Manipulating patients’ memories: Not for the unfamiliar

Memory manipulation is no longer an outlandish plot element in movies such as “Eternal Sunshine of the Spotless Mind.” It has risks and benefits that need careful consideration from ethical, clinical, social and cultural perspectives. For example, when new technologies promise memory healing or enhancement, how should physicians represent the possible outcomes to patients and their loved ones? This month’s AMA Journal of Ethics explores this and related ethical issues, including neuropsychology’s application to Alzheimer’s disease, autism, children’s mental health and disorders of consciousness.

Take a moment to consider this question: Who should have access to emerging technologies that change or alter memories?

1. No one
2. Only patients in limited therapeutic contexts, like those with PTSD, on a case-by-case basis
3. People in medical and non-medical contexts, as long as the risks are minimal
4. Anyone who can assess potential (even severe) risk and provide consent

Give your answer and find responses to this poll in the December issue of the AMA Journal of Ethics, which explores strategies for understanding and caring for transgender patients.

Articles include:

• “Neuroethics and disorders of consciousness: Discerning brain states in clinical practice and research.” Decisions about end-of-life care and participation in clinical research for patients with disorders of consciousness begin with diagnostic discernment. Get to know the distinctions clinicians should consider between minimally conscious states and vegetative states, and review efforts to bring scientific advances, including the investigational use of deep brain stimulation, to patients with disorders of consciousness.
• “The legal implications of detecting Alzheimer’s disease earlier.” Is a neurological indicator of increased risk for Alzheimer’s disease a legally relevant brain state before there are any behavioral manifestations? How should courts address evidentiary challenges to the admissibility of Alzheimer’s disease-related neuroimaging? And how should the government regulate the marketing of neuroimaging diagnostic tools? Explore answers to these and other questions relating to the insurance, contract and criminal law implications of early detection of Alzheimer’s disease.
• “Autism, art and accessibility to theater.” Art has the ability to unlock vital insights into the human experience, and new efforts are making theatrical productions more accessible for people with autism spectrum disorder. Investigate the ethical questions surrounding how accommodations should be made to provide access to cultural activities, and for whom.
• “Locating risk in the adolescent brain: Ethical challenges in the use of biomarkers for adolescent health and social policy.” Technological developments over the last 20 years have generated excitement about the potential of neuroscientific insights to aid understanding of and intervention in children’s and adolescents’ behavior. Find out how recent insights from developmental cognitive neuroscience have been applied to adolescent mental health.

In the journal’s December podcast, Allen Buchanan, PhD, a professor of philosophy at Duke University, discusses how physicians can safely explore cutting-edge biomedical enhancements.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit an article for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on human trafficking, legitimacy and authority, language and hierarchy, moral psychology and "difficult" patient-clinician dyads, mental health and oncology, and moral distress. Sign up to receive email alerts when new issues are published.