The Bioethics of Neuroimaging in Law

As an emergent discipline of the legal field, neurolaw is becoming more salient as imaging technologies such as fMRIs and PET scans are finding application in the courtroom. Neuroimaging has been standard use in hospitals and clinics for decades, but its use in legal decisions is a relatively recent advancement in the intersection of law and neuroscience. Neuroimaging techniques are not infallible, especially when their interpretation serves as a piece of evidence regarding the culpability of a defendant in a criminal trial. Neuroimaging has come to the fore of debate due to its increasing use as evidence in criminal trials by plaintiffs and defendants. Additionally, studies show that exposure to neuroscience explanations in a legal setting—specifically, neuroimaging—can influence perceptions and decision-making, making many legal practitioners and scientists wary of the ability of judges and juries, who lack neuroscience training, to understand, interpret, and weigh the information presented. Until the bar council and medical board can bridge their respective disciplines with a set of standard protocols and informed interpretation of scientific instruments, neurolaw is at a standstill.

While the evidentiary utility of neuroimaging in court is contested, there is potential for the further development of neuroimaging as an indicator of criminal culpability in the future. The application of neuroimaging begs several questions. Neuroimaging cannot determine causation, only correlation. In a criminal case, what is in question is the mental state of the defendant at the time the alleged crime was committed (mens rea); neuroimaging cannot tell us this, but it can give insight into the loci of activation associated with disordered behavior, leaving significant room for interpretation on other legal decisions regarding criminality.

The legal system maintains a hardline stance on the age of majority (18), for example. If neuroimaging continues to advance and become more reliable in court, how might it be used in cases where this instrumentation indicates that a 14-year-old with a brain like a 19-year-old ought to be tried as an adult or a 19-year-old with the brain of a 14-year-old ought to be tried as a juvenile. The lines quickly blur in this hypothetical situation. What’s more, are people of means advantaged by a potential buttress in the form of neuroimaging? As neuroscientists continue to uncover more about the functionality and structure of the brain, they also develop more precise instrumentation. Undoubtedly, the use of neuroimaging will garner further attention from the public eye, with wide-reaching ethical and legal implications for the future. (by AB and CP)

Bibliography

Alda A. 2013. Brains on trial. PBS. The Chedd Angier Company.

BrainFacts.org. 2008. Neurolaw: Neuroscience in the courtroom. BrainFacts/SfN.

Ed Thomas Law - Iowa Code Section 229.22. 2010. Iowa Department of Public Safety.

Klein, Ann. 2016. My Son Killed the Town Hero.

Kuersten A. 2015. Opinion: Brain scans in the courtroom. TheScientist.

N’Diaye M. 2018. How much neuroscience is actually allowed in the courtroom? Seeker.

The Mental Insanity Plea

Mental insanity, as referred to as a plea in the courtroom, is a legal term rather than a medical term. Three laws regulate who is capable of using the insanity plea: the M’Naghten law states that a person must be unaware that their actions are incorrect, the Durham law states that if the crime is a product of their mental illness they can utilize the insanity plea, and the Model Penal Code Rule states that at the time of the crime they lacked capacity to decide if their actions are right or wrong as a result of their mental disease. Each of these laws can be used independently and each state dictates which law is to be used in the courtroom. While these laws are very precise, it is rather difficult to regulate insanity via these laws due to the nature of mental illness.

When a person using the insanity plea is acquitted, the person will then be placed into a psychiatric ward rather than the prison system as an alternative consequence. Often the sentence to the ward is longer than a prison sentence for the same crime. Failure to win the insanity plea results in the person ending up in prison, and therefore their mental illness not being treated. This leads to the flaws in both the mental health and prison systems.

Many that support the mental insanity plea do so because they believe that punishing the insane is wrong from a moral standpoint because they cannot be held responsible for a crime if they were not aware of the circumstances. Supporters often believe that the mentally ill should receive treatment at the psychiatric ward rather than simply being put into the prison system. While placement into the psychiatric ward is appealing due to treating the mental illness, this does not punish the individual in ways that some opposers of the insanity plea believe they should be. Some of the worry that opposers have is that individuals can be provided a loophole to account for their actions while they are perfectly sane. The psychiatric ward is not effective at isolating the individuals who are able to utilize this loophole, creating uncertainty in the opposers of the plea.

Media plays a large role in the understanding of the insanity plea to the public. It portrays the insanity plea as popular when in reality it accounts for less than 1 percent of all felony court cases. Popular opinion about the insanity plea is swayed by the media portrayal of current cases, fictional and nonfictional. This plays a large part in whether or not the public supports the usage of the insanity plea.

