Stunted Trees and Broken Bridges

Written by Ben Musgrave / Produced by Theatre of Debate

Research

Bioethics

Bioethics is the study of the ethical and moral implications of new biological discoveries and biomedical advances. Bioethicists are concerned with the ethical questions that arise in the relationships between life sciences, biotechnology, medicine, politics, law and philosophy.

Neurotechnology

Neurotechnology is an emerging science comprising the development and application of advanced technology for the study of the brain and treatment of its disorders.

Novel-Neurotechnologies

Humans have intervened directly in the brain for a long time. Archaeological evidence shows that people in the late Stone Age in Europe, pre-Incan civilizations, the Ancient Egyptians, the Romans and Byzantines all performed brain surgery for medical, spiritual and magical purposes. During the last century, brain intervention experienced a steep rise and fall: electroconvulsive therapy (ECT), ‘split-brain’ surgery and lobotomy were each first heralded as wonder cures for depression, epilepsy, schizophrenia and many other illnesses in the first half of the 20th century. But each was to some extent discredited as they came to be seen as treatments that were often inappropriate and sometimes harmful, leading to the view that their uncritical and widespread use arose from the hubris of a medical profession bound by too few rules.

Far more targeted applications of these treatments, and other treatments that intervene directly into the human brain, are only slowly being re-introduced to medical practice, with very strict risk/ benefit assessments and strong consent and oversight procedures in place.

Intervening in the brain has always raised hope and fear in equal measure: hope of curing crippling neurological conditions or improving human capabilities beyond normal limits against fear of harmful manipulation with unforeseen consequences or the wilful destruction of what it means to be human. Currently, technologies are emerging that intervene in the brain which seem to promise significant benefits to people with neurological conditions. Such neurotechnologies could also potentially be used in non-medical settings. For example, Brain Computer Interfaces (BCIs) which connect the brain to a computer system could help people who have a locked-in syndrome to communicate or even interact with the outside world by using thoughts to direct a bed, wheelchair or speech computer. BCIs can be used in non-medical ways, for computer gaming, where games are ‘thought-controlled’ – and there is growing interest in using BCIs in the military, to enable military personnel who have lost limbs to control their prosthetic devices directly from their brain, or to improve soldiers’ capabilities or employ though-controlled, remote weaponry.

Neurostimulation such as Deep-Brain Stimulation (DBS), where electrodes are implanted into the brain, has been used to treat illnesses such Parkinson’s and severe depression. Transcranial Direct Current Stimulation (tDCS), where areas of the brain are stimulated directly with low electrical current, is being used to treat some psychiatric disorders, to aid rehabilitation and in some cases in the hope of enhancing cognitive performance.

Non-Invasivetranscranial Magnetic Stimulation (TMS), where the brain is stimulated from outside using a magnetic field, is used to treat patients with depression and is also being researched to improve cognitive skills, both in patients and healthy subjects.

Finally, Neural Stem Cells, inserted into the brain, are being investigated for treating people with stroke and dementia.

While the clinical benefits of some of these treatments are thought to be significant for particular groups of patients, they nevertheless raise questions not only about safety, but about possible effects on personality and personhood; about responsibility; about enhancing human capabilities; and about how we secure beneficial uses, whilst avoiding the dangers. Most of this is still being researched, but it is important that we address the ethical considerations at this early stage.

In contrast to established interventional neurotechnologies – such as electroconvulsion or brain prostheses – that have been discussed for several decades, ‘novel neurotechnologies’ are in the early stages of transition from the laboratory to use in medical treatment or in other, non-medical settings.

Through the performance, debate and online resources ‘Stunted Trees and Broken Bridges’ explores how the use of neurotechnology and novel neurotechnologies impact on our lives now, and might in the future. The project is also a starting point for exploring the bioethics related to this area of scientific research.

This article is taken from the Nuffield Council on Bioethics website: http://www.nuffieldbioethics.org

Glossary

Anti-Social Personality Disorder

Is described by the American Psychiatric Association’s Diagnostic and Statistical Manual, fourth edition, as personality disorder characterized by “…a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”

Autism

Is a disorder of neural development characterised by impaired social interaction and communication, and by restricted and repetitive behaviour. The diagnostic criteria require that symptoms become apparent before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organise; how this occurs is not well understood.

Brain Disorder

Any disorder or disease related to the brain.

