[Paleopsych] NYTBR: 'The Ethical Brain': Mind Over Gray Matter

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'The Ethical Brain': Mind Over Gray Matter
New York Times Book Review, 5.6.19
[First chapter appended.]

By Michael S. Gazzaniga.
201 pp. Dana Press. $25.


    TOM WOLFE was so taken with Michael S. Gazzaniga's ''Social Brain''
    that not only did he send Gazzaniga a note calling it the best book on
    the brain ever written, he had Charlotte Simmons's Nobel Prize-winning
    neuroscience professor recommend it in class. In ''The Ethical
    Brain,'' Gazzaniga tries to make the leap from neuroscience to
    neuroethics and address moral predicaments raised by developments in
    brain science. The result is stimulating, very readable and at its
    most edifying when it sticks to science.

    As director of the Center of Cognitive Neuroscience at Dartmouth
    College and indefatigable author of five previous books on the brain
    for the general reader alone, Gazzaniga is less interested in
    delivering verdicts on bioethical quandries -- should we clone? tinker
    with our babies' I.Q.? -- than in untangling how we arrive at moral
    and ethical judgments in the first place.

    Take the issue of raising intelligence by manipulating genes in
    test-tube embryos. Gazzaniga asks three questions. Is it technically
    possible to pick out ''intelligence genes''? If so, do those genes
    alone determine intelligence? And finally, is this kind of
    manipulation ethical? ''Most people jump to debate the final
    question,'' he rightly laments, ''without considering the implications
    of the answers to the first two.'' Gazzaniga's view is that someday it
    will be possible to tweak personality and intelligence through genetic
    manipulation. But because personhood is so significantly affected by
    factors like peer influence and chance, which scientists can't
    control, we won't be able to make ''designer babies,'' nor, he
    believes, will we want to.

    Or consider what a ''smart pill'' might do to old-fashioned sweat and
    toil. Gazzaniga isn't especially worried. Neither a smart pill nor
    genetic manipulation will get you off the hook: enhancement might
    enable you to grasp connections more easily; still, the fact remains
    that ''becoming an expert athlete or musician takes hours of practice
    no matter what else you bring to the task.''

    But there are ''public, social'' implications. Imagine basketball
    stars whose shoes bear the logo not of Nike or Adidas but of Wyeth or
    Hoffman-La Roche, ''touting the benefits of their neuroenhancing
    drugs.'' ''If we allow physical enhancements,'' Gazzaniga argues,
    ''some kind of pharmaceutical arms race would ensue and the whole
    logic of competition would be neutralized.'' Gazzinga has no doubt
    that ''neuroscience will figure out how to tamper'' with neurochemical
    and genetic processes. But, he says, ''I remain convinced that
    enhancers that improve motor skills are cheating, while those that
    help you remember where you put your car keys are fine.''

    So where, as Gazzaniga asks, ''do the hard-and-fast facts of
    neuroscience end, and where does ethics begin?'' In a chapter aptly
    called ''My Brain Made Me Do It,'' Gazzaniga puts the reader in the
    jury box in the case of a hypothetical Harry and ''a horrible event.''
    This reader confesses impatience with illuminated brain scans
    routinely used to show that people ''addicted'' to drugs -- or food,
    sex, the Internet, gambling -- have no control over their behavior.
    Refreshingly, Gazzaniga declares ''the view of human behavior offered
    by neuroscience is simply at odds with this idea.''

    ''Just as optometrists can tell us how much vision a person has (20/20
    or 20/40 or 20/200) but cannot tell us when someone is legally
    blind,'' he continues, ''brain scientists might be able to tell us
    what someone's mental state or brain condition is but cannot tell us
    (without being arbitrary) when someone has too little control to be
    held responsible.''

    Last year, when the United States Supreme Court heard arguments
    against the death penalty for juveniles, the American Medical
    Association and other health groups, including psychiatrists and
    psychologists, filed briefs arguing that children should not be
    treated as adults under the law because in normal brain development
    the frontal lobe -- the region of the brain that helps curb impulses
    and conduct moral reasoning -- of an adolescent is still immature.
    ''Neuroscientists should stay in the lab and let lawyers stay in the
    courtroom,'' Gazzangia writes.