Overall there are pros and cons of the insanity plea. It is hard to decide who should and should not be able to utilize this claim due to the inadequate laws and non-standard procedures. Media’s representation of the insanity plea hinders the overall ability of this claim to be used in court cases. Currently there is no distinct way to identify someone as insane; therefore, research needs to be completed to create concrete evidence that would support a person pleading mentally insane. (by SN and BH)

Quick References

NowThisWorld. 2015. Does pleading insanity work [video]. Youtube. 

VanDercar AH, Resnick PJ. 2018. The insanity defense: Historicalprecedent and modern application. Psychiatric Annals. 48(2): 95-101. (full text not available without subscription)

Yoong G [internet]. 2012. Top 10 Most Notorious Insanity Defense Cases. Listverse. [updated 2012 Apr 11, cited 2019 Mar 26].        

Pain and Biases in Treating It

Today in class we discussed pain. We talked about racial biases and perceptions of pain. Specifically, we talked about how this effects the health field. Although no one believed themselves to be free of biases, it was interesting to talk about some common misconceptions, and how we should go about making the healthcare industry and professionals free from or at least aware of these biases. Along with race we discussed the topic of age. It was interesting how through an activity, when asked to agree/disagree with a statement that many in the class felt that they would not consent to piercing their infant’s ears, but did reveal that they would consent to a male infant circumcision procedure. We talked about the history of pain perception and how this might still effect parent’s decisions about painful procedures and in turn perhaps how that could be life-altering for the child. The ethics of prescribing pain medication and consenting to pain-inducing procedures were topics of discussion. To read additional stories on racial disparities, circumcision, and to view the original studies in which we talked about in class, click on the links below. (by DT and SB)

Studies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402596/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

Additional Resources

http://www.cirp.org/library/pain/anand/

https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why

https://www.healthline.com/health/circumcision#procedure

https://www.psychologytoday.com/us/blog/moral-landscapes/201501/circumcision-s-psychological-damage

Ethics behind transplants and organ donations

Organ donation is a topic that has gotten a lot of coverage over the years and there have been many controversial conversations that have commenced when talking about the ethics behind organ donation. Our ethics topic looked specifically at monetary compensation for body products, and the future of donations as science progresses. Current policies dictating when someone can become an organ donor can be based on an “opt-in” or an “opt-out” principal. These “opt- in, opt-out” policies apply to major organs such as the heart and the liver. The choice of whether or not one is classified as an organ donor is something that causes others to think about their perception of what they think the norm is when it comes to organ donation and how that may affect their choice when choosing if they will become an organ donor. In some states, if you do not specifically state “yes” or “no” to being an organ donor you are automatically opted into the classification of being an organ donor.

Compensation for bodily donations is currently allowed for plasma, sperm, eggs, and more recently bone marrow. Although people are not currently able to be compensated for organs, payment for bone marrow may commence a trend in that direction. It is important to bear in mind the risks that could be associated with this, including unintentionally targeting low-income groups or jeopardizing the safety of the supplies as people may not be truthful about medical backgrounds. We must ensure people are educated about the risks, benefits, and processes of organ donation as policies and procedures continue to change. (by AG and NG)

CRISPR Cas9 and Designer Babies: How Far is too Far?

            A very new, exciting, and controversial topic is gaining attention all over the world. Genome editing is possible with the use of CRISPR Cas9, a genome editing tool that allows addition, removal, and alteration of DNA segments within a genome. CRISPR is a segment of DNA with short repeats of base sequences, derived from prokaryotic organisms which use CRISPR in their defense against viruses. Cas9 is an enzyme that cuts a specific segment of double-stranded DNA within a genome, allowing addition or removal of DNA. It is currently the cheapest, most convenient, most versatile, and precise way of gene manipulation.

China and the United States are the only two places in the world that are currently performing human trials for genome editing. There are many restrictions as to what these human trials can entail, and scientists are looking into future implications of genome editing in humans. In the future, CRISPR Cas9 could be used for getting rid of diseases, creating designer babies, allowing eternal youth, and aiding in infertility. Genome editing could eventually change the entire human gene pool if there aren’t any regulations of what people are able to change about themselves or their children. When discovering the power of genome editing and its implications, we must determine what is right from wrong. We must ask ourselves, at what point is genome editing not necessary or ethical? The real question is, “How far is too far when it comes to genome editing?” (by RB and CA)

Sources

CRISPR Cas9. 

