The Medicalization of Love: Why Scientists Should Study the Effects of Pharmaceuticals on Human (Romantic) Relationships ‣
Brian D. Earp — Oxford Centre for Neuroethics, UK
Over a series of papers, my colleagues and I have argued that the use of biochemical substances to enhance salvageable (or already good) relationships, or to end bad relationships, would sometimes be justifiable. In earlier work, we focused on narrow, highly specific cases in order to establish our ethical framework. But we didn’t touch so much on the wider social consequences that the “medicalization of love” might bring about. In this talk, I try to address some the major worries one might have about a society that allows love and loving relationships to enter into the domain of medicine. I also suggest that the timing for this conversation is urgent: there are already a number of commonly-used drugs (prescribed for other purposes) that are undoubtedly having effects on our relationships, and we should do our best to study those effects to avoid the harms to which such drugs may be contributing, or even harness their (good) effects to better ends.
Neuroscience and addiction in criminal cases in The Netherlands ‣
Dr Katy de Kogel — Ministry of Security and Justice, The Netherlands
To assess in which ways neuroscientific and behavioral genetic information are used in criminal justice practice in het Netherlands, we systematically collected Dutch criminal cases in which neuroscientific or behavioral genetic information is introduced with respect to behavior or mental condition of the defendant. The Dutch database now contains more than 700 of such criminal cases. Although the cases are diverse, several themes appear, such as frontotemporal bran damage, dementia, epilepsy, sleep disorders, adolescent brain development, and addiction.
This presentation will focus on addiction cases. I will first briefly introduce the views on criminal responsibility of addicted offenders that we generally find in Dutch criminal law, and what is known about neurobiological changes involved in addiction and the impact of these on cognition and behaviour. With cases from the database it is illustrated how neuroscientific knowledge is influencing views on responsibility of addicted defendants. The cases show that if one topic is good at provoking opposing views, it’s addiction, and that the ‘culpa in causa’-principle is maybe starting to lose some ground. I will conclude by exploring two ways in which neurosciencecould aid law with respect to addicted defendants.
Is neuroscience relevant to criminal responsibility? Yes and No. ‣
Prof Katrina Sifferd — Elmhurst College, USA
Neuroscientific evidence has been offered in criminal courts to prove certain offenders are partially or fully excused from criminal responsibility. I will argue that neuroscientific data is relevant to the capacity responsibility of certain classes of offenders. Contra Morse, we do have some idea how the brain grounds the capacities necessary for understanding legal and moral rules, as well as volitional control; thus neuroscience can provide evidence that some groups of offenders have diminished capacity to commit a crime. This is the case with juveniles. However, work in the neuroscience of psychopathy does not indicate that as a class psychopaths suffer from diminished capacity. Therefore a diagnosis of psychopathy may be irrelevant to criminal responsibility.
“That is my mini brain”: What is the ethical significance of 3D bioprinted neural structures and models? ‣
Susan Dodds — University of New South Wales
Eliza Goddard — University of Tasmania
Anna Blum — University of New South Wales
Recent developments in 3D structured printing of human neural stem cells, have generated interest in the potential ethical significance of printing or growing brain tissues. There are two developments we wish to explore: first, recent studies have shown that neurons printed in 3-dimensional layered structures are capable of “communicating” with each other. When one neuron is stimulated by an electrical input, it activates, firing an electrical output that affects certain other neurons in what could be a specific pattern or order. Second, some researchers have been able to develop what are called neural or brain organoids from 3D structured neural cells. These organoids display some of the structural organization of a developing brain (e.g. the folds of a cerebral cortex). These two developments give rise to questions and concerns about (1) how we should understand the functional capacities of these 3-dimensional neural models, (2) the moral value, if any, we should assign to them, and even (3) whether the neural models might contain, or at the very least provide clues suggesting the origination of, consciousness. Responses to those questions could influence whether existing regulation of human stem cell research is still adequate, and they could also revolutionize our understanding of brain development and neuronal communication. This paper engages in some conceptual clarification to assist in making defensible ethical judgments about the status and use of these neural structures.
Non-human primate research in the age of the major brain projects ‣
Prof Tom Buller — Illinois State University, USA
In the last few years, a considerable number of major national and international projects have been launched with the goal of understanding how the brain works.(i) To varying degrees these major brain projects will conduct research on non-human primates. For example, the China Brain Project and Brain/MINDS Japan will involve substantial research on the marmoset and the macaque monkeys, respectively, as a means to mapping the brain and in the development of potential treatments for neurodegenerative and other diseases.
According to the prevailing ethical framework, non-human primate research should be governed by the “three R’s” – replacement, refinement, and reduction. Furthermore, research should be “undertaken with a view to the avoidance, prevention, diagnosis or treatment of debilitating or potentially life-threatening clinical conditions in human beings.” A number of important ethical questions need to be addressed:
(1) Is the goal to map the brain at all levels consistent with the existing ethical framework, since no specific debilitating condition is addressed?
(2) Is there a moral difference between conducting NHP research to address specific existing debilitating conditions and research conducted for the purpose of enhancing brain function or in the development of advanced neurotechnologies?
(3) Does it matter morally that the research on NHP pertains to conditions that are naturally absent in NHP, for example, dementia and, accordingly, have to be specifically engineered?
(i) Australian Brain Alliance, BRAIN Initiative, Human Brain Project, Canada Brain Research Fund, China Brain Project, Cuban Human Brain Mapping Project (CHBMP), Israel Brain Technologies, Latin American Brain Mapping Network (LABMAN), Brain Mapping by Integrated Neurotechnologies for Disease Studies (Brain/MINDS), Korean Brain Initiative, Blue Brain Project.
Public health and safety: The social and neurological determinants of health and criminal behavior ‣
Prof Gregg D. Caruso — Corning SUNY, USA
There are a number of important links and similarities between public health and safety. In this paper I will defend and expand my public health-quarantine model (see Caruso 2016; Pereboom and Caruso 2017), which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing my account, I will explore the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime rates, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental health problems), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how forensic psychology and neuroscience can be ethically used to predict and prevent criminal behavior, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. My approach will draw on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and I will deliver a set of ethically defensible and practically workable proposals for implementing the public health- quarantine model. I will conclude by introducing a capability approach to social justice, grounded in six key features of human wellbeing, and I will argue that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice.
Caruso, Gregg D. 2016. Free Will Skepticism and Criminal Behavior: A Public Health-Quarantine Model. Southwest Philosophy Review 32(1): 25-48.
Nussbaum, Martha. 2011. Creating Capabilities: The Human Development Approach. Harvard University Press.
Pereboom, Derk, and Gregg D. Caruso. 2017. Hard-Incompatibilism Existentialism: Neuroscience, Punishment, and Meaning in life, in Neuroexistentilism: Meaning, Morals, and Purpose in the Age of Neuroscience, ends. Gregg D. Caruso and Owen Flanagan. New York: Oxford University Press.
Sen, Amartya. 1985. Commodities and Capabilities. North-Holland.
Sen, Amartya. 1999. Development as Freedom. New York: Oxford University Press.
Reconceiving emotions in punishment: A proposal for a Socio-rehabilitative Correctional Model with the aid of social and affective neuroscience ‣
Dr Federica Coppola — Columbia University, USA
Research in social and affective neuroscience impugns cognition-based views of (im)moral decision-making and (anti)social behavior. A growing body of literature suggests that (im)moral decisions and (anti)social behavior are significantly influenced by our moral emotions, as well as our emotion-related capacities (e.g., empathy). For emotions are key to successful prosocial behavior, it is hypothesized that the treatment of antisocial behavior should hinge on antisocial individuals’ emotional transformation to develop prosocial attitudes.
Acknowledging emotions in the treatment of antisocial subjects might have dramatic repercussions on correctional policies. Notably, it could lead to a gradual dismissal of retribution and incarceration quibus main approaches to criminality, and imply an increasing espousal of rehabilitative and restorative justice models. Also, it could foster the identification of alternative (or supplementary) socio-rehabilitative measures, ones that infuse prosocial attitudes in offenders and are more likely to facilitate their social reintegration. In this respect, some neuroscientists suggest that socio-rehabilitative strategies can provoke positive changes in brain areas – like the amygdala– that are critical components of the neurocircuitry involved in empathy, emotional learning, and prosocial behavior. Consequently, this kind of measures are thought of increasing offenders’ capacity to empathize and socialize with others, and therefore to develop prosocial attitudes. Importantly, since prosocial attitudes are best created in relationally-based situations, these measures should take place outside of prison or other security facilities.
