Neuroethics Noon Seminar

2017

Ethical and regulatory challenges from intelligent medical systems and big data in clinical neuroscience
Philipp Kellmeyer
MD, MPhil, Postdoctoral Researcher
Translational Neurotechnology Lab, Department of Neurosurgery, University of Freiburg – Medical Center

Monday June 26, 2017, 12:00PM – 01:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Overview:
We currently witness the convergence of several technological macro-trends: the aggregation of unprecedented amounts of personalized “big” data by researchers, health organizations and consumer companies, the increasing analytical and predictive power of advanced machine learning algorithms, and the trend towards wearable sensors for gathering biometric data for clinical and consumer applications. In his talk, Dr. Kellmeyer will address some emerging ethical challenges that arise from this constellation, e.g.the problem of an “accountability gap” in scenarios in which agency is shared between humans and intelligent medical devices.

Furthermore, he will discuss the challenges for the regulation and governance of intelligent medical systems and how to safeguard neural data from unauthorized access and exploitation.

Bio:
Dr. Philipp Kellmeyer, MD, MPhil is a board-certified neurologist at the Translational Neurotechnology Lab, Department of Neurosurgery, University Medical Center Freiburg, Germany. He currently works on a project for using a wireless, intracranial EEG based brain-computer interface to restore communication in severely paralyzed neurological patients. He is also a scientific member of the Cluster of Excellence BrainLinks-BrainTools, an interdisciplinary research consortium on neurotechnological research at the University of Freiburg, funded by the German Research Foundation (DFG). In his neuroethical work he is particularly interested in the ethical challenges of emerging neurotechnologies, machine learning and big data in clinical neuroscience, as well as ethics issues in disorders of consciousness, neuroimaging and neurodegenerative diseases. He is a member of the Emerging Issues Advisory Task Force of the International Neuroethics Society and the Advisory Committee of the Neuroethics Network.
Reading in Two Languages with One Brain: Functional Connectivity in the Adult Brain System for Word Processing
Edith Brignoni Pérez
PhD Candidate, Interdisciplinary Program in Neuroscience
Center for the Study of Learning, Department of Pediatrics, Georgetown University Medical Center

Friday June 23, 2017, 11:00AM – 12:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Overview:
Word reading relies on a left-lateralized brain system including occipito-temporal, temporo-parietal, and inferior frontal cortices. Most of this evidence, however, comes from monolingual populations, predominately in speakers (and readers) of English, which is a deep orthography (i.e., has greater exceptions to the grapheme-to-phoneme conversion, or GPC, rules). Whether this brain system is the same in shallow orthographies (e.g., Italian, Spanish, German) and in bilingual populations is still unclear. Drawing on functional magnetic resonance imaging data, Ms. Brignoni-Pérez will discuss the modulatory roles of orthographic depth (i.e., the consistency of GPC) and lifelong bilingualism on the brain system for reading in bilingual and monolingual adults. Together, this investigation intends to advance our understanding of the neurofunctional bases of reading in early bilinguals as a factor of orthography and language experience, and to provide a foundation by which to eventually study bilingual-biliterate children and populations with the common reading disability developmental dyslexia.

Bio:
Edith Brignoni-Pérez is a Ph.D. candidate in the Interdisciplinary Program in Neuroscience (IPN) at Georgetown University (GU). Her dissertation focuses on the neurofunctional bases of reading in bilingual-biliterate children and adults, conducted at the Center for the Study of Learning under the mentorship of Dr. Guinevere F. Eden.

Ms. Brignoni-Pérez holds a Bachelor of Arts in Psychology from the University of Puerto Rico (UPR), Río Piedras Campus. At the UPR’s Medical Sciences Campus, she did her two-year NIH BP-ENDURE fellowship, studying the neural circuits of active-avoidance expression in rats, relevant to stress- and trauma-related disorders, in Dr. Gregory J. Quirk’s lab. Edith also studied the physiological effects of acute stress on extinction (a new, safety memory) recall in humans during her undergraduate summer fellowship at New York University under Dr. Elizabeth A. Phelps’ mentorship. After graduation, Ms. Brignoni-Pérez completed a one-year NIH postbaccalaureate fellowship at the University of Pennsylvania, studying the role of glutamatergic signaling in the development of social behaviors in mice, relevant to negative symptoms of Schizophrenia, in Dr. Edward S. Brodkin’s lab.

In addition to her passion for research, since younger stages Ms. Brignoni-Pérez has been involved in several outreach efforts, such as educational collaborations with non-profit organizations; students’ professional development and recruitment; school- and college-students mentoring; science teaching and tutoring; and, science-into-the-community initiatives. While being in Georgetown, she pioneered and leads the Annual GU Free Neuroscience Public Lecture (2015, 2016, 2017) in collaboration with the NeuroPolicy Affinity Group of the American Association for the Advancement of Science, as part of the worldwide celebrated Brain Awareness Week. Moreover, Ms. Brignoni-Pérez has served as the: communications officer of the GU Medical Center Graduate Student Organization (2014-15), student representative for recruitment in graduate school fairs (2014-present), student representative in the IPN curriculum committee (2015-present), and past secretary (2015-16) and current president (2016-17) of the Society for Neuroscience’s Washington, D.C. Metro Area Chapter.

 

Fulfilling the moral obligation to inform disease communities about scientific research – a case study
Jeff Carroll
PhD, Associate Professor
Department of Psychology, Western Washington University

Thursday May 11, 2017, 11:00AM – 12:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Overview:
Huntington’s Disease is a fatal genetic neurodegenerative disease, for which no disease modifying treatments exist. Thanks to it’s genetics – autosomal dominant and completely penetrant – and typical onset in midlife, there is a large community of HD affected people around the world. This community is hungry to understand the process of developing effective therapies for HD. In 2011 we developed an online information portal – HDBuzz.net – with the mission: “Huntington’s disease research news. In plain language. Written by scientists. For the global HD community.” I will discuss our success and failures, and explain why I believe researchers have a moral obligation to inform disease communities about the progress of research which impacts them.

