The rapid pace of change in the field of neuroscience research brings with it a host of new ethical issues in both research and treatment, which will need to be addressed. An influential set of moral principles guide the ethics of biomedical research (80, 81). These are the principles of autonomy, non-maleficence, beneficence, and justice (82).
The principle of respect for autonomy is usually taken to require informed consent to treatment or research participation, voluntariness in research participa- tion, and maintenance of confidentiality and privacy of information provided to a researcher. The principle of non-maleficence simply means, ‘‘do no harm’’, and requires researchers to minimize the risks of research participation. Positive beneficence requires us to perform actions that result in a benefit. The benefits to society of the research should outweigh its risks to participants, and the benefits to individual participants in research should exceed the risks. Distributive justice refers to the equitable distribution of the risks, as well as the benefits of research participation.
Perhaps the most urgent ethical issues arise around the issue of genetic screening, which is already on the horizon. A person identified by a genetic screen as vulnerable or at risk is potentially disadvantaged by that identification in a number of ways. In the first place, the person’s own self-esteem may be reduced. The person’s financial and status interests may be adversely affected if the identification is available to anyone else: an insurance company may refuse insurance, an employer may choose not to employ, a lover may refuse to marry. At present, in many countries, these adverse effects of such identification are not at all theoretical: for instance, insurance companies may have routine access to health records, or may require such access as a condition of applying for insurance (thus coercing consent).
Ethics and types of neuroscience research on substance dependence
There are many types of research on substance dependence, all of which have both unique and common ethical issues that will have to be dealt with. These include animal experiments, epidemiological research, human experimental studies, and clinical trials of therapies for substance dependence.
Clinical trials compare the effects of different drug or behavioural treatments, and sometimes placebos, on the substance use, health, social adjustment and well-being of persons with substance dependence (80). Clinical trials differ from experimental studies in one key respect: participants in clinical trials have some chance of benefiting from their participation in the study (80). The criteria for good clinical trials agree in requiring that a representative sample of the population at risk is recruited into such studies (80). An ethical issue of increasing significance, given the extent of pharmaceutical company funding of clinical trials, is ensuring public confidence in the results of clinical trials (83, 84). Additional policy recommendations have been made that have not so far been implemented. These include: independent monitoring of compliance with the study protocol, especially with reporting of any adverse events experienced by participants; and a requirement that investigators and the sponsors of a trial commit to publishing its results within two years of completing data collection, as a condition of the study protocol being approved by an ethics committee (85).
The outcomes of neuroscience research for the treatment of substance dependence will bring ethical issues to the fore. One such issue is ensuring equal access to treatment for all those who may need it. Economic and social costs of treating people with substance dependence with publicly subsidized substance treatment, as opposed to the criminal justice system will also be relevant (86, 87). As well, the potential use of a pharmacological treatment for substance dependence or a substance immunotherapy under legal coercion needs to be considered (88-90).