Consciousness and Neuroethics: Brain, Body, Mind and Environment Interactions

Interdisciplinary workshop on Neuroethics

On May 2-4, a small group of philosophers, theologians, physicians, scientists, lawyers, and bioethicists gathered to discuss the work of the first few chapters of Walter Glannon’s book Brain, Body, and Mind: Neuroethics with a Human Face. The author was also present in this workshop which was sponsored by the UNESCO Chair in Bioethics and Human Rights, the Neurobioethics group, the Institute of Science and Faith, the Institute for the Medical Humanities at the University of Texas Medical Branch, Galveston, and Health, Law and Policy Institute at the University of Houston Law Center.

We discussed many interesting questions about the mind and its relationship with the brain, consciousness and even the soul.

Neuroreductionism, consciousness and the mind

The main argument of Walter Glannon’s book is to counter what he calls “neuroreductionism” which is so prevalent among scientists today.  He opened the debate with a disagreement with Francis Crick who in The Astonishing Hypothesis states that “You… are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.”  According to Glannon, there are two aspects to this position: Explanatory reductionism which states that everything about the mind can be explained in term of the brain; and ontological reductionism what equates the mind with the brain.  In this vision, personhood and agency can be accounted for entirely in terms of neural processes. The mind is not explained but explained away.

Glannon proposes instead the idea of emergentism as an alternative understanding of the mind.  According to this theory, the mind is not identified totally with the brain, but is distributed in the whole individual. It is substantiated by brain activities but is not restricted by them and includes interactions with the endocrine system, the immune system, and the environment. Emergent property means that the mind emerges from the brain when a certain level of complexity is reached.  However, Glannon is careful to avoid the pitfall of dualism by emphasizing that this interaction is not linear or one way, but rather circular or multidirectional.

Consciousness is one of the questions addressed in the beginning chapter.  Once again, the author resorts to the concept of a causally emergent property which rejects dualism but affirms the dual aspect of a unit. To suppose that consciousness is localized somewhere in the brain is a failure to properly understand neurophysiology. According to Glannon, the brain generates consciousness by distributed cortico-thalamic networks which depend on the ability of a frontal parietal network to integrate information.  Related to consciousness are the concept of arousal which is a state or level of wakefulness generated and sustained by the thalamus and the ARAS (ascending reticular activating system); and the concept of self-awareness which is the content of consciousness—selfhood and surrounding environment—and results from interactions among the ARAS, thalamus and distributed areas of cerebral cortex.  In addition, phenomenal consciousness refers to the qualitative character of experience, the awareness of being what it is like to be in that state.  Access consciousness refers to information available for rational control in planning and decision making, and is temporally extended.

The group agreed that the mind is greater than the confines of the brain—as a process not a state.  The neurobiological substrate is necessary, but not sufficient to encompass the human mind.  Also, the mind is affected by its interaction with its environment.  Our body adapts and changes in response to the environment—for e.g. in the endocrine or cardiovascular systems –which in turn has an impact on our brain.  The one in control is the human subject.  Glannon asserts that the subject emerges when brain reaches certain level of complexity according to the emergent theory.

John Lunstroth from University of Houston Law Center wondered if Glannon is successful in avoiding reductionism by appealing to emergent property.  It can still be materialistic and may not escape dualistic understanding

of the mind.  It was suggested by several participants that the Aristotelian metaphysical principle of the form and matter might provide a solution.  In this hylomorphic conception of the mind, consciousness is part of the form, whereas the individuality of each mind is found in the matter.  That is, one cannot think without the individual’s mind who holds the thoughts, but the thought itself is not material.  Fr. Shane Johnson, LC of New York observed that there are different ways of looking at causality: Bottom up causality which tends to be reductionist and emergent (akin to the streets of Manhattan where there is no central district or town center); top down causality which is the Aristotelian approach based on unity of center of control and working down, and circular causality which foresees a bidirectional approach (this seems to be the proposal by Glannon.)

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Free Will and Ethical Mind

The group focused the next chapter on the “free will” debate because new objections were put forth by experiments in the 1980s.  In one widely quoted experiment by Libet, subjects were asked to flex their wrists or fingers.  Researchers discovered that neural activities are detected in the brain to perform these actions milliseconds before the subjects have finalized their decision.  Supposedly, this would then be a proof that we are not free, since the brain acted before we have decided.  However, the group agreed with Glannon that there are many problems with this and similar experiments.  In this case, the decision to flex the finger has already been artificially made.  Free will means more than flexing a muscle, but implies moral responsibility. Real life human actions are often preceded by a complex process of forming conscious intentions distal to the action, intentions that were not tested in these experiments.  Moreover, one cannot reduce normative notions from the empirical observations.  That is, correlations found in imaging and other empirical tests are not indicative of causations.  Also, Adriana Gini, Fellow of the UNESCO Chair and Coordinator of the Neurobioethics group, noticed that these experiments did not have a control group which makes their validity dubious.