Bio:
Dr. Jeff Carroll is an Associate Professor in the Behavioral Neuroscience Program and the Department of Psychology at Western Washington University. His scientific interest is in the understanding the systemic effects of Huntington’s Disease, especially metabolic changes, which he studies using a mouse “knock-in” model of Huntington’s Disease. He also has an interest in gene silencing approaches to HD therapeutics, particularly using antisense oligonucleotides (ASOs). Dr. Carroll’s PhD and postdoctoral studies all involved using mouse models to understand basic mechanisms of HD and preclinical testing of therapeutic interventions in these models. During his PhD he trained with Michael Hayden (UBC), his postdoctoral studies were conducted under the supervision of Marcy MacDonald (MGH, Harvard Medical School). As well as conducting research, Dr. Carroll is a member of an HD family and himself carries the mutation which causes the disease.

 

MAID in Canada: How did we get here, and where are we going?
Sue Hughson
DVM, BSc, Vice Chair & Vancouver Chapter Coordinator
Dying With Dignity Canada

Friday April 21, 2017, 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Discussion topics may include:

  • From the Carter case to legislation
  • Lost in translation, obstacles and access to MAID
  • Mature minors, advance consent and mental illness as a primary diagnosis

Bio: Dr. Sue Hughson is a veterinarian in her 28th year of private practice, a mother, social justice advocate, Past President of the BC Humanist Association, poet and Art Song collaborator.

 

Case-based discussion of some interesting dilemmas in clinical neuroethics
Thomas I. Cochrane
MD, MBA, Assistant Professor of Neurology, Director of Neuroethics
Center for Bioethics, Harvard Medical School

Wednesday March 15, 2017, 11:30AM – 12:30PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Other discussion topics may include:

  • Life support after high cervical cord injury
  • Life support for neonates with brain injury

Bio: Dr. Thomas Cochrane is the Director of Neuroethics at the Center for Bioethics at Harvard Medical School. Additionally, Dr. Cochrane is an Assistant Professor of Neurology at Harvard Medical School, an Associate Neurologist at Brigham and Women’s Hospital. He is a Senior Ethics Consultant on the Ethics Consultation Service at Brigham and Women’s Hospital.

Dr. Cochrane received a combined MD and MBA from the Tufts University School of Medicine and completed his residency in neurology in the Partners Neurology program at Massachusetts General Hospital and Brigham and Women’s Hospital. He then completed a fellowship in neuromuscular medicine and electromyography at Brigham and Women’s Hospital. He completed the Fellowship in Medical Ethics at Harvard Medical School, and then served as a Faculty Fellow at the Safra Foundation Center for Ethics at Harvard University.

Dr. Cochrane’s energies are primarily directed toward education, scholarship, and research in medical ethics and neurology. He teaches medical students in their course on Medical Ethics and Professionalism, and directs a Masters-level course in Neuroethics. He has given over a hundred invited lectures and presentations. Dr. Cochrane has authored dozens of peer-reviewed articles, book chapters, educational material for medical professionals, ethicists, and laypeople. He co-edited the popular neurology board review book First Aid for the Neurology Boards, and also a book on Medical Ethics and Professionalism, intended for use in training physicians and other medical providers.

 

The Addiction Recovery & Community Health (ARCH) Team: Patient and Stakeholder Perspectives
Elaine Hyshka
PhD, Assistant Professor
School of Public Health, University of Alberta

Wednesday February 15, 2017, 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117


Background:
The Addiction Recovery & Community Health (ARCH) team is a unique multidisciplinary addiction service implemented at Edmonton’s Royal Alexandra Hospital. The team works with socially marginalized patients with substance use disorders, and is comprised of physicians, a nurse practitioner, social worker, peer support worker, and addictions counsellor. The team offers withdrawal management, treatment, health promotion interventions, harm reduction services, and social supports (housing, income, ID, long term treatment). We undertook a qualitative process evaluation to 1) explore patient and stakeholders’ perspectives of the ARCH Team, 2) identify factors which may facilitate or impede ARCH’s delivery of care and 3) assess the perceived impact of ARCH’s services on patients, the hospital and community.

Methods: Utilizing a focused-ethnographic design, we conducted semi-structured interviews with 21 ARCH patients, 10 hospital staff, and 10 community stakeholders. Interviews were recorded and transcribed verbatim and latent content analysis was employed to outline primary themes.

Results: For patients the most salient aspect of the ARCH team was their humanistic approach combined with a focus on patient autonomy and choice. Many patients reported psycho-social benefits and positive changes in substance use patterns. Stakeholders felt the ARCH team improved patient care, enhanced other service providers’ understanding of substance use disorders, and helped bridge hospital community transitions. Barriers to team success included limited access for individuals in the community, unmet expectations for some patients, as well as incongruence between how some hospital staff and the ARCH team approach patient care.

Conclusion: Overall, patients perceive ARCH as a valuable service for a variety of reasons. More work, however, is needed to support hospital staff in understanding and adopting a harm reduction approach. Results of this evaluation provide useful information for refining the ARCH program and improving acute care for patients experiencing substance use disorder and social iequities.

Brief Bio
Dr. Elaine Hyshka is an Assistant Professor of Health Policy and Management in the University of Alberta’s School of Public Health, and the Scientific Director of the Royal Alexandra Hospital’s Inner City Health and Wellness Program. Her research focuses on advancing a public health approach to substance use in Canada, and improving healthcare services for patients experiencing problematic substance use. Dr. Hyshka is committed to engaged scholarship and her research is conducted in partnership with several local, provincial, and national-level service providers, policymakers, and public health advocacy organizations.

