Disease or Developmental Disorder: Competing Perspectives on the Neuroscience of Addiction
AbstractLewis ’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction (BDMA) that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His view is consistent with epidemiological evidence of add icted individua...
Source: Neuroethics - January 31, 2017 Category: Medical Ethics Source Type: research
Views of Caregivers on the Ethics of Assistive Technology Used for Home Surveillance of People Living with Dementia
AbstractThis paper examines the ethics of using assistive technology such as video surveillance in the homes of people living with dementia. Ideation and concept elaboration around the introduction of a camera-based surveillance service in the homes of people with dementia, typically living alone, is explored. The paper reviews relevant literature on surveillance of people living with dementia, and summarises the findings from ideation and concept elaboration workshops, designed to capture the views of those involved in the care of people living with dementia at home. The research question relates to the ethical considerat...
Source: Neuroethics - January 23, 2017 Category: Medical Ethics Source Type: research
Threats to Neurosurgical Patients Posed by the Personal Identity Debate
AbstractDecisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal id...
Source: Neuroethics - January 20, 2017 Category: Medical Ethics Source Type: research
Does Kantian Ethics Condone Mood and Cognitive Enhancement?
AbstractThe author examines whether Kantian ethics would condone the use of pharmaceutical drugs to enhance one ’s moods and cognitive abilities. If key assumptions concerning safety and efficacy, non-addictiveness, non-coercion, and accessibility are not met, Kantian ethics would consider mood and cognitive enhancement to be impermissible. But what if these assumptions are granted? The arguments for the pe rmissibility of neuroenhancement are stronger than those against it. After giving a general account of Kantian ethical principles, the author argues that, when these assumptions are granted, Kantian ethics no longer j...
Source: Neuroethics - January 20, 2017 Category: Medical Ethics Source Type: research
Addiction Doesn ’t Exist, But it is Bad for You
AbstractThere is a debate about the nature of addiction, whether it is a result of brain damage, brain dysfunction, or normal brain changes that result from habit acquisition, and about whether it is a disease. I argue that the debate about whether addiction is a disease is much ado about nothing, since all parties agree it is “unquestionably destructive.” Furthermore, the term ‘addiction’ has disappeared from recent DSM’s in favor of a spectrum of ‘abuse’ disorders. This may be a good thing indicating more nuance in typing the heterogeneous phenomena we used to call ‘addiction’. (Source: Neuroethics)
Source: Neuroethics - January 16, 2017 Category: Medical Ethics Source Type: research
Addiction and the Brain: Development, Not Disease
AbstractI review the brain disease model of addiction promoted by medical, scientific, and clinical authorities in the US and elsewhere. I then show that the disease model is flawed because brain changes in addiction are similar to thosegenerally observed when recurrent, highly motivated goal seeking results in the development of deep habits, Pavlovian learning, and prefrontal disengagement. This analysis relies on concepts of self-organization, neuroplasticity, personality development, and delay discounting. It also highlights neural and behavioral parallels between substance addictions, behavioral addictions, normative c...
Source: Neuroethics - January 10, 2017 Category: Medical Ethics Source Type: research
Responsibility without Blame for Addiction
AbstractDrug use and drug addiction are severely stigmatised around the world. Marc Lewis does not frame his learning model of addiction as a choice model out of concern that to do so further encourages stigma and blame. Yet the evidence in support of a choice model is increasingly strong as well as consonant with core elements of his learning model. I offer aresponsibility without blame framework that derives from reflection on forms of clinical practice that support change and recovery in patients who cause harm to themselves and others. This framework can be used to interrogate our own attitudes and responses, so that w...
Source: Neuroethics - January 6, 2017 Category: Medical Ethics Source Type: research
Deep Brain Stimulation Through the “Lens of Agency”: Clarifying Threats to Personal Identity from Neurological Intervention
AbstractThis paper explores the impacts of neurological intervention on selfhood with reference to recipients ’ claims about changes to their self-understanding following Deep Brain Stimulation (DBS) for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken and occludes what is ethically salient in changes from DBS. ...
