniscient and even omnipotent with respect to my brain, would that make me no longer morally responsible for my actions? -How does it affect my conception of my own personhood? -If my personality, my soul is my brain, and if someone else has access to my brain and can control it, then has someone else somehow taken me over? I am going to concentrate on three examples of settings in which some of these issues have surfaced in the U.S.A (Moreno, 2004) : -politics; -legal responsibility; -and national security. During the last two U.S. presidential election cycles, major newspapers published "studies" where functional magnetic resonance imaging (fMRI) had been used to determine people's opinions about some of the candidates running for election 1 . According to the fMRI data, a picture of Hillary Clinton did not elicit much response in a male subject's brain but elicited a marked activation in a female subject's brain. Images of Mitt Romney activated the amygdale in both sexes, which was interpreted as being a fear response. These items, and their appearance in a national newspaper without conventional peer review as would occur in a scientifically credible publication, struck many neuroscientists as downright silly and perhaps even damaging to the field, but the media interest in the work clearly demonstrated that brain imaging has caught the public imagination (Racine et al., 2010; O'Connell et al., in press ). At least one cognitive psychologist has claimed that liberal politicians could take advantage of neuroimaging to study brain activation patterns in order to develop a more appealing political message. My own reaction to such notions is one of skepticism, though I do allow that there may be value in social psychological studies for crafting political messages and increase their changes of being elected. I think that we may rightly dismiss such claims as nonsense. The legal issues are far more substantive. Here, opinions are very polarised, particularly at the interface between neuroimaging and criminal justice, where different expert witnesses have used examples of neuroimaging when acting for the defence or for the prosecution either to mitigate the sentence or to increase the chances of convicting the accused, and so I will cite some very specific examples. Even within one University, the University of Pennsylvania where I work, I have colleagues who represent somewhat differing views of the significance of neuroimaging for the law. One is a neuropsychologist and criminologist. As a prison psychologist, my colleague was very interested in what makes very pathological people behave the way they do. He has represented people who have engaged in horribly violent crimes, at the sentencing phase. He claims that a reduction in grey matter, visible on neuroimaging, explains this kind of psychopathology. He proposes that this is physical structural defect that in some people manifests itself as an "attachment disorder," or the inability to empathize with another person's suffering (Raine et al., 2000) . He further states that it may be possible to detect the grey matter abnormality in young children which might enable preventive behavioural therapy to be given that would prevent criminal activity in adulthood 2 . The problem is that the studies on which these theories are based are small, they have not been replicated in large unselected populations, there is insufficient knowledge of population norms, and therefore the reliability, sensitivity and specificity of a particular grey matter thickness in a particular area of the brain is unknown. A modest statistical association based on comparison of group data does not equate to a reliable diagnostic test. Another colleague is from the University of Pennsylvania law school, who states, from the legal perspective, that the law does not recognise, and has no reason to recognise, this subtle association demonstrated with complex neuroimaging methods, or any other psychology data as evidence; as he might say, just because your social background was disruptive to you as a child is no justification for committing a crime as these kinds of considerations do not have any significant bearing on the law as it currently stands (Morse, 2006) . Aristotle long ago observed that people may associate with, and be influenced by, a bad crowd, yet are still subject to the legal system because they were responsible for that choice of association and the consequent actions. As far as the law is concerned, metaphysical discussions about grey matter, freewill and responsibility are not relevant (Morse, 2007) . The law is concerned primarily with whether the accused did the crime in question and nothing else. In this respect, Morse believes moral and philosophical factors as indicated by neuroimaging never will be decisive, although they may at some stage have a role. For example, in the sentencing phase of a criminal prosecution neuroimaging findings such as the above could indicate mitigating circumstances that could influence the severity of the sentence, so the judge might not apply the death sentence (in the USA) but instead sentence the accused to life imprisonment or rehabilitation, or even some kind of institution for the criminally insane. In that context, i.e., modifying a sentence once convicted, neuroimaging findings and other psychological tests might well be taken into consideration. Finally, I turn to the USA National Security Agency's (NSA) interest in brain imaging (Moreno, 2006) . The NSA has a deep interest in technologies for probing the mind to determine behavioural characteristics and read thoughts as this could help catch terrorists, and to enhance intellectual performance, particularly in soldiers under battle stress. Indeed a major source of research funding, including for neuroimaging, is the Defence Advanced Research Projects Agency (DARPA, http:// www.darpa.mil/) a research arm