2016

The Death With Dignity Debate
Leslie Laforest
Writer, Artist, and Patient advocate

UPDATE: This event is currently postponed. Please visit us again for updates.
Wednesday November 23rd, 2016 (September 21st, 2016), 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Overview: Ms. Laforest will speak on:

  • How she arrived at her philosophical approach to dignified death
  • How she became involved in the Carter case upon which law was changed (patient advocacy)
  • The current status of her health that further entrenches those beliefs
  • How Canada’s health care model/budgetary limitations thwarts palliative care as a viable alternative for many
  • Why the current change in law does not fully serve those who seek a dignified death

Leslie Laforest is a writer, artist and patient advocate. Having experienced a series of health adversities since 2004, Leslie became immersed in the medical world, not only as a patient, but as a researcher and witness to the impacts of health care delivery on patients by a system under severe economic strain. Recording graphically her own and other patient experiences, these were shared with senior administrators at St. Paul’s and Vancouver General hospitals in a series of thought provoking meetings urging changes in the way health care was being delivered to thousands of British Columbians, to positive effect.

Leslie’s medical journey further entrenched her belief that every individual has the right to a dignified death, and medical assistance to achieve this ought not to be a criminal act but one of compassion protected by law. Her affidavit material setting out vividly and emotionally the toll of irremediable disease became part of the public record in the unanimous Supreme Court “Carter decision” that has changed forever the landscape of medically assisted death in Canada.

 

Psychiatric conditions and medical aid in dying (MAiD): Should mental suffering alone be sufficient for eligibility?
Jennifer Chandler
LLM, Full Professor
Centre for Health Law, Policy and Ethics, University of Ottawa

Wednesday November 2nd, 2016, 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

There are strongly held views on both sides of the issue of whether capable people with a psychiatric disorder should be eligible for MAiD on the basis of mental suffering alone and while they are presently excluded, the Canadian Government has committed to study the issue further. This presentation considers the legality of the present exclusion of MAiD for psychiatric conditions, given the possibility that access to MAiD may allow increased identification and intervention for those at risk of impulsive suicide. It also considers possible intermediate positions between the extremes of complete exclusion from and unlimited access to MAiD for those whose suffering is solely psychological in nature.

Jennifer Chandler is a Professor of Law and holder of the Bertram Loeb Research Chair at the Faculty of Law, University of Ottawa. She studies the intersection of the brain sciences, psychiatry and the law, as well as other topics related to the legal impact of advances in biomedical knowledge and technology. She is the co-editor, with Colleen Flood, of the recent book Law and Mind: Mental Health Law and Policy in Canada (LexisNexis 2016). She serves on multiple international editorial and advisory boards in the fields of neuroethics and law and neuroscience, including the journal Clinical Neuroethics, the Springer Book Series Advances in Neuroethics, the Institut du Cerveau et de la Moelle Epiniere (ICM) Neuroethics Network (Paris), the Société française de psychologie juridique (Paris), the Canadian Institute for the Administration of Justice and the International Neuroethics Society.


Cause of Death: Schizophrenia?
Jenny Young
MSW, MA, Clinical Ethicist
Providence Health Care

Tuesday August 9th, 2016, 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Patients who have both life-threatening physical illnesses and severe mental disorders may deny they are ill. Frequently such patients fall through the cracks in the health care system and do not receive appropriate medical care for their physical illnesses. We propose a decision-making process for these complex cases that is informed by an ethical analysis based on the principles of autonomy, non-maleficence, beneficence, and justice, as well as by a review of the literature and relevant legislation in British Columbia. This process is congruent with the law and can be used to make ethically justifiable decisions about treating the physical illness of a patient with a mental disorder when a cure or meaningful extension of life is possible. Mentally ill patients should not be allowed to die solely because they have a psychiatric disorder and are unable to make informed medical decisions or follow through on necessary treatment.


E-health and the future of health care – ready for a paradigm shift
Michael Krausz
MD,PhD,FRCPC, Scientist
Centre for Health Evaluation and Outcome Sciences, University of British Columbia

Wednesday May 18th, 2016, 12:00PM – 1:00PM
Djavad Mowafaghian Center for Brain Health, Room 3402 C


Early mortality from external causes in Aboriginal mothers: A retrospective cohort study
Jenny Fairthorne
PhD, Postdoctoral Fellow
Child and Family Research Institute

Tuesday May 3rd, 2016, 12:00PM – 1:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external causes.

We linked data from four state administrative datasets to identify all women who had a child from 1983-2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and their dates and causes of death prior to 2011. Comparing Aboriginal mothers with other mothers, we estimated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide, and homicide, and the corresponding age of their youngest child.

Compared to non-Aboriginal mothers and after adjustment for parity, socio-economic status and remoteness, Aboriginal mothers were more likely to die from accidents [HR=6.43(95% CI: 4.9, 8.4)], suicide [HR=3.46(95% CI: 2.2, 5.4)], homicide [HR=17.46(95% CI: 10.4, 29.2)] or any external cause [HR=6.61(95% CI: 5.4, 8.1)]. For mothers experiencing death, the median age of their youngest child was 4.8 years.

During the study period, Aboriginal mothers were much more likely to die than other mothers and they usually left more and younger children. These increased rates were only partly explained by socio-demographic circumstances. Further research is required to examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children.


The Neuroscience of Decision-Making and the Ability to Value
Winston Chiong
MD, PhD, Assistant Professor
Memory and Aging Center, University of California – San Francisco

Wednesday April 20th, 2016, 11:00AM – 12:00PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Recent international controversies provide an opportunity to reevaluate prevailing legal and clinical standards of decision-making capacity. While prevailing standards focus on communicative and intellectual abilities, research on the cognitive neuroscience of decision-making indicates that emotional and motivational faculties also play a critical role. Thus, prevailing standards may underestimate preserved aspects of decision-making in patients with primarily intellectual or communicative impairments (as in Alzheimer’s disease), while overestimating the capacity of other patients who suffer from the disruption of emotional and motivational systems that underlie what we term the ability to value. Neuroscientific research on clinical populations such as frontotemporal dementia, anorexia nervosa and major depression reveals important parallels between the neural bases of the abilities to retain, manipulate and communicate information, and the neural basis of the ability to value.


