Neuroethics: Moral Implications of Meddling With the Mind
By Christina M.H. Powell
Advances in neuroscience will expand our knowledge of the brain in the 21st century in much the same way that our knowledge of genetics was expanded at the end of the 20th century. While these scientific discoveries are complex, the results of these discoveries will profoundly impact our medical care, our criminal justice system, and our society’s receptiveness to spiritual truth.
Results of neuroscience research also influence ministry today as pastors counsel increasing numbers of people who are taking medications to improve their thought processes or stabilize their moods. Pastors and chaplains who are ministering to families facing difficult end-of-life decisions quickly learn how determining different levels of consciousness impacts patient care. Pastors and evangelists must also combat the materialistic view of life prevalent in our culture from the pulpit. To prepare you to address these issues in your ministry, I will examine four issues in neuroethics to discern the moral implications that arise from meddling with the mind.
Medicating the Mind
Scientists have developed medications to increase attention span and improve memory for people suffering from attention deficit disorder or Alzheimer’s disease. Similarly, scientists have designed medications to treat debilitating emotional problems by stabilizing a person’s mood. One question that arises from the development of these medications is whether these pills can also improve thinking and elevate mood in healthy people.
On college campuses, healthy students are looking to answer this question when they attempt to increase their concentration and alertness when studying for final exams by using drugs developed for people who have attention deficit disorder. Students often obtain these smart drugs from friends who have a legitimate prescription. Is such a practice ethical and appropriate?
The first problem with using these drugs in healthy people is the danger of potential side effects. Researchers do not know how safe these drugs are for healthy people or the potential for damage to their nervous system.
The brain is a complex system. Prolonged use of these drugs could result in unanticipated problems. A medication that repairs the effects of a biochemical imbalance in a person with a certain psychological condition may cause an imbalance when used by a healthy person. For example, a drug that improves attention in people who have ADD can occasionally cause manic symptoms in people with no prior history of bipolar disorder.
The second problem is social. The use of performance enhancers creates an unfair advantage for those with access to the drugs. In addition, when some people use performance enhancers, others feel pressured to use them as well to stay competitive. The use of performance-enhancing drugs in sports has demonstrated this. People in the workplace could feel pressured to enhance their mood or decrease their need for sleep to remain competitive with co-workers.
Finally, technology, such as the use of drugs to improve study habits, ultimately short-circuits the development of skills and character that is a vital part of the educational process. Mood enhancement raises concerns about maintaining personal authenticity. Do we become someone other than our true self when we artificially regulate our moods?
Another question that arises from the development of medicines for the mind is whether these pills supplement or supplant personal growth. A related question — especially relevant for ministers to consider — is whether, in certain cases, doctors are prescribing medications in an attempt to fill a spiritual void in a person’s life. While medications for the mind may be life saving in some situations, one wonders if, in other cases, taking psychoactive drugs to help people overcome the emotional hurdles in their lives is simply an expedient choice — for both patient and caregiver — but not necessarily the best choice for long-term resolution of challenging life issues. In any case, the use of psychoactive drugs to treat the biological aspects of a person’s behavior does not negate their need for pastoral care. Pastors have an obligation to meet the spiritual needs of a person who is experiencing the stress of coping with mental illness.
One practical consideration, given the increasing numbers of people who are taking medications for their minds, is to consider the effects of these medications in ministry settings. For example, a person whose behavior suddenly changes may have stopped taking prescribed medications. When a person with bipolar disorder experiences a period of elevated mood, he may exhibit erratic behavior, sleep problems, rapid speech, and a sense of being chosen for a special mission. A pastor counseling a person with a recent unexplained change in behavior needs to consider gently asking the person whether he is taking any medications now or has in the past.
When discussing medication in counseling sessions, a pastor must avoid assuming the place of a doctor or undermining a doctor’s advice. For some behavioral conditions, alternatives to taking medications exist. While a pastor can help a person work through his feelings about medications, any decision to stop taking medication is one a counselee must make in conjunction with his doctor. A person should not suddenly stop taking most psychoactive medications; instead, he must gradually decrease doses to avoid unwanted side effects.
Pastors can work to reduce the stigma associated with mental illness. This will help make it possible for people struggling with mental health issues to receive the ministry they need. Mental illnesses, such as clinical depression, have a genuine biological component. A pastor should not view this condition as a sign of spiritual failure. Pastors can incorporate illustrations reflecting emotional struggles in sermons, promote compassion toward those suffering from these struggles, and send the message that seeking help for mental and emotional problems is not only appropriate, but also commendable.
Viewing the Mind Materialistically
Research in neuroscience will result in more than just new treatments for psychiatric problems. Neuroscience discoveries will shape how society views the spiritual aspect of humanity. As neuroscience research begins to offer biological explanations for personality traits, human behavior, emotions, perception of reality, decision-making ability and even sense of spirituality, people will question the existence of an immortal soul. As a result, pastors will need to help people look beyond a materialistic view of the mind to recognize the reality of their spiritual needs.
Does the existence of a biological basis for many aspects of human behavior mean scientists have disproven the concept of a human soul? To answer this question, consider whether the existence of a soul is an appropriate topic for science to address.
Science operates by reducing complex problems into hypotheses that scientists can either verify or falsify through experimentation. Scientists then conduct experiments to analyze parts of a system with the hope that they will better understand the whole system. However, complete understanding of the whole from understanding individual parts is rarely possible, because the whole is usually more than just the sum of its parts.
