Medical Ethics of Hippocrates or Population-Based Bioethics — A Symposium based on the Interview of Dr. Miguel A. Faria by Kerry Sheridan, Agence France-Presse

Journal/Website: 
Agence France-Presse
Article Type: 
Interview
Published Date: 
Thursday, May 15, 2014

This interview resulted in the May 14, 2014 article, "U.S. Experts urge focus on ethics in brain research" by Kerry Sheridan, AFP Correspondent. The article was distributed through the NewsCred Smartwire, Agence France Presse.

Kerry Sheridan, Agence France-Presse (AFP): Hi Dr. Faria, I'm working on a story about calls for consideration of ethics in neuroscience research, and I was wondering if I could interview you about your thoughts on the need for ethical oversight in neuroscience?

My questions on neuroscience ethics are:
 
1. Is it possible to make sure certain ethics are adhered to in neuroscience, whether in a single country or globally?
 
2. What do you think are the greatest dangers in modern neuroscience?
 
3. This commission is calling for ethics to be considered, but has not defined any standards. Would that be harder to do? What kinds of boundaries should neuroscientists respect?
 
Thanks so much!
Best,
Kerry

Dr. Miguel Faria (Answers): I will combine your questions on neuroscience ethis (i.e., neuroethics) and answer more conveniently together as follows: Yes. This worthwhile goal is feasible, as long as neuroscientists adhere to a code of Medical Ethics dictated by their conscience and their professional calling — and not imposed by the state. For example physicians, in this instance, neurologists and neurosurgeons researching in the field of neuroscience not only in this country but globally, should recollect and adhere to the traditional, universal, and individual-based ethics of Hippocrates, centered on their individual patients or human subjects; rather than utilitarian, population-based ethics that place monetary considerations, or the interest of third parties or the state, ahead of their patients. In fact, I think this is one of the two greatest dangers in modern clinical and research neuroscience.

Hippocrates of KosTechnology has outpaced ethical considerations and many young medical scientists have not been properly introduced to medical ethics. Yet, fortunately, many physician clinicians and researchers adhere to the individual-based ethics of Hippocrates (photo, left) that they learned in medical school; some may have even taken the Oath of Hippocrates or the alternative Oath of Maimonides on graduation. That is a good start. Seminars should be encouraged to educate their colleagues.

I'm aware many, if not the majority of neuroscientists, are PhDs and may not have been introduced to the Oaths of Hippocrates or Maimonides. Again, this can be remedied by encouraging seminars in Medical Ethics. On the other hand, I have some concerns as to the Bioethics, now in vogue because, frankly, it is a system of population-based ethics, and therefore, in my opinion, sometimes dangerous when we are dealing with human patients or experimental subjects. I don't mean to offend members of the Bioethics Commission but they need to know many of us, physician neuroscientists, have these concerns. The application of population-based bioethics is an equally dangerous path to neuroscience, as to outright neglect of medical ethics when dealing with human subjects. Why? Because it is centered on utilitarianism and monetary considerations rather than committed to placing the interest of the individual patient or experimental subject above all other considerations. I admit Bioethics principles may be helpful when the ethics of Hippocrates are not applicable, as when dealing with laboratory animals in neuroscience research.

As it regards the Commission, yes, it should set standards, but let me just speak in general terms and allow me to re-state what I wrote about a specific topic in an area of interest to me as a neurosurgeon. I refer you to the "Conclusion" in Part 3 of my three-part series, Violence, mental illness, and the brain — A brief history of psychosurgery. In the article, I was discussing ethical considerations in violent individuals afflicted with psychopathy, neuroscience research in this area, and the possibility of psychosurgical intervention in some selected patients. These are my conclusions:

I continue to believe that for the foreseeable future, violent individuals, who commit crimes but have no discernible brain neuropathology, should be managed conventionally, prosecuted by the criminal justice system according to the law. Our modern society, not even in democratic self-governance, to say nothing of authoritarian systems, has not advanced in ethical or moral wisdom to deal with the problems emanating from the technical and social “progress” of the age. Human violence and aggression persist, reminding us daily that civilization is a step away, perhaps only a generation away, from barbarism.

