Psychiatric Neuroethics

This book is an analysis and discussion of questions at the intersection of psychiatry, neuroscience, philosophy, and law that have arisen from advances in psychiatric research and clinical psychiatric practice in the last 30 years. Are psychiatric disorders diseases of the brain, caused by dysfunctional neural circuits and neurotransmitters? What role do genes, neuroendocrine and neuroimmune interactions, and a person’s response to the environment play in the development of these disorders? How do different explanations of the etiology and pathophysiology of mental illness influence diagnosis, prognosis, and decisions about treatment? How do psychiatric disorders affect consciousness and agency? Could the presumed salutary effects of neural interventions for pathological thought and behavior change one’s mental states in undesirable ways? What are the social justice issues regarding access to treatment and experimental and innovative interventions for treatment-refractory conditions? What are the obligations of clinicians and researchers to patients and research subjects in psychiatry? Could the interests of society in preventing recidivism and public harm override the cognitive liberty of criminal offenders with a psychiatric disorder to refuse a therapeutic intervention in the brain? Would it be rational for a person with a chronic treatment-resistant disorder to request euthanasia or assisted suicide to end his suffering? Could psychiatric disorders be predicted and prevented? The book examines these questions in a comprehensive, systematic, and thematically integrated way. It is written for a multidisciplinary audience, including psychiatrists, neurologists, neurosurgeons, philosophers, psychologists, legal theorists, and informed lay readers.

Intervening in the psychopath’s brain

This chapter discusses whether pharmacological intervention in the brains of criminal psychopaths to modify and enable them to control their behavior could be justified as an alternative to continued incarceration. It also considers the question of whether treatment designed to rehabilitate the offender following release from prison could be forced on him against his wishes and whether it would violate his cognitive liberty. The chapter examines the connection between psychiatric disorders and mental integrity and whether mental impairment can weaken the presumed right to noninterference in the brain. It also considers whether direct brain interventions could be justified in adolescents with risk factors for criminal psychopathy. The key issue is weighing the interests and rights of the offender against the interest of society in preventing recidivism and protecting the public from harm.