The blog of the Presidential Commission for the Study of Bioethical Issues

Capacity, Consent, and Progress: Recommendations from the Bioethics Commission

(This post also appears on PRIM&R’s Amp&rsand blog)

Earlier this year, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released the second part of its report on neuroscience and ethics—Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2). The report examines in depth several controversial topics that bring ethical issues to the fore, including cognitive enhancement, neuroscience and the law, and the ethical conduct of research with participants with impaired capacity for informed consent.

The challenge of impaired consent capacity has been a perennial issue in research ethics for decades yet it is nonetheless well-placed in a report about contemporary neuroscience. Neuroscientists commonly study the very diseases that can cause impairments in decision-making capacity, making informed consent difficult or impossible. These include head trauma, stroke, dementia, schizophrenia, and major depression, among others. Neuroscience research can promote progress towards understanding and alleviating these conditions, but that progress requires the participation of persons affected. Informed consent is a central tenet of research ethics and, in its absence—when working with participants whose capacity is impaired—researchers and IRBs need clear guidelines for whether and how to proceed ethically.

It is vital to find ways whenever possible to ethically and responsibly include individuals with impaired consent capacity in research, but researchers must also vigilantly protect participants from exploitation and abuse. In addition, researchers must guard against and mitigate stigma and harmful assumptions about individuals based on diagnoses or impaired consent capacity.

With all of this in mind, Gray Matters, Vol. 2 explains the long and complex history of national bodies crafting guidance about impaired consent capacity, describes the current regulatory framework to protect participants, and elucidates additional protections that can be employed when consent capacity is impaired or in question. These additional protections include using improved assessment techniques, respecting assent and dissent, engaging independent consent monitors, limiting acceptable levels of risk, requiring legally authorized representatives, honoring research advance directives, and ensuring meaningful stakeholder engagement. The Bioethics Commission made four recommendations in this area, emphasizing responsible inclusion, and calling for clearer requirements for identifying legally authorized representatives to provide permission on behalf of participants when consent capacity is impaired.

As a part of its continued efforts to distribute its findings and recommendations to relevant stakeholders, the Bioethics Commission has developed educational materials to accompany its reports. Included among the Gray Matters educational material is a primer for researchers on neuroscience and consent capacity. Researchers can use the primer to aid ethical decision making and ensure that they have considered and implemented appropriate safeguards. All of the Bioethics Commission’s materials are free and available at http://bioethics.gov/education.

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Update: The Growing Need for a Systematic Approach to Compensation for Research-Related Injuries

(This post also appears on the Penn Wharton Public Policy Initiative)News Image

In December 2011, the Presidential Commission for the Study of Bioethical Issues (the Bioethics Commission) released its report Moral Science: Protecting Participants in Human Subjects Research. In it, the Commission responded to a charge from the President to determine if federal regulations and international standards adequately guard the health and well-being of participants in scientific studies supported by the federal government. Although the Bioethics Commission noted the substantial protections for the health, rights, and welfare of research participants under the existing U.S. system, it also found room for improvement in several areas.

One such area identified by the Bioethics Commission was the treatment and compensation of participants who sustain research-related injuries. Over the last several decades, almost every developed country has instituted policies requiring researchers or sponsors to provide treatment and compensation for research subjects’ injuries. Despite recommendations from the Presidential Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1982, the National Bioethics Advisory Commission (NBAC) in 2001, and the Institute of Medicine (IOM) in 2002 that the federal government either explore the issue further or implement a system of its own, U.S. action has been minimal.

In Moral Science, the Bioethics Commission argued that the absence of such a system was ethically unjustified. Rooted in longstanding ethical principles the Bioethics Commission wrote that “treatment or compensation… is appropriate as an act of benevolent regard for an individual’s willingness to participate in an enterprise of important benefit to the public.”[1] Offering arguments based in justice, professional obligations, and utility, the Bioethics Commission recommended that the federal government evaluate the need for a national system of compensation for research-related injuries and study possible program mechanisms. Just over one year later, the Bioethics Commission took up this issue again in its report Safeguarding Children: Pediatric Medical Countermeasure Research. In this report, the Bioethics Commission reviewed the ethical considerations of conducting clinical trials of medical countermeasures—interventions used in the event of a terror attack—with children. When considering ethical requirements for these studies, the Bioethics Commission reaffirmed its ethical argument for research-related injury compensation from Moral Science and recognized the additional need in the context of pediatric MCM research.

