Prodromes and preclinical detection of brain diseases: Surveying the ethical landscape of predicting brain health

• Type of Material: Article
• Authors: Nathan S. Ahlgrim, Emory University; Kristie Garza, Emory University; Carlie Hoffman, Emory University; Karen Rommelfanger, Emory University
• Language: English
• Date: 2019-07-01
• Publisher: Society for Neuroscience: eNeuro
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Ahlgrim et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1523/ENEURO.0439-18.2019
• Title of Journal or Parent Work: eNeuro
• ISSN: 2373-2822
• Volume: 6
• Issue: 4
• Grant/Funding Information: This work was supported by the Institute for Developing Nations Publication Fund of Emory University.
• Keywords: autism; prodrome; Alzheimer; preclinical detection; neuroethics; schizophrenia
• Research Categories: Psychology, Clinical; Biology, Neuroscience

Abstract

The future of medicine lies not primarily in cures but in disease modification and prevention. While the science of preclinical detection is young, it is moving rapidly. Preclinical interventions offer hope to decrease the severity of a disease or delay the development of a disorder. With such promise, the research and practice of detecting brain disorders at a preclinical stage present unique ethical challenges that must be addressed to ensure the benefit