Book Review

Intervening in the Brain: Changing Psyche and Society

N Engl J Med 2007; 357:2095-2096November 15, 2007

Article

Intervening in the Brain: Changing Psyche and Society
(Ethics of Science and Technology Assessment. Vol. 29.) By Reinhard Merkel, Gerard Boer, and Jörg M. Fegert, with four others. 533 pp. Berlin, Springer, 2007. $99. ISBN: 978-3-540-46476-1

Neuroethics is the name recently applied to the ethical issues that arise from advances in neuroscience — particularly brain science. During the past 5 years, neuroethics has grown from an obscure area of interest to a defined discipline with its own scholars, books, journals, professional society, meetings, and Web sites. In 2005, Reinhard Merkel and six other scholars from Germany, Belgium, and the Netherlands who have backgrounds in clinical and basic neuroscience, philosophy, and law formed a study group to systematically analyze brain interventions, an essential problem in neuroethics. Written jointly by the study group, this book provides the group's ethical, legal, and social analyses, as well as its recommendations for preliminary guidelines and further study.

The authors devote the first half of the book to descriptions of current techniques of brain intervention that generate the ethical problems they analyze in the second half. They describe the historical development of each technique, its current status, and the nature of the ethical issues it has produced or may later produce. They consider the psychopharmacology of childhood disorders, neurotransplantation, gene transfer, neurologic enhancement, central neural prostheses, electrical brain stimulation, and psychosurgery. These chapters provide current, accurate data and impartial accounts of the ethical issues.

Part II of the book is completely different. In the 100-page initial chapter, the authors offer a biophilosophical analysis of personhood, personal identity, and personality. Although interesting, this material is pursued to a conceptual depth that is greater than necessary for most readers and out of proportion to the coverage of material in other chapters. The chapter on the ethics of neurologic enhancement is particularly well done, with careful and clear discussions of the difficulties of distinguishing enhancement from therapy; reasonable guidelines are also included. The authors end the book with a chapter that is a summary of their conclusions and recommendations; it is also reprinted in the original German.

The authors do a commendable job of reviewing analyses by other scholars and recommendations by expert panels in several other countries (particularly the U.S. President's Council on Bioethics 2003 report, Beyond Therapy: Biotechnology and the Pursuit of Happiness), but there is an inevitable cultural bias toward European standards and laws. Of course, the same criticism can be made about reports that were written in the United States and elsewhere. Although these biases do not affect the authors' analyses or conclusions, their applicability will be limited by laws and practices within their countries.

Merkel and colleagues draw firm and reasonable conclusions. They focus on informed consent and approved protocols as the principal means for mitigating the ethical problems that arise from innovative research and practice in neuroscience. They conclude that neurologic enhancement in healthy persons is not a genuine part of the responsibility of health care professionals and that enhancements that cannot be classified as preventive of disease or disability should not be included in the sphere of “proper” medicine as a social system. As a result, the authors recommend that research on techniques that would be used solely for mental enhancement should not be subsidized by public funds that are earmarked for health care. They recommend a moratorium on surgical interventions and electromagnetic brain stimulation that are intended solely to enhance cognitive function in children, even with parental consent, until a social consensus on normative issues has been achieved.

The authors have written thoughtful and thought-provoking analyses of several important issues in neuroethics that deserve careful study by clinicians, scientists, philosophers, and policymakers. Although it does not purport to be a textbook of neuroethics, the book provides a rigorous and impartial examination of the ethical, legal, and social problems that result from emerging forms of technology in brain intervention.

James L. Bernat, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756