The next question the group discussed regards moral reasoning. Recently, neuroscientists and clinical psychologists are interested in this question by looking at the neurobiological bases of moral intuition and reasoning.  Some of them believe that moral intuitions are found in certain regions of the brain.  In a famous thought experiment, subjects were given the choice to redirect a trolley which would kill one innocent bystander instead of five.  By correlations with neuroimaging techniques, they concluded that our moral thinking has evolved from a “deontologist,” emotional and irrational gut feeling to a more consequentialist, utilitarian and thus rational reasoning.  Glannon objects to this type of reductionism where moral justification is identified with an area of neurological substrate.  Rather, the group agreed that moral behavior is more complex and cannot be just reduced to areas of the brain.  Moral intuition is a gut feeling, and it is only a point of departure that needs to be further fleshed out.  Intuition seems to imply the existence of the unconscious part of us before rational reflection. The group found these experiments too contrived, and with certain bias.  The human will has been neglected in this consideration. The question of sacrifice and teleology in our moral decision making were not found in these thought experiments.  Moral decisions in life are often complex and takes many elements into consideration.  Also, the group believed that it might be more reflective of the way we make moral decisions if the time frame is of these experiments were extended.

With the advances of neuroimaging techniques to detect pathologies in the brain functions, new questions have been raised about personal responsibility of our acts.  This may also have legal implications regarding liability, mitigation and exculpation of crime.  When abnormalities are present, how much can they tell us about agency, free will or moral responsibility?  What degrees of abnormality would be indicative that the individual was not able to control their impulses?  These questions on mental capacity are raised when we look at neuroscientific evidence from imaging for correlation.  Once again, the group was careful to state that even though brain pathologies may correlate with defects of moral behavior, one must be careful not to equate imaging correlation with causation of behaviors.  There is a danger to see in the seductive allure of colorful images more data than they actually could provide.  It was noted that standards of normality in the images are population-based, but its interpretations when applied to individuals may not correspond exactly. Besides, abnormality of brain does not imply lack of control or function due to plasticity of brain.  Also, Glannon noted that defect may not mean lack of capacity, but difficulty or lack of will.  Imagining is only one component or factor of determining liability.  It is still unclear where we can draw the line along the continuum of impairment to deduce the level of moral and legal liability.  Adriana was very skeptical that state of the art imaging techniques have much to say. She suggested the best way to study this in-depth would require the formation of a multidisciplinary taskforce to study a normal moral agent longitudinally, in order to develop such a neuro-psycho-socio-moral model.

glannon1Fostering the art of dialog in neuroethics

At the end of the meeting, the group shared their findings with members of the Neurobioethics group.  Walter Glannon found the meeting very useful and helped him reformulate some of his ideas.  He found the Aristotelian hylomorphic system a good explanation of the relationship between the mind and the brain.  He reiterated that imaging is only one component of the biospyschosocial complex of moral reasoning.  Regarding the artificiality of the thought experiments, the seminar group agreed that even though they do not give us a complete account, they could nonetheless generate discussions and insights that can be the beginning of a long process of reflection.

Fr. Juan José Sanguineti of Holy Cross University reminded us that to understand brain activity requires a complete understanding of the human reasoning process and of causality.  These processes will not be a linear but multidirectional.  He believes that there is a need for greater discussion on moral liability not only at the legal level but at the level of the will including when there is dysfunction or coercion.  It is important to recuperate the natural moral inclinations of the will towards the objective good.  Even though these values can be influenced by historical circumstances, they are not simply empty choices which the libertarian account of freedom sees all values as indifferent.

Paulie Gaido from Galveston commented that it is necessary to avoid the two extremes of either overrating or dismissing the usefulness of neuroimaging.  We must keep in mind that this is an entirely new science.  It is normal that initial steps can be halting but these methods can improve with time to provide better information.  At the same time, we must constantly look at these findings with a critical eye and not underestimate the complexity and flexibility of the brain.

Dr. Michael Ewer from M.D. Anderson Cancer Center was very appreciative of the many good exchange of ideas present at the workshop as a way to stimulate dialog and discussions.  Even though there was no consensus on every point, he believed that the sum is more important than the parts.  All the participants have come out enriched as a result of this meeting.  John Lunstroth noted the political implications of reaching consensus.  Fr. Shane Johnson appreciated the model of interdisciplinary work.  He recognized the complexity of these arguments because of the different background and metaphysical assumptions of the group.  But he noted that exposure of different points of view were very enriching. Br. Alberto Carrara, LC enjoyed the familial spirit of this meeting and the interpersonal relationships have helped us to grow positively.

Dr. Adriana Gini noted that many of our assumptions are still hypothetical due to the fact that we are far away from a complete understanding of how the brain works and do not know how to integrate neuroscientific data in a much wider and complex interdisciplinary framework. Having said this, she believed that our trajectory of mutual collaboration among scholars from different fields is, at present, the best strategy to understand human life with its meaning and goals which is oriented toward human flourishing advocated by many.

Alberto Garcia, Director of the UNESCO Chair, also found the discussion on the neuroscience of ethics illuminating from the perspective of a lawyer.  He recognized the underpinning all these concepts can have definite legal implications and impact on our understanding of human rights–questions of human dignity, fundamental good, personal identity, and rights to privacy, integrity, and freedom.