In view of this, this paper aims to use current neuroscientific knowledge on emotions and prosocial behavior to provide an outline for a hypothetical socio-rehabilitative correctional model. Notably, it combines neuroscientific literature with legal arguments to trace the essential features of a potential justice model of corrections based on offenders’ emotional transformation and social rehabilitation. Potential benefits that such a model might have in terms of public safety and protection of offenders’ rights are also considered.
1. Reisel, D. 2016. The neuroscience of restorative justice. TED talk. Retrieved from https://www.youtube.com/watch?v=tzJYY2p0QIc. Accessed June 29 2017.
2. King, M.S. 2008. Restorative justice, therapeutic jurisprudence, and the rise of emotionally intelligent justice. Melbourne University Law Review 32(3):1096-1126. Retrieved from http://law.unimelb.edu.au/__data/assets/pdf_file/0003/1705647/32_3_10.pdf. Accessed June 20 2017.
3. Day, A. 2009. Offender emotion and self-regulation: Implications for offender rehabilitation programming. Offender Cognition & Emotion 15(2-3):119-130. doi: http://dx.doi.org/10.1080/10683160802190848.
4. Tangney, J.P., J. Stuewig, and L. Hafez. 2011. Shame, guilt and remorse: Implications for offender populations’. Journal of Forensic Psychiatry and Psychology 22(5):706-723. doi: http://doi.org/10.1080/14789949.2011.617541.
Capacity, control and responsibility in Parkinson’s disease patients with impulse control disorders: Views of neurological and psychiatric experts ‣
Andrew Dawson — Monash University
Dopamine replacement therapy (dopamine agonists and levodopa) induces impulse control disorders (e.g., pathological gambling and hypersexuality) in roughly one in seven Parkinson’s disease patients . Impulse control disorders can lead to criminal offending, such as theft to enable pathological gambling or possession of child pornography related to hypersexuality . In past cases of impulse control disorder-related offending in Commonwealth jurisdictions [3,4], offending patients have been deemed to be suffering from ‘irresistible impulses’. Their decision-making capacity, behavioural control and responsibility were considered completely compromised. This stands in contrast to Commonwealth courts’ general scepticism of drug-induced ‘compulsion’ in more common cases of addiction-related offending . The cases involving patients with impulse control disorders, however, featured uncontested testimony from a limited number of experts. We explored whether this testimony truly reflects the views of the broader neurological and psychiatric communities. Thematic analysis of qualitative data gathered from neurologists, geriatricians and psychiatrists (n = 11) revealed several key findings. First, experts attributed impulse control disorders to a variety of causes, not just dopamine replacement therapy. Secondly, experts recognised afflicted patients’ decision-making capacities and behavioural control are compromised in certain ways, but rejected a universal loss of capacity and control. Thirdly, no clear picture of patient responsibility emerged – experts were either divided (full responsibility or no responsibility) or ambivalent. Experts also expressed the general difficulties inherent in assessing complex constructs such as ‘control’ and ‘responsibility’. In sum, our findings suggest the testimony in past cases was not reflective of the views of the wider neurological and psychiatric communities. Prosecution teams might engage their own experts in future cases of offending related to impulse control disorders, even if recognising the likely futility of a custodial sentence for this particular class of offenders.
 Weintraub, D., J. Koester, M. Potenza, A.D. Siderowf, M. Stacy, V. Voon, J. Whetteckey, G.R. Wunderlich, and A.E. Lang. 2010. Impulse control disorders in Parkinson disease: A cross-sectional study of 3090 patients. Archives of Neurology 67(5): 589-595.
 Bartlett, F., W. Hall, and A. Carter. 2013. Tasmania v Martin (No 2): Voluntariness and causation for criminal offending associated with treatment of Parkinson’s disease. Criminal Law Journal 37(5): 330-341.
 Martin, Tasmania v. (Sentencing comments, Supreme Court of Tasmania, Porter J, 29 November 2011).
 Henderson, R v. 2011. MBCA 9.
 Hall, W.D., and A. Carter. 2013. How may neuroscience affect the way that the criminal courts deal with addicted offenders? In Neuroscience and Legal Responsibility, ed. Nicole Vincent, 279-302. UK: Oxford University Press, Oxford.
Epistemic Hurdles in Psychiatry: How Gender Bias Shapes Autism Spectrum Disorder ‣
Lienkie Diedericks — Kings College London, UK
Psychiatric diagnoses differ from diagnoses of somatic disorder in that there exists a logical gap between the subjective, observed symptoms and the objective diagnosis. This logical gap is reflected on the level of constructing mental disorder categories, where symptoms are often grouped together subjectively, but do not necessarily reflect a unified underlying etiology.
I argue that the inherent epistemological hurdle to psychiatry need not be paralyzing, as long as quality biological and non-biological explanations are sought for a said mental or developmental disorder. Disorder categories only become problematic when they are unquestioningly reified, and when they are a prerequisite for structuring new research.
My paper considers Autism Spectrum Disorders (ASD) as a case study, with a specific focus on the missed or misdiagnosis of women on the Spectrum. My ASD case study points towards issues, such as male ascertainment bias, that arise from neglecting to address the logical gap both on the level of ASD diagnosis and ASD neuroscientific research.
I conclude that researchers and clinicians have an ethical duty to establish the most epistemologically reliable disorder categories and diagnoses respectively, as the effects of a diagnosis is ultimately the burden of patients and their caregivers.
1. Reznek, L. 1998. On the Epistemology of Mental Illness. History and Philosophy of Life Sciences. 20 (2): 215-232.
2. Hyman, S.E. 2010. The Diagnosis of Mental Disorders: The Problem of Reification. The Annual Review of Clinical Psychology. 6: 155-179.
3. London, E.B. 2014. Categorical Diagnosis: A Fatal Flaw for Autism Research? Trends in Neuroscience. 37: 683-686.
4. Mandy, W et al. 2012. Sex Differences in Autism Spectrum Disorder: Evidence from a Large Sample of Children and Adolescents. Journal for Autism and Development Disorders. 42: 1304-1313.
5. Poland, J et al. 1994. “Problems with the DSM Approach to Classifying Psychopathology”, in Philosophical Psychopathology, eds Graham, G and Stephens G.L. Cambridge, MA: MIT Press. 235-260.
Ageing in a ‘neuro-society’ ‣
Dr Cynthia Forlini — University of Sydney
The social and economic advantages of optimizing brain function are a topic of policy debate. Recently, attention is focused on the prevention of cognitive decline in the ageing population. Whether and how older individuals are taking care of their brains and cognitive health is unclear. In this talk, I examine the recommendations for healthy cognitive ageing and respond with (1) qualitative data from the Australian Longitudinal Study on Women’s Health and (2) reflections on how current recommendations might be improved.
Regulating for fairness in the age of the algorithm ‣
A/Prof Colin Gavaghan — University of Otago, New Zealand
While much attention has been drawn to the large-scale and long-term threats of artificial intelligence (to employment, for instance, or even human survival), these technologies also present a series of short- and medium-term regulatory challenges. Some of the more serious relate to the increasing use of predictive algorithms in a variety of contexts, including the criminal justice system.
In this talk, I will set out some of these uses, and explain the concerns they have generated. Next, I will consider some of the regulatory strategies and safeguards that have been proposed or adopted to maximise the benefits of these technologies, while avoiding or mitigating the risks.