Regulation of Clinical Trials in Canada
Nina Preto
JD, PhD, Senior Clinical Research Ethics Analyst
Office of Research Ethics, University of British Columbia

Wednesday January 28th, 2016, 12:00-1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

This presentation will provide a brief overview of the regulation of health research in Canada, with a focus on clinical trials. The roles of each of the three main oversight actors (Health Canada, the REB and the Sponsor) will be described, followed by a discussion of some key challenges facing our oversight system.

Dr. Preto practiced law with a medical malpractice defense firm in Vancouver before pursuing her MSc and PhD in research ethics. She has served as the ethics member on many of UBC’s affiliated REBs, and was a partner in the Vancouver based ethics consulting firm of Engage Associates. The focus of her research and work has predominantly been at the interface of law and research ethics. For example, her doctoral dissertation focused on the pressures that arise at the investigative site/CRO interface in clinical trials and included a critical ethical and legal analysis of Canada’s clinical trial oversight framework. This work informs the presentation she is giving today.


2015


Therapeutic Recreation Programs for Children with Neurodisability: A Community Response to System Deficiency?
Jean-Paul Collet
MD, PhD
Faculty of Medicine, University of British Columbia

Wednesday December 9th, 2015, 12:00-1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

The prevalence of children and youth with neurodevelopmental disability (CYND) ranges from 4 to 10% depending on definitions. Most CYND share key features of difficulty coping with activities of daily living, experience some degree of social isolation, and miss the benefits of full participation in group-interactions, which is a fundament part of children’s’ neurological and social development. Hence, families may seek and attend community-based activity “Therapeutic Recreation” (TR) programs that stimulate the child’s psychosocial development and motor functions, with the ultimate goal of improving physical well-being, social integration and quality of life. Some evidence suggest that TR program may also contribute to parents’ and family health, by reducing their fears and anxieties, add to their confidence and well-being, and contribute to resiliency in providing care. Presently however, there is no good documentation of the services offered and their real effects on the child/youth’s learning experience.

We organize a partnership with the stakeholders (families and organizations, TR practitioners, educators, clinicians, and policy makers) to examine the contributions of TR programs to CYND and their families. The ultimate goal is to identify: (i) the existing gaps in the Health and Education systems that make the TR programs valuable for these families; (ii) the specific needs of CYND and families that make TR programs important; (iii) the effects of TR programs on the children and the families; (iv) which factors affect the success of TR experience.

Dr. Collet’s study focuses on the use of clinical research methodology to address questions of public health interest and facilitate decision making, and the development and evaluation of patient-centred approaches through the promotion of integrative medicine.


The Impact of Toxins on the Developing Brain: Our Failure to Prevent Brain-based Disorders in Children
Bruce Lanphear
MD, MPH, Professor
Faculty of Health Sciences, Simon Fraser University

Thursday November 12th, 2015, 12:00-1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

The impact of toxins is usually subtle for an individual child, but they can be substantial at the population level. Widespread exposures to toxins – such as lead, pesticides and flame retardants – are implicated in the development of intellectual deficits and behavioural problems, like ADHD and antisocial behaviors. Yet, despite compelling evidence and extraordinary cost-beneficial calculations, too little has been done to protect children from these ubiquitous, but insidious toxins. This session will provide an overview of the population impact of toxins on children’s health, describe our failures to act on evidence to protect children and set the stage for dialogue about ways to articulate the impact and importance of toxins on the developing brain.

Dr. Lanphear is currently principal investigator for a study examining fetal and early childhood exposures to prevalent environmental neurotoxins including lead, pesticides, mercury, alcohol, PCB’s and environmental tobacco smoke.


When Words Hurt and Being Nice Does not Suffice
Elvira V. Lang
MD, FSIR, FSCEH, Creator of Comfort Talk®, Founder & President
Hypnalgesics, LLC

Tuesday September 15th, 2015 3:30–4:30 PM (*please note that this seminar is in the afternoon*)
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

How visits to the doctor and hospital change the way people take in suggestions and make them more suggestible. How healthcare professionals unknowingly engage in giving patients negative suggestions which increase pain and anxiety and how empathy, when not expressed in ways that help patients help themselves, can lead paradoxically to increased risk of adverse events. Presentation of supportive clinical trial data and alternative approaches. Benefits of the use of targeted hypnoidal language alone or as adjunct for distress management towards better patient outcomes and satisfaction. How to address the ethical dilemma and resistance of personnel in adopting new more patient-centric behaviors that feel unfamiliar to the communicator’s personality and usual practice.

Elvira Lang, MD is an award-winning interventional radiologist known for research about the clinical effectiveness and cost savings of pre and intra- procedural hypnotic interventions. She held faculty positions at the University of Heidelberg, Stanford University, the University of Iowa, and Harvard Medical School. With a substantive government-funded research program she demonstrated in three large-scale prospective randomized studies with more than 700 patients that hypnosis on the procedure table reduces pain, anxiety, drug use, and complications. This work provided much of the evidence-based foundation for widespread acceptance of procedural hypnosis. In >150 research papers and chapters, Dr. Lang has presented and analyzed medical procedures and interactions with healthcare professionals as well as the effects of patients’ age and disposition on outcomes. She developed and rigorously tested training in methods of advanced rapport skills and hypnoidal language for busy healthcare professionals who have no extra time to spare. This experience culminated in the creation of Comfort Talk®. She currently oversees a multicenter trial on the training of MRI teams in Comfort Talk® which has already yielded impressive improvements in patients’ satisfaction and ability to complete examinations at the participant sites. She is working with Toronto Hospital for Sick Children on a clinical trial on improving the perioperative and postoperative experience surrounding cardiac interventions. Her research work has been acknowledged with the Ernest R. Hilgard Award for Scientific Excellence for a Lifetime of Published Experimental Work.


