Book Review

Bioethics and the Brain

N Engl J Med 2007; 356:2758-2759June 28, 2007

Article

Bioethics and the Brain
By Walter Glannon. 235 pp. New York, Oxford University Press, 2007. $45. ISBN: 978-0-19-530778-8

Much attention is being focused on the influence that new genetic knowledge will have on medicine, the development of new drugs and vaccines, the law, insurance, civil rights, and the workplace. It is no doubt true that knowing more about human, animal, and microbial genomics has already begun to have, and will continue to have, revolutionary consequences. But the consequences are likely to arrive relatively slowly because of the long causal distance from genes to many traits and behaviors that are of great interest.

Less attention has been paid to the influence new knowledge of the human brain will have on these same areas of endeavor. This situation makes little sense, because the causal link from the brain to the traits and behaviors that interest us is far tighter than it is in the case of genes. Even with the incomplete and sketchy picture now emerging about the structure and function of the brain, it is possible to discern information about ourselves and others that has enormous medical, social, and legal importance. Simply correlating brain images with the potential for certain behavior is starting to embolden people to introduce information about the brain into courtrooms, classrooms, and clinics.

Walter Glannon recognizes the power and importance of the ongoing revolution in our understanding of the human brain, and this recognition is what makes Bioethics and the Brain especially welcome as one of the first efforts to systematically examine the metaphysical, existential, ethical, and legal consequences of this revolution.

The book covers a lot of conceptual terrain, which is both a virtue and a failing. Those looking for an overview of the current state of knowledge regarding ongoing efforts to map, monitor, and modify the human brain will find this book to be a useful resource. Neuroimaging, pharmacologic interventions, neurosurgery, brain death, and the mind–body problem are all on the radar screen. Unfortunately, Glannon's attempt to be thorough can leave even the dedicated reader exhausted as the studies, experiments, and latest breakthroughs are paraded across page after page. About halfway through the book, I found myself wishing for more in-depth analysis and a bit less syncopation in the sometimes eclectic selection of the scientific literature addressed.

Glannon is at his best when arguing about why structural and chemical correlates for human behavior are not as threatening to our sense of free will and moral accountability as they might initially appear. He argues that we create the normative frameworks that govern what is acceptable and unacceptable conduct in human society, and that it is human beings in a social context — not their brains — that have free will. Free will, personal responsibility, and obedience to the law are as much social properties as they are properties of a person's brain.

Glannon is not as persuasive when it comes to arguing against efforts to enhance or improve human performance and behavior by using pharmacologic or surgical interventions. His argument boils down to the truism that the brain is complex, and it is difficult to know all the possible consequences of intervention when dealing with such a complex organ system. True enough, but the same argument could easily be made against the use of new foods, medicines, electronic devices, or even books that may have unpredictable effects on the brain. Actually, arguments like Glannon's are often made, but they quickly fail. His views in this case are unlikely to do much more than briefly slow efforts to improve or enhance brain function.

Glannon has given us a useful, and in many ways comforting, guide to the ethical implications arising from emerging knowledge of the human brain. My hunch is that the next generation of books on this topic will of necessity be less thorough, more focused, and far less comforting as to where the brain sciences could be taking us.

Arthur L. Caplan, Ph.D.
University of Pennsylvania, Philadelphia, PA 19104
caplan@mail.med.upenn.edu