The Neuroethics of Biomarkers: What the Development of Bioprediction Means for Moral Responsibility, Justice, and the Nature of Mental Disorder

The Neuroethics of Biomarkers: What the Development of Bioprediction Means for Moral Responsibility, Justice, and the Nature of Mental Disorder

The Neuroethics of Biomarkers: What the Development of Bioprediction Means for Moral Responsibility, Justice, and the Nature of Mental Disorder

The Neuroethics of Biomarkers: What the Development of Bioprediction Means for Moral Responsibility, Justice, and the Nature of Mental Disorder

Synopsis

Neuroscientists are mining nucleic acids, blood, saliva, and brain images in hopes of uncovering biomarkers that could help estimate risk of brain disorders like psychosis and dementia; though the science of bioprediction is young, its prospects are unearthing controversy about how bioprediction should enter hospitals, courtrooms, or state houses. While medicine, law, and policy have established protocols for how presence of disorders should change what we owe each other or who we blame, they have no stock answers for the probabilities that bioprediction offers. The Neuroethics of Biomarkers observes, however, that for many disorders, what we really care about is not their presence per se, but certain risks that they carry. The current reliance of moral and legal structures on a categorical concept of disorder (sick verses well), therefore, obscures difficult questions about what types and magnitudes of probabilities matter. Baum argues that progress in the neuroethics of biomarkers requires the rejection of the binary concept of disorder in favor of a probabilistic one based on biological variation with risk of harm, which Baum names a "Probability Dysfunction." This risk-reorientation clarifies practical ethical issues surrounding the definition of mental disorder in the DSM-5 and the nosology of conditions defined by risk of psychosis and dementia. Baum also challenges the principle that the acceptability of bioprediction should depend primarily on whether it is medically useful by arguing that biomarkers can also be morally useful through enabling moral agency, better assessment of legal responsibility, and fairer distributive justice. The Neuroethics of Biomarkers should be of interest to those within neuroethics, medical ethics, and the philosophy of psychiatry.

Excerpt

“See, it shakes a little,” he said, holding out his hand. The man’s fingers circled in unison with his index finger rubbing repetitively against the soft underside of his thumb; a classic “pill-rolling tremor,” he went on to say. The man’s tremor was the only visible symptom of his new diagnosis of Parkinson’s disease. Parkinson’s disease is thought to be caused by the deterioration of a certain population of neurons that produce the neurotransmitter dopamine, and are important for the control of voluntary movement. These neurons are progressively lost from a specific area of the brain called the substantia nigra, which is named after the characteristically dark pigment that the high concentration of dopamine gives these neurons. Interestingly, the paradigmatic symptoms of the disorder —tremor, shaking arms, bobbing head, and slowness of voluntary movement—do not appear until the person has already lost over 80 percent of these key neurons (Nestler et al. 2009). Therefore, once a person’s symptoms can be diagnosed as Parkinson’s, this neuronal population is mostly dead, and treatment difficult.

Modern efforts in neuroscience are building an increasingly convincing case that many mental and neurological disorders, from this man’s Parkinson’s disease to mental retardation, schizophrenia, epilepsy, bipolar disorder, and Alzheimer’s disease, develop over time. In what is sometimes referred to as a molecular cascade (Boenink 2009), these disorders are often preceded by increasingly aberrant molecular and circuit-level changes that develop over weeks, months, years, and even decades, before the appearance of the recognizable clinical symptoms of the disorders. As a student of molecular biology studying these disorders, I became increasingly fascinated by the possibility that many of the disorders as we currently diagnose them might actually be severe end states rather than newly onset dysfunctions. The idea is that with many disorders we are arriving very late, as if to the scene of a car accident; maybe things could be different if we could find the equivalent of sticky brakes, overinflated tires, and busted headlights that increase the likelihood of a crash.

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