Funding: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat to the (...) self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don’t respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case. (shrink)

The human mind strives to maintain equilibrium between memory and oblivion and rejects irrelevant or disruptive memories. However, extensive amounts of stress hormones released at the time of a traumatic event can give rise to such powerful memory formation that traumatic memories cannot be rejected and do not vanish or diminish with time: Post-traumatic stress disorder may then develop. Recent scientific studies suggest that beta-blockers stopping the action of these stress hormones may reduce the emotional impact of disturbing memories or (...) prevent their consolidation. Using such an intervention could, in principle, help people who suffer from post-traumatic stress disorder, but the idea of doing so is controversial. I shall here discuss memory manipulation in this perspective. (shrink)

Neuroscientists have made significant advances in identifying drugs to dampen the intensity of traumatic memories. Such drugs hold promise for victims of terrorism, military conflict, assault, car accidents, and natural disasters who might otherwise suffer for many years from intense, painful memories. In 2003, the President's Council on Bioethics released a report entitled Beyond Therapy: Biotechnology and the Pursuit of Happiness, which analyzed memory dampening in some detail. While the Council acknowledged the potential benefits of memory dampening, some Council members (...) were concerned that it may: (1) discourage us from authentically coping with trauma, (2) tamper with personal identity, (3) demean the genuineness of human life and experience, (4) encourage us to forget memories that we are obligated to keep, and (5) inure us to the pain of others. In this Article, I describe possible legal and ethical implications of memory dampening. For example, I note that traumatic events frequently lead to legal proceedings that rely on memories of those events. Drugs that dampen traumatic memories may someday test the boundaries between an individual's right to medically modify his memories and society's right to stop him from altering valuable evidence. More broadly, I respond to the Council by arguing that many of its concerns are founded on controversial premises that unjustifiably privilege our natural cognitive abilities. While memory dampening may eventually require thoughtful regulation, broad-brushed restrictions are unjustified: We have a deeply personal interest in controlling our own minds that entitles us to a certain freedom of memory. (shrink)

At least since 2003, when the US President’s Council on Bioethics published Beyond Therapy: Biotechnology and the Pursuit of Happiness , there has been heated debate about the ethics of using pharmacology to reduce the intensity of emotions associated with painful memories. That debate has sometimes been conducted in language that obfuscates as much as it illuminates. I argue that the two sides of the debate actually agree that, in general, it is good to reduce the emotional intensity of memories (...) associated with traumatic events, when (as in the case of Post Traumatic Stress Disorder) the intensity of those memories is dis proportionate to the precipitating traumatic event. Both sides also agree that, in general—not as an ironclad rule—it is bad to reduce the emotional intensity of memories associated with difficult but normal human problems of living, when the intensity of the emotions is proportionate to those problems. Between those two areas of agreement, there is a zone of ambiguity, in which reasonable people, who proceed from different but equally ethical frameworks, may indeed reach different conclusions about the same set of facts. But I will argue that even in the zone of ambiguity, there is more agreement than the language favored by the different frameworks sometimes suggests. Ultimately, I suggest that if we see the extent to which the substantive differences between the two frameworks are smaller than their articulators’ language sometimes suggests, we can engage in a more productive conversation about whether a particular intervention will facilitate or diminish human flourishing. (shrink)

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth (...) by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

In this essay I argue that the film Eternal Sunshine of the Spotless Mind eloquently and powerfully suggests a controversial philosophical position: that the harm caused by voluntary memory removal cannot be entirely understood in terms of harms that are consciously experienced. I explore this possibility through a discussion of the film that includes consideration of Nagel and Nozick on unexperienced harms, Kant on duties to oneself, and Murdoch on the requirements of morality.

The prospect of using memory modifying technologies raises interesting and important normative concerns. We first point out that those developing desirable memory modifying technologies should keep in mind certain technical and user-limitation issues. We next discuss certain normative issues that the use of these technologies can raise such as truthfulness, appropriate moral reaction, self-knowledge, agency, and moral obligations. Finally, we propose that as long as individuals using these technologies do not harm others and themselves in certain ways, and as long (...) as there is no prima facie duty to retain particular memories, it is up to individuals to determine the permissibility of particular uses of these technologies. (shrink)

Disturbances in aspects of memory described in current learning and cognitive theories are much more strongly associated with the presence of psychiatric disorder than with mere exposure to traumatic events. In posttraumatic stress disorder (PTSD), there are numerous associated changes that involve memory capacity, the content of memories for trauma, and a variety of memory processes. Whereas some changes appear to reflect the effects of the disorder, other evidence supports a predictive or causal role for memory disturbance. The following aspects (...) of memory are likely to play a causal role in the development or maintenance of PTSD: verbal memory deficits, negative conceptual knowledge concerning the self, overgeneral memory, avoidance or suppression of memories, and negative interpretation of memory symptoms. Other aspects of memory likely to play a causal role that are in addition specific to PTSD are the integration of the trauma with identity, impairment in retrieval of voluntary trauma memories, and increased incidence of sensation-based memories or flashbacks. (shrink)