Addiction and self-representation ‣
Prof Philip Gerrans — University of Adelaide
There is now an interdisciplinary consensus (“standard account”) that addiction is a neural adaptation that impairs self-control rather than a brain disease that removes the addict’s autonomy (Levy 2013, Kennett 2011, Pickard 2011).
substance related cues trigger bottom up mechanisms in substance abusers, influencing top-down mechanisms such as impulse and attentional control. [They]hijack the top down goal driven cognitive resources needed for the normal operation of the reflective system and exercising the willpower to resist drugs. (Bechara 2005)
This account however is not easy to square with the idea that addiction can be explained in terms of impairments in the capacity for extended agency (Levy 2006) or diachronic self-control. (Gerrans and Kennett 2010). Proponents of the diachronic conception add to the standard picture the idea that self control requires the ability to construct and use a representation of the self as a temporally unified entity in order to maintain stability of preference ranking across time. We need to be able to represent the relationship between present and future selves so that we can act beneficially on behalf of our future selves. On this view addiction can be characterized in terms of a disunified or fragmented self–representation.
The idea is an attractive one, and certainly fits the phenomenology not only of addiction but other disorders characterized by problems in constructing, accessing or acting on representations of a future self. However the content and nature of the relevant self-representation and its relation to the mechanisms identified by the standard account is presently underspecified. This paper addresses that issue, describing the relevant self-representation, its mechanisms and the way they interact with other mechanisms of self-control in addictive and non-addictive behavior. I shall argue that the inventory of neural adaptions involved in addiction needs to supplemented by an account, including neural correlates of affective self-representation.
To make my argument I discuss an intriguing result whose interpretation focuses the issues nicely. The result is a finding that stroke victims with lesion to the anterior insula cortex (AIC) found it very easy to stop using a very addictive drug: nicotine.
To understand why this is we need an account of the role the AIC plays in addiction and self-control. On the standard conception, as employed by neuroscientists, activity of the AIC produces cravings that drive addictive behavior (Gray and Critchley 2007, Naqvi, Rudrauf et a l. 2007, Naqvi and Bechara 2009). On this view AIC lesion disrupts addiction by removing cravings following cessation of use. However that literature is disconnected from another literature that treats the AIC as a substrate of self-awareness (Critchley 2005, Craig 2009, Craig 2010, Seth, Suzuki et al. 2011). My aim here is to provide a conceptual framework that integrates these two literatures and provides a conceptual and mechanistic underpinning for theories of diachronic self-control.
Implantable Brain Computer Interface: Exploring Estrangement and Embodiment ‣
Dr Fred Gilbert — University of Washington & University of Tasmania
While new generations of implantable Brain Computer Interfaces (BCI) devices are being developed, concerns about potential effects on patients’ sense of the agency and identity are growing (Klein et al 2016; Glannon and Ineichen 2016). For instance, the evolution of prosthetic limbs controlled by BCI introduces questions regarding body ownership, self-image and self-understanding. To what extend does an implantable BCI device become phenomenologically embodied into a patient’s deliberative process and sense of the agency? To what degree can BCI induce self-estrangement?
To shed light on these questions, I use data I obtained from the first-in-human experimental trial involving a novel generation of ‘intelligent implants’ capable of predicting epileptic seizures (Cook et al. 2013). I explore perceptions of self-change by six patients who volunteered to be implanted with a new experimental BCI device. I used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews (Gilbert 2015; Gilbert et al 2017).
I conclude with suggestions for the proactive creation of preparedness ethical protocols specific to intelligent BCI technologies essential to prevent potential iatrogenic harms.
Cook, et al. 2013. Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: A first-in-man study. Lancet Neurology 12(6): 563–571.
Gilbert, et al. 2017. “I miss being me”: Phenomenological effects of deep brain stimulation. American Journal of Bioethics Neuroscience 8(2): 96-109.
Gilbert 2015. A thread to Autonomy? The intrusion of predictive brain devices. American Journal of Bioethics Neuroscience 6(4): 4-11
Glannon, W., C. Ineichen. 2016. Philosophical aspects of closed-loop neuroscience. In Closed loop neuroscience, ed. A. El Hady. 259-270. Elsevier. London.
Klein, et al. 2015. Engineering the brain: Ethical issues and the introduction of neural devices. Hastings Center Report 45(6): 26-35.
Ethical issues raised by the Australian ban on electronic nicotine devices ‣
Prof Wayne Hall — University of Queensland
Over the past 30 years the daily smoking prevalence among Australian adults has declined to 13% thanks to very high tobacco taxes, bans on cigarette advertising, smoke-free policies in all public spaces, graphic health warnings and plain packaging of cigarettes. The advent of e-cigarettes or electronic nicotine delivery devices (ENDS) has been a disruptive technology that promises to provide smokers with a much lower risk way of obtaining nicotine than smoking cigarettes. Australia has banned the sale of ENDS to adults. This policy is supported by the most of the Australian tobacco control community. Australia’s policy contrasts with that in the UK where ENDS are freely available for sale and regulated as consumer goods. This paper explains how the Australian ban has come about, critically analyses the arguments offered to justify the policy and discusses the ethical and policy issues that it raises. It also describes ways in which the sale of ENDS could be regulated for recreational use that would address the more reasonable concerns of those who support a ban.
Distributed cognition and distributed morality: agency, artifacts and systems ‣
Dr Richard Heersmink — Macquarie University
There are various philosophical approaches and theories describing the intimate relation people have to artifacts. In this paper, I explore the relation between two such theories, namely distributed cognition and distributed morality theory. I point out a number of similarities and differences in these views regarding the ontological status they attribute to artifacts and the larger systems they are part of. Having evaluated and compared these views, I continue by focussing on the way cognitive artifacts are used in moral practice. I specifically conceptualise how such artifacts (a) scaffold and extend moral reasoning and decision-making processes, (b) have a certain moral status which is contingent on their cognitive status, and (c) whether responsibility can be attributed to distributed systems.
Murder and Dementia: An exploration of legal and neuropsychological factors of Australian cases ‣
Prof Jeanette Kennett and Dr Amee Baird — Macquarie University
When a murder is committed by an elderly person, the question of whether they have any cognitive impairment may be raised. A specific type of dementia, namely behavioural variant fronto-temporal dementia (bv-FTD), with the hallmark symptom of behavioural and personality change, has been found to be more commonly associated with criminal behaviour compared with other types of dementia such as Alzheimer’s Dementia (AD). Our aim was to explore neuropsychological factors such as type of dementia, reference to neuroimaging results and dementia diagnostic criteria, and ethico-legal factors such as types of expert witnesses and sentencing issues, in Australian cases of murder in which dementia was raised as a possible diagnosis of the offender. We searched the Australian Neurolaw Database using the keyword ‘dementia’ and identified a total of 9 cases. In regard to the type of dementia, FTD was considered a possible diagnosis in 3 cases, while the remainder were vascular dementia or vascular/AD (n=2), alcohol related related (n=2) or type not specified (n=2). Neuroimaging results were referenced in the majority of cases, and in some cases were relied heavily upon by expert witnesses in their diagnostic opinion, despite conflicting results. The quality and validity of cognitive assessment in some cases was questionable. There was an overwhelming reliance on psychiatrists as expert witnesses in all 9 cases. There was no reference to diagnostic criteria for dementia in any of sentence summaries. Overall, there appears to be a gap between how dementia is diagnosed in the clinical world (typically by a geriatrician or neurologist, with neuropsychological assessment) versus the court room (psychiatric expert witnesses) A diagnosis of dementia in a criminal offender also raises complex issues regarding criminal responsibility and sentencing. A decrease in culpability must be weighed against other sentencing factors including risk and failure of individual deterrence. The issue of the justice of sentencing of offenders who may forget why they are being punished is also raised.
Technologies for Cognitive Health: Translating the Evidence to the Home ‣
Dr Amit Lampit — Brain and Mind Centre, University of Sydney
Developing effective strategies to prevent cognitive decline and dementia is an international health priority. Against a backdrop of disappointing results from drug trials, greater focus is now placed on primary and secondary prevention by means of targeting modifiable risk factors such as cognitive and physical inactivity, depression and cardiovascular disease. Perhaps the of greatest interest are technological interventions that are not only effective, but also safe and can be rolled out relatively inexpensively and at scale.
Computerised cognitive training (CCT) is one of the few potential technologies that have met the efficacy and safety criteria and now entering practice. CCT is based on repeated practice on adaptive, specifically defined and well-controlled learning events, aiming to enhance cognitive performance and underlying neural processes using game-like interface. However, strong body of evidence suggest that while CCT is efficacious in general, its effects are limited to supervised training, whereas training at-home is associated with poor adherence and appears to be inefficacious.
