Abstract
Significant advancements in neuroscience, including neuroimaging and neurotechnologies, have resulted in remarkable discoveries which have deepened our understanding of the brain, from identifying neural correlates of consciousness to understanding disorders of consciousness, brain death and groundbreaking therapies. These advancements have revealed and posed unprecedented ethical concerns, leading to the emergence of the field of neuroethics. Neuroethics has been defined in various ways in the literature. In this book, Walter Glannon describes neuroethics as “a multidisciplinary field at the intersection of neurology, psychiatry, neurosurgery, radiology, cognitive psychology, philosophy of mind, moral philosophy, and law” (p. 1). He asserts that the purpose of neuroethics is to examine and address the ethical and social implications of neuroscience research and clinical practice. Neuroethics draws on conceptual frameworks and principles from these diverse disciplines to evaluate issues such as brain interventions, moral and cognitive enhancements, privacy of neural data and the impact of emerging neurotechnologies.
In his book, Glannon examines the ethical issues introduced above. He explores how neuroethics can directly and indirectly affect people in society and emphasises the importance of the field in addressing those ethical issues. The book is aimed at both scholars and laypersons, and hopefully, could be a powerful tool to initiate conversations about the implications of neuroethics and drive progress in the field involving members of society. The book equips readers with the foundational knowledge to think about and engage critically with ethical issues arising from neuroscience research and clinical practice, and the need to implement laws to protect the public and vulnerable individuals. Although neuroimaging has been instrumental and central to many breakthroughs in neuroscience, several ethical issues have emerged, including the appropriate use of neuroimaging technologies, the privacy of neural data, equitable access to these imaging modalities, and the growing need for neurorights.
A real-world case illustrating several ethical concerns surrounding neuroimaging is the public interpretation of Kim Kardashian's brain SPECT scan by psychiatrist Dr Daniel Amen [https://www.independent.co.uk/life-style/health-and-families/kim-kardashian-low-brain-activity-scan-b2877015.html]. Single-photon emission computed tomography (SPECT) involves the administration of intravenous radioactive isotopes that emit gamma rays and are used to assess patterns of blood flow in organs such as the brain and heart. In this case, the scan was reportedly performed without a clear clinical indication, and the interpretation of the results did not follow standardised scientific terminology. Descriptions such as “holes”, “low activity”, and “sleepy frontal lobes” illustrate the concern raised by Glannon that the depiction of brain imaging as showing activity in “real time” can be misleading (p. 23). Additionally, Glannon also raises concerns regarding the use of neuroimaging as a screening tool in asymptomatic individuals for neurological conditions that currently have no effective cure. Neuroimages contain highly sensitive neural data about an individual, raising important questions about privacy and the potential misuse of such information. Although Kardashian consented to having her brain scan discussed on public television, the public disclosure of neural data raises concerns that such information could be used in ways that reinforce discrimination or exacerbate existing social inequalities. The concept of neurorights has therefore been proposed as a means of protecting individuals by ensuring that access to neural data is carefully regulated and not used in discriminatory ways (p. 49–50). Another ethical concern raised by the scientific community relates to equitable access to neuroimaging technologies. When imaging techniques are used for purposes that are not scientifically or medically justified, there is a risk that they may become commercialised in ways that prioritise profit over clinical need. Such practices could further exacerbate existing disparities in healthcare access, reinforcing inequalities regarding who is able to benefit from advanced neuroimaging technologies.
The chapters on disorders of consciousness (DoC) and brain death highlight significant ethical challenges related to end-of-life care and decisions regarding the withdrawal of life-sustaining treatment. Neuroimaging has played a significant role in differentiating between persistent vegetative states and minimally conscious states. While these tools can be effective in making an accurate diagnosis and explaining the patient's condition to their relatives, they still do not address the elephant in the room: “what happens next?” There is a prevailing expectation in medicine that every sophisticated diagnostic investigation must and can be followed by an equally sophisticated intervention. There is a wide range of interventions aimed at addressing DoCs - from pharmacological agents such as amantadine, to minimally invasive transmagnetic stimulation (TMS) and invasive deep brain stimulation (DBS). The challenge is that these interventions have differing efficacy depending on the extent of preserved brain function. An important question that arises is whether medical intervention should always be pursued in cases of disorders of consciousness. In considering this question, the reader is encouraged to reflect on the ethics frameworks introduced by Glannon in Chapter 1 and how they might guide these difficult decisions.
Traditionally, death has been defined as the permanent cessation of cardiopulmonary functions, namely the irreversible cessation of spontaneous breathing and blood circulation. Advances in medical technology, however, have challenged this definition, as life-support systems can artificially maintain respiration and circulation even when brain function has ceased. As a result, the whole-brain definition of death emerged, which defines death as the irreversible cessation of all functions of the entire brain, including the brainstem. Nevertheless, this definition has also been subject to debate. In some cases, certain biological functions may persist even after cortical and brainstem activity have ceased, such as continued activity of the hypothalamus.
Glannon argues that a purely biological definition of death - according to which death occurs when an organism loses its capacity to function as an integrated biological whole - does not fully capture the normative implications of death. Death is not solely a biological event but also a psychological, social, and cultural phenomenon. Furthermore, relying strictly on a biological definition could have significant consequences for transplant medicine. If death required the complete cessation of all bodily functions, organs would often become nonviable before they could be retrieved for transplantation.
Chapter 4 also introduces the higher-brain definition of death, which defines death as the irreversible loss of the capacity for consciousness and higher cognitive functions. Although this definition has been widely debated, it is rarely adopted as a legal standard because of the difficulties involved in making reliable diagnoses and prognoses, even with advanced neuroimaging technologies. Proponents argue that the higher-brain definition better captures the normative meaning of death, as it focuses on loss of the capacities that underlie personhood and conscious experience. However, this view also raises important challenges, as it separates the concept of death from the biological functioning of the organism and could imply that some patients in persistent vegetative states are effectively dead despite remaining biologically alive.
Reading Glannon's book will not make one an expert in neuroethics, but it offers a strong and accessible foundation for engaging meaningfully with the field. In an era marked by rapid advances in neurotechnology, ethical reflection must evolve alongside scientific innovation. As neuroimaging and other technologies increasingly influence research, diagnosis, prognosis, and clinical decision-making, neuroethics must play a vital role in shaping policies that govern their responsible use, equitable access, and protection against misuse. This book equips readers with the conceptual tools needed to think critically about these developments. Importantly, it also encourages difficult yet necessary conversations about personal wishes in the event of disorders of consciousness or brain death. By prompting such discussions, it helps ensure that families are not left to make deeply challenging decisions without guidance. Ultimately, the book serves not only as an introduction to neuroethics but as an invitation to sustained ethical engagement in neuroethics research, clinical practice and society.