Since the release of these reports, several developments have highlighted the importance of the Bioethics Commission’s recommendations to study and evaluate different approaches to designing a system for compensation. These developments include:

  • New evidence that suggests that, without government intervention, some private institutions have yet to develop their own compensation policies. As of 2012, there has been no substantial change in research-related injury compensation policies among U.S. institutions since 2000 despite the calls for change from NBAC, the IOM and the Bioethics Commission during that time. In addition, over ten percent of U.S. research institutions actually changed their consent forms to include exculpatory language as of 2012 despite having had none in 2000.[2]
  • A 2013 strengthening of India’s legal protections for injured research subjects that prompted the National Institutes of Health (NIH) to halt as many as 40 clinical trials in light of what many industry experts considered to be an “unstable regulatory climate.”[3],[4] Despite making a reluctant return to India when the law was further clarified, the NIH faces continued legal challenges to providing appropriate compensation.[5],[6] The situation in India is not an isolated incident. On other occasions, the lack of a systematic compensation system has forced U.S. research teams abroad to work around existing regulations or in some cases, even stop clinical trials.[7]
  • A 2013 study demonstrating the possibility that costs of treatment for research-related injury might be shifted to local health care systems within developing countries where research takes place. The study of NIH HIV/AIDS clinical trials in Africa found that although many investigators use portions of their funding to cover treatment or reparation for research-related injuries, data from one African country suggest that “overburdened and under-resourced health systems may be forced to provide care and treatment for injuries caused by research when sponsors fail to do so.”[8]
  • A 2013 revision to the World Medical Association’s Declaration of Helsinki adding that “appropriate compensation and treatment for subjects who are harmed as a result of participating in research must be ensured.”[9] The revision represents growing consensus on the issue of research-related injury compensation within the international community. The update has resulted in rising acknowledgement among scholars and physicians that the United States remains an outlier on this issue.[10]

In Moral Science, the Bioethics Commission presciently observed that, among other ethical arguments, general utility supports such a system, noting “if there is a growing commitment toward harmonization of policies and recognition of equivalent protections, the fact that federally sponsored human subjects research differs substantially in this policy toward compensation for humans subjects who are harmed in the course of research could prove a significant barrier [to recruitment of participants].”[11]

As the United States remains one of the few industrialized countries without a strong legal infrastructure providing for research-related injury compensation, recent events further highlight the strategic and ethical imperative for federal action. Amidst continued attention within the international community, the need for a systematic approach to compensation continues to grow.

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[1] Presidential Commission for the Study of Bioethical Issues (PCSBI). (2011, December). Moral Science: Protecting Research Participants in Human Subjects Research. Washington, DC: PCSBI, p. 58.

[2] Resnik, D.B., et al. (2014). Research Related Injury Compensation Policies of U.S. Research Institutions. IRB 36 (1), 12-19.

[3] Gupta, Y.K. et al. (2014). Compensation for Clinical Trial-Related Injury and Death in India: Challenges and the Way Forward. Drug Safety, 37 (12), 995-1002.

[4] Krishnan K. and J.P. Koshy. (2013, 11 July). US agency NIH scraps nearly 40 clinical trials in India. Livemint. Retrieved on June 24, 2015 from http://www.livemint.com/Politics/zwG7cCA7nFYFdpzYLXcCVM/US-agency-NIH-cancels-nearly-40-ongoing-clinical-trials-in-I.html.

[5] Reardon, S. (2014). NIH makes wary return to India: Some clinical trials funded by US agency resume, but strict regulations have put off others. Nature, 506 (7487), 143-144.

[6] Marwick, C. (1998). Compensation for Injured Research Subjects. Journal of the American Medical Association, 279 (23), 1853-1855.