Thus, one of the key goals of current CCT research is to bridge this and other efficacy gaps in order to ensure the public health value of this promising intervention. This talk will overview several lines of research aiming to develop technologies that could enable effective home-based training, maximise personalisation of training goals, and measure the effects of CCT on cognitive and everyday function.
Frontal brain injury in Court: What is good practice in the assessment of executive functions in medico-legal reports? ‣
Dr David Manchester — St Vincent’s Hospital, Sydney
Some of the highest awards in the civil courts are due to the long term effects of frontal brain injury on personality, cognition and behaviour. Frontal brain injury often leads to changes in a person’s higher cognitive abilities for example the ability to reason, to problem solve and to control behaviour. These higher cognitive abilities are referred to by psychologists as the ‘executive functions’.
Impairments in executive functions also contribute significantly to criminal behaviour via impulsive offending, lack of empathy for victims and impaired judgement. Despite its importance the assessment of frontal brain dysfunction and its presentation in court is fraught with difficulties. Problems include disorders that mimic frontal brain injury, unreliable testing procedures and confusion between normal and abnormal personality development. Drawing upon recent court judgements in the United Kingdom the paper outlines the strengths and weaknesses of commonly used neuropsychology tests of executive functions before suggesting guidelines for enhancing medico-legal reports in this complex area.
Manchester D., Priestley, N., and Jackson H. (2004). The assessment of executive functioning. Coming out of the office. Brain Injury, 18(11), 1067-1081.
Priestley, N., Manchester, D., Aram, R. (2013). Presenting evidence of executive functions deficit in court: Issues for the expert neuropsychologist. Journal of Personal Injury Law, 4, 241-248.
Priestley, N., and Manchester, D. (2014). Presenting evidence of executive functions deficit in court. Why is behaviour so important? Personal Injury Brief Update Law Journal, 1st March 2014.
Neuroscience, unequal bodies and hostile environment law ‣
Dr Karen O’Connell — University of Technology Sydney
The brain sciences along with other contemporary biosciences are experiencing an “environmental turn”, as the brain, body and genome are increasingly seen as porous and open to their social and material environment (Landecker and Panofsky, 2013). This entanglement of brain, body and environment has intensified under the influence of neuroepigenetics, which traces longer term and potentially heritable genetic changes impacting the brain (Meloni 2014). With this entanglement, attention is also turning to the impact of environmental stress — including the stress of pervasive and systemic inequality (D’Anguilli et al, 2012) — on the brain as the “central organ of stress” (McEwan et al 2015).
Even as we are newly attentive to the harm of environmental stressors there is an impulse to regulate individual, “unequal” bodies rather than their hostile environments. Existing laws that set out to protect and redress discrimination and inequality preference individual complainants and acts of harm. Yet experiential accounts of discrimination have long emphasised its pervasive and cumulative effects and the negative impact of a hostile environment.
In this paper, I consider whether emerging knowledge about the impact of social inequality on the brain and body requires a new legal response. Past and proposed legal attempts to redress systemic discrimination can provide a means of responding to inequalities that are inscribed in the brain and body. I return to the “hostile environment” cases of sexual harassment law, that focused on the gendered toxicity of the institutional environment to evidence harm. I argue that these cases offer an alternative legal approach to regulating environmental stressors that can protect against the pervasive and cumulative effects of gender inequality on brains and bodies.
D'Angiulli A., S.J. Lipina, A Olesinska. 2012. Explicit and implicit issues in the developmental cognitive neuroscience of social inequality. Frontiers in Hum. Neuroscience. 6:254
Landecker, H., and A Panofsky, A. 2013. From social structure to gene regulation and back: a critical introduction to environmental epigenetics for sociology. Annual Review of Socioloogy. 39
McEwen, Bruce S., Jason D. Gray. and Carla Nasca. 2015. Recognizing resilience: Learning from the effects of stress on the brain. Neurobiology of Stress. 1: 1-11.
Meloni, M. 2014. The Social Brain Meets the Reactive Genome: Neuroscience, Epigenetics and the New Social Biology. Frontiers in Hum. Neuroscience. 8:309.
Pain in the brain: Worker’s compensation claims for CRPS-I in Australia ‣
Dr Chris Rudge — University of Sydney
Neuroscientists disagree about the underlying mechanisms of chronic regional pain syndrome (CRPS), a debilitating neurological condition characterised by severe pain in the limbs. In CRPS type I, the patient typically suffers from an acute form of pain — one that is frequently not accompanied by any tissue damage or nerve lesion, and is typically disproportionate to the trauma that has incited the condition. These clinical paradoxes make CRPS-I a confounding disorder not only for scientists in medical settings, but for judges, tribunals, and claimants in legal settings.
My analysis of Australian neurolaw, undertaken in the context of working on the Australian Neurolaw Database, has revealed the high incidence of worker’s compensation claims brought in Australia by plaintiffs diagnosed with CRPS-I. While the majority of these plaintiffs are unsuccessful in attaining compensation (with most injuries found to be psychological or psychiatric, not physical or neurological, impairments), this paper analyses these tribunals’ processes, together with the legislative schemes that shape their statutory interpretation of neuroscientific evidence, to show how the legal system impacts on the assessment of chronic pain disorders, and raises crucial questions of great neuroethical import.
To compare these Australian legal cases to developments in the US, this paper will also detail a fascinating US worker’s compensation dispute of 2007 in which both the plaintiff and the defendant appointed separate pain experts to give evidence for their legal claims. What followed was a public disagreement between two distinguished professors of neuroscience about whether the plaintiff’s chronic pain could be detected in BOLD-contrast images (via fMRI). When the judge rejected a motion brought by the defence that that the plaintiff’s evidence was inadmissible – evidence that proposed chronic pain could be detected by fMRI – the defence settled the claim for an amount reportedly more than ‘ten times’ its original offer.
Wager, T.D. 2015. Using Neuroimaging to Understand Pain: Pattern Recognition and the Path from Brain Mapping to Mechanisms.” In The Brain Adapting with Pain: Contribution of Neuroimaging Technology to Pain Mechanisms, ed. V. Apkarian. 23–36. Philadelphia: Wolters Kluwer.
Davis, K.D. 2016. Legal and ethical issues of using brain imaging to diagnose pain. PAIN Reports 1 (4): e577.
Camporesi, S., B. Barbara, and G. Zamboni. 2011. Can we finally ‘see’ pain?: Brain imaging techniques and implications for the law. Journal of Consciousness Studies 18 (9–10): 257–276.
Reardon, S. 2015. The Painful Truth: Brain-scanning techniques promise to give an objective measure of whether someone is in pain, but researchers question whether they are reliable enough for the courtroom. Nature 518, 26 February. Retrieved July 5, 2017, from http://www.nature.com/news/neuroscience-in- court-the- painful-truth- 1.16985.
Salmanowitz, N. 2015. The case for pain neuroimaging in the courtroom: Lessons from deception detection. Journal of Law and the Biosciences 2 (1): 139–148. doi: 10.1093/jlb/lsv003.
Motivational Enhancement and Praiseworthiness ‣
Prof Julian Savulescu — University of Oxford, UK
A number of philosophers have provided persuasive responses to the charge that biomedical enhancement of capacities is cheating. Counterarguments tend to point out that (1) natural capacities are not fairly distributed and (2) the agent still needs to put in the effort necessary to reap the benefits of the enhancement. Agents’ claims to praise are accordingly unaffected; their achievements not undermined. Neuroscientists have recently suggested that plausible biomedical enhancers are more likely to enhance not capacities, but motivation. If this is true, then the cheating objection (and its more nuanced variants) must be revisited, since motivational enhancements, unlike capacity enhancements, may significantly reduce the need for effort. We revisit the ‘no pain, no gain’ objection in the context of motivational enhancement. Examining possible effects of biomedical enhancements on intrinsic motivation (‘enjoyment’) and extrinsic motivation (‘grit’), we suggest that possible effects which reduce or eliminate the need for effort force us to reconsider the fundamental grounds for praise. We argue that, contrary to widespread intuition, effort is in fact not the fundamental ground for praise. Rather, it is a good but fallible proxy for more fundamental grounds: the agent’s choice and (often costly) commitment to pursuing worthwhile achievements. Following Aristotle, our analysis reveals that, more broadly, ‘active’ agency is the relevant domain for assessment of praiseworthiness. Motivational enhancement would only remove the grounds for praise if it rendered an agent sufficiently ‘passive’ with respect to her achievement. Throughout, we emphasize the importance of a diachronic perspective on active exercise of agency, to include training, prior planning and consciously employed strategies to overcome weakness of will, even where this reduces the need for effort.