    Moving on to the provocative concept of ''brain privacy,'' Gazzaniga
    describes brain fingerprinting -- identifying brain patterns
    associated with lying -- and cautions that just like conventional
    polygraph tests, these ''much more complex tests . . . are fraught
    with uncertainties.'' He also provides perspective on the so-called
    bias tests increasingly used in social science and the law, like one
    recently described in a Washington Post Magazine article. Subjects
    were asked to pair images of black faces with positive or negative
    words (''wonderful,'' ''nasty''); if they pressed a computer key to
    pair the black face with a positive word several milliseconds more
    slowly than they paired it with a negative word, bias was supposed.
    The unfortunate headline: ''See No Bias: Many Americans believe they
    are not prejudiced. Now a new test provides powerful evidence that a
    majority of us really are. Assuming we accept the results, what can we
    do about it?''

    Nonsense, Gazzaniga would say. Human brains make categories based on
    prior experience or cultural assumptions. This is not sinister, it is
    normal brain function -- and when experience or assumptions change,
    response patterns change. ''It appears that a process in the brain
    makes it likely that people will categorize others on the basis of
    race,'' he writes. ''Yet this is not the same thing as being racist.''
    Nor have split-second reactions like these been convincingly linked to
    discrimination in the real world. ''Brains are automatic,
    rule-governed, determined devices, while people are personally
    responsible agents,'' Gazzaniga says. ''Just as traffic is what
    happens when physically determined cars interact, responsibility is
    what happens when people interact.''

    Clearly, Gazzaniga is not a member of the handwringer school, like
    some of his fellow members of the President's Council on Bioethics. At
    the same time, his faith in our ability to regulate ourselves is
    touching. He notes that sex selection appears to be producing
    alarmingly unbalanced ratios of men to women in many countries.
    ''Tampering with the evolved human fabric is playing with fire,'' he
    writes. ''Yet I also firmly believe we can handle it. . . . We humans
    are good at adapting to what works, what is good and beneficial, and,
    in the end, jettisoning the unwise.''

    Gazzaniga looks to the day when neuroethics can derive ''a brain-based
    philosophy of life.'' But ''The Ethical Brain'' does not always make
    clear how understanding brain mechanisms can help us deal with hard
    questions like the status of the embryo or the virtues of prolonging
    life well over 100 years. And occasionally the book reads as if
    technical detail has been sacrificed for brevity.

    A final, speculative section, ''The Nature of Moral Beliefs and the
    Concept of Universal Ethics,'' explores whether there is ''an innate
    human moral sense.'' The theories of evolutionary psychology point
    out, Gazzaniga notes, that ''moral reasoning is good for human
    survival,'' and social science has concluded that human societies
    almost universally share rules against incest and murder while valuing
    family loyalty and truth telling. ''We must commit ourselves to the
    view that a universal ethics is possible,'' he concludes. But is such
    a commitment important if, as his discussion suggests, we are guided
    by a universal moral compass?

    Still, ''The Ethical Brain'' provides us with cautions -- prominent
    among them that ''neuroscience will never find the brain correlate of
    responsibility, because that is something we ascribe to humans -- to
    people -- not to brains. It is a moral value we demand of our fellow,
    rule-following human beings.'' This statement -- coming as it does
    from so eminent a neuroscientist -- is a cultural contribution in

    Sally Satel is a psychiatrist and resident scholar at the American
    Enterprise Institute and a co-author of ''One Nation Under Therapy:
    How the Helping Culture Is Eroding Self-Reliance.''