[7] Pike, E.R. Recovering from Research: A No-Fault Proposal to Compensate Injured Research Participants. American Journal of Law and Medicine, 38 (1), 42-43.

[8] Mamotte N., Wassenaar D. and N. Singh. (2013). Compensation for Research-Related Injury in NIH-Sponsored HIV/AIDS Clinical Trials in Africa. Journal of Empirical Research on Human Research Ethics, 8 (1), 45-54.

[9] World Medical Association (WMA). (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Journal of the American Medical Association, 310 (20), 2191-2194.

[10] Many who covered the revision to the declaration or who were quoted in articles that followed it expressed doubts about whether or not US regulators would enact changes following the statement from the WMA. For more see: Kurihara, C. and Takeo S. (2013). Discussion toward he 50th anniversary of the Declaration of Helsinki: Interview with Dr. Otmar Kloiber, Secretary General, World Medical Association. Rinsho Hyoka (Clin Eval), 41 (2), 351-372; Morris, K. (2013). Revising the Declaration of Helsinki. The Lancet, 381 (9881), 1889-1890; Lynch, H.F. (2013) Bill of Health: Revisions to the Declaration of Helsinki. Retrieved on July 2, 2015 from http://blogs.law.harvard.edu/billofhealth/2013/04/18/revisions-to-the-declaration-of-helsinki/.

[11] PCSBI, (2011, December), op cit, p. 62.

 

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Bioethics Deliberation and Education in New Directions

Two weeks ago, in the blog post “A Background on Deliberation and Education in Bioethics,” we discussed the role of deliberation and education in the recommendations issued by the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission). These principles remain a common thread throughout the Bioethics Commission’s work. This second post of the new “Deliberation and Education” series will examine the role that these two principles played in the Commission’s first report: New Directions: The Ethics of Synthetic Biology and Emerging Technologies.

Released in December 2010, New Directions was undertaken at the request of President Barack Obama, who asked the Bioethics Commission to review the developing field of synthetic biology and identify appropriate ethical boundaries to maximize public benefits and minimize risks. The Commission made 18 recommendations in the report, centering around five ethical principles: public beneficence; responsible stewardship; intellectual freedom and responsibility; democratic deliberation; and justice and fairness.

In order to promote responsible stewardship, the Bioethics Commission made a recommendation (#9) that included ethics education:

Ethics education similar or superior to the training required today in the medical and clinical research communities should be developed and required for all researchers and student-investigators outside the medical setting, including in engineering and materials science.

The Bioethics Commission recognized that integrating ethics education into the curriculum was necessary in order to cultivate responsible research practices. In addition, democratic deliberation appeared as its own principle with three corresponding recommendations (# 14-16):

Stakeholders are encouraged to maintain an ongoing exchange regarding their views on synthetic biology and related emerging technologies, sharing their perspectives with the public and with policy makers.

When discussing synthetic biology, individuals and deliberative forums should strive to employ clear and accurate language.

Educational activities related to synthetic biology should be expanded and directed to diverse populations of students at all levels, civil society organizations, communities, and other groups.

The three recommendations, which also include education, serve to guide democratic deliberation, a process the Bioethics Commission uses in its own decision-making.

Bioethics education and deliberation have served as a foundation for the Bioethics Commission since its very first report. These concepts appear throughout the Commission’s work, demonstrating their applicability across the biomedical, research, and clinical spheres.

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New Educational Module from the Bioethics Commission on Vulnerable Populations in Neuroscience Research Now Available

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has posted a new educational module on its website, Bioethics.gov. The module on vulnerable populations accompanies the Bioethics Commission’s two-volume report Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society (Gray Matters, Vol. 1) and Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2). Additional educational materials on vulnerable populations include a background module, as well as report-specific modules that accompany the Bioethics Commission reports: Safeguarding Children: Pediatric Medical Countermeasure Research and “Ethically Impossible”: STD Research in Guatemala from 1946 to 1948. Other topics covered by the Bioethics Commission’s educational modules include community engagement, compensation for research-related injury, informed consent, privacy, and research design.