Moral Enhancement and Moral Progress: Compatibilist Concerns ‣
Dr Nicole A Vincent — Macquarie University
It’s difficult to deny the intuitive appeal of bio-medical moral enhancement (BME). What right-minded individual could possibly scoff at using better tools to make themselves into better versions of themselves, morally speaking, especially when what constitutes “better” is something that reflects their own considered judgments? Perhaps motivated by this clear intuitive appeal, Thomas Douglas and John Harris have both come out in support of BME, although each of them proposes significantly different methods.
Although I too acknowledge this intuitive appeal of BME, in this talk I will highlight two under-appreciated concerns. The first relates to the potentially detrimental long term cumulative effects of BME. Namely, that over time the repeated use of BME may, somewhat paradoxically, lead to the eventual loss of our normative compass, and, potentially, even to an arrest of moral progress. The second concern is more conceptual in nature. Namely, that a common core intuition behind BME – that moral failures are results of fixable faults in our agential architecture – is fundamentally incompatible with what I take to be the dimensions (as opposed to the contents) of our conventional moral landscape.
In my view, the first concern can be addressed in two different ways. Either by creating social institutions that help us keep track of how we change ourselves over time, and that feed this information back into our subsequent reasoning about how we have reason to alter ourselves. Alternatively, by pursuing BME through cognitive enhancement based methods (like what John Harris advocates) instead of non-cognitive enhancement based methods (like what Thomas Douglas advocates). The second concern, though – which afflicts Douglas’s and Harris’s methods equally – is much harder to address, because, I will argue, it springs from the very same concerns that animate the long-standing dispute between hard determinists and compatibilists about responsibility. The upshot of this, I will claim, is that compatibilists about responsibility cannot embrace BME without becoming seriously revisionist about moral responsibility.
Culpable madness: When should mental illness not affect sentencing? ‣
Dr Jamie Walvisch — Monash University
In the leading case of R v Verdins (2007) 16 VR 269, the Victorian Court of Appeal held that an offender’s mental health condition may affect a sentencing judge’s assessment of (i) culpability; (ii) the kind of sentence to be imposed; (iii) general deterrence; (iv) specific deterrence; (v) the burden of the sentence; and (vi) the effect of imprisonment. These ‘Verdins principles’ have subsequently been adopted in all Australian jurisdictions, as well as in New Zealand.
While the Verdins principles have been addressed in over 500 higher court cases since 2007, there has been almost no judicial (or academic) discussion about whether there are any circumstances in which an offender’s mental health conditions should not be taken into account by a sentencing judge. In particular, courts have failed to address the question of whether offenders whose mental functioning was substantially impaired at the time of the offence, and whose impairment contributed to the offence, may nevertheless be considered fully culpable for that offence because of their earlier behaviour (such as failing to take their medication or to undergo treatment).
This issue is of increasing significance, given advances in neuroscience. As more treatment options become available, it is essential to determine whether citizens have a responsibility to undergo such treatment, and what consequences they face if they fail to do so. Drawing on the works of RA Duff, JM Fischer and M Ravizza, this paper argues that citizens do have such a responsibility, and that in limited circumstances offenders whose mental functioning was substantially impaired at the time of the offence may be held fully culpable for their actions.
Neurodegeneration in the elderly and the loss of human rights ‣
Cara Warmuth — Gottfried-Wilhelm-Leibniz-Universität Hannover, Germany
Dementia, Parkinson's disease and stroke are the most prevailing brain diseases in the elderly. The treatment of these and other neurodegenerative diseases is a field of ongoing research. However, growing old in nowadays’ societies and suffering from cognitive impairment is not only a medical issue but also a topic providing scope for wide-ranging legal and social constraints. In many European countries, for instance, older citizens with cognitive impairment may lose their driver’s license. Apart from that, they may not be able to form legally binding contracts or may eventually lose their right to vote.
So, with growing knowledge about age-related neurodegenerative conditions comes a growing fear for the elderly that their status as socially and legally respected members of an organised community is threatened. As this status is essential in order to enjoy rights, neurodegenerated elderly will most often have substantially less rights than other “healthy” citizens. In ethical terms, it seems highly disconcerting when losing neurological control will also mean losing rights as a citizen and as a human.
Against this background, it is necessary to define a clear legal framework as to how we want to cope with neurodegeneration in the elderly. The elderly’s wish for autonomy needs to be respected. At the same time, however, society shall be protected from potential behavioural dangers the neurological diseases encompass. For vulnerability is part of the human condition, the elderly with cognitive impairment shall undoubtedly be granted full citizen rights. It is hereby proposed that neurological categories must not be the primary determining factor in the granting of citizen rights, particularly as those categories are changing with ongoing research. A reasonable and humane demarcation will not be possible if neuroscience sets the tone for legal frameworks. Instead, everyone shall enjoy the same rights, irrespective of their state of mind.
Cortina, A., and J. Cornill. 2016. Ethics of Vulnerability. In Human Dignity of the Vulnerable in the Ages of Rights, eds. Masferrer, A., García-Sánchez, E., 45–61. Heidelberg, Berlin: Springer.
Martin, C., D. Rodríguez-Pinzón, and B. Brown. 2015. Human Rights of Older People: Universal and Regional Legal Perspectives, Heidelberg, Berlin: Springer.
The brain as a witness: The use of concealed information testing in the Courtroom ‣
A/Prof Debra Wilson — University of Canterbury, New Zealand
There is always one person who knows who committed a particular offence: the perpetrator. This person is, however, strongly motivated to conceal this, and criminal procedural rights prioritise his right not to provide this information (to refrain from giving a statement or from testifying) above the public interest in solving crime. Reversing this prioritisation is undesirable, one reason being that any information given would potentially be unreliable. Could this change if there was a test that could accurately reveal the person’s knowledge?
Concealed information testing, first proposed in 1895, involves measuring physiological responses to images/words associated with a crime scene, based on the theory that it takes effort to lie, and therefore one can expect indicators like sweating and increased pulse rate when a person tries to conceal knowledge. The most well-known example, the polygraph test, is also well-known for its inaccuracy, and more modern techniques like the use of fMRI also appear inaccurate.
In June 2017 US convicted murderer Steven Avery petitioned for a rehearing on the basis that a form of CIT known as ‘brain fingerprinting’ would demonstrate that he was innocent: his memory simply did not know information that the murderer would know. Brain Fingerprinting has previously been used in the US to secure a guilty plea in a rape/murder case, and to exonerate a man who had served 25 years for murder. A similar technique in India has resulted in 12 murder convictions. In 2010 the Indian Supreme Court determined that compelling suspects to undergo testing was contrary to criminal procedure rights, despite arguments that it was instrumental in solving crime, and less problematic than torture.
This paper will discuss brain fingerprinting’s potential in investigating crime, and the research currently being carried out by the author’s team into the potential ethical implications of its voluntary/compulsory use.
Farwell, Lawrence, Richardson, Drew. 2013. Brain Fingerprinting field studies comparing P300-MERMER and P300 brainwave responses in the detection of concealed information. Cognitive Neurodynamics 7: 263-299.
State of Wisconsin v Steven A Avery, Notice of Motion, Case No. 05-CF- 1381, 7 June 2017.
The Negligent Mind? How Neuroscience Will Change Our Understanding of Tort Law and Moral Responsibility ‣
Benjamin Allen — University of Sydney
Advances in neuroscience and artificial intelligence will rapidly change tort law. To understand how part one of the paper examines the existing utilitarian, economic and corrective justice theories of tort law. Such traditional theories are flawed in light of rapidly changing technology and the growth of artificial intelligence and the paper proposes a re-examination of tort theory based on a conceptual model more closely aligned to these changes.