Neuroscience, Health Interventions, and British Society: (Dis)Engagements with the Brain in Policy, Practice and Everyday Life
Martyn Pickersgill
PhD, Wellcome Trust Senior Research Fellow in Biomedical Ethics
Edinburgh Medical School

Monday May 25th, 2015 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Asking Google ‘are we are brains?’ brings up a lot of (diverse) answers, some of which articulate closely with philosophical and neurobiological research and reflection. Sociologists and anthropologists too have spent time dealing with questions of the neuro, the sciences orientated towards it, and the relationships of these with identity. In this talk, I will present an overview of some of the sociological research on neuroscience and society that I have been engaged in over recent years. This includes focus group research with scientists, neurological patients and members of a range of professions – as well as interview-based work with psychiatrists, clinical psychologists, and mental health policymakers and social policy advisors. Interview data are currently also being collected from users of early intervention services for young parents. The projects emerge from work funded by, in particular, the ESRC, Leverhulme Trust and Wellcome Trust, and help to cast light on the social life of the brain within British society. I hope to show that whilst neuroscience – and ideas about the brain more broadly – have considerable traction in a range of spheres, engagements with these by (mental health and other) professionals, patients and wider publics is also often ironic, cautious, or antagonistic. This pattern of (dis)engagements has, I suggest, implications for the response of scholars concerned with the ethical, legal and policy implications of science to emergent neuroscientific knowledge.

Dr. Pickersgill is a sociologist of science, technology and medicine, and currently Wellcome Trust Senior Research Fellow in Biomedical Ethics. To date, his research has focused primarily on the social, legal and ethical dimensions of biomedicine and the health professions. In particular, Dr. Pickersgill’s work has considered the sociologies of epigenetics, neuroscience, and mental health (supported through a range of funders, including the AHRC, ESRC, Leverhulme Trust, Newby Trust and Wellcome Trust).


Evolutionary Neurology, Enactive Consciousness, and Neuroethics
Grant Gillett
MSc (Psych), MBCHB, FRACS (Neurosurgery), D.Phil. (Oxon; Philosophy), FRS (NZ)
University of Otago, New Zealand

Tuesday Apr 14th, 2015 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Aristotle famously divided the intellective functions of the soul – the embodied and active form of a human being or other living creature – into active and passive principles. These were not separate parts of a composite whole but allowed us to distinguish the active use of our appetitive, sensori-motor, and intellectual capacities in a tract of experience from the mere potential to use them. His naturalistic embodied account of the human intellect resonates in a striking way with contemporary cognitive neuroscience and its growing acceptance of embodied cognition and the global neuro-cognitive workspace as the basis of human consciousness and its special place in our thinking about nature. That picture will be explored using John Hughlings-Jackson’s evolutionary neurology and its basis in the integration of sensori-motor routines and re-representation to form higher mental functions. The possibility of moral cognition as a higher order development of that process raises interesting critiques of some prevailing models in neurotics.

Dr. Gillett research ranges quite widely in Bioethics, philosophy, and neuroscience. In Bioethics he works on end of life care, complementary and alternative medicine, autonomy, and the patient’s journey. In Neuroethics he has written widely on brain birth, brain death, PVS, and minimally conscious states, and issues of free will identity and responsibility.

Dr. Gillett’s work in neuroethics arose from research in Philosophy of psychiatry focusing on the nature of mental disorder, psychopathy, and dissociative disorders. He examines these topics through Post-structuralist philosophy, an exploration of the patient’s voice, post-colonialism, and human subjectivity and he has authored Subjectivity and being somebody: neuroethics and human identity, Bioethics in the Clinic(Johns Hopkins University Press) The mind and its discontents (Oxford Univ Press) Reasonable Care(Bristol Press), Representation, Meaning and Thought (Oxford University Press) and co-authored The Discursive Mind (Sage) as well as numerous articles in a variety of international journals such as Philosophy, British Medical Journal, Lancet, Philosophical Psychology, Inquiry, Mind, Journal of Medical Ethics, Journal of medicine and Philosophy, Consciousness and cognition, Brain, Philosophy, psychiatry and psychology, and Bioethics.


Strategies to Evaluate the Mental Health of Cetaceans under Human Care
Barak Caracheo
PhD Candidate, Neuroscience Program
University of British Columbia

Tuesday Mar 24th, 2015 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Cetaceans are marine mammals that have complex brain structures and sophisticated intelligence. Under ethical human care, they must be provided with high levels of mental and physical stimulation to maintain optimal levels of well being. The talk will mention some strategies used to achieve such stimulation, discuss currently used indicators of psychological welfare and propose new ones that are being developed.

Mr. Barak Caracheo is a PhD candidate in the Neuroscience Program at UBC. He earned a B.Sc. in Exercise Science at the University of Lethbidge and was a Dolphin Trainer in Dolphinaris Cancun before beginning his doctoral work in the laboratory of Dr. Jeremy Seamans at the UBC Brain Research Centre. Mr Caracheo performs in-vivo electrophysiological recordings in rodents and analyzes the neural dynamics of the anterior cingulate cortex during choice behaviour. Upon completion of his PhD, he aims to continue his work with cetaceans by focusing on cognitive research and the development of strategies to evaluate and improve their mental health while in captivity.


