NeuroNews on Wired

Another driveby post: Wired Science has two stories in Neuroscience the last two days that will be sure to be of interest to bioethicists:

Modafinil May Be Addictive:

The alertness drug developed as an addiction-free alternative to amphetamines might be addictive after all.

Researchers have found that people taking modafinil experience a surge of dopamine, an important cognitive neurotransmitter. Such dopamine upswings are seen in people taking Ritalin, and are considered a chemical signature of possible addictiveness. [Link to full article here.]

AND

MRI Lie Detection to Get First Day in Court

Defense attorneys are for the first time submitting a controversial neurological lie-detection test as evidence in U.S. court.

In an upcoming juvenile-sex-abuse case in San Diego, the defense is hoping to get an fMRI scan, which shows brain activity based on oxygen levels, admitted to prove the abuse didn't happen. [Link to full article here.]

Neurodiversity blogger subpoenaed in "vaccine-autism link" lawsuit

Kathleen Seidel, of Neurodiversity Blog, has been subpoenaed by the plaintiffs' lawyer in a lawsuit claiming that vaccines caused autism. It appears that this subpoena may be retributive action from the lawyer for the plaintiffs, whom Seidel criticized a few weeks ago.

She has since filed a motion to quash the subpoena because she is uninvolved in the Sykes v. Bayer case other than as an independent blogger who has discussed issues related to neurobiology and autism.

This action has many potential impacts for the medical and legal arenas, and opens up the possibility of harassment and undue barriers for bloggers if they can be required to produce the amount of paperwork required in a subpoena at the drop of a hat by a bitter lawyer who perpetuates fraud.

More from:

* Pure Pedantry

* Pharyngula

Novels for Teaching

Over the past two years my "inner English major" has been emerging and I have been integrating novels into my health law classes including bioethics and public health. It has been going amazingly well--the students have engaged with the characters and plots in these books in a way that second and third year law students do not usually engage with the material. They are excited, passionate and curious (something that law school can breed out of students). When I have taught medical students it is much harder to use novels because the courses are usually shorter. I, personally, don't enjoy short stories, however, so I wanted to try this since I have a whole semester with each class. Also, I thought you might be interested because although there is a canon of bioethics and medicine literary works, there are fewer interesting novels which combine law and medicine.

The books I recommend so far are "My Sister's Keeper" by Jodie Picault and "Intuition" by Allegra Goodman.

"My Sister's Keeper" is a very compelling story about a 14 year old girl who walks into a lawyer's office and says she wants to be legally emancipated from her parents so she can make her own decision about donating her kidney to her sister who is dying of cancer. One of the many twists in this story is that the girl (Anna) was selected by her parents as an embryo to donate cord blood to her older sister. It is a great story which is told from the perspective of all the characters, Anna, her mother, her father, brother (who is ignored in the face of his older sister's illess), lawyer and others. We are always trying to introduce our young students to life situations they have yet to experience and this book does so from the first page to the melodramatic conclusion (yet full of teachable topics).

The unpromising setting of "Intuition" a basic science research institute in which there is an allegation of research misconduct, is, against all odds, another engaging story. It is written by Allegra Goodman who has written several very good works of serious literary fiction and this among them. I am teaching a course on legal and ethical issues in clinical research and for the past week, had a room of 14 law students arguing passionately about the contents of a research notebook. Here, again, is a world with which my law students may have had no experience. By portraying how truly intense and competitive the life of research scienctists can be, the novel puts in context the horror stories they hear about research studies in which investigators seem to have ignored the fundamentals of ethics and common sense. My students are shocked that people with Ph.Ds. are treated like servants by the directors of the lab.


I think what is different about these books from the usual fiction in bioethics is that they are not classics--no WilliamCarlos Williams; no Camus; no Arrowsmith. These are contemporary, well researched and written compelling stories that quickly put students into a new world where they can better understand difficult ethical and legal situations.

(And yes, we did read "Wit" (which has become a staple of the medical school humanities curriculum) and then saw the DVD. Few law professors have to handle a seminar room full of crying students (men and women) and it has really enhanced and energized my experience as a teacher).

I am well aware I am far behind the vanguard of those using literature in bioethics or even literature in law school to teach health law (There is a great article on this by Professor Stacey Tovino which I will link tomorrow), but I wanted to relay my experiences, since they have been so positive, and to bring these two books to your attention. I look forward to giving you an update what students get out of a book I enjoyed very much "Wickett's Remedy" by Myla Goldberg which involves the 1918 flu and an actual research experiment with prisoners which took place on Deer Island in Boston harbor.

Religion of the Father?

AP reports that the Oregon Supreme Court has ruled that a 12 year old boy's preferences on whether or not to be circumcized should guide the decision in the dispute between his parents.

Excerpt:

The father, James Boldt, converted to Judaism in 2004 and wants the boy to be circumcised as part of the faith. The mother, Lia Boldt, appealed to the high court, saying the operation could harm her son physically and psychologically.

The state Supreme Court ruled that earlier court decisions failed to determine whether the boy wanted the circumcision, as his father contended, or opposed it, as his mother alleged.

The Supreme Court sent the case back to the trial court to answer that question.

If the trial court finds the child agrees to be circumcised, the Supreme Court said, it should deny the mother's requests. But if the trial court finds the child opposes the circumcision, the court has to determine if it will affect the father's ability to care for the child.

The custody dispute began when the child was 4 and the circumcision issue began three years ago when he was 9.

We have several interesting issues impacting this case. First: informed consent of the patient. Is a 12 year old mature and competent enough to make a decision about this permanent operation? There is a precedent in our society that denies non-medically indicated permanent procedures. For reference, most physicians deny elective sterilization operations to women even if they are of legal, consenting age (depending on the state, 25 is often used as a "no questions approval" cutoff).

Second, what is the nature of the circumcision procedure? Ought it be considered a ritual fully protected by free exercise of religion, or an elective permanent surgical procedure for non-health related reasons, thus violating the non-maleficence clause of the Hippocratic Oath? Note the sliding scale of the perceived magnitude of circumcision - from something akin to a piercing to mutilation of one's body and bodily function.

Third, the dispute between the parents should be considered carefully, and both parties' motives must be separated from what is in the best interest of the teenager. However, the "father's ability to care for the child" should not be used as a factor, as it should be categorically seen as a sign of unfit parenting to abuse or neglect one's child for not conforming to religious practice.

In my opinion, a case would be made for supporting such a procedure on someone not legally competent only if 1) there were a medical indication or 2) there were a time-sensitive factor to the procedure in terms of reducing side effects or discomfort. Thus, there is potential for supporting circumcision of infants over children or teenagers because some believe less pain is felt at that time (I do not endorse this position, I simply present it for argument) than would be felt later on. And there are rare cases where a circumcision is medically indicated in a child or a teenager due to developmental or other impairments.

However, this situation does not fulfill either criterion - a 12 year old does not have time-sensitive reasons for seeking a circumcision, there is no medical indication, and even the religious argument falls short due to the father's recent conversion. I do not see a reduction in suffering that would result from the operation occuring now or occuring six years from now, but the difference legally, cognitively, and ethically would be significant. Therefore, while I applaud the court's intent to look to the teenager's wishes, I do not feel that he is able to ethically consent to such a procedure at this time, and there should not be a circumcision until he comes of legal age of consent.

Addendum: Upon further reflection, I suspect that this is an attempt by the court to foist responsibility for the act (or non-act) onto the teenager so they do not have to risk appearing to be anti-religion. If so, that is an irresponsible course of action.

Legal Rights for Embryos?

Attorney and reproductive rights expert Jessica Arons has written a compelling analysis of a bizarre piece of legislation granting individual rights to embryos. According to Arons, "The state of Louisiana has assigned to human embryos a legal identity with rights that can be litigated in court—regardless of whether the embryo is in a Petri dish in a lab or in a womb, so long as rights have attach[ed] to an unborn child. The statutes go on to provide the fertilized ovum with an entitlement to sue or be sued. The implication of this provision is that an embryo should be thought of as a child. But embryos and children are patently not the same and the law should not treat them as such." The article is published in the Center for American Progress’ exciting new science policy journal called Science Progress. You can read the complete article here.

My Neurons Made Me Do It...

The Blossoming Field of "Neurolaw": An article in the NY Times explores the 'biology as the basis for behavior' defense in criminal cases. In a trial that opened in the last few days in a State Supreme Court in Manhattan, jurors will be asked to decide whether the defendant was a sadistic man preying on an unsuspecting woman or whether his actions were the result of mental illness.

Disease Drove Sex Attack, Defense Says
"...Now the writer, Peter Braunstein, 43, is about to go on trial, charged with a bizarre crime against a woman who worked in his own newsroom. Prosecutors say he dressed as a firefighter, staged a fire to get into her Chelsea apartment, tied her to a bed, drugged her with chloroform and sexually molested her for 13 hours...
In similar cases, lawyers have argued that their clients were in a dissociated state, much like sleepwalking. A version of this defense, said Rachel Barkow, a law professor at New York University, would be: “You know killing is wrong, but it turns out you think you’re in the middle of a video game. Because of a paranoid delusional state, you thought it was all a fantasy.”

To read the rest of the article, click here.