Source: Neuroethics - January 2, 2017 Category: Medical Ethics Source Type: research
Why Enhancing Autonomy Is Not a Question of Improving Single Aspects of Reasoning Abilities through Neuroenhancement
AbstractIn a recent paper, Schaefer et al. proposed to enhance autonomy via improving reasoning abilities through (genetic) cognitive enhancement [1]. While initially their idea additionally seems to elegantly avoid objections against genetic enhancements based on the value of autonomy, we want to draw attention to several problems their approach poses. First, we will show that it is not at all clear that safe and meaningful methods to genetically or pharmaceutically enhance cognition will be feasible any time soon. Second, we want to provide a deeper discussion of the role of cognition and reasoning abilities in philosoph...
Source: Neuroethics - January 2, 2017 Category: Medical Ethics Source Type: research
Addiction and the Concept of Disorder, Part 2: Is every Mental Disorder a Brain Disorder?
AbstractIn this two-part analysis, I analyze Marc Lewis ’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis’s critique of the brain ev idence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, I defended the view that addiction is a medical disorder and a brain disorder. In Part 2, I consider some ...
Source: Neuroethics - December 29, 2016 Category: Medical Ethics Source Type: research
Addiction and the Concept of Disorder, Part 1: Why Addiction is a Medical Disorder
AbstractIn this two-part analysis, I analyze Marc Lewis ’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity and learning in response to the intense rewards provided by addictive substa...
Source: Neuroethics - December 28, 2016 Category: Medical Ethics Source Type: research
Intertemporal Bargaining in Habit
AbstractLewis ascribes the stubborn persistence of addictions to habit, itself a normal process that does not imply lack of responsiveness to motivation. However, he suggests that more dynamic processes may be involved, for instance that “our recurrently focused brains inevitably self-organize.” Given hyperbolic delay discounting, a reward-seeking internal marketplace model describes two processes, also normal in themselves, that may give rise to the “deep attachment” to addictive activities that he describes: (1) People lea rn to interpret current choices as test cases for how they can expect to choose in the futu...
Source: Neuroethics - December 8, 2016 Category: Medical Ethics Source Type: research
Emerging Ethical Issues Related to the Use of Brain-Computer Interfaces for Patients with Total Locked-in Syndrome
AbstractNew brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome (total LIS), characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics committ...
Source: Neuroethics - December 7, 2016 Category: Medical Ethics Source Type: research
Psychopathy, Executive Functions, and Neuropsychological Data: a Response to Sifferd and Hirstein
AbstractKatrina Sifferd and William Hirstein, in their paper ‘On the criminal culpability of successful and unsuccessful psychopaths’, argue that neuropsychological data show that unsuccessful psychopaths have diminished mental capacities that warrant a partial or diminished responsibility defence. We respond that the currently available neuropsychologica l evidence does not warrant their conclusion that unsuccessful psychopaths should not be deemed completely legally responsible. Instead, we maintain that the current state of this type of research suggests that psychopaths might be suffering very specific cognitive im...
Source: Neuroethics - December 5, 2016 Category: Medical Ethics Source Type: research
Squaring the Circle: Addiction, Disease and Learning
AbstractThe history of ideas about addiction often comes down to a history of debates over the use and meaning of language (Levine et al. Journal of Studies on Alcohol 15:493–506, 1978). Nowhere is this more clear than in the interminable “Is addiction a ‘disease’?” debate. In Marc Lewis’ excellentBiology of Desire and in his paper that centers this issue, there is far more agreement between his work and mine than there is disagreement on the “disease” question. Here, however, I make a case for greater compatibility between the “disease” view and learning models of addiction than Lewis does, because...
Source: Neuroethics - December 2, 2016 Category: Medical Ethics Source Type: research
