The excuse of pathology: ethical considerations for the investigation of psychopathology and other disorders.

Neuroimaging techniques continue to become more advanced, and thus allow us to derive more information about the brain. This has permitted an opening into research on psychopathology, which has taken the media’s interest (http://www.bbc.co.uk/news/health-15386740). However, researchers have also been investigating possible underlying pathologies for pedophilia and psychiatric disorders (Schiffer, Peschel, Gizewski, Forsting, Leygraf, Schedlowski & Krueger, 2007; Andreason, 1988). Putting aside the scientific issues with such claims, this article will attempt to put forward two pressing ethical issues with the discovery of such pathologies, and how such questions might be answered. The two issues raised here will be confidentiality and responsibility.

First, the issue of confidentiality will be looked at from the hypothetical standpoint that such pathologies may have demonstrated both validity and scientific rigor. Given that approximately 10% of neuroimaging studies discover incidental findings (IFs) such as tumours, it is likely that IFs would increase in prevalence when associated with these kinds of pathologies (The Royal College of Radiologists, 2011). This issue then becomes two-fold: should researchers allow the individuals to know about their abnormalities, and should they inform authorities of the potential risk of such individuals? Informing individuals will be discussed in more detail below (Fuchs, 2006). Informing authorities breaches the confidentiality of the participant. This becomes a debate between the public’s right to safety and the individual’s right to freedom. Taking pedophilia as an example,the issue of confidentiality is minimal with convicted pedophiles, due to the various equivalents of Megan’s law (Canli & Amin, 2002). But should a non-criminal with this pathology be treated as those convicted; should they be forced to register or inform their employers? This issue needs to be addressed by the scientific community at large (Glannon, 2006). There should be a consensus determining the significance of such scans, and guidelines pertaining to each population at risk implemented.

In terms of the issue of responsibility, two problems may arise here: informing a participant of their pathology before they’ve exhibited at-risk behaviour, and the discovery of such pathologies after they committed a crime. Informing the participants may lead to self-fulfilling prophecies and diminished responsibilities, increasing the likelihood of such behaviour (Glannon, 2006). Hand-in-hand with this, the discovery of pathologies after a crime has been committed may take away the individual’s responsibility. We don’t blame Phineas Gage’s bad behaviour on himself, but rather on the injury caused to his brain, so how can we blame a person with a neurological disposition to such behaviour for acting as such (Farah, 2006)? A proposed answer for the former solution is directing such individuals towards treatments or therapies that can help them overcome such pre-dispositions. The latter could be dealt with by treatment in a high-security mental health facility rather than imprisonment. Although the underlying pathology may not be subject to change, the tendency towards such dangerous behaviours could be inhibited through treatment.

The ethical issues surrounding the discovery of these kinds of pathologies in the brain are complex, and no single answer appears to be the right fit. However, in the words of neuroscientist, Joseph LeDoux (2003): “It is testimony to the progress being made that these questions need to be asked” (p.221).

References

Andreasen, N. C. (1988). Brain imaging: applications in psychiatry. Science,239(4846), 1381-1388.

Canli, T., & Amin, Z. (2002). Neuroimaging of emotion and personality: Scientific evidence and ethical considerations. Brain and cognition50(3), 414-431.

Farah, M. J. (2005). Neuroethics: the practical and the philosophical. Trends in cognitive sciences, 9(1), 34-40.

Fuchs, T. (2006). Ethical issues in neuroscience. Current opinion in Psychiatry,19(6), 600- 607.

Glannon, W. (2006). Neuroethics. Bioethics20(1), 37-52.

LeDoux, J. E. (2003). Synaptic self: How our brains become who we are (p.221). Penguin.

Schiffer, B., Peschel, T., Paul, T., Gizewski, E., Forsting, M., Leygraf, N., Schedlowski, M., & Krueger, T. H. (2007). Structural brain abnormalities in the frontostriatal systemand cerebellum in pedophilia. Journal of psychiatric research41(9), 753-762.

The Royal College of Radiologists. (2011). Management of incidental findings detected during research imaging. London: The Royal College of Radiologists.

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