seminar

Since May 2016, we have convened a twice-monthly Neuroethics Seminar at the UCSF Mission Bay campus, in collaboration with Jalayne Arias. The purpose of the seminar is to engage neuroscientists and clinicians in broad, interdisciplinary conversations about ethical and policy issues arising in their work. In addition to providing a forum for stakeholders to explore their own ethical concerns about situations they face, we also aim to foster new scholarly collaborations that emerge from novel questions at the forefront of research and clinical practice. In general, our meetings follow one of three formats: (1) case discussions arising from ethically complex clinical encounters or research developments, (2) journal clubs drawn either from recent neuroscience or neuroethics literature, and (3) works-in-progress to refine upcoming grants, conference abstracts and manuscripts.

To be added to the mailing list, contact Celeste Fong at celeste.fong (at) ucsf.edu.

upcoming:

recent meetings:

Cultures of responsible research in STEM

Dan Dohan
December 4, 2019

The final seminar of the year featured a works-in-progress by Dan Dohan. The group helped him brainstorm ideas for a grant he is interested in developing on cultures of responsible research in STEM laboratories. Our meeting began with an overview of social theories of culture, as explained by Lizardo and Strand in their article, “Skills, toolkits, contexts, and institutions: Clarifying the relationship between different approaches to cognition in cultural sociology.” We compared four approaches and perspectives of culture: classic anthropology, classic sociology, contemporary anthropology, and contemporary sociology.

In contemporary sociology, culture, that is, our ideology, values, or norms, are more powerful when times are socially unsettled – we tend to rely on them more to guide practice. On the other hand, during settled times, culture can work like a toolkit, where we can do things in ways that feel natural to us as individuals instead of relying on particular values or norms. These toolkits form cognition because they are ingrained into how we think and act.

Technological advances can regularly unsettle biological science fields and raise new ethical concerns. Our discussion explored how particular sites in biological science fields do or do not display lab culture, including how to identify the inherited values of team members that have followed them through their experiences, and how their resulting behaviors in new or different groups can change or upset existing ethical cultures. We also spent some time creating strategies to identify the goals of calls for grants that institutions put out, as these institutions have particular ideas and thinking about culture engrained in them already.


Remembering and forgetting in bioethics

Tobias Haeusermann and Celeste Fong
November 20, 2019

Today’s seminar was led by Toby Haeusermann and Celeste Fong, discussing a recent review they wrote with fellow Decision Lab member, Cailin Lechner, on the book The Origins of Bioethics: Remembering When Medicine Went Wrong by John A. Lynch. They presented an overview of the three case studies included in the book (the Tuskegee Syphilis Study, the Willowbrook Hepatitus Study, and the Cincinnati Whole Body Radiation Study), followed by a summary of how, and why, the author depicted public remembrance of the events as either minimal remembrance or meaningful forgetting.

The primary criticism of the book is that it is less about the history of bioethics as a field as much as it is an analysis of how bioethics events are presented to the public to foster remembrance (or perhaps, forgetting). As such, the discussion gravitated towards how institutions and the public could best present bioethics cases honestly, with an accepting of responsibility and duty to improve without instilling unwarranted fear or mistrust in the community.


Capgras syndrome in Lewy Body Dementia

Sarah Dulaney and Jennifer Merrilees
October 16, 2019

Sarah Dulaney and Jennifer Merrilees led another seminar on ethical concerns in the care and management of people with Capgras syndrome which is common in, though not exclusive to, patients with Lewy Body Dementia. It can lead people to believe that those close to them have been replaced by imposters, or render them unable to recognize themselves, or their surroundings, pets, plants, etc. Drawing from conclusions in Meeri Kim’s article (The Washington Post, 2018) and Thaipisutikul et al.’s paper (International Psychogeriatrics, 2013), ethical concerns present in cases of Capgras reflect the effects of caregiver burden and the high rates of visual hallucinations and symptoms of anxiety in patients, which can lead to experiences of guilt or conflicts in value systems for behaving in certain ways as a result of being unable to remember loved ones.

As Capgras is associated with regions of the brain involved in visual processing and emotional response, we discussed potential coping mechanisms like triggering remembering through non-visual sensations, using phone calls to trigger voice recognition, or having a friend or family member call the patient to help reduce any anxiety associated with not being able to visually recognize others. We also spent some time analyzing three case studies of patients with Capgras where we identified considerations of care based on the bioethical principles of autonomy, beneficence, and non-maleficence. These included maintaining the patients’ best interests in relation to patient and caregiver safety and convenience, navigating between quantity versus quality of life when considering treatment options, and acknowledging the potential financial burden of adequate care.


Who should obtain consent for human intracranial electrophysiology studies?

Cailin Lechner
October 2, 2019

During today’s seminar, Cailin Lechner presented on a collaborative project investigating consent in human intracranial electrophysiology studies. Regulations and policies attempt to provide recommendations on how to consent, yet often lack guidelines on which members of the study team could best obtain consent. This can be further complicated in studies involving human intracranial electrophysiology research as these require patients, undergoing neurosurgery for serious neurological disease, to consent to technically complex interventions for primarily investigative, non-therapeutic purposes. Providing appropriate context for such decisions may require a team member with a high degree of expertise, typically a clinician involved in the study, to obtain consent. Papers by Morain et al. and Da Silva et al. entertain potential pitfalls of such “dual-role” consent, including therapeutic misconception, conflicts of interest, or compromised voluntariness.

