Neuroethics: the pursuit of transforming medical ethics in scientific ethics

Medicine emerged in Greece as a profession, that is, a professio, which has a religious origin: to profess is an act that demands delivering, an activity that demands committing one’s self entirely and for life. It is a kind of consecration and those who exercise it are consecrates [7, 8]. From this the Hippocratic “Oath” was born at the dawning of medicine (tekhné iatriké) around the fifth century B.C. and consequently every physician is committed not only to executing his/her techniques well, but also to profess a moral. This moral is not just any, but rather is one that tends toward perfection or excellence (areté) and the doctor is a special person because he/she seeks to conduct a virtuous life. The moral perspective has accompanied us continuously throughout history, in completely distinct civilizations like the Hindu, Jewish, Arabic and Chinese. This means that the raison d’être of the moral perspective is so deep and so deeply rooted in our tradition that any person that takes up its exercise is required to begin with a strict and solemn ritual, that of taking an oath, real or symbolic, of respect and obedience [9–11].

The situation changed dramatically after the first half of the twentieth century and in a short time bioethics burst forth, imposed itself and spread with unstoppable force; despite the numerous investigations dedicated to its genesis—medical, legal, economic, historical, philosophical-, there has not yet been a satisfactory elucidation of the motives that provoked this revolution that definitively upset the way in which medicine is practiced. In short, there is a before and an after of this event [12–14]. With a bilocated birth, ecological bioethics, headed by Van Rensselaer Potter [15] and medical bioethics, guided by André Hellegers and Daniel Callahan [16, 17], followed the proposal of the cancer specialist Madison: “As a new discipline….combines biological knowledge with knowledge of the systems of human values” [18]. Its objective was ambitious, to bridge two modes of understanding the condition of human illness based on biological sciences and the humanities and its values. Its spectacular expansion exceeded any prediction and in a few years it compromised not only medicine in its totality, but also law, economy, philosophy and politics. Three attributes characterize its growth when applied to human illness: to elaborate specific procedures that serve to guide medical action in its very diverse fields; a particular concern about its application with the aim that it not remain in dead letters, because of which it was necessary to recommend sanctions in cases of negligence or abuse; and developing certain principles sufficiently general that they can serve as the basis for ordering behavior and taken in account requires acceptance by all members in order to aspire to universal in an axiological and polytheistic society like that of today [19]. In other words, foundations, systems of prescriptions or procedural guides and regulated and effective sanctions.

Despite the coincidence in time, the situation was very different from the ethical problems resulting from the biotechnological revolution: uncertainty, risk and danger. In the early 1970s, the revolutionary cellular and animal virus research began to show its misty and ominous face: the growing threat to which researchers were exposing the entirety of humanity. Alarms went off vividly, recalling the words of Oppenheimer after the fateful nuclear tests, “physicists have known sin and this is a knowledge which they cannot lose” [20]. It was in June 1973 and again from February 24–27 in 1975 at the Asilomar conferences on the risks of recombinant DNA that, after heated discussion, safety guidelines were approved with two types of protective barriers, biological and physical, and four levels of risk. With what was termed the “precautionary principle” and the certain awareness that the manipulation of genetic material is always done in the context of uncertainty, GenEthics was born. Its main conclusion, unprecedented as it had never been expressed before so unequivocally, was that humanity had to be considered as a limiting end to scientific and technical interventions, for example, to positive and negative genetic engineering [21]. But at the same time the biological sciences passionately took up again the doctrine that has moved it with growing force in the beginning of the 19th century, the essence of human beings lies in their primarily biological condition and empirical data is proving that it is the gene where the ultimate truth lies.

The situation changed and again explosively when in May 2002, 150 biologists, neuroscientists, physicians, lawyers, psychologists, and sociologists met in San Francisco and proclaimed, in the words of the journalist and organizer William Safire, that neuroethics had been born and that it was characterized as “the study of ethical, legal and social questions that emerge when scientific discoveries about the brain led to medical practices, legal interpretations and health and social policies” [22]. It was concluded that neuroscience and its technology had progressed with such vigor that encompass, drive, configure and determine decisively the different areas of human activity—art, philosophy, law, economics, theology, medicine. A century ago Husserl firmly maintained that “there is no idea more powerful and whose advance is more irresistible than that of science …, nothing can stop its triumphal march” [23]; now neuroethics reaffirms it with propriety and feels authorized to assert that it is empirical science that can and should provide the fundamental responses and basic truths about the place of humans in the cosmos. In this it is similar to GenEthics, but from there also differences emerge. While GenEthics reminds us of the potential dangers, it promotes the regulation of its actions and elaborates strict precautionary protocols (which have been becoming progressively more flexible over time), Neuroethics raises as an inalienable right to investigate without limits or hindrance, has as a goal to provide the scientific basis of the ethic supported in empirical findings and assumes among its tasks that of modifying the human essence, or some its features, according to advances in research. Neurophilosophy emerged with unusual speed as a result of its proposals and in consonance with them burst forth neurophilosophy, neurotheology, neuropolitics, neuroeconomics, neuroaesthetics, neuroeducation, just to name the main disciplines, novice disciplines that have placed traditions in check and obliged them to rethink under threat of being relegated to the past.