Criminal repeat offenders, on the other hand, who during medical examination are shown to have neuropathology discernible by the current state of medical knowledge, should, after the appropriate informed consent, be further evaluated and treated by qualified medical and nursing personnel trained in the management of “psychopathy.” Their management should include the usual treatments, for example, removal of brain tumors, control of seizure disorders with anticonvulsants, etc., as well as the administration of psychotropic drugs, ECT, and functional neurosurgery for their associated psychopathy in private facilities by private and academic physicians, but not government doctors or facilities. Government guidelines have been available since 1978 and seldom utilized for fear of bureaucratic red tape, legal repercussions, and the political and social zeitgeist of the times.

The state, though, still has a role; it can make sure the law is complied with, that the guidelines and amendments set by physicians are followed, that medical ethics (i.e., the individual-based ethics of Hippocrates) are observed,[1,7-10] but the state should not ideally be directly involved with funding institutions, medical personnel, or managing programs.Ethics Management should be left entirely in private hands, as the situation existed a century ago, when medical research took incredibly gigantic steps in scientific advancement in the hands of individual innovators and researchers with private funding and institutions. It is my belief that after a public education campaign, philanthropic individuals and institutions would step forward with private endowments to fund such a humanitarian endeavor. Still others may be propelled by tax incentives, as is the case with so many other beneficial activities encouraged in the public interest, such as other types of medical research and scholarship grants in higher education. Needless to say, all of my suggestions and considerations must be carefully considered by the general public and policy makers either before being implemented or more likely being dismissed outright.

The understandable concern is that if the state became a third-party payer in this endeavor, it would seek to control it, and in the process pervert medical ethics in the context of financial or political considerations. Once the state enters the equation, it would, if history is any guide, tilt the balance, not on behalf of the individual patient’s interest, but in its own budgetary or political interest. And so, were this process to go forward, the physicians must guard the interest of the “criminally insane” patient first, and the collective benefit to society, second. History forbids it otherwise.

Participating physicians, surgeons, and researchers must be very careful and remember what has been written and restated elsewhere. Namely, the lessons of history sagaciously reveal wherever the government has sought to alter medical ethics and control medical care, the results have been as perverse as they have been disastrous. In the 20th century both in the communist Soviet Union and fascist Nazi Germany, medicine regressed after these authoritarian systems corrupted the ethics of the medical profession and forced it to descend to unprecedented barbarism. The Soviet psychiatrists and Nazi doctor’s dark descent into barbarism was a product of physicians willingly cooperating with the totalitarian state, purportedly in the name of the “collective good,” at the expense of their individual patients.[8-10]

Reference: Faria MA. Violence, mental illness, and the brain — A brief history of psychosurgery: Part 3 — From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans. Surg Neurol Int 2013;4:91. [Available from: http://www.surgicalneurologyint.com/text.asp?2013/4/1/91/115162]

The numbers in the text refer to the appropriate references cited in the article above.

I hope this is helpful!
Dr. Miguel A. Faria

Miguel A. Faria, Jr., M.D. is Associate Editor-in-Chief and a World Affairs Editor of Surgical Neurology International (SNI); Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine. He served under President George W. Bush as member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05); Realclearhistory Author (2012-present); Founder & Editor-in-Chief of the Medical Sentinel (1996-2002); Editor Emeritus; Author, Vandals at the Gates of Medicine (1995), Medical Warrior: Fighting Corporate Socialized Medicine (1997), and Cuba in Revolution: Escape From a Lost Paradise (2002). His website is http://www.haciendapub.com or http://www.drmiguelfaria.com

Read also the Follow up Editorial published in Surgical Neurology International (SNI) and posted here, "The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?" (October 7, 2014) by Dr. Miguel A. Faria

Also available is Kerry Sheridan's completed article U.S. Experts urge focus on ethics in brain research by Kerry Sheridan, AFP Correspondent, May 14, 2014, on Yahoo News. Copyright ©2014 Agence France Presse.

