The Neurocognitive Enhancement of Surgeons: An Ethical Perspective (original) (raw)
Related papers
Neuroenhancement in surgeons: benefits, risks and ethical dilemmas
British Journal of Surgery, 2020
Background Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance-enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice. Methods Use of transcranial direct-current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed. Results Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also ...
ArXiv, 2020
With the shortage of physicians and surgeons and increase in demand worldwide due to situations such as the COVID-19 pandemic, there is a growing interest in finding solutions to help address the problem. A solution to this problem would be to use neurotechnology to provide them augmented cognition, senses and action for optimal diagnosis and treatment. Consequently, doing so can negatively impact them and others. We argue that applying neurotechnology for human enhancement in physicians and surgeons can cause injustices, and harm to them and patients. In this paper, we will first describe the augmentations and neurotechnologies that can be used to achieve the relevant augmentations for physicians and surgeons. We will then review selected ethical concerns discussed within literature, discuss the neuroengineering behind using neurotechnology for augmentation purposes, then conclude with an analysis on outcomes and ethical issues of implementing human augmentation via neurotechnology...
Ethical challenges of in-the-field training: a surgical perspective
Learning Inquiry, 2007
The teaching of professions in which technical and manual acts combined with excellent judgment are used to enhance the safety of people, poses challenges to educators. Book learning combined with mock or simulated situations goes a long way, but ultimately ''in-the-field'' instruction and learning is necessary to qualify trainees for many occupations such as doctors, pilots, firefighters, police officers, and many others. The dilemma is how to teach potentially life-altering techniques in a real-life setting without compromising the safety of the recipient of the service being taught. Using the exemplary model of surgical teaching in the technology-heavy and high-tension world of neurosurgery, the authors attempt to explore this ethical and practical dilemma.
Neuroenhancement - A Controversial Topic in Contemporary Medical Ethics
2012
Neuroenhancement will become an important topic of medical ethics in future years and decades, due to the increasing insights of neuroscience into the functions of the brain and the growing possibilities of meaningful interventions. Consequently, several crucial topics need to be discussed in order to address this emerging issue, and these topics correspond to the following sections of this article:
Neuroethics: the pursuit of transforming medical ethics in scientific ethics
Ethical problems resulting from brain research have given rise to a new discipline termed neuroethics, representing a new kind of knowledge capable of discovering the neural basis for universal ethics. The article (1) tries to evaluate the contributions of neuroethics to medical ethics and its suitability to outline the foundations of universal ethics, (2) critically analyses the process of founding this universal ethic. The potential benefits of applying neuroimaging, psy-chopharmacology and neurotechnology have to be carefully weighed against their potential harm. In view of these questions, an intensive dialogue between neuroscience and the humanities is more necessary than ever.
Should surgeons have mental skills training?
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2016
Stress, the resulting response when cognitive demands are appraised to exceed one's ability to manage those demands [1], can negatively impact surgical performance technically (e.g. fine motor coordination and dexterity), cognitively (e.g. decision-making ability, ability to maintain attention), emotionally (e.g. emotional control) and interpersonally (e.g. ability to communicate), which may contribute to poor patient outcomes [2, 3]. However, little is known about the prevalence and breadth of stressors in the operating suite, how surgeons cope with these stressors and what their perceived need for training on stress management techniques is. To gain insight into these issues, we recently surveyed 72 surgeons at an academic medical centre [4]. Our surgeons, consisting of both practising surgeons and surgical trainees, reported that complex and rarely performed cases, poor assistance, technical challenge (i.e. more so for trainees), time pressure, operating on high-risk patients, having unresolved issues with operating room staff members, long operating room turnaround times, distractions, suboptimal surgical environment and issues with attending surgeons (for trainees) were factors negatively impacting their performance (Fig. 1). Surgeons also identified several coping strategies that they regularly used to manage intraoperative stressful situations, such as refocusing on the task if distracted, relaxing (i.e. deep breathing/relaxing muscles), pausing or being patient, communicating through the problem with the team, developing action plans oriented to goals of the procedure and using mental rehearsal/visualization. Besides these positive stresscoping strategies, however, some surgeons also reported negative responses including getting quiet, yelling, sweating and pacing (Table 1). Given that none of our responders had prior training in stress-coping techniques, the reported strategies were likely developed serendipitously over time, leading to a combination of positive and negative strategies. Ineffective stress-coping strategies, however, increase a performer's stress level by exacerbating their cognitive and physiological arousal and may not allow surgeons to adequately address the stressful situations they encounter in their practice, thus making them more liable to errors in performance. Indeed, 40% of our surgeons reported that they had witnessed an intraoperative complication that was directly related to the stress, and 15% of surgeons acknowledged that they personally caused an intraoperative complication due to stress that they could not handle appropriately. Thus, formal curricula on effective stress-coping strategies and other performance-enhancing techniques for surgeons would likely be beneficial both for individual surgeons but potentially also for their patients. Indeed, the vast majority (82.5%) of responding
Ethical and legal implications of neuro-enhancement: New concerns and future perspectives
Neuro-enhancement can be broadly defined as the attempt to improve the brain's functioning in healthy individuals through the use of both pharmacological and non-pharmacological means. Although the rapid development of these technologies in the last decade has been received with enthusiasm by many, an increasing number of scholars have raised important ethical, moral, social and legal concerns associated with their use. In general lines, these issues can be grouped into six different classes: medical safety and effectiveness, enhancement vs. treatment, distributive justice, coercion, human authenticity, and fairness and the value of achievement. In this paper, I add some ideas to the previous categories and I try to contribute to the neuroethical debate by addressing three issues that have barely received attention on the literature: the re-stigmatization of people with mental health disorders, the depoliticization of sociocultural struggles and the "technocratization of the brain." The legal and policy implications of cognitive enhancers are discussed in the conclusion.
Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform
Neurosurgery, 2017
Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physicianpatient relationship that may occur in the context of health care reform. The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of "Big Data. " Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care.