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Breaking Down Neuroethics with Dean Hassan El-Fawal

Ioanna Moriatis

As AUC’s first Regional Symposium in Neuroethics approaches, community members are asking, what does the term “neuroethics” actually mean? How does it apply to the University’s academic programs and culture of research?

The symposium’s panelists will attempt to broach challenging questions of neuroethics, aiming to understand how the discipline of neuroscience, in addition to most other scientific fields, requires consideration of the complex ethical elements of research and practice. As those planning to attend begin to ruminate over these questions, News@AUC took a closer look into neuroethics with Dean of the School of Sciences and Engineering Hassan El-Fawal.

What are neuroethics?

In a world of neuroscience – whether clinical or experimental – the term is a relatively new one. It is considered a subdiscipline of neuroscience, and there are two faces of what we consider to be neuroethics. It is built very much on the premises of bioethics and the discussion of doing no harm. It is not species-specific, but has to do with the confidence you owe the public, patients and the research community.  So some people tell you that neuroethics is the ethics of neuroscience as well as the neuroscience of ethics.

What kinds of questions fall under neuroethics?

When we talk about the ethics of neuroscience, a lot of it has to do with the ethical conduct of research, and even clinical practice. So in almost all countries, if you’re going to do animal research, you have to go through a process to ensure that you alleviate pain and that the research is not trivial or spurious, so that you’re not abusing the animals needlessly. If we’re talking about humans, what are the obligations toward that human? In many countries, you go through a process with an institutional review board as well as training.

Another aspect is ethical treatment in terms of the integrity of your data. So even though you may be doing preclinical or clinical research, you always have in the back of your mind the integrity of what you’re going to be presenting. This has to do with the validity and veracity of your data.

If I’m trying to develop a diagnostic marker, what is my obligation to the patient if I believe in what I’m measuring, even though my data may not have been validated or widely accepted? Do I alert the patient?

The flip side of this definition is very exciting and very controversial -- the neuroscience of ethics. For example, if I discover and validate that a certain anomaly that we see on a magnetic resonance image of the brain is associated with criminality or drug addiction, what is my obligation?

Are ethical principles relative, or are there set principles applicable to any context?

There are conventions and widely accepted hallmarks to what we recognize as ethics and bioethics. These include 1) respect for persons; 2) concerns for welfare; and 3) justice. When we talk about specific countries, this is where the ethical debate is very important. People think that if you’re going to develop an ethical paradigm, what applies to the United States is going to apply to the Middle East, or what applies to Europe is going to apply to Southeast Asia and in a similar manner. That’s not true, because what informs ethics in all societies is the cultural, spiritual nuances. Even if we’re talking about secular societies, that secular society still develops from a religious tradition. To ensure ethical behavior, you must have buy-in and, therefore, must coach it in the language of that culture and all that informs that culture.

Are there any principles or practices in terms of neuroethics that should be adopted by everyone, no matter the country?

At the United Nations level, there is a definition of ethics and list of consequences for deviating from them. A lot of it has to do with the autonomy of the individual, the freedom to act, freedom of opinion, etc. These are common denominators. Nevertheless, they have to be interpreted, or articulated, within the cultural framework to get everyone on board, even if in opposition to traditional practices.

A lot of ethical issues are not easily resolved, but they should be on the burner for every researcher. The researcher does not need to be a neuroethicist per se, but these are things that should be on his or her mind.

How is ethical conduct in the sciences monitored?

There has to be buy-in from society or the community involved. It’s very important if you’re going to implement it because ethics per se cannot be policed. I can’t tell you that you have to act this way because that’s it, it’s the law. You adopt an ethical practice because you have bought into it.

Ethics refers to things we’ve always done. So if you’re someone who values the quality of your research, whether it’s in a lab or clinic, we all practice ethical guidelines. We may not necessarily articulate them, but it’s actually a part of what we do. Indeed, it must become the fabric of what we preach and practice.

Why is this such an important topic?

Neuroethics has to do with seeing that the individuals you’re working with are not guinea pigs. You can actually begin to apply ethics to every single field. It is realizing that you have responsibility toward the individual, toward society and toward your fellow beings.

What impact do you hope a symposium on this topic will have?

The whole idea of this symposium is to start a dialogue. This is a relatively new field. There are actually very few programs worldwide that deal academically with neuroethics.

One of the things that I’d like to see come out of an exercise like this is that students and participants learn that there is a human face to a lot of questions. A lot of times, in academia, regardless of what country or university you’re in, we develop this attitude that book learning is going to prepare us for the world. And over time, we lose sight of the fact that there’s an individual associated with what we are learning or hope to make our career goals.

You don’t have to be a neuroscientist to appreciate the content. This is why we tried to keep it as diverse as possible in terms of our presenters. Every time you deal within the social context, there’s an ethical question. Overall, the overarching purpose of this is to raise awareness that this is a dialogue we need to have, and it needs to become a part of everything we consider.

Another aspect of this dialogue is to start encouraging interaction between people across the board.

Why is there a focus on neuroethics as opposed to ethics in another field?

The strong keen interest, which has sort of cut neuroethics from general bioethics, is that mystery we associate with the brain and the nervous system, and the challenges of accessibility. Overwhelmingly, regardless of what discipline you’re in, people tell you that the most complex thing is your brain. The brain is what’s enabling us to have this conversation. It’s my personality, my ability to teach, my ability to communicate, to lead and so on. So, there’s a particular sensitivity and mystery when it comes to the brain.

Why is this dialogue important in Egypt?

Something interesting is that there’s actually no Arabic word for ethics, as it is defined in English. This is where cultural nuances are actually very important. The word under whose umbrella the word ethics would fall is akhlaqeyat. This means behavior, conduct, ethics. It means opening the door for someone, being hospitable, not using foul language. That’s where ethics falls in this. There is no specific course in ethics. The way you are brought up in Egypt falls under akhlaqeyat.

There are very strong guidelines in the United States that protect the patient’s bill of rights. I’m sure individual practitioners here in Egypt do that, but do they practice the same kind of confidentiality? Egypt has its challenges, but I think it’s not so much that individual practitioners may not be giving ethical dimensions of their practice any thought. Rather, it’s about how you articulate it so that it becomes the norm of what you do.

When I talk about having a dialogue, a lot of it has to do with the fact that a lot of these practices have not been institutionalized. So one reason for dialogue is for a country like Egypt to rebuild its research credibility. I want to have confidence in the science that’s coming out of institutions. Part of this dialogue’s focus is: Let’s build a policy, a regulatory framework and an enforcement arm, based on guidelines that we can all buy into.