First chapter of 'The Ethical Brain'


    Conferring Moral Status on an Embryo

    Central to many of the bioethical issues of our time is the question,
    When should society confer moral status on an embryo? When should we
    call an embryo or a fetus one of us? The fertilized egg represents the
    starting point for the soon-to-be dividing entity that will grow into
    a fetus and finally into a baby. It is a given that a fertilized egg
    is the beginning of the life of an individual. It is also a given that
    it is not the beginning of life, since both the egg and the sperm,
    prior to uniting, represent life just as any living plant or creature
    represents life. Yet is it right to attribute the same moral status to
    that human embryo that one attributes to a newborn baby or, for that
    matter, to any living human? Bioethicists continue to wrestle with the
    question. The implications of determining the beginning of moral
    status are far-reaching, affecting abortion, in vitro fertilization,
    biomedical cloning, and stem cell research. The rational world is
    waiting for resolution of this debate.

    This issue shows us how the field of neuroethics goes beyond that of
    classic bioethics. When ethical dilemmas involve the nervous system,
    either directly or indirectly, those trained in the field of
    neuroscience have something to say. They can peek under the lid, as it
    were, and help all of us to understand what the actual biological
    state is and is not. Is a brain present? Is it functioning in any
    meaningful way?

    Neuroscientists study the organ that makes us uniquely human-the
    brain, that which enables a conscious life. They are constantly
    seeking knowledge about what areas of the brain sustain mental
    thought, parts of mental thought, or no thought. So at first glance,
    it might seem that neuroethicists could determine the moral status of
    an embryo or fetus based on the presence of the sort of biological
    material that can support mental life and the sort that cannot-in
    other words, whether the embryo has a brain that functions at a level
    that supports mental activity. Modern brain science is prepared to
    answer this question, but while the neurobiology may be clear,
    neuroethics runs into problems when it tries to impose rational,
    scientific facts on moral and ethical issues.

    The Path to Conscious Life

    As soon as sperm meets egg, the embryo begins its mission: divide and
    differentiate, divide and differentiate, divide and differentiate. The
    embryo starts out as the melding of these two cells and must
    eventually become the approximately 50 trillion cells that make up the
    human organism. There is no time to lose-after only a few hours, three
    distinct areas of the embryo are apparent. These areas become the
    endoderm, mesoderm, and ectoderm, the initial three layers of cells
    that will differentiate to become all the organs and components of the
    human body. The layer of the ectoderm gives rise to the nervous

    As the embryo continues to grow in the coming weeks, the base of the
    portion of the embryo called the neural tube eventually gives rise to
    neurons and other cells of the central nervous system, while an
    adjacent portion of the embryo called the neural crest eventually
    becomes cells of the peripheral nervous system (the nerves outside the
    brain and spinal cord). The cavity of the neural tube gives rise to
    the ventricles of the brain and the central canal of the spinal cord,
    and in week 4 the neural tube develops three distinct bulges that
    correspond to the areas that will become the three major divisions of
    the brain: forebrain, midbrain, and hindbrain. The early signs of a
    brain have begun to form.

    Even though the fetus is now developing areas that will become
    specific sections of the brain, not until the end of week 5 and into
    week 6 (usually around forty to forty-three days) does the first
    electrical brain activity begin to occur. This activity, however, is
    not coherent activity of the kind that underlies human consciousness,
    or even the coherent activity seen in a shrimp's nervous system. Just
    as neural activity is present in clinically brain-dead patients, early
    neural activity consists of unorganized neuron firing of a primitive
    kind. Neuronal activity by itself does not represent integrated

    During weeks 8 to 10, the cerebrum begins its development in earnest.
    Neurons proliferate and begin their migration throughout the brain.
    The anterior commissure, which is the first interhemispheric
    connection (a small one), also develops. Reflexes appear for the first
    time during this period.

    The frontal and temporal poles of the brain are apparent during weeks
    12 to 16, and the frontal pole (which becomes the neocortex) grows
    disproportionately fast when compared with the rest of the cortex. The
    surface of the cortex appears flat through the third month, but by the
    end of the fourth month indentations, or sulci, appear. (These develop
    into the familiar folds of the cerebrum.) The different lobes of the
    brain also become apparent, and neurons continue to proliferate and
    migrate throughout the cortex. By week 13 the fetus has begun to move.
    Around this time the corpus callosum, the massive collection of fibers
    (the axons of neurons) that allow for communication between the
    hemispheres, begins to develop, forming the infrastructure for the
    major part of the cross talk between the two sides of the brain. Yet
    the fetus is not a sentient, self-aware organism at this point; it is
    more like a sea slug, a writhing, reflex-bound hunk of sensory-motor
    processes that does not respond to anything in a directed, purposeful
    way. Laying down the infrastructure for a mature brain and possessing
    a mature brain are two very different states of being.