Recovery Takes More Than a Stimulator: An Evolving View of DBS for Depression
Helen S. Mayberg
Professor of Psychiatry, Neurology and Radiology
Dorothy Fuqua Chair in Psychiatry Imaging and Therapeutics

Emory University

Wednesday Mar 18, 2015, 12:00 PM – 1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Please visit us again for updates.


The Ethics and Practice of Care: Rethinking Habitus
Aiste Bartkiene
Postdoctoral Fellow
Lithuanian University of Health Sciences

Wednesday Mar 11, 2015, 12:00 PM – 1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Mainstream bioethical approaches tend to offer principles or rules for medical practice which are based on premises that valorize individualism, autonomy, and rational choice as primary modes of ethical action. The adherents of care ethics claim that this perspective underappreciates the role of emotions, relations and practices for moral development and action – it flattens and distorts the understanding of moral domain. According to such care ethics theorists as Nell Noddings and Joan Tronto the background of morality is caring for others, while these others can be humans, plants, ecosystems or ideas. The purpose of this presentation is to bring care ethics in conversation with sociology of Pierre Bourdieu, particularly by linking the ethics of care with the notion of social practice and habitus developed by him. An incorporation of habitus into the ethics of care is useful because it highlights the ways in which interpersonal relations relate to one’s moral development and points to the significance of sociocultural and historical contexts in shaping behaviors.

Aiste Bartkiene, Ph.D., is a visiting postdoctoral fellow from Lithuanian University of Health Sciences. She received her Ph.D. from Vilnius University in 2012. The main object of her dissertation has been bioethical theories based on deontology and utilitarianism and the research was focused on the normative justification of bioethical principles proposed in mainstream approaches. Current research is designated to explore the concept of care in biomedical and environmental paradigm and is funded by the European Union Human Resources Program in Structural Funds and administered by the Research Council of Lithuania. This project aims at questioning foundational assumptions in bioethics both in European and North American contexts. Most of the current writings in bioethics tend to draw on the European intellectual traditions that valorize individualism, autonomy, and rational choice as primary modes of ethical action. Using the works of Nell Noddings, Joan Tronto and Pierre Bourdieu, Aiste Bartkiene seeks to bring bioethics in a closer conversation with the ethics of care and, in so doing, to re-imagine bioethics in terms of relationality and interdependency.

On the limits of conventional approaches to evidence-based public health policymaking: The case of supervised injection services
Elaine Hyshka
PhD Candidate
Addiction and Mental Health Research Laboratory
University of Alberta School of Public Health

Monday Mar 2, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Health science researchers typically approach engaged scholarship and evidence-based policymaking as a rational exercise that involves working with policymakers to identify, implement, and evaluate health interventions. This conventional approach emphasizes forming mutually beneficial partnerships, producing and adapting high-quality evidence, and developing tools and strategies to encourage uptake of interventions with a strong evidence base into routine services. But how relevant are these tactics for public health interventions that mobilize multiple service sectors (e.g., health, justice, education) and target highly contentious health issues (drug use, sexual health, health inequities, etc.)?

This presentation draws on Ms. Hyshka’s experience researching and supporting the implementation of supervised injection services (SIS) in Canada to highlight some limitations of conventional approaches to engaged scholarship and evidence-based policymaking in public health. Findings from two recent research projects: (1) a legal and policy analysis examining prospects for scaling-up SIS in Canada, and (2) an engaged scholarship research project surveying injection drug users to assess the need for SIS in Edmonton, Alberta, will be highlighted.

Decision-making around SIS illustrates how failure to implement evidence-based policies is not always attributable to breakdowns in communication, collaboration, implementation or other aspects of typical engaged scholarship cycles. Rather, values, politics, and beliefs are often the more salient determinants of public health decision-making. Ms. Hyshka concludes that maximizing the influence of scientific evidence on public health policy, at least with regards to contentious health policy issues, requires researchers to move far beyond conventional engaged scholarship and evidence-based policymaking approaches. To extend the effectiveness of engaged scholarship efforts, public health policy research should treat social, political, and cultural barriers to evidence-based policymaking as legitimate objects of inquiry rather than externalities that cannot be changed.

Elaine Hyshka is a PhD candidate in the Addiction and Mental Health Research Laboratory at the University of Alberta’s School of Public Health. Her research focuses on social, legal and political aspects of substance use and frequently engages community and government partners. Elaine is a Killam Laureate and recipient of the Canadian Institutes of Health Research Doctoral Research Award, and an Alberta Innovates: Health Solutions Health Research Studentship. She previously completed a Masters of Arts in Sociology and a Certificate in Addiction Studies at the University of Toronto.


2014

The Intersection of Wilderness Medicine and Chinese Herbal Medicine: Prescriptive Practices, Translational and Neuroethical Considerations
Polly Ambermoon
Chinese Medicine Practitioner
Coorparoo, Brisbane, Australia

Friday Oct 24, 2014, 12:00 PM – 1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Wilderness medicine is an evolving specialty covering a range of often unique medical conditions requiring diagnosis and treatment in resource-limited, austere environments. The pathophysiology and treatment methods for environmental-based illnesses, such as high altitude sickness and frostbite, are still under investigation. The Shang Han Za Bing Lun (‘Treatise on Cold Damage Disorders and Complex Diseases’) was written by Zhang Zhong Jing at the end of the Eastern Han dynasty and is the first Chinese medicine clinical text for acute, often life-threatening disorders. It provide insight into how external environmental conditions influence normal physiology, outlines progression of disease and associated Chinese herbal formulae to counter pathophysiological processes. The seminar will provide an overview of both medical systems, with their congruence providing a unique platform for discussion and future research into translational and clinical considerations regarding disease processes and treatment options for wilderness conditions. Neuroethical considerations will be discussed in relation to wilderness neurology.