Part two examines the objective standard of care in negligence law. Advances in neuroscience cast serious doubt on the sustainability of an objective standard of care. The paper contends that if an objective standard across a class of persons cannot be sustained then its ongoing value must seriously be called into question lest it become a rule of strict liability. Whilst the man on the Clapham omnibus  may be in robust health it is time that he alighted at the next stop.
Part three examines the recovery of loss for pure mental harm or recovery for eggshell mind plaintiffs. Despite recovery of loss for pure mental harm being permitted in theory, in practice there remain significant barriers. New neuroscientific discoveries should reduce and limit these barriers so that the dichotomy between recovery for physical injuries and recovery for pure mental harm is eliminated.
Part four considers the role moral responsibility and reasoning play in our cognitive decision-making processes through an examination of moral dilemmas. Certain dilemmas trigger particular neurological reactions that can be measured and predicted enhancing our understanding of moral responsibility. Commercial law is heavily laced with moral reasoning and responsibility such as the law of unconscionable conduct. The paper proposes that the law of unconscionable conduct should be expanded beyond its origins in equity as well as its current formulation in the Australian Consumer Law. 
 First reported by Collins MR in McQuire v Western Morning News  2 K.B 100 at 109 but attributed to Baron Bowen.
 See section 20-21 Australian Consumer Law in Schedule 2 of the Competition and Consumer Act 2010 (Cth).
Neurolaw in Australia: The Use of Neuroscientific Evidence in Criminal Proceedings ‣
Armin Alimardani — University of New South Wales
Jason M. Chin — University of Queensland
Despite recent research finding that parties increasingly rely on neuroscience as evidence in court, much less is known about how such evidence is being used in the Australian legal context. To fill this void, we performed a review of neuroscience in Australian criminal cases. We found that this evidence is being used in two general ways: as diagnostic evidence (i.e., the evidence tells the court something about the specific accused) and as framework evidence (i.e., the evidence tells the court something about people like the accused). Regarding diagnostic evidence, neuroscience is being used at several stages in the legal process. It is being used pre-trial as evidence of the accused’s fitness to stand trial. At trial, it is being used to support the defence of insanity and substantial impairment of the mind (i.e., a defence that can reduce murder to manslaughter). Finally, in sentencing, offenders rely on neuroscience to support arguments that the sentence should be lowered due to an underlying neurological condition. Use of neuroscience as framework evidence is more variable, but is generally used to support more general psychological propositions, such as the lower ability of adolescents to control their behaviours.
We also identify several themes and hazards that flow from the use of neuroscience in Australian criminal cases. With respect to diagnostic evidence courts seem to occasionally prefer neuroscientific evidence even when it conflicts with well-established behavioural psychological findings. Further, neuroscience can represent a double-edged sword: parties sometimes lead neuroscientific evidence at trial as a defence, but it is then used to support a longer sentence. Regarding framework evidence, neuroscience can be of dubious relevance because it often restates well-accepted psychological propositions. Still, we find that many courts use neuroscience in a cautious and measured manner.
Sex on the brain: Hypersexuality and the law ‣
Amee Baird — Macquarie University
Hypersexuality, or a dramatic increase in sex drive and activity, can occur in people with brain injury or disease, including behavioural variant fronto-temporal dementia and temporal lobe epilepsy. It is typically associated with damage to frontal or temporal lobes, particularly right sided or bi-temporal damage, and can present as a symptom of Klüver Bucy Syndrome , or during drug treatment for Parkinson’s Disease [PD, 2]. Hypersexuality can range from increased sexual thoughts to a high frequency of sexual activity that in some cases can involve a change in sexual orientation or de novo pedophilia. The resulting conflict with social rules and laws raises complex medicolegal issues regarding responsibility for behavior and sentencing. There are published case studies of childhood sexual offences that occurred in the context of hypersexuality associated with a neurological condition (e.g. following right temporal lobectomy for treatment of seizures) that resulted in imprisonment in the UK and USA . We explored relevant Australian cases using the Australian Neurolaw Database. Only one case was found using the keyword ‘hypersexuality’ (R v TM, 2011). TM developed hypersexuality during drug treatment for PD and manifested unprecedented homosexual and pedophilic interests. The direct link between his sexual offences against children and medication was cited as a significant mitigating factor in his sentence. Using the key words ‘sexual assault’ 9 cases were found. The offenders had a range of suspected or diagnosed neurological conditions, including acquired brain injury. None had features of hypersexuality, namely ‘all or noneness’ and ‘insatiability’ . Rather, the offences occurred in the context of a longstanding neurodevelopmental condition (intellectual disability), many years after a suspected brain injury, or involved repeated offences over an extended period of time without any clear relationship to the brain injury or disease. Criminal behaviour occurring in the context of hypersexuality due to a neurological condition is rare, but when it does occur it epitomises the discipline of ‘neurolaw’.
 Baird, A.D., Wilson, S.J., Bladin, P.F., Saling, M.M. and Reutens, D.C. 2007. Neurological control of human sexual behaviour: insights from lesion studies. Journal of Neurology, Neurosurgery and Psychiatry 78: 1042-9.
 Nakum, S and Cavanna, A.E. 2016. The prevalence and clinical characteristics of hypersexuality in patients with Parkinson’s disease following dopaminergic therapy: A systematic literature review. Parkinsonism Related Disorders 25: 10-16.
 Devinsky, J, Sacks, O., and Devinsky O. 2010. Klüver Bucy Syndrome, hypersexuality and the law. Neurocase 16: 140-145.
Bias in Data: The Ethical Risks of Using Machine Learning in Healthcare ‣
Oisín Deery — Monash University
Katherine Bailey — Acquia, Inc.
Machine Learning (ML) is everywhere, including in healthcare. Yet patients can be put at increased risk of harm as a result of two features of how ML systems are deployed . First, there are inherent limitations in what ML systems can do, as well as problems in how ML systems are trained, that make these systems, in effect, artificially stupid. Second, there is widespread misunderstanding of what ML systems are capable of, with a resulting overconfidence in their outputs .
For example, researchers at Stanford University recently trained an ML system to identify skin cancer . But this system was trained by using photos from predominantly white people as training data. As a result, the system can’t reliably classify lesions in black patients. Yet the claim was that the system could outperform dermatologists. However, dermatologists receive extensive training in visually detecting skin cancer in black patients. As a result, they can be expected to vastly outperform the Stanford system in visually detecting malignant lesions in blacks (a result that didn’t show up while testing the Stanford system against 21 board-certified dermatologists, since images of lesions on black skin also didn’t feature in that test).
Some have suggested that systems like Stanford’s be deployed in diagnosis, as apps that patients can use on their smartphone before contacting a doctor . But then, a black patient might be given the all-clear, despite actually having skin cancer, since the system can’t reliably classify lesions on anything except white skin. Such a patient would be put at increased risk of harm, relative to their being seen by a dermatologist.
We argue that in order to safeguard patients, ML diagnostic tools have to be better developed, better understood by the medical profession, and – in most cases – only deployed in conjunction with human medical expertise .
 Cohen, Glenn, Ruben Amarasingham, Anand Shah, Bin Xie, and Bernard Lo. 2014. The legal and ethical concerns that arise from using complex predictive analytics in health care. Health Affairs 33/7: 1139–1147.  Esteva, Andre, Brett Kuprel, Roberto A. Novoa, Justin Ko, Susan M. Swetter, Helen M. Blau, and Sebastian Thrun. 2017. Dermatologist-level classification of skin cancer with deep neural networks. Nature 542: 115–118.
 Holzinger, Andreas. 2016. Interactive machine learning for health informatics: when do we need the human-in-the-loop? Brain Informatics 3:119–131
 Lofgreen, Seth, Kurt Ashack, Kyle Burton, and Robert Dellavalle. 2016. Mobile device use in direct patient care. Journal of the American Academy of Dermatology 74/5: AB106.
 Wheeler, Gregory. 2017. Machine epistemology and big data. In The Routledge companion to the philosophy of social science, eds. Lee McIntyre and Alex Rosenberg, 321– 329. New York: Routledge.