Consciousness and the end of life issues

The Neurobioethics Group published their first article, “Consciousness and the end of life issues: a multi and interdisciplinary proposal by the Neurobioetica Research and Study Group in Rome” in the Proceedings of the Conference of the National Forensic and Legal Medicine  Association, Ancona, Italy (September 29th – October 2nd). The authors of this article are: R. Amante V.A., Amodio G., Chieragatti P., Ciadamidaro, M. Farisco, A. Garcia, A. Gini, R. Luna, M.A. Mangione, P.R. Pascual, L.C., A. Soddu.

Italian title: R. Amante V.A., Amodio G., Chieragatti P., Ciadamidaro, M. Farisco, A. Garcia, A. Gini, R. Luna, M.A. Mangione, P.R. Pascual, L.C., A. Soddu, “La Coscienza e le cosiddette Questioni di “Fine Vita”: l’approccio multi e interdisciplinare proposto dal Gruppo di Neurobioetica,” ATTI DEL CONGRESSO NAZIONALE DI MEDICINA LEGALE, Ancona, 29 settembre – 2 ottobre 2009

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“Beautiful Faces” Documentary

Usually we see people and societies who argue for self-evident rights. Hardly ever, or never, I had heard about “right to a beautiful face”. We believe that it is something which we born with it, inherent in human. Only that can miss after an accident (burn, etc), an injury… However, there are children who born like that, without a pleasant face, without an expression that could become apparent the immense beauty of their inner.

In the presence of these children, adults later, we usually suppress the sights, distract the mind, perhaps – in the better case – pray for them. They are the victim of their classmates, their neighboring, and other people in the street who find them. As adults, they will get the stigmata of ugliness: do not marry a wife or husband, be reject by relatives, nearby people, etc; do not find work, except in a dark corner of some job where they will be accepted or exploited them. Their life is almost certainly forced to be a failure.

These people have right to a face, to a means for express the extraordinary richness of their potential that they bring with them. So that, when I was enjoying the film “Beautiful Faces” (www.beautifulfacesfilm.com) felt a warm sense of humanity; this movie helped me to discover the magnificent beautiful, the truth beautiful of the soul of these children, real humans beings, the pain of their suffering, the anxiety of their parents, the humiliation of being so different to the others. Likewise, I identified one of the real goals of medical vocation: the generous dedication, selfless, with high professional level, in a team doctors and collaborators than, even though no have everything of a nation of the First World, they have reached to set up an oasis of hope for those children in the south of the great metropolis of Mexico City. It is a possibility has a medical service of first level there. And it is free. They have achieved not only “cut and stitch”, but they offer a medium to the revered spiritual richness contained in these children.

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“Beautiful Faces” introduce us in the fascinating work of a medical group directs by Dr. Fernando Ortiz Monasterio. It is “the most exciting clinical of the world, the only place where I should stay”. Dr. Ortiz Monasterio has founded the Plastic and Reconstructive Surgery Unit at Dr. Manuel Gea González Hospital, in the frenetic area of Tlalpan, in the Federal District of Mexico City. His enormous talent, his compassion, his principles provide a font of inspiration as for his collaborators as his patients. He has demonstrated at the most sceptics than until the poorest people can get an official sanitary service with quality without that assistance means the failure of Health System. Each person must be fit to a fundamental human right: to have a common and presentable face.

The documentary lead us into the world seeing from the eyes of these children: how they watch to their parents, to their classmate, it reflects the hope that they put on their doctors. Because of Dr. Ortiz Monasterio does not work alone. An interdisciplinary team of doctors of the highest level surrounds him. Likewise, we can meet the worldwide known Dr. Kenneth Salyer, founder of the World Craniofacial Foundation, and other specialists of extraordinarily high level dedicated themselves body and soul. All of them are developing an exemplary task in a city with a bad reputation in other places of the world.

With so many negatives news, so many interests broadcast by the media, to proposals that some people recommend as “the final solution” to these patients, the loss of confidence or discredit to the medical profession, what we see, what we experience with this film gives us hope not only in this gentle exercise career, but in the same human being. Be immense pride in being a medical professional to examples like this: medical training, study, teamwork, humanity to the patient, not to spare resources, but not stopped in the lack of them, have faith and love in the task in hand.

“Beautiful Faces” brings hope in this profession, if someone had lost it. It is a marvellous Russell Martin and Alvera de León’s production.

Members of UNESCO Chair on Bioethics and Human Rights are extremely proud of sponsoring this project. On 26, July, the “Say Yes Quickly Productions” made ​​its world premiere at the Universidad Nacional Autónoma de México. Constituted a birthday gift, because that day met Dr Ortiz Monasterio 94.

Reconstructive Surgery Service, at Hospital General Dr. Manuel Gea Gonzalez, began about forty years. That is, at the time he was fifty-four years. At this age, society rejected many people, and they are unable to find work. Many companies and institutions feel they can not contribute anything new. This Department of Surgery is an example of what can be achieved when there is love in task, conviction for an ideal, ability to inspire others, professionalism and a strong and true love for one’s fellows, but pain and suffering are there.

A concrete example of these noble ideals that the world so desperately needs today.