What Could CRISPR Do Tomorrow?

As Claims of CRISPR Use in First Gene-Edited Babies Emerge, Scientists and Ethicists Respond. 

Stigma Associated with Mental Health and Personality Change

            With the rate of mental illness on the rise, it is impacting the lives of people across the world. According to the American Psychiatric Association, nearly 1 in 5 U.S. adults experience some form of mental illness. People who suffer from mental illnesses, though, are typically shunned, ridiculed, or shamed. This creates a barrier, and prevents proper treatment for people suffering from mental illness. Breaking down this barrier could result in better treatment by implementing routine screenings and interventions to expose predispositions and treat the individual before the disease progresses. The American Psychiatric Association claims that mental illness is treatable, and the vast majority of individuals can continue to function in their daily lives. To end this stigma towards mental illness, we must recognize mental illness for what it is, an illness that can be treated.

            The connection between personality and mental illness is becoming more and more prevalent with the increased research in the area of mental health and treatment. It is sometimes difficult to define where one’s illness stops and personality begins, so researchers look more at individual personality traits such as neuroticism and introversion. Chi-Hua Chen and colleagues (2017) found that characteristics such as these have been linked to a possible development of a disorder later in life. Personality has a genetic component, with the environment influencing how people learn how to recognize and cope with their behaviors.

There has been a lot of debate over how to treat mental illnesses. How much is too much? Is it ethical or good to change one’s personality? This can be applied even further with personality tests that have become commonplace in order to apply for a job. The applications of mental health research go beyond the treatment of a patient and extend into many aspects of their lives and the lives of those around them. It’s important that mental health is destigmatized so we can have a better understanding of those affected and that we discuss the ethics surrounding the treatment of those with mental illness. (by HW and NB)

Sources for more exploration:

Esposito L.  2017.  Personality and Mental Illness: What's the Link?  US News and World Report.  

Liberman J.  2016.  Imagine There Was No Stigmato Mental Illness. TEDxCharlottesville. 

Foundations Recovery Network.  2019.  History of Mental Health Treatments 1800’s-2000’s. 

Clinical Trials in the 21st Century: Adequate Representation and Ethical Funding

The Federal Drug Administration (FDA) is responsible for the approval and regulation of various medical drugs and treatments. Before the FDA approves a drug or treatment, it must go pass a series of phases during the clinical trial. Phase I of the clinical trial process uses a small, healthy group of human subjects to determine safe doses. Phase II experiments divide participants with the disease or condition into control and experimental groups to determine if the drug or treatment is more beneficial than no treatment.  Phase III trials are large-scale and aim to confirm external validity and to monitor adverse side effects. Phase IV has the largest sample size and is the final phase of the process. Only after this extensive clinical research will a drug be available in the pharmaceutical market. While the clinical trial process is highly regulated and relatively thorough, ethical concerns arise when considering aspects such as source of funding, participation of minority racial groups, and compensation for participation.

One ethical concern for clinical trials is the source of funding for the experiment. The pharmaceutical industry provides funding to conduct clinical research, but because many clinical trials are published after Phase III is complete, financial conflicts of interests during the clinical trial process are not clearly revealed. The public may have reason to be weary of privately-funded or industry-funded research, considering the industry’s benefit when drugs get to market.

Compensation is a tool used for participant recruitment for clinical trials. Under current regulations, disclosure of the monetary value of compensation is not required. Individuals with low socioeconomic status are often recruited for Phase I trials by means of compensation. Some research has indicated that people of low socioeconomic status from minority groups are over-represented in Phase I experiments but underrepresented in later phases, possibly because these individuals are utilizing compensation as a means of income.

There is also reason to be concerned that samples in clinical research do not accurately reflect the population. While minority groups are under-represented in the later phases of the trial process, it is difficult to ethically recruit people of ethnic minorities if they have low socioeconomic status or poor education. Additionally, in 2016, the FDA reported that during 2011-2015, 42% of participants in Phase II and III trials worldwide were residing in the United States, reflecting a possible lack of global external validity for the treatment in question. In addition, globally, males participate in clinical trial research at higher rates than females. Even with compensation for participants, clinical trials are not always indicative of the diversity within the general population. (by AP and BH)

Additional Readings:

Global Participation in Clinical Trials Report. Federal Drug Administration (FDA). 2017.

First do harm. Walter M. 2012. Nature. 482:148-152. This article highlights the unethical Tuskegee and Guatemalan syphilis experiments.