of the US military. Perhaps the neurotechnology that has attracted the most concrete interest so far is one that claims to detect what is known as the P300 wave, which is an oscillation in the line traced by electroencephalography (EEG) equipment exactly 300 msec after the stimulus; therefore, the impulse is released before the subjects can suppress the response. The idea behind this device is that if a person reacts in a certain way to a photo of a crime scene but denies having ever viewed that place, he could be lying. It might, for example, be used to identify when terrorist suspects are planning a bomb attack on a major target by eliciting a different response to images of the target than to other neutral places (Meixner and Rosenfeld, 2010) . A notion that has captured the attention of security officials is that of a neuroimaging device that could work "at a distance" say as a screening tool for people having hostile or violent thoughts in sensitive public spaces like airports or railway stations. This idea has surely occurred to those of us who have been part of the routine mass screening for elevated temperature that was introduced at international airports in China and Japan following the severe acute respiratory syndrome (SARS) epidemic. A "terrorist screening" device is not so far fetched. There are already numerous closed circuit video cameras throughout most airports. These are being tested with software that analyses walking patterns of people passing through the airport and is said to be able to detect suspicious or subversive behaviour that is associated with terrorist activities. Following recent, much publicised, attempts by terrorists to smuggle explosive devices hidden in various garments onto transatlantic aircraft, many airports in Europe and North America have just in the last year been fitted with "whole body X-ray scanners" at security checkpoints through which all passengers have to pass, something that was unimaginable a few years ago. How far are we away from MR scanners to read thoughts (in those without pacemakers), or rapid whole brain computed tomography (CT) with software to identify passengers with reduced prefrontal grey matter volume (Raine et al., 2000) ? After all, if a mobile Positron emission tomography (PET) scanning device can now be worn by a conscious, mobile laboratory rat while it engages in various reward-seeking activities (RATCAP) 3 , how unlikely is it that before long, we will be required to subject ourselves to some remote mindreading device, promoted by Governments in the interests of national security? However, the concern is that even if the mindebrain and physical obstacles could be overcome (and the laws of nature may in fact make such devices impossible), depending on the sensitivity and specificity of these measures, the privacy considerations would be immense. As a precedent, the infrared temperature screening devices are not encouraging, as they result in numerous false positives and false negatives. A 2008 U.S.A NRC report on emerging cognitive neuroscience was undertaken at the request of the Defence Intelligence Agency. Its conclusions reflect a consensus among neuroscientists on the state of the art on the potential for neuroimaging. The report notes that "Cognitive neuroscience and neurotechnology constitute a multifaceted discipline that is flourishing on many fronts. Important research is taking place in detection of deception, neuropsychopharmacology, functional neuroimaging, computational biology, and distributed humanemachine systems, among other areas." However, the report is cautious in assessing the implications of these developments." Newer brain imaging technologies promising both high spatial and high temporal resolution of brain processes began to appear only in the past decade. It remains to be seen how technology will evolve and how it will aid in the detection of psychological states and lies by neurophysiological means." With regard to detecting deception, it concludes that "insufficient, high-quality research has been conducted to provide empirical support for the use of any single neurophysiological technology, including functional neuroimaging, to detect deception." As the report suggests, given the varying degree of success with each device (Bles and Haynes, 2008) , on grounds of validity alone it seems difficult to justify their use without a great deal of further development (Logothetis, 2008). At a merely technical level, before these kinds of instruments may be considered practical, they will require more human testing. Experimental neurotechnologies raise questions about respect for persons as individuals and potential violations of their cognitive privacy. Here the issue is not simply physical risk, but mental intrusion. The problems raised for research ethics are intriguing. For example, should the research subject simply be required to read a consent form that explains the intrusion of cognitive privacy and ensures data confidentiality? How can privacy rights be respected in a research study that is intended to disclose suppressed mental activity? Liberal democracies face some fundamental questions about whether these are technologies that should even be pursued and, if so, with what kinds of international governance. Detecting concealed information using brain-imaging technology e-pub ahead of print, 2010. Moreno JD. Bioethics and the national security state Mind Wars: Brain Research and National Defence Incidental findings on brain magnetic resonance imaging: Systematic review and meta-analysis Morse SJ. Moral and legal responsibility and the new neuroscience Voluntary control of behavior and responsibility Neuroimaging in society: Legal, corporate, social and security implications Contemporary neuroscience in the media Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder Thank you to Prof Joanna Wardlaw for assistance with editing.