This article may be cited as: Faria MA. Medical Ethics of Hippocrates or Population-Based Bioethics — A Symposium based on the Interview of Dr. Miguel A. Faria by Kerry Sheridan, Agence France-Presse. Available from: http://www.haciendapub.com/articles/medical-ethics-hippocrates-or-population-based-bioethics-%E2%80%94-symposium-based-interview-dr-mig

Interview answers: Copyright ©2014-2016 Miguel A. Faria, Jr., M.D.

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The ethics of mass-thinking

There is very good reason to be opposed to treating individual patients on the basis of rules designed with the “one size fits all” approach, regardless of whether such rules are called “guidelines”, or “consensus”, or some other seemingly innocuous term. What we see in all parts of our society, medicine not excluded, is the increasing inability and unwillingness to live and work among others on a human scale, which is necessarily the scale of one person interacting with another. The almost universal acceptance of social networking such as Facebook and Twitter shows that people no longer care to have unique relationships with other individuals and that they are disinterested in establishing and negotiating degrees of closeness and shades of intimacy that previously defined all human relationships. Our voracious narcissism feeds on having as large an audience as possible and saying something to one person and to one person only is no longer seen as desirable. In the computer age people no longer even have a unique handwriting by which they are known (or sometimes have to be deciphered) by others.

So it is no surprise that all current medical research focuses on identifying group effects rather than studying what makes one individual different from another. We forget that the statistical conclusions established by such studies are in reality theoretical constructs or mere probabilities that apply to individual patients in
very approximate ways, if at all. When the topic of ethics is raised in the post-industrial, 21st century the inevitable implication is that we will be speaking of mass ethics because the paradigm of mass-thinking is the ruling paradigm of the times in which we live. When Dr. Faria points out that such thinking is centered on utilitarianism and monetary considerations he is certainly correct, but such considerations are merely the logical extensions of a certain philosophical shift that clearly obscures the trees for the forest.

Even in ancient times a notion existed that members of a certain profession ought to behave professionally, in others words, there was a desired set of behaviors or attitudes applying to all of one’s professional dealings. An example of such a notion was the Hippocratic Oath. Although the physician making this oath was likely to have dealings with many different patients in the future, the ethics of the Hippocratic Oath were necessarily individual-based. In part this was so because it was the voluntarily made promise of a single individual and in part because it was understood that the future physician would be treating individuals and not populations. The driving force behind this oath was a moral commitment made by invoking a deity and not the utilitarian or financial motive on which population-based ethics are usually built.

What I have to say next I will preface by saying that it is not my intent either to offend those working in neuroscience or to diminish the very real healing that takes place at the hands of neurologists and neurosurgeons. However, it is my understanding that contemporary neuroscience sees man as only a biologically sophisticated machine and that although we do not quite understand all the inner workings of this machine, all emotional states, including the sense of self, the sense of right and wrong, and conscience and consciousness themselves are nothing other than neurochemical phenomena. It seems to me that by espousing such a view of human beings we reject any morality other than morality of convenience or utility. In others words, why should a field making an a priori statement that man is nothing other than a complicated beast have any ethics other those based on what would be convenient, or cheap, or would benefit the most beasts at the expense of the few? By stressing individual-based ethics we make a stand for a moral attitude toward man, along with which comes an entire set of beliefs about man’s nature and purpose on this Earth that is rendered null and void if we accept the assumptions of contemporary neuroscience. The train has left the station, I am afraid. We cannot inject moral significance into a specialty that has rejected the very notion of morality. And here I am speaking not merely of neuroscience, but of much of modern medicine. So population-based ethics would seem to be a most natural development, just as Facebook is a natural development in those societies where mass-thinking has become the ruling paradigm by which people live and communicate with one another.