The Vulnerable Populations in Gray Matters module focuses on vulnerability specifically in the context of neuroscience research. The module provides instructors with a description of the ways in which individuals with impaired consent capacity might be vulnerable. It describes circumstances that might make potential participants vulnerable, including desperation and imprisonment, which merit ethical consideration in neuroscience research. It also addresses additional protections researchers can employ to protect potentially vulnerable populations in research, including those with impaired consent capacity.

The educational modules produced by the Bioethics Commission are based on the contemporary ethical issues addressed by the Commission, and are designed to provide instructors with foundational information, ethical analysis, discussion questions, problem-based learning scenarios, exercises, and additional resources to support ethics education and the integration of bioethical analysis into coursework across disciplines.

All Bioethics Commission educational materials are free and available at www.bioethics.gov/education. The Bioethics Commission encourages feedback on its materials at education@bioethics.gov.

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A Background on Deliberation and Education in Bioethics

Last August, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) began formally discussing the role of deliberation and education in bioethics. As a part of this examination, the Bioethics Commission is exploring the idea of teaching deliberation as a tool to promote ethical literacy.

From the start, the Bioethics Commission has adopted democratic deliberation as its process for decision making. At the heart of this process is open and robust dialogue, demonstrated in the Commission’s quarterly public meetings, held most recently on May 27, 2015. The goal of democratic deliberation and the Commission’s decision-making process is not to have Commission members agree completely on all issues; instead, members strive to clearly identify issues during their deliberation and to reach consensus as to what advice to offer on how to navigate such issues.

Bioethics by its very nature is a multidisciplinary field, bringing together experts in medicine, law, science, and philosophy; however, there remains a need for improved bioethics education. Noting this educational gap, the Bioethics Commission has developed pedagogical materials to support the teaching of bioethics ideas, principles, and theories across many areas of study. The creation of these educational materials serves to further promote the development of deliberative democracy.

The resulting capstone report will serve to represent the Bioethics Commission’s “commitment to advance and promote education and deliberation on some of the most important issues of bioethics in our time,” said Commission Chair Dr. Amy Gutmann. “Recognizing that education is required for informed deliberation, and that deliberation enhances education at all levels, this new report will integrate deliberation and education as overarching themes of the Commission’s work, and focus on their symbiotic relationship as twin pillars of public bioethics,” Gutmann said.

While all reports produced to date have been topic-specific, deliberation and education have been a constant thread throughout the Bioethics Commission’s work. In this new blog series, we will examine how deliberation and education have appeared in the Commission’s reports and recommendations, from New Directions: The Ethics of Synthetic Biology and Emerging Topics to Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society. Can’t wait and want to examine the reports for yourself? Visit bioethics.gov/projects for a complete list of all Commission reports.

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Bioethics Commission Recommends Multidisciplinary Efforts to Support Neuroscience and Ethics Research and Education

On March 26 the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released the second volume of its two-volume report on neuroscience and ethics, Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2), which takes an in-depth look at three topics that have captured the public’s attention: neural modification, including cognitive enhancement, consent capacity, and neuroscience and the legal system.

In Gray Matters, Vol. 2 the Bioethics Commission calls for research on several critical topics to help address unresolved empirical scientific and policy questions. Research requires support in the form of funding, personnel, and other resources. The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, as a White House Grand Challenge, is well positioned to establish and support efforts to bring together multidisciplinary expertise to advance research and education at the intersection of neuroscience, ethics, and society. The Bioethics Commission recommended that:

The BRAIN Initiative should establish and fund organized, independent, multidisciplinary efforts to support neuroscience and ethics research and education, including the activities recommended in this report.

Organized, independent, multidisciplinary efforts would provide necessary infrastructure to address ethics integration, education, and research. They also should support the development and dissemination of educational tools including training materials and guidance, among others, for various audiences to facilitate informed public debate.

The Bioethics Commission acknowledged several examples of how such efforts could be structured, and encouraged the architects of the new BRAIN Initiative supported efforts to look to these examples to discern the best approach.

Gray Matters, Vol. 2 and all other Bioethics Commission reports are available at Bioethics.gov.