Consider the classic calculation of lines of communication within a small-group ministry setting. In a small group with five members, if every member is able to communicate with every other member, there will be 10 possible lines of communication between group members. If you double the number of group members to 10, however, the number of lines of communication increases to 45. Doubling the group size more than quadruples the lines of communication.
In scientific studies, the same principle is at work. Possible combinations of individual parts explode exponentially as systems increase in complexity.
Living systems are highly complex. The brain, with its estimated 100 billion neurons, is an example of such biological complexity. Consider that the brain of a 3-year-old child is estimated to have about 1 quadrillion synaptic connections (lines of communication between neurons). Neuroscience may be poised to help us better understand brain function, but the question of the existence of an eternal soul is outside the scope of scientific inquiry.
Humans are much more than just the sum of their biological parts. Even a thorough understanding of how individual parts function does not rule out the existence of a soul. This involves a level of complexity beyond the workings of the physical brain.
Placing Blame on the Brain
Along with the existence of a soul, neuroscience findings suggesting that physical causes determine behavior challenge the ideas of free will and moral agency. We base our legal systems on the premise that a person is responsible for his choices and actions, not merely a victim of a chain of neurological events outside his control. Nevertheless, evidence that an offender has sustained damage to brain structures involved in impulse control may influence a judge’s decision, especially when determining the penalty for the crime committed. The extent of an offender’s punishment often depends on the extent of his responsibility for his own actions.
Cognitive neuroscience has identified brain systems that are involved in several psychological abilities required for positive social behavior. One example is the importance of the prefrontal cortex in the ability to weigh uncertain risks and make wise choices. Impairment in decisionmaking and willingness to risk negative consequences might predispose a person to criminal behavior.
Not all brain damage is a result of obvious brain injury. For example, researchers have linked the use of many illegal drugs to gradual impairment of prefrontal function. Childhood abuse and neglect can also affect the development of brain areas and integration between cerebral hemispheres. Thus, determining the extent to which brain impairment has affected a person’s behavior, thereby reducing his culpability, is difficult.
While understanding the physiological nature of a person’s behavior can increase our compassion for people who have made poor choices, we must exercise caution in placing blame entirely on the brain. A predisposition for a behavior does not mean that a person has lost all ability to choose between good and evil. We must be careful that people do not feel powerless to make positive behavioral choices. A key component of the gospel is that each person has the power to make a decision, choosing eternal life through Christ and turning from sin.
Evaluating Levels of Consciousness
Another area of neuroscience research that has ethical implications is the development of new technologies to help doctors determine whether a patient who cannot communicate is aware of his surroundings. Brain-damaged patients who are aware of their surroundings require different levels of care from patients who are in a vegetative state. Thus, determining the level of consciousness of a brain-damaged patient is an ethically important medical question. Understanding whether a patient can hear and understand the bedside conversations of his family and pastor during hospital visitation has ministry implications as well.
As severely brain-damaged patients emerge from a coma, they may enter varying levels of consciousness. One such level is a persistent vegetative state, characterized by the absence of awareness of the environment. Another level is the minimally conscious state in which doctors can observe certain behavioral evidence of consciousness, such as the ability to follow simple commands or to indicate a yes/no response through sounds or gestures. The locked-in syndrome is a third possible level. Patients who have locked-in syndrome are alert and aware of their environment but unable to move or communicate beyond blinking or moving their eyes vertically because of complete paralysis of nearly all voluntary muscles in the body.
Interpreting a patient’s behavior alone provides an imperfect measure of a patient’s mental state, since other neurological damage may complicate the interpretation. Doctors are now using functional brain imaging as an additional means of evaluating levels of consciousness. Some studies using functional magnetic resonance imaging have uncovered a surprising level of thinking ability in patients whose behavior is consistent with persistent vegetative state or minimally conscious state. For example, researchers asked a woman in a vegetative state to imagine playing tennis. Using fMRI, they detected activity in the area of her brain that activates when a person thinks about normal subjects, such as playing tennis. Her ability to activate these regions of her brain and to cooperate with researchers by imagining particular tasks when asked to do so demonstrated a conscious awareness of herself and her environment.
The implication of this research for pastoral care is the realization that we still have much to learn regarding levels of consciousness in brain-damaged patients. Pastors would do well to treat all patients as if they were aware of their surroundings. When at patients’ bedsides, speak to them and pray with them as if they can understand you.
Do not make comments to the family in the presence of the patient that would be upsetting to the patient if he could hear your words. No harm comes from erring on the side of caution and assuming that the patient has a higher level of consciousness than he may possess. The patient, however, could experience great distress should he hear a conversation that assumes he is unaware of his surroundings when, in fact, he can understand every word.
Providing a Biblical Perspective
What do these developments in neuroscience mean for ministers? A pastor can provide a biblical perspective to people encountering this technology in their lives. Medications and technologies that treat psychological and emotional difficulties do not negate the need for pastoral counseling to address the patient’s spiritual needs. In the face of a materialistic deterministic worldview, a pastor can uphold the concept of personal responsibility, value science while reminding parishioners of its limitations, and promote discernment and the importance of informed consent for those facing difficult medical decisions. Finally, ministers must endeavor to connect people with the One who can transform them by the renewing of their minds (Romans 12:2) in ways beyond the reach of even the most ambitious neuroscience research.