    Synapses-the points where two neurons, the basic building blocks of
    the nervous system, come together to interact-form in large numbers
    during the seventeenth and following weeks, allowing for communication
    between individual neurons. Synaptic activity underlies all brain
    functions. Synaptic growth does not skyrocket until around
    postconception day 200 (week 28). Nonetheless, at around week 23 the
    fetus can survive outside the womb, with medical support; also around
    this time the fetus can respond to aversive stimuli. Major synaptic
    growth continues until the third or fourth postnatal month. Sulci
    continue to develop as the cortex starts folding to create a larger
    surface area and to accommodate the growing neurons and their
    supporting glial cells. During this period, neurons begin to myelinate
    (a process of insulation that speeds their electrical communication).
    By the thirty-second week, the fetal brain is in control of breathing
    and body temperature.

    By the time a child is born, the brain largely resembles that of an
    adult but is far from finished with development. The cortex will
    continue to increase in complexity for years, and synapse formation
    will continue for a lifetime.

    The Arguments

    That is the quick and easy neurobiology of fetal brain development.
    The embryonic stage reveals that the fertilized egg is a clump of
    cells with no brain; the processes that begin to generate a nervous
    system do not begin until after the fourteenth day. No sustainable or
    complex nervous system is in place until approximately six months of

    The fact that it is clear that a human brain isn't viable until week
    23, and only then with the aid of modern medical support, seems to
    have no impact on the debate. This is where neuro "logic" loses out.
    Moral arguments get mixed in with biology, and the result is a stew of
    passions, beliefs, and stubborn, illogical opinion. Based on the
    specific question being asked, I myself have different answers about
    when moral status should be conferred on a fetus. For instance,
    regarding the use of embryos for biomedical research, I find the
    fourteen-day cutoff employed by researchers to be a completely
    acceptable practice. However, in judging a fetus "one of us," and
    granting it the moral and legal rights of a human being, I put the age
    much later, at twenty-three weeks, when life is sustainable and that
    fetus could, with a little help from a neonatal unit, survive and
    develop into a thinking human being with a normal brain. This is the
    same age at which the Supreme Court has ruled that the fetus becomes
    protected from abortion.

    As a father, I have a perceptual reaction to the Carnegie
    developmental stages of a fetus: the image of Stage 23, when the fetus
    is approximately eight weeks old, suggests a small human being. Until
    that stage, it is difficult to tell the difference between a pig
    embryo and a human embryo. But then-bingo-up pops the beginning shape
    of the human head, and it looks unmistakably like one of us. Again,
    this is around eight weeks, more than two thirds into the first
    trimester. I am reacting to a sentiment that wells up in me, a
    perceptual moment that is stark, defining, and real. And yet, at the
    level of neuroscientific knowledge, it could easily be argued that my
    view is nonsensical. The brain at Carnegie Stage 23, which has slowly
    been developing from roughly the fifteenth day, is hardly a brain that
    could sustain any serious mental life. If a grown adult had suffered
    massive brain damage, reducing the brain to this level of development,
    the patient would be considered brain dead and a candidate for organ
    donation. Society has defined the point at which an inadequately
    functioning brain no longer deserves moral status. If we look at the
    requirements for brain death, and examine how they compare with the
    developmental sequence, we see that the brain of a third-trimester
    baby, or perhaps even a second-trimester baby, could be so analyzed.
    So why would I draw a line at Carnegie Stage 23 when the
    neuroscientific knowledge makes it clear that the brain at this stage
    is not ready for prime-time life?