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New Primer for Researchers on Neuroscience and Consent Capacity Now Available

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has posted to Bioethics.gov a new educational primer: this primer provides researchers with information on neuroscience and consent capacity. The module accompanies the Bioethics Commission’s two-volume report Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society (Gray Matters, Vol. 1) and Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2).

The primer on neuroscience and consent capacity was designed to help researchers, especially those working in neuroscience, understand and implement the Bioethics Commission’s recommendations about responsibly including individuals with potentially impaired consent capacity in their studies. The primer will aid ethical decision making and help researchers consider and implement appropriate ethical safeguards throughout their work.

The primer consists of frequently asked questions, which help researchers understand whether they should include participants with impaired consent capacity in their studies, and how to do so ethically. It includes an explanation of the ethical considerations involved in enrolling such participants, catalogues relevant laws and regulations, and describes potential safeguards that could help protect participants. The primer directs researchers to the Gray Matters report for further in-depth reading about the topics covered in it.

In addition to this primer, other educational materials have been posted to accompany the Bioethics Commission’s work. Several other primers have been developed to accompany the Bioethics Commission’s 2014 report Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings. The goal of the primer series is to provide concise, understandable materials for researchers, clinicians, and other health care professionals looking to implement some of the Bioethics Commission’s recommendations in particular contexts.

All Bioethics Commission educational materials are free and available at www.bioethics.gov/education. The Bioethics Commission encourages feedback on its materials at education@bioethics.gov.

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Bioethics Commission Urges Neuroscientists to Participate in Legal Processes, and Cautions Against Hype

Earlier this year, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released the second of its two-volume report on neuroscience and ethics—Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2). One of the topics it examined in depth was the application of neuroscientific evidence and concepts to legal and policy decision making processes. Neuroscience research and evidence have the potential to add value to the law by improving accuracy, decreasing errors, and helping us gain a deeper understanding of human motivation and behavior. However, the application of this novel and advancing science to the centuries-old legal institution is not without ethical and practical challenges.

In Gray Matters, Vol. 2, the Bioethics Commission made several recommendations to address ethical and practical challenges and maximize the potential value of neuroscience to the legal system. In particular, the Bioethics Commission recommended that:

Neuroscientists should participate in legal decision-making processes and policy development to ensure the accurate interpretation and communication of neuroscience information.

Neuroscience researchers are in the best position to explain scientific concepts, research results, and limitations of neurotechnologies to a legal audience. Judges and jurors need to understand how neurotechnologies work, what their limitations are, and how to accurately translate and apply research findings to a legal setting. Neuroscientists have several options for engagement. For example, they can act as expert witnesses in court, act as consultants for legal teams, or help attorneys write briefs. In addition, neuroscientists also can assist in policy making at local, state, and federal levels, by ensuring that their research findings are accurately explained to legislators and policy makers.

Additionally, the Bioethics Commission recommended that:

Neuroscientists, attorneys, judges, and members of the media should not overstate or rely too heavily on equivocal neuroscientific evidence to draw conclusions about behavior, motivations, intentions, or legal inferences.

This recommendation reflects one of the primary themes of the Gray Matters report—the imperative to mitigate hype and exaggeration. Hyperbole permeates conversations about the intersection of neuroscience and society. Attention-grabbing headlines exaggerate research findings, and set unrealistic expectations. Hype is especially prevalent in conversations and debates about the application of neuroscience to the legal system. Media reports often suggest that neuroscience might fundamentally alter legal decision making and overturn existing norms and notions of blameworthiness and responsibility. But these claims are overblown. Unrealistically high expectations can lead to a loss of public trust when those expectations are not borne out. Many stakeholders share the responsibility to avoid and minimize hype, including neuroscientists, attorneys, judges, and members of the media, among others. To realize the potential value of neuroscience’s application to the law, we must not put the cart before the horse.

Hype and its associated consequences are discussed at length throughout both volumes of Gray Matters. That report and all other Bioethics Commission materials are available at Bioethics.gov.

