Ethical implications of clinical neuroscience

This paper deals with ethical implications of neuroscientific research on p atients as well as with the application of its results in diagnosis and tre atment for brain diseases, in which a considerable demand for research exis ts due to their high frequency, long duration, disabling consequences,and u nsatisfactory or nonexistent treatment possibilities. Such indispensable re search on patients calls forth the basic ethical tension between respect of autonomy and dignity of the sick individual (as well as the avoidance of s omatic and psychic risks and burdens) and the ethically justified demand fo r flawless research in recognizing, preventing, reducing, or eliminating di sability and suffering caused by disease. The demand for research today als o results from the increasing orientation of insurance companies towards sc ientifically proven evidence of the efficacy and safety of medical interven tions: "evidence-based medicine. "This is illustrated by 3 examples: (1) us e of fetal brain tissue/cells from planned abortions in patients in therapy -resistant final stages of Parkinson's disease and the effects of neurotran splantation on the recipients, (2) research with demented patients incompet ent to give informed consent, and (3) predictive (presymptomatic, prenatal) testing in the genetic counseling of individuals from families with Huntin gton's chorea. We conclude that adherence to high ethical standards is of i nestimable significance, not only for those participating in research but a lso for public acceptance of that research. This is particularly valid in G ermany, where nonobservance and the undermining of ethical principles was g rossly practiced in the first half of this century on the slippery descent into the abyss. Therefore, continued scrutiny with the increasing variety o f ethical problems in medical research is demanded. However, this will be a chieved not by taboos and prohibitive regulations but only through open dis cussion between scientists, particularly probands in research, patients' re latives, and the public. This leads to four demands: listening honestly and openly, both in single cases and in the public sector,training in recognit ion and consideration of ethical problems, and reducing unfavorable conditi ons such as complex bureaucratic regulations, negative public views, overze alous efficiency, and insufficient time. Sufficient numbers of qualified pe rsonnel are needed who are trained in listening and who will have the time to do so.