Polly Ambermoon is a Chinese medicine practitioner based in Brisbane, Australia and has over 15 years research experience in the Health Sciences including behavioural neuroscience and addiction neuroethics. She has a keen interest in the clinical practices and collaborative opportunities of Western and East-Asian medicines. She has a Masters degree in Chinese herbal medicine and Bachelor degrees in psychology and acupuncture.

Cognitive enhancement and increasing Ritalin in use in the Netherlands: empirical and ethical perspectives
Maartje Schermer
Professor Philosophy of Medicine
Department of Medical Ethics and Philosophy
Erasmus MC – University Medical Center
Rotterdam, The Netherlands

Thursday Oct 23, 2014, 12:00 PM – 1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

The use of cognitive enhancers, especially by students and academics, has given rise to heated ethical debates. After a brief overview of this debate, I will report on recent empirical research regarding the actual use of such cognitive enhancers, as well as public opinions about enhancers, in the Netherlands. Interestingly, while in Dutch the public debate cognitive enhancement is not a very big topic, there has been much critical discussion about the rising use of Ritalin by children diagnosed with ADHD. I will argue that in some important respects the ethical arguments surrounding both topics are very similar.

Maartje Schermer, MD, PhD, holds the Civis Mundi chair in Philosophy of Medicine at the department of Medical Ethics at ErasmusMC University Medical Center in Rotterdam, the Netherlands. She is vice-chair of the standing committee on Ethics and Law of the Dutch Health Council, and chair of the Dutch Society for Philosophy and Medicine. Her main research interests are in neuroethics and human enhancement.

Ethical considerations in functional MRI on acutely comatose patients in the intensive care unit
Charles Weijer
Professor of Philosophy and Medicine
Canada Research Chair in Bioethics
Western University

Wednesday Oct 1, 2014, 12:00–1:00 PM
Djavad Mowafagian Centre for Brain Health, 2215 Wesbrook Mall, Room 3402B+C

Acquired brain injury is a leading cause of death and disability. After a severe brain injury, patients are treated in an intensive care unit and may be comatose for days or weeks. Prognosis is assessed using clinical examination, structural neuroimaging, biomarkers and electrophysiological testing. Although these tests are useful, prognostication is imprecise in the acutely comatose state. As the majority of deaths following severe brain injury are the result of withdrawal of life support, accurate information is essential for families and healthcare providers. Recent research has used functional MRI to assess intact neural networks in comatose patients. Future fMRI studies may provide evidence of intact neural networks and cognitive function which may, in turn, predict reversible impairments in consciousness. In this paper, we provide the first analysis of ethical issues in fMRI research in acutely comatose patients in the intensive care unit. We argue that six ethical issues ought to be addressed in any prospective fMRI study in this setting: (1) Is fMRI a therapeutic or nontherapeutic procedure in the study context? (2) Have the risks of research participation, including the risks of intrahospital transport, been minimized consistent with sound scientific design? (3) Are the risks of nontherapeutic procedures no more than a minor increase above minimal risk? (4) Have study participants been selected equitably? (5) Will valid surrogate consent for study participation be obtained? (6) Are adequate plans in place to share individual research results with the responsible physician or the family?

The Relationship Between Accountability Pressures and Motivations for Funding hESC Research: An International Comparative Study Focused on Philanthropists
Noomi Weinryb
PhD Candidate
Department of Business Studies, Uppsala University

Tuesday June 17 2014, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Due to the harsh funding circumstances during the first decade of the millennia, private research funders facing other accountability pressures than public agencies took a lead in funding hESC research. Organizational theory indicates that resource provision as well as geographic location will effect motivations for funding hESC research. Focusing on independently wealthy philanthropists, this study investigates how the extent of accountability pressures experienced by funders in different institutional environments influenced their motivations for funding hESC research. The study compares philanthropists to fundraising dependent nonprofits, public agencies, and corporations across three different institutional environments.

Methods: The data was collected in 2011/2012 in direct interviews with funders of hESC research, N=86, in Sweden, California, and South Korea, three countries having different tax systems, legislation, and normative climate when it comes to hESC research. The sampling was based on a systematic analysis of all hESC publications in PubMed coming out of Sweden, California and South Korea, and all funders were listed and categorized. The interviews had a survey part using pre-validated scales as well as a structural qualitative component. The survey was analyzed in one-way between-groups ANOVA with planned comparisons. The qualitative data was coded following a structured interview format.

Results: The ANOVA reveals that philanthropists experienced lower accountability pressures than public agencies, corporations, and fundraising nonprofits. Differing from other research funders, the ANOVA also shows that philanthropists did not primarily fund hESC research motivated by its clinical or commercial promise. Instead, the qualitative data indicates that philanthropists’ motivations for funding hESC research were more diverse and differed between countries.

Conclusion: The extent of accountability pressures experienced by hESC research funders seems to have some influence on their motivations for funding hESC. Public agencies, corporations, and fundraising nonprofits experienced higher accountability pressures than philanthropists and were to a higher extent motivated by the clinical and commercial promise of hESC. Facing lower accountability pressures, philanthropists seemed to be influenced more by the national institutional environment than by the clinical potential of the research. In Sweden, philanthropists tried to mimic public research funders, whereas in California they strived to complement the NIH. South Korean philanthropists were not distinguishable from other types of funders in their country in terms of their motivations, which can potentially be explained by the centralized institutional environment.

Noomi is a PhD Candidate at the Department of Business, Uppsala University, expected defense 06/2015. Her BA/MA is from Stockholm School of Economics. Noomi has been a visiting PhD Student at the Schools of Business and Public Health, University of Alberta and at Ewha Center for Medical Ethics and Humanities, Seoul.

Introduction to Qualitative Research
Jacqueline Davidson
Research Coordinator
National Core for Neuroethics, University of British Columbia

Friday May 30, 2014, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Why do we do qualitative research? What are the benefits and limitations of taking a qualitative approach? This seminar will provide a brief introduction to qualitative research for beginners. It will outline the paradigm and principles of qualitative research and consider the kinds of research questions that can be addressed by taking a qualitative approach. The seminar will draw on examples of the speaker’s research into disability, unemployment and health.