 

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Bioethics Commission Recommends Funding Research on the Intersection of Neuroscience and the Legal System

In March of this year the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2), the second volume of its two-part report on ethics and neuroscience. In Gray Matters, Vol. 2, the Bioethics Commission analyzed three topics, including the application of neuroscience to the legal system. Advances in neuroscience might help us achieve more accuracy in decision making, decreased errors in advancing justice, and improved policymaking. However, the application of neuroscience to the legal system also raises concerns about conceptions of free will and mental privacy, among others.

Applications of neuroscience to the legal system include supporting propositions concerning competency to stand trial, mitigation of criminal responsibility, and predicting future dangerousness. The Bioethics Commission recognized the importance of comprehensive information regarding the use of neuroscience evidence in making important legal and policy decisions. The Commission urged organizations and government bodies to publish reports that address the successes, challenges, and limitations of neuroscience’s application to the legal system. Specifically, the Bioethics Commission recommended:

Relevant bodies, such as the National Academies of Science, the U.S. Department of Justice, the National Institute of Justice, and the Social Security Administration, should support comprehensive studies of the use of neuroscience in legal decision making and policy development.

In response to the surge in DNA evidence used in criminal investigations, and in response to evidence obtained by polygraph examinations, various groups produced reports and recommendations that addressed questions about and limitations of these technologies. Similar reports on the application of neuroscience to the legal system should address the potential, limitations, and challenges for the use of neuroscience evidence in the courtroom and neuroimaging techniques for investigative purposes. For example, government agencies that collect and process data on medical claims in administrative legal proceedings, such as the Social Security Administration, could support new studies to improve understanding of pain and disability to facilitate accuracy in claim processing and arbitration.

Gray Matters, Vol. 2 and all other Bioethics Commission reports are available at Bioethics.gov.

 

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Bioethics Commission Recommends Creation of Educational Tools for Neuroscience in the Legal System

On March 26 the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released the second part of its two-volume report on neuroscience and ethics, Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2). In Gray Matters, Vol. 2, the Bioethics Commission addressed the application of neuroscience to the legal system. Advances in neuroscience offer a deeper understanding of human behavior and, when applied to legal decision making and policy development, can potentially improve accuracy, reduce errors, and advance justice. However, the application of neuroscience to the legal system is not without ethical concerns, including questions about scientific reliability and overreliance.

Neuroscience is already and increasingly being used in criminal and civil court cases and to influence policy at the highest levels. Bridging the interdisciplinary gap between neuroscience and the law can be difficult. To understand and accurately interpret neuroscience, stakeholders must be educated. Specifically, the Bioethics Commission recommended:

Government bodies and professional organizations, including legal societies and nonprofit organizations, should develop, expand, and promote training resources, primers, and other educational tools that explain the application of neuroscience to the legal system for distribution to members of the public, jurors, judges, attorneys, and others.

Practical challenges make it difficult for neuroscience to be applied accurately to the legal system. Neuroscience and the law are two disciplines that involve vastly different kinds of expertise, assumptions, terminology, and goals. Generally, neuroscience research aims to make correlations in the aggregate across populations, whereas the law seeks to draw conclusions about individual behavior and motivation. Neuroscientific evidence also can be relevant and add value to decision making processes, but the persuasive allure of brain images can unduly influence decision makers.

Judges and lawyers need to understand and accurately interpret new kinds of scientific evidence—including neuroscience evidence—and work to avoid overreliance and misapplication. In addition, members of the public that might serve as jurors would benefit greatly from educational resources that help bring high-level scientific concepts and information into lay terms. Efforts to train lawyers and judges are already under way. For example, organizations like the American Association for the Advancement of Science and the MacArthur Foundation have created materials, hosted seminars, and developed continuing education programs that help legal decision makers understand and keep up with developments in neuroscience.

Neuroscience has the potential to improve legal and policy decision making. But its effective use requires easing the translation of concepts and results across disciplines. Education is essential to achieving this goal.

Gray Matters, Vol. 2 and all other Bioethics Commission reports are available at Bioethics.gov.

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This is a space for the members and staff of the Presidential Commission for the Study of Bioethical Issues to communicate with the public about the work of the commission and to discuss important issues in bioethics.

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