Neuroscience Ethics

Comments posted in response to article at Yahoo News:

Cognitive Dissident: I'd like to see some ethics in the Executive Branch.

Death By Taxes: I find that finding ethical people is a 50-50 proposition. About half arent. Those are the people who also lack integrity, honesty and general morality. this is an individual issue and you can not tie it to a specific group.

Ron M: It appears that the "researchers" are workin' the same Gov't Grants & Paychecks game as the Climate "scientists"("We think we have the Computer Models correct this time, because we keep Tricking the models to get the results that give us MORE Gov't Grants & Paychecks")

William: The SCIENCE is what is important here. Ethics have a role but ethics should only come in to play when the technology gets to the point of treating humans with the newly developed technology. Ethics should not play a role in terms of what areas of basic research should and should not be followed. Ethics is subjective and can be dictated by narrow-minded groups such as the "politically correct" thought control wannabe's...

Comments posted in response to article at HaciendaPublishing.com:

Dr. James Ausman: Miguel, This is a blockbuster subject and a sly way for the government to gain more control of medicine and decisions. On the surface where do they get the right or where is the data that this is necessary? I like your answer.

Why isn’t there an ethics panel for business or automobile manufacturers. Automobiles can kill and look at the defects and recalls. Why not for the banking industry? Why not for Congress and the Executive Branch itself. Yes, I think we ought to have an Ethics Panel for Congress and the politicians. I think the panel should have powers of dismissal, etc. You get my drift.

Control of Medicine is the linchpin of controlling the people. — Jim

Dr. Russell Blaylock: I enjoyed your comments concerning the issue of bioethics in neuroscience. As with all other segments of society the totalitarians are solidifying control and part of that control is to move scientists under their control. One important way to do that is to create a system of bioethics laws that are designed to collectivize and regiment scientists. Neuroscience is critical for one who desires to control the world under a one world government structure as it entails using neuroscience to control human behavior.

There have been a number of excellent books written about this. Massive amounts of money are flowing into neuroscience for this very reason. I am concerned with the cognitive research that is claiming to have found defective brain structures that explain conservative thinking — which is a short step away from ways to correct this brain defect. This is something familiar to those of us wise to the use of psychiatric prisons in the Soviet system.

I have noticed a concerted effort by these elitists to regiment the medical profession and scientists in general and they do this by making ethical rules. The large banking institutions (international bankers) and international corporations are not only funding these regimentation protocols but through their tax-exempt foundations are designing them. The government is merely the enforcer. 

The best protection, as you say, is to have independent neuroscientists and physicians create a set of agreed upon bioethical rules that are designed to only prevent obvious abuses and not to micromanage science. Socialism, as we all know, is all about regimentation and micromanaging society. In the eyes of the collectivist, the enemy is the individual. Again, Miguel you have produced and excellent argument. — Russell

Dr. James Ausman: Read it and liked your comment. Russell’s was excellent as usual. This all reminds me of the time in the 1960s when there was a push to get others than doctors involved in healthcare and patient care decisions. It was also the time of Medicare in which government began its encroachment into Medicine. The hospitals become the center of care as private physicians could not do X-rays in their offices or sell drugs. Tests were done in hospitals as there was disdain that multiple physicians doing tests which were cheaper were not reliable. My father was a physician at the time and did these things in his office. Then hospitals were rewarded with 3% over costs so they raised their prices and made huge profits, the results of which linger today in hospitals charging high prices for what they do and even more for private insurers. So money was the incentive and now money is limiting doctors pay. Doctors were against Medicare as was the AMA at the time with Morris Fishbein as a leader, but to no avail. So now 50 years later, we are rapidly going down the road to Socialized Medicine, which my father, and probably yours, feared. These things take time to overtake society as you well know.

As I have written, the commerce between the doctor and patient has been broken (as the government paid for the health insurance) as in no other area of society. Now the third parties are consuming the money leaving much less for patient care and leaving others in control. The promise of something for FREE was too much for the population to resist. Now, they are paying more and getting less. That is Collectivism as Russell has stated.

With that has come the entitlement mentality, the dumbing down of the education system, all filled with the same propaganda from the left and the same scenario of inducing people to be controlled by offering whatever for FREE. It follows the ten quotes from Lenin that I stated in my article.

We are going down a road to Socialism, and I do not see anything to stop it. I think there will be an economic crisis because, simply, you cannot spend your way out of debt. After that usually there is a dictatorship. There are discussions in Congress about the government taking over pensions and IRAs. You have experienced this yourself in Cuba.

As far as the ethics for the brain, if anyone did it, it should be doctors alone. But you can imagine the arguments that will be posed against this idea. So everyone will be in the game and then the doctors will have no decision in this process as other decide what is best for the patient. Sound familiar?

As I said yesterday, we need to have a similar system of review for politicians, so that their decisions would be reviewed by a panel of people chosen by some outside group not even by a democratic process. OF course this group would be subject to the temptations of corruption, etc. Imagine in a restricted world of brain surgery, a politician being corrupted to make a choice on treatment. Sorry for the good news. —Jim

Dr. Miguel Faria: Jim and Russell, thanks to both of you for your kind remarks. We are in agreement on this subject of collectivism encroaching on neuroscience ethics. I have fought against collectivism in all of its incarnations from the time I was in college. It was at the University of South Carolina, my alma mater (Columbia, S.C.), that "streaking" became fashionable, not too mention inceptions of "New Age Religions," etc. I had long and very curly hair at the time and sometimes wore a headband, so all the radicals thought I was one of them — a fellow radical from communist Cuba to boot!

Suddenly, the chess game which we were playing on the campus (about the only activity I engaged in at the campus despite my radical appearance) went soar! I began to denounce communism, collectivist deception, and Che Guevara, whenever his name, which came up frequently, was mentioned. Moreover, Che visited my home when I was a child when he was passing through to fight the great battle of Santa Clara! (Cuba in Revolution, pp. 65-71) The Carolina radicals, students and professors, did not know what to do with me! But it also earned me a "C" in my English 1101 Class when I lambasted the Black Panthers and Eldridge Cleaver in an essay that we also discussed in class. I really deserved and "A", but with this undeserved "C", I ended up graduating Magna Cum Laude, instead of Summa! — Miguel

Dr. Blaylock: Jim, I like your comments as well; they were right on target. I remember the first efforts at Medicaid. I was working in a charity hospital in my home town. The Tulane residents rotated there. When all this hit, we all discussed the proposal and all were against it and recognized it as Socialism. I remember Fishbein as director of the AMA produced a workable alternative to Medicaid, but it was rejected by the collectivists as it gave to much power to individuals. First, the government proposed health care for the poor (Medicaid) and then the elderly (Medicare), and now it is for everyone else — so called, ad hoc socialism. This is the Fabian method — creeping socialism, which enviably ends up as total control (communism). The drugs are to be paid for by the government, rehabilitation and nursing homes — each step bringing us closer to total collectivist control. Treatment and diagnostic protocols are designed by elite groups, which solidifies the control — follow the protocols or face punishment by the state. Next will be controlling what speciality one is to be assigned to and then where one will practice — not just in the U.S. but the world. All of these topics can be found in discussion papers in the tax-exempt foundations. It is the major international corporations who have led the way to collectivism and are funding and designing it. The CFR and Trilateral Commission are both controlled by major corporate heads and they dictate to the government what is to be done. The government is merely the tool of the corporate world. — Russell

*Search also "Bioethics" at HaciendaPublishing.com



Diary of Dreams performs at the 2016 M’era Luna festival in Hildesheim, Germany. M’era Luna, “one of the biggest dark music events in Germany,” is held each year on the second weekend in August. Close to 25,000 people attend the festival annually to hear gothic, metal and industrial music performed on two large festival-style stages.