The Speculist

Phil has linked to and commented on several stories in the last couple of days that have a common theme:

• Brain Juice [electrical currents enhancing brain function]

• Ho Hum [monkey controlling a robot with its brain]

• The Brain Fix [electronic brain prosthesis]

• Brain tissue transplants

Even though most of these treatments would only be used on diseased or injured brains, some ethical issues must be considered.

If a patient has a stroke that damages a portion of her brain, will she remain the same person if she is treated with a brain prosthesis or brain tissue transplant?

Objectively there is little to argue about. If my family member has suffered a stroke and can't speak or take care of herself, and if a brain tissue transplant could reverse that, then the post-op person is more like the person I knew before the stroke.

But what is the subjective experience of the patient? Is her personhood violated by the treatment? Certainly the stoke or neurodegenerative disease violated the patient first. But there are many instances in medicine where doctors choose not to treat rather than risk additional harm.

This problem is akin to issues science fiction fans have discussed for years. If my memories and personality are copied into a computer or into another body, have I, personally, been moved? Am I live or Memorex?

Or if the "transporter" from Star Trek can take apart my atoms, transport them through space, and reassemble me perfectly on some alien world, is that still me? Maybe. But, what if - as Star Trek suggests - only the digital information of my pattern is transported. My actual atoms are left behind to replicate Hot Earl Grey tea or something. Is that still me?

I don't know, but I certainly understand Dr. McCoy's aversion to the transporter.

The ethical problem with brain prosthesis and tissue replacement is different from these fictional dilemmas only in degree. A brain prosthesis or tissue transplant might simply be thought of as an aid for the remaining brain, but it just as logically could be said to be "new brain." Where exactly does "self" reside? Does "self" remain in the damaged brain that the prosthesis or new tissue is aiding, or is it within the "new brain?" Could it be a both?

There is no easy answer to that. But I know that if I had a stroke and was told that the only way I could walk again or speak would be to undergo a such a procedure, I'm sure I'd agree to the treatment.

This seems to be the best solution to the problem. Our decisions have an impact on who we are anyway, so there seems little reason to question a patient's decision regarding such care - provided they are capable of making the decision.

Obviously someone will have to judge whether the patient is capable of understanding the treatment and making the decision. Should that be the doctor or the family? Its time to update my living will forms.