One of the ethical issues that has been raised recently regarding emerging neurotherapies is that people will be coerced explicitly or implicitly in the workplace or in schools to take cognitive enhancing drugs. This article builds on this discussion by showing how the law may pressure people to adopt emerging neurotherapies. It focuses on a range of private law doctrines that, unlike the criminal law, do not come up very often in neuroethical discussions. Three doctrines—the doctrine of mitigation, the standard (...) of care in negligence, and child custody determinations in family law—are addressed to show how the law may pressure people to consent to treatment by offering a choice between accepting medical treatment and suffering a legal disadvantage. The doctrines considered in this article apply indirect pressure to submit to treatment, unlike court-ordered medical treatment, which applies direct pressure and is not addressed here. The outcome of this discussion is to show that there is a greater range of social pressures that may encourage the uptake of novel neurotherapies than one might initially think. Once treatments that were developed and offered with therapeutic benefits in mind become available, their existence gives rise to unintended legal consequences. This certainly does not mean we should cease developing new therapies that may be of tremendous benefit to patients, but it does raise some questions for physicians and for legal policy-makers. How should physicians, who are required by medical ethical principles to obtain valid consent to treatment, react to a patient’s reluctant consent that is driven by legal pressure? From the legal policy perspective, are our legal doctrines satisfactory or should they be changed because, for example, they unduly promote the collective interest over individual freedom to reject medical treatment or because they channel us toward economically efficient treatments to the detriment of more costly but potentially superior approaches of dealing with behavioural problems? (shrink)

Psychotropic and other drugs can alter brain mechanisms regulating the formation, storage, and retrieval of different types of memory. These include “off label” uses of existing drugs and new drugs designed specifically to target the neural bases of memory. This paper discusses the use of beta-adrenergic antagonists to prevent or erase non-conscious pathological emotional memories in the amygdala. It also discusses the use of novel psychopharmacological agents to enhance long term semantic and short term working memory by altering storage and (...) retrieval mechanisms in the hippocampus and prefrontal cortex. Although intervention in the brain to alter memory as therapy or enhancement holds considerable promise, the long term effects of experimental drugs on the brain and memory are not known. More studies are needed to adequately assess the potential benefits and risks of these interventions. (shrink)

To date, 1.7 million US military service personnel have been deployed to Iraq and Afghanistan. Of those, one in five are suffering from diagnosable combat-stress related psychological injuries including Posttraumatic Stress Disorder (PTSD). All indications are that the mental health toll of the current conflicts on US troops and the medical systems that care for them will only increase. Against this backdrop, research suggesting that the common class of drugs known as beta-blockers might prevent the onset of PTSD is drawing (...) much interest. I urge caution against accepting too quickly the use of beta-blockers for dealing with the psychological injuries that combat experiences can wreak. Beta-blockers are thought to work by disrupting the formation of emotionally disturbing memories that typically occur in the wake of traumatic events and that in some people manifest as PTSD. Focusing on a single dimension of soldiers' experience in combat, namely, their perpetration of other-directed violence, I argue that some of the emotional memories blunted by beta-blockers play important roles in the recovery of moral aspects of soldiers' selves damaged by experiences of combat violence — specifically, in the achievement of a state of grace— and, therefore, that the use of beta-blockers may come with distinct moral costs. (shrink)

it has recently been discovered that propranolol — a beta-blocker traditionally used to treat cardiac arrhythmias and hypertension — might disrupt the formation of the emotionally disturbing memories that typically occur in the wake of traumatic events and consequently prevent the onset of trauma-induced psychological injuries such as Posttraumatic Stress Disorder. One context in which the use of propranolol is generating interest in both the popufor and scientific press is sexual violence. Nevertheless, feminists have so far not weighed in on (...) propranolol. I suggest that the time is ripe for a careful feminist analysis of the moral and political implications of propranolol use in the context of sexual violence. In this paper, I map the feminist issues potentially raised by providing propranolol to victims of sexual assault, focusing in particufor on the compatibility of propranolol use and avaüability with an understanding of the social and systematic dimensions of rape s harms. I do not deliver a final verdict on propranolol; in fact, I show that we do not yet have enough information about propranolol's effects to do so. Rather, 1 provide a feminist framework for evaluating the possibilities and penis opened up by therapeutic memory manipuktion in the context of sexual violence against women. (shrink)

Emerging technologies raise the possibility that we may be able to treat trauma victims by pharmaceutically dampening factual or emotional aspects of their memories. Such technologies raise a panoply of legal and ethical issues. While many of these issues remain off in the distance, some have already arisen. In this brief commentary, I discuss a real-life case of memory erasure. The case reveals why the contours of our freedom of memory—our limited bundle of rights to control our memories and be (...) free of outside control—already merit some attention. (shrink)

Henry et al. (2007) claim they are concerned with the overmedicalization of bad memories and its subsequent exploitation by the pharmaceutical industry. However, they downplay the contributing role...

This paper primarily explores the ethical debate surrounding the use of memory erasure for therapeutic ends. It argues that procedures such as kinase inhibition therapy, which can entail memory erasure in the individual, incur a high cost in terms of the integrity of our individual identities, thus jeopardizing our claim to individual rights and accountability. Therefore, we should reserve such therapies for the extreme cases in which the procedures have the potential to actually restore a person’s autonomy. Furthermore, this paper (...) goes on to explore which situations might fit this criterion, while still accounting for the cost of memory erasure in each instance. (shrink)

The formation and recall of memories are fundamental aspects of life and help preserve the complex collection of experiences that provide us with a sense of identity and autonomy. Scientists have recently started to investigate pharmacological agents that inhibit or “dampen” the strength of memory formation and recall. The development of these memory-dampening agents has been investigated for the treatment of posttraumatic stress disorder (PTSD). Currently, these agents are being tested in multicenter clinical trials and will likely soon be approved (...) for the treatment of PTSD. With advancements in technology, more targeted memory-dampening techniques may be developed in the future. Accessibility to these agents will inevitably affect one's sense of identity and also one's sense of autonomy. Therefore, it is essential that the legal and ethical implications of using these agents be examined for governments and courts to appropriately address issues that may emerge. (shrink)