Science to Psyche: Building an Evidence Base for Psychotherapy Based on Neuroscience ‣
Rachael Holt — University of Sydney
Currently in Australia there are several counselling/psychotherapy modalities seeking to incorporate research from neuroscience into treatment frameworks for mental health and recovery from trauma. These include:
(i) the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders, based on the work of Russell Meares;
(ii) electroencephalogram (EEG) neurofeedback brain training, which provides feedback to the client when they learn to increase or decrease specific amplitudes and frequencies in the electrical activity in their brain, and has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and
(iii) Somatic Experiencing, an integrative mind-body approach based on how the body responds to threat and fear, especially thwarted attempts to enact fight or flight in the face of threat and developed by Peter Levine.
These modalities rely on current scientific understanding of brain development and plasticity, attachment, and stress responses. However, an evidence-based framework for practice is not limited to the translation of affirmed research findings into the counselling office; good treatment accounts for individual response, client preferences, the context of treatment and ongoing monitoring of progress and outcomes. While large clinical trials provide evidence of comparative effectiveness, practice-based research, case studies, N=1 trials, observational and qualitative enquiry can assist in discovering how discrete or combinations of interventions best suit and are most sustainable for individual patients in actual care. This leads to research which can also address concepts often difficult to capture – such as ethical practice and medical versus humanistic aspects of mental health treatment. This paper narratively reviews how the evidence base for the above trauma recovery modalities is being built to support clinical practice in Australia.
1. Fisher, Sebern F. 2014. Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain. New York: W. W. Norton & Company.
2. Levine, Peter A. 2010. In an unspoken voice: how the body releases trauma and restores goodness. Berkely California: North Atlantic Books.
3. Lillie, Elizabeth O, Bradley Patay, Joel Diamant, Brian Issell, Eric J Topol, and Nicholas J Schork. 2011. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized Medicine 8 (2):161-173.
4. Meares, Russell. 2006. The conversational model. In An Introduction to the Psychotherapies, ed. S Bloch, 287-305. Oxford: Oxford University Press.
Can You Make Me a Better Person without Telling Me What a Better Person Looks Like? Moral Perfectionism and Moral Enhancement ‣
Pei-hua Huang — Monash University
Recently, the proposal of compulsory moral bioenhancement  has been accused of committing to moral perfectionism . Briefly speaking, the concern is that since a state-driven compulsory moral bioenhancement will have to invite a group of ‘experts’ to decide who has to be enhanced with what moral traits, the enhancement program inevitably commits itself with moral perfectionism. Such commitment renders great threat to the enhancement recipients’ political autonomy and their personal freedom to shape their own moral worldviews.
In this paper, I argue the bioenhancement program’s commitment of moral perfectionism could indeed be detrimental to potential enhancement recipients’ ability to develop their own conception of the good(s), yet this concern requires further calibration. This is because rejecting the bioenhancement program out of this reason will, at the same time, undermine the legitimacy of the most widely used and least controversial form of moral enhancement program, i.e. moral education.
The endorsement we give to moral education and other social institutes in liberal democratic society suggests that the real concern about the proposal of moral bioenhancement lies elsewhere – how thick the conception of the good(s) committed by a moral enhancement program is. Such intuition can be found in the work of the capabilities approach  and Nagel’s argument for the importance of the impersonal good , in the sense that moral education and institutes employed by a liberal society might not be truly value neutral, but the values should be as thin as possible so that individual citizens can enjoy the freedom to form their own moral worldview. I call this approach, libertarian perfectionism. The worry concerning compulsory moral bioenhancement, therefore, should be recast. The proposal is worrisome, not because of its commitment of perfectionism per se, but that the perfectionism it commits to is not libertarian enough.
 Persson, Ingmar., Savulescu, Julian. 2012. Unfit for the Future: The Need for Moral Enhancement, Oxford University Press, Oxford.
 Sparrow, Robert. 2014. Better Living Through Chemistry? A Reply to Savulescu and Persson on ‘Moral Enhancement’. Journal of Applied Philosophy, 31(1): 23-32.
 Nussbaum, Martha. 1999. Sex and Justice. Oxford University Press.
 Nagel, Thomas. 1991. Equality and Partiality, Oxford University Press.
From Citizen to Charity Case: Has Contracted Welfare Breached the Sovereign’s Duty to Her Subjects? ‣
Adam Johnston — Macquarie University Law School
My thesis considers several parallel but related processes in Australia’s legal and social history. The main one is the establishment of the National Disability Insurance Scheme (NDIS) which is aimed to bring certainty of service and support to all eligible people with permanent impairments. Many in the disability sector have campaigned for such a reform over many decades; but did they get what they expected?
The NDIS was introduced to solve the issue of inequitable funding and support. Its funding is based on meeting individual assessed need. This means that clients are funded directly and they can choose the services they need to access and enjoy an ordinary life, in line with in the Convention on the Rights of People with Disabilities.
But what does it mean to enjoy an ordinary life? An implicit but curiously unchallenged element of the NDIS is the assumption that disability will continue to be lifelong, with services delivered by charities and funded by government. From a human rights perspective, why should people with disabilities not expect their living standards and expectations for life to rise with those of all other Australians? The scheme’s administrators have already been criticised for their interpretation of what is reasonably necessary for an ordinary life.
With the development of medical technology like stem cells, exoskeletons and brain implants, genetics and cellular technology, the public expectation of what is reasonably necessary for an ordinary life will change. However, as currently understood, the NDIS assumes disability and then assesses the need for equipment and support services based on reasonable necessity.
People with disabilities and their families may become discontent with the charitable dependence norm, as they witness the advancement of science and technology. Could an ordinary life come to have with it, as a condition precedent, the absence of permanent disability?
Fabig, H. (2013). “NDIS: rights-based paradigm shift or same old charity?” Ramp Up – Disability, Discussion, Debate., http://www.abc.net.au/rampup/articles/2013/04/11/3734962.htm
Manne, A. (2011). “Two nations: The case for a national disability insurance scheme.” The Monthly, https://www.themonthly.com.au/issue/2011/august/1314794058/anne-manne/two-nations
Perkins, Miki (2017), Woman with disabilities scores landmark win over NDIS, June 18 2017, The Age, Victoria, http://www.theage.com.au/victoria/woman-with-disabilities-scores-landmark-win-over-ndis-20170615-gwrz7c
Reddihough, D. S., et al. (2016). “The National Disability Insurance Scheme: a time for real change in Australia.” Developmental Medicine & Child Neurology 58: 66-70. http://dx.doi.org/10.1111/dmcn.13007
Simms, R. (2017). Privatising NDIS services could be a repeat of the VET-fee disaster. Sydney Morning Herald, Fairfax Media. http://www.smh.com.au/action/printArticle?id=1019423500
Smith, B. (2016), Human trials for Australian-made bionic spine to start next year, Sydney Morning Herald, February 9, 2016, http://www.smh.com.au/technology/sci-tech/human-trials-for-australianmade-bionic-spine-to-start-next-year-20160202-gmjqdj#ixzz3zik2ip00
Strom, M. (2016), Hope for the paralysed: UTS to establish Centre for Neuroscience and Regenerative Medicine, Sydney Morning Herald, September 16 2016, http://www.smh.com.au/technology/sci-tech/hope-for-the-paralysed-uts-to-establish-centre-for-neuroscience-and-regenerative-medicine-20160915-grgudc.html
Tiernan, E. (2017), ReWalk exoskeleton allows paraplegic Paul Jenkins to walk again, Sydney Morning Herald, February 13 2017 http://www.smh.com.au/technology/sci-tech/rewalk-exoskeleton-allows-paraplegic-paul-jenkins-to-walk-again-20170117-gtt5ar.html
Explanatory Memorandum, National Disability Insurance Scheme Bill 2012 (Cth), Statement of Compatibility with Human Rights: Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011, http://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r4946_ems_2e629de9-8977-4c7e-9886-28db156673e1/upload_pdf/375307.pdf;fileType=application%2Fpdf
Neuroplasticity throws downs the gauntlet: Can we rise to the ethical and clinical challenge to ‘mental illness’? ‣
Dr Haley Peckham — University of Melbourne
Before your birth, actually even before your conception, your parents’ experience of their environment, written into their biology, was making a ‘best guess’ at the kind of environment putative ‘you’ were going to be born into, precisely so you would be better prepared for it . Adaptation supports survival of our species, so mechanisms that transduce our lived experience into adaptive biological changes have evolved. These mechanisms include epigenetics, neurogenesis, synaptic plasticity, and white matter plasticity. The brain is literally built by experience, and it is experience that sets the tone of our hormonal and autonomic nervous systems . Learning from experience increases our chances of surviving long enough to continue our line, in accordance with evolution’s ruthless imperative. Our formative experiences biologically select the most adaptive survival strategy for the environment we are in. However, we should not confuse adaptive with contented. The biologically adaptive strategy for living in a dangerous and risky environment is to be anxious, hypervigilant, defensive, aggressive or passive, impulsive, exploitative, and motivated to begin bearing many children from as early as possible . These traits are survival positive, but incur and perpetuate such great suffering and tragedy to generations that we label them ‘pathological’. Emotional and physiological dysregulation, alongside desperate attempts to self-regulate through violence, dissociation, self-harm and addictions to substances or compulsive behaviours, occur across mental illnesses. Our suffering has traditionally been viewed as symptomatic of our mental illness but is an adaptive strategy written into our biology by our lived experience. Surely, a healthy brain is a brain that can adapt to experience? Is it ethical then to diagnose pathology within a person when they have adapted to adversity in their environment? Could our suffering instead be validated by neuroplasticity? Could we draw upon our neuroplasticity to alleviate our suffering with reparative experiences and relationships? This presentation critically considers the implications of understanding suffering and anguish as adaptations that warrant our care, or as pathologies intrinsic to us requiring a cure.