    I am trying to make a neuroethical argument here, and I cannot avoid a
    "gut reaction." Of course, it is my gut reaction, and others may not
    have it at all. In recognizing it within me, however, I am able to
    appreciate how difficult these decisions are for many people. Even
    though I can't imagine, and do not have, a gut reaction to seeing a
    fourteen-day-old blastocyst, an entity the size of the dot of an i on
    this page, that dot may serve as a stimulus to the belief system of
    those who hold that all fertilized eggs are worthy of our respect.
    Still, I would argue that assigning equivalent moral status to a
    fourteen-day-old ball of cells and to a premature baby is conceptually
    forced. Holding them to be the same is a sheer act of personal belief.

    The Continuity and Potentiality Arguments

      There is, they argue, no clear place to draw a line after the
      earliest formation of the organism, and so there can be no stark
      division between the moral standing of nascent human life and that
      of more mature individuals. -From Monitoring Stem Cell Research,
      the President's Council on Bioethics, 2004

    Obviously there is a point of view that life begins at conception. The
    continuity argument is that a fertilized egg will go on to become a
    person and therefore deserves the rights of an individual, because it
    is unquestionably where a particular individual's life begins. If one
    is not willing to parse the subsequent events of development, then
    this becomes one of those arguments you can't argue with. Either you
    believe it or you don't. While those who argue this point try to
    suggest that anyone who values the sanctity of human life must see
    things this way, the fact is that this just isn't so. This view comes,
    to a large extent, from the Catholic Church, the American religious
    right, and even many atheists and agnostics. On the other side, Jews,
    Muslims, Hindus, many Christians, and other atheists and agnostics do
    not believe it. Certain Jews and Muslims believe that the embryo
    deserves to be assigned the moral status of a "human" after forty days
    of development. Many Catholics believe the same, and many have written
    to me expressing those views based on their own reading of church

    When we examine the issue of brain death, that is when life ends, it
    also begins to become clear that something else is at work here: our
    own brain's need to form beliefs. If we examine how a common set of
    accepted rational, scientific facts can lead to different moral
    judgments, we see the need to consider what influences these varying
    conclusions, and we can begin to extricate certain neuroethical issues
    from the arbitrary contexts in which they may initially have been

    Different cultures view brain death differently. Brain death is
    declared medically when a patient is in an irreversible coma due to
    brain injury-from a stroke, for example-and has no brain stem
    response, leading to a flat EEG (that is, no sign of brain activity on
    an electroencephalography recording), or ability to breathe
    independently. A survey published in the journal Neurology in 2000
    compared worldwide standards and regulations for declaring brain
    death. The concept of brain death is accepted worldwide: even in the
    most religious societies no one argues that human life continues to
    exist when the brain is irreversibly unable to function. What differs
    is the procedure for determining brain death. And these societal
    differences reveal how bioethical practices and laws can vary so
    wildly, for reasons that have nothing to do with science but instead
    are based on politics, religion, or, in most cases, the differing
    personal beliefs of a task force. For instance, China has no
    standards, while Hong Kong has well-defined criteria-left over, no
    doubt, from its having been under the rule of the United Kingdom. The
    Republic of Georgia requires that a doctor with five years of
    neuroscience practice determine brain death; this is not so in Russia.
    Iran requires the greatest number of observations-at twelve,
    twenty-four, and thirty-six hours-with three physicians; and in the
    United States, several states have adapted the Uniform Definition of
    Death Act, including New York and New Jersey, both of which have a
    religious-objections loophole.

    The example of brain death illustrates how rules and regulations on
    bioethical issues can be formed and influenced by beliefs that have
    nothing to do with the accepted scientific facts. No one debates that
    a line has been crossed when the loss of brain function is such that
    life ceases. What we differ on isn't even when that line should be
    drawn-most countries have similar definitions of brain death. What
    differs is largely who makes the call and what tests are
    used-differences, basically, in how you know when you get there, not
    where "there" is.

    So, too, we all seem to be in agreement that there must be a point at
    which moral status should be conferred on an embryo or fetus. However,
    we seem to have a harder time defining that point, regardless of the
    facts. . . .

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