Dr. Davidson has a background in qualitative research for social policy analysis. Before joining the National Core for Neuroethics as a Research Coordinator, she worked on a number of national and international qualitative research projects in the fields of health and social welfare in the UK.

The Pulse of Modernism: Physiological Aesthetics in Fin-de-Siècle Europe
Robert Brain
Associate Professor
Department of History, University of British Columbia

Monday June 2, 2014, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

How does art compel its effects? During the late 19th century many scientists thought the answer could be found by “elucidating physiologically the nature of our Aesthetic Feelings” and “to exhibit the purely physical origin of the sense of beauty, and its relativity to our nervous organization.” By the eve of the First World War research into “physiological aesthetics” had elaborated an extensive body of evidence for the bodily and mental basis of artistic perception, including the psycho-physiology of eye-movements, perception of time, space and rhythm, attention, color perception, kinesthetic empathy, emotional responses to art, and much more. Across Europe avant-garde artists—painters, poets, composers—turned to the new laboratory work as a resource for new ways of using and conceptualizing the basic media of art—line, color, phonation, sound— as well as for new ways of thinking about art’s place in society. In this paper I will describe late nineteenth-century physiological aesthetics and its impact on the development of modernism in painting and poetry, using fresh interpretations of canonical artworks to challenge entrenched assumptions about the art/science “two-cultures” divide. I will also compare this episode in the history of science and art to current work in neuroesthetics and related fields, delineating what is similar and different, and considering what might be learned by this earlier attempt to understand art and human nature with the tools of the experimental laboratory.

Dr. Robert Brain is an Associate Professor in the UBC Department of History, specializing in the history of science, with research foci in the biomedical sciences in nineteenth-century Europe and European cultural history. He is the author of the forthcoming book The Pulse of Modernism: Physiological Aesthetics in Fin-de-Siècle Europe (In Vivo: Cultural Mediations of Biomedicine, University of Washington Press), as well as several edited volumes and over sixty articles, chapters, and reviews. Brain received his degrees from Berkeley (BA, Philosophy), University of Wisconsin-Madison (MA, History of Science), and UCLA (PhD, History). He has held fellowships at the University of Cambridge, the Max Planck Institute for the History of Science-Berlin, and the École des Hautes Études en Sciences Sociales, Paris. Before coming to UBC, Brain was an Associate Professor in the Department of History of Science at Harvard University.

The Bucharest Early Intervention Project: Lessons for the Ethical Conduct of Research
Joseph J. Fins
Chief, Division of Medical Ethics
The E. William Davis, Jr., M.D. Professor of Medical Ethics
Professor of Medicine
Professor of Health Care Policy and Research
Professor of Medicine in Psychiatry
Weill Cornell Medical College

Tuesday February 25 2014, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

North American Bioethicist and Physician, Joseph J. Fins, M.D., M.A.C.P., will share his thoughts on the landmark Bucharest Early Intervention Project (BEIP) which studied the development of the so-called Romanian Orphans left institutionalized after the fall of the Ceausescu regime. He will critique the ethics of the BEIP and voice concerns that a misplaced desire for scientific rigor led to irreparable harm to young children kept in orphanages as part of this study. Fins will examine how and why the BEIP happened and proceeded with proper regulatory oversight and offer suggestions on how to bring ethics back into regulatory oversight.

For background reading, see attached from the Bioethics Forum Blogs. The articles are also available at http://www.thehastingscenter.org/Bioethicsforum/

Adam Smith on Moral Psychology
Margaret Schabas, Professor, Department of Philosophy, University of British Columbia

Monday February 24 2014, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

Adam Smith’s Theory of Moral Sentiments (1759) was part of a broader Enlightenment project to devise an ethical system that was entirely secular. Smith, Hume, and many other Scottish savants argued that ethical behavior sprang reflexively from our more deeply rooted capacity for sympathy which was in turn grounded in our human physiology. My talk will canvass some of the physiological and medical pursuits of the period (electric shock treatment, neurology, animal magnetism) and join this to Smith’s specific guide to moral improvement. In short, this is an early case of ethics conjoined with somatic investigations, much of which we might find easy to ridicule. The more interesting question is why this was promoted at the time; why did Smith and his contemporaries situate our ethical predilections in our physiology rather than propose that they are part of rational discourse.


2013

Implications at home and abroad of British Columbians’ pursuit of medical tourism
Valorie A. Crooks, Associate Professor, Department of Geography, Simon Fraser University
Jeremy Snyder, Associate Professor, Faculty of Health Sciences, Simon Fraser University

Monday October 21 2013, 12:00–1:00 PM
National Core for Neuroethics, UBC Hospital Koerner Pavilion, Conference Room S117

When patients intentionally pursue privately-purchased medical care abroad they are engaging in medical tourism. There is a global medical tourism industry that connects patients seeking various medical procedures (e.g., orthopaedic surgery, stem cell procedures, bariatric surgery, CCSVI) from a range of countries to destination facilities around the world. British Columbians are among those participating in this practice. Our team (http://www.sfu.ca/medicaltourism/) conducts research that aims to provide evidence to enable a more ethical, equitable, and safe medical tourism practice, particularly by Canadian patients. In this presentation we will share the findings of some of our most recent studies, highlighting their health policy and practice implications for British Columbia. Specifically, we will discuss Canadian patients’ decision-making regarding going abroad for surgery, the roles that family doctors in British Columbia play towards patients pursuing medial tourism, and the health and safety implications of British Columbians’ outbound medical tourism. We will also provide an overview of the medical tourism industry and conclude by sharing details about our current Canadian Institutes of Health Research-funded studies.