Brain imaging/neuroimaging

Includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain. It is a relatively new discipline within medicine and neuroscience/psychology. Doctors who specialise in the performance and interpretation of neuroimaging in the clinical setting are called neuroradiologist

Brain scanners

Are machines that “picture” activity within or structures of the brain. In the play, the forensic investigator uses functional magnetic resonance imaging or functional MRI (fMRI). This procedure measures brain activity by detecting associated changes in blood flow.

Cochlear implants

Are surgically implanted electronic devices that provide a sense of sound to a person who is profoundly deaf or severely hard of hearing. Cochlear implants are often referred to as bionic ears.

Cognitive function

Is an intellectual process by which one becomes aware of, perceives, or comprehends ideas. It involves all aspects of perception, thinking, reasoning and remembering.

Croydon Syndrome

Is a made-up syndrome for the purposes of the play in which the patient has tendency for arson which can be detected through scanning their brain.

Deep brain stimulation (DBS)

Is a surgical treatment involving the implantation of a medical device sometimes called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as chronic pain, Parkinson’s disease and tremor.

Depression

Can be described as severe despondency and dejection, accompanied by feelings of hopelessness and inadequacy. A condition of mental disturbance, typically with lack of energy and difficulty in maintaining concentration or interest in life.

Interventions

A term used in the play to refer to scientific inventions (techniques or therapies) to use to help Emerson.

Diminished responsibility

Or diminished capacity is a potential defence by excuse by which defendants argue that although they broke the law, they should not be held fully criminally liable for doing so, as their mental functions were “diminished” or impaired.

Dyslexia

Is a common type of learning difficulty that mainly affects the skills involved in the reading and spelling of words. A person with dyslexia has difficulty “decoding” words despite appropriate learning opportunities, and this difficulty will be significantly greater than for other areas of their learning.

Electrodes

Are conductors that pass electrical current between metallic and non-metallic parts of a circuit.

Forensic science

Often shortened to forensics, is the application of a broad spectrum of sciences to answer questions of interest to a legal system. This may be in relation to a crime or a civil action. A forensic investigator is someone who uses forensic science to investigate crime.

Free running/parkour

Is a relatively new sport that was developed out of military obstacle course training. Practitioners aim to move from one place to another, negotiating the obstacles in between. The discipline uses no equipment and is non-competitive.

Lobotomy

Is a form of brain surgery in which the connections to and from the prefrontal cortex, – at the front of the brain – are cut. The procedure has been controversial since it was first used in 1935, yet was a mainstream procedure for more than two decades to treat psychiatric (and occasionally other) conditions, despite general recognition of frequent and serious side-effects.

Neuroforensics

Is the application of neurophsychological principles and practices to matters relating to legal decision-making. In the play, the forensic investigator uses brain scans to determine Emerson’s role in the crime he is being questioned about.

Neurones

Are brain cells that process and transmit information by electrical and chemical signalling.

Neurotransmitters

Are the chemicals which allow signals to be sent between neurones across gaps called synapses. They are also released at the “neuromuscular junction” where neurones stimulate muscle fibres and so initiate movement.

Oxytocin

Is a powerful hormone which also acts as a neurotransmitter in the brain. It seems to play a major role in our reaction to friends and loved ones: its levels go up when we hug or kiss, during sex, birth, breast feeding, and the list goes on. It has been described as the thing that makes us human.

Pre-frontal cortex

Is the part of the frontal lobes of the brain, lying in front of the motor and premotor areas. This brain region has been implicated in planning complex behaviour, as well as personality, decision-making and moderating social behaviour. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals.

Psychiatrist

Is a doctor who specialises in the diagnosis and treatment of mental disorders.

Psychiatric institutions

Are also known as mental hospitals, and specialise in the treatment of serious mental disorders. Patients are often admitted on a voluntary basis, but where an individual poses a risk to themselves or others, they may be “sectioned” – which refers to their compulsory admission under a section of the mental health act.

Smack

Is a slang name for heroin, a highly addictive illegal drug that can be injected or smoked.

Transcranial magnetic stimulation (TMS)

Is a non-surgical method that uses magnetism to stimulate areas of the brain without causing pain and while the patient is conscious. Scientists hope to use TMS to investigate illnesses such as schizophrenia, and also to see how the brain rewires after damage such as stroke. Doctors now use TMS to diagnose diseases that affect the communication between brain and body, such as multiple sclerosis. It also seems to be effective in treating some forms of depression.