Matthew L. Baum
Neuroscientists are mining nucleic acids, blood, saliva, and brain images in hopes of uncovering biomarkers that could help estimate risk of brain disorders like psychosis and dementia; though the science of bioprediction is young, its prospects are unearthing controversy about how bioprediction
should enter hospitals, courtrooms, or state houses. While medicine, law, and policy have established protocols for how presence of disorders should change what we owe each other or who we blame, they have no stock answers for the probabilities that bioprediction offers. The Neuroethics of
Biomarkers observes, however, that for many disorders, what we really care about is not their presence per se, but certain risks that they carry.
The current reliance of moral and legal structures on a categorical concept of disorder (sick verses well), therefore, obscures difficult
questions about what types and magnitudes of probabilities matter. Baum argues that progress in the neuroethics of biomarkers requires the rejection of the binary concept of disorder in favor of a probabilistic one based on biological variation with risk of harm, which Baum names a "Probability
Dysfunction." This risk-reorientation clarifies practical ethical issues surrounding the definition of mental disorder in the DSM-5 and the nosology of conditions defined by risk of psychosis and dementia. Baum also challenges the principle that the acceptability of bioprediction should depend
primarily on whether it is medically useful by arguing that biomarkers can also be morally useful through enabling moral agency, better assessment of legal responsibility, and fairer distributive justice. The Neuroethics of Biomarkers should be of interest to those within neuroethics, medical
ethics, and the philosophy of psychiatry.
Introduction
1. The Biomedical Promise Of Biomarkers
2. Bioprediction Of Brain Disorder: Definitions And Scope
PART I: REORIENTATION OF THE CONCEPT OF DISORDER
3. "There Is More Light Here." Re-Illuminating The Categories Of Mental
4. The Probability Dysfunction
5.
The Practical Ethics Of Predictive Markers In Diagnosis: Can Risk Banding Address The Ethical Controversy Surrounding "Psychosis Risk Syndrome" And "Preclinical Alzheimer's Disease"?
PART II: BIOPREDICTION AND MORAL RESPONSIBILITY
6. Enhanced Responsibility: Foreseeability And New
Obligations To Others
7. Reduced Responsibility: Distinguishing Conditions In Which Biomarkers Properly Reduce Legal Responsibility
PART III: BIOPREDICTION AND SOCIETY
8. Bioprediction And Priority
Conclusion
Appendix I
Appendix II
Appendix
III
References
Index
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Matthew L. Baum, DPhil, is an MD-PhD trainee at Harvard & MIT within the Division of Health Sciences & Technology and the Harvard Program in Neuroscience. He earned a DPhil from Oxford via his work at the Oxford Centre for Neuroethics and the Ethox Center as a Rhodes Scholar. He holds an MSc
in Neuroscience from Trinity College Dublin, where he studied as a Mitchell Scholar. He has also served as the student/post-doc representative to the board of the International Neuroethics Society.
Bioprediction, Biomarkers, and Bad Behavior - Edited by Ilina Singh, Walter P. Sinnott-Armstrong and Julian Savulecu
Oxford Handbook of Neuroethics - Edited by Dr. Judy Illes and Dr. Barbara J. Sahakian
Neurobiology of Mental Illness - Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar and Joseph D. Buxbaum
Bioethics and the Brain - Walter Glannon