 Peckham, H., Epigenetics: The dogma-defying discovery that genes learn from experience. international journal of neuropsychotherapy, 2013. 1: p. 9-20.
 Schore, A.N., The Science of the Art of Psychotherapy (Norton Series on Interpersonal Neurobiology). 2012: WW Norton & Company.
 Chisholm, J.S. and D.F. Sieff, Live fast, die young: an evolved response to hostile environments. Understanding and Healing Emotional Trauma: Conversations with Pioneering Clinicians and Researchers (ed Sieff DF), 2015: p. 163-81.
The Impact of Deep Brain Stimulation on Personality, Identity and Interpersonal Relationships in Neurological and Psychiatric Conditions ‣
Cassandra Thomson — Monash University
Adrian Carter — Monash University
Rebecca Segrave — Monash University
The potential for DBS-related changes in personality, identity and interpersonal relationships are significant issues facing people who undergo DBS and their families. There has been growing ethical and philosophical debate in recent years about the impact of DBS on identity and our understanding of the neural origins of personhood. The ethical and philosophical literature on the topic often holds a theoretical and speculative stance that largely ignores the growing neuropsychiatric, psychological and social scientific literature. I will describe my current study that is attempting to bridge this gap, investigating the experience of both Parkinson’s disease (PD) and major depressive disorder (MDD) patients and caregivers.
The study will: 1) prospectively examine the impact of DBS on patient personality, identity, interpersonal relationships and quality of life; 2) patient expectations of DBS outcomes and how these may relate to lived outcomes; and 3) obtain multiple perspectives on these issues by documenting the perception of patients, their caregivers and DBS clinicians. The study employs a prospective mixed-methods approach with a combination of semi-structured interviews and psychometric self-reports/observer-reports. Small groups of PD and MDD patient/caregivers dyads are being recruited for interviews pre-surgery and 9-months post-surgery. Clinicians working in the DBS field are also being interviewed for their perspectives on issues of patient and relationship change, and patient/caregiver expectations.
This is one of the first studies to employ qualitative methods that capture nuanced clinical data that cannot be assessed using quantitative psychometric measures, a repeated measures prospective study design, and the triangulation of perspective from multiple stake holder groups (patients, caregivers, and clinicians). This study will contribute to our understanding of the changes in personality, identity, interpersonal relationships, and quality of life that occur following DBS and reveal the extent to which these changes impact upon the individual, their family, and social networks. Preliminary results will be presented.
Neuroenhancement Could Help with Battling the Shooter Bias ‣
Cara Warmuth — Gottfried-Wilhelm-Leibniz-Universität Hannover
While the ethics of neuroenhancement, whether in civil or in military use, are generally debatable, there might be an advantage of enhancing people’s brains for public policy which has been undiscussed up to now. This new aspect refers to the psychological phenomenon of “shooter bias”. This term describes the effect that racial bias triggers police officers to shoot black suspects faster and more often than white suspects. The effects of this phenomenon have proven to be fatal, especially in the United States where a recent case was that of Philando Castile, a black man who was shot and killed by a police officer during a traffic stop. When Castile reached for his ID, the police officer shot him, wrongly assuming that the suspect was reaching for a gun. Shooter Bias, like many other biases, is thought to be uncontrollable, at least not with the known debiasing strategies.
However, neuroenhancement could be a promising way of battling this bias. This would mean that, if someday one were to identify the underlying neuronal mechanism for the shooter bias, neuroenhancement could come to help and “switch off” this mechanism. When someone faces the need to decide whether someone is potentially threatening, an enhanced brain would be able to disambiguate potentially threatening persons fairly and equally, with absolutely no regard to the respective person’s skin colour. By that, neuroenhancement could lead to an improved cognition of people and especially of police officers, ideally coming close to a rather objective perception, free of stereotypes. This, in turn, would eventually save many lives.
Correll, J., B. Park, C.M. Judd, and B. Wittenbrink. 2002. The Police Officer’s Dilemma: Using Ethnicity to Disambiguate Potentially Threatening Individuals. Journal of Personality and Social Psychology 83 (6): 1314-1329.
Moral Cognition: Extending the Linguistic Analogy. ‣
Graham Wood — University of Tasmania
The application of the linguistic analogy assumes that the lessons learned within the cognitive science of language will help guide our understanding of moral cognition. The analogy has been applied by Rawls, Hauser, Dwyer, Heuber and Mikhail, among others, in an attempt to understand the nature of the moral faculty, a distinct cognitive faculty assumed to exist by those applying the analogy. This paper assumes the existence of a moral faculty, endorses the application of the linguistic analogy, and extends the application of the analogy to the work of Cosmides & Tooby and Haidt & Joseph. One of the central assumptions of the analogy is the existence of a moral grammar, and current research focuses on attempting to articulate the structure and rules of that moral grammar. Mikhail has applied the idea of a moral grammatical rule to the permissibility or impermissibility of causing harm in trolley car cases. Thus, following Mikhail, the permissibility or impermissibility of causing harm can be understood as relating to one moral grammatical rule. However, the moral status of causing harm is only one dimension of moral judgment. Fairness is another dimension of moral judgment and the work of Cosmides & Tooby concerning rationed benefits can be understood as pointing to a second moral grammatical rule. The work of Haidt & Joseph on Moral Foundations Theory can be understood as pointing to further moral grammatical rules. Their theory lists a number of foundations including: harm/care; fairness/reciprocity; in-group/loyalty; authority/respect; and purity/sanctity. The work of Mikhail on harm, and Cosmides & Tooby on fairness, offer models of how to analyze the moral grammatical rules underlying the first two moral foundations in Haidt and Joseph’s theory, and furthermore this work can be used to help identify possible moral grammatical rules relating to in-group/loyalty, authority/respect and purity/sanctity.
Cosmides, Leda, & Tooby, John. 1989. Evolutionary psychology and the generation of culture, II. Case study: a computational theory of social exchange. Ethology and Sociobiology, 10: 51-97.
Haidt, Jonathan & Joseph, Craig. 2007. The moral mind: How five sets of innate intuitions guide the development of many culture-specific virtues, and perhaps even modules. In The Innate Mind, Vol. 3, eds Peter Carruthers, Stephen Laurence, and Stephen Stich, 397-391, New York: Oxford.
Hauser, Marc. 2006. Moral minds: how nature designed our universal sense of right and wrong. New York: HarperCollins Publishers.
Mikhail, John. 2011. Elements of moral cognition: Rawl’s linguistic analogy and the cognitive science of moral and legal judgment. Cambridge: Cambridge University Press.
Rawls, John. 1971. A Theory of Justice. Cambridge MA: Harvard University Press.
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