Cailin’s project involved interviewing 26 investigators from various human intracranial electrophysiology studies using semi-structured interviews. Most studies included employed a hybrid approach, where more than one team member was involved in the consenting of potential participants. For example, a surgeon or principal investigator might be responsible for detailing the complexity of the surgery, while a second team member, usually a research coordinator, would obtain the patient’s signature. While studies varied regarding specifically which team member would obtain
consent, rationales reflected several themes, including the need to provide expert knowledge while also preserving voluntariness, logistical needs such as availability around the time of surgery, regulatory guidance, and ethical instinct (where particular team members were chosen based on what seemed like the right thing to do).

Our following discussion centered primarily on navigating between the values of expertise and knowledge versus voluntariness in the consent process. We wondered if a non-physician team member could provide enough expertise to ensure that the patient was knowledgeable about his or her involvement and maintain the quality of the discussion while still preserving the voluntariness of consent. We then considered if IRB guidelines could help provide better consent processes if boards were more aware of the details of the experiments and what degree of understanding would be required in order to have informed consent. Finally, the group also acknowledged the need for additional inquiries on whether or not patients believed if they were adequately informed or if they liked or would have preferred being consented by certain team members, although we also recognized the influence that research outcomes may have on these types of post-hoc responses.


Hypersexuality in Lewy Body Dementia

Sarah Dulaney and Jennifer Merrilees
September 18, 2019

During this week’s seminar, Sarah Dulaney and Jennifer Merrilees led a discussion on hypersexuality in Lewy Body Dementia. Throughout our conversation, we drew connections from Bronner and Korczyn’s article, “The Role of Sex Therapy in the Management of Patients with Parkinson’s Disease” (Movement Disorders Clinical Practice, 2018). We focused on ethical considerations related to patients and caregivers’ concerns about issues with intimacy as a result of dementia.

We began by introducing sexual issues that couples may have as a result of dementia, making note of the need to acknowledge and address the lack of sexual health discussions in healthcare settings with people who have these and other disabilities. Some ethical concerns that arose included sexual consent capacity in aging populations and the medicalization of sexuality. The group was also interested in the role that providers and sex therapists have in helping to mitigate sex-related issues in relationships, where significant others must often navigate between the spousal/partner and caregiver roles. Finally, we used a set of three case studies (hypersexuality as a result of Parkinson’s medications, hypersexuality due to Lewy Body Dementia, and hypersexuality in an assisted living facility) to discuss how to best address sex-related conflicts that may occur between patients with dementia and their caregivers.


previous meetings:

September 4, 2019 - “Neurohype” and public impressions of research (Winston Chiong)

August 7, 2019 - The Pre-Caregiver in Preclinical Alzheimer’s Disease (Jalayne Arias)

July 8, 2019 - Research in participants with Down syndrome (Melanie Stephens)

June 24, 2019 - Partial preservation of neural/vascular activity in post-mortem pig brains (Winston Chiong)

June 10, 2019 - Off-label DBS for rare pediatric disorders (Philip Starr)

May 20, 2019 - Language-based learning disabilities in a prison population (Andrea Lollini)

May 13, 2019 - NIH BRAIN Initiative Neuroethics Roadmap (Winston Chiong)

March 25, 2019 - Architecture, design and dementia (Emi Kiyota)

March 11, 2019 - Qualitative and social research (Daniel Dohan & Katherine Rankin)

February 25, 2019 - Care for persons with Down syndrome who develop dementia (Melanie Stephens)

January 28, 2019 - The Parkinson’s disease mortality myth (Maya Katz)

January 16, 2019 - Unanticipated side-effects and investigator-participant relationships in aDBS for chronic pain (Prasad Shirvalkar)

November 26, 2018 - Linking social neuroscience and the traditional social sciences (Dan Dohan & Katherine Rankin)

November 19, 2018 - Consent for data sharing in dementia research (Jalayne Arias, Renaud La Joie & Jen Yokoyama)

October 22, 2018 - Artificial companions for older adults with cognitive impairment (Elena Portacolone)

October 8, 2018 - Consent and recruitment in neurophysiology studies (Joncarmen Mergenthaler)

September 24, 2018 - Personality changes in deep brain stimulation (Tobias Haeusermann)

September 10, 2018 - Experimentation in human brain model systems (Galen Dods)

August 27, 2018 - Position paper on dementia care ethics (Winston Chiong)

July 9, 2018 - Using genetic ancestry sites for criminal investigations (Jalayne Arias, Joanne Taylor, Jen Yokoyama & Jamie Fong)

June 25, 2018 - Capacity to marry and to consent to sex in dementia (Joanna Hellmuth & Mahnoor Allawala)

June 11, 2018 - Professionalized intimacy – care in the dementia village (Tobias Häusermann)

May 14, 2018 - Opioids in elder populations (Monroe Butler)

April 16, 2018 - Patient and caregiver perspectives on physician assisted death in ALS (Catherine Lomen-Hoerth)

April 2, 2018 - FAA regulations and preclinical Alzheimer’s biomarkers (Matt Lawrence)

March 25, 2018 - California End of Life Option Act working meeting

March 12, 2018 - Brain death and the Jahi McMath case (Sharon Kaufman)

February 12, 2018 - Cognitive testing and political leaders (Jalayne Arias)

January 25, 2018 - Palliative medicine (Krista Harrison)

January 11, 2018 - Ethical issues in the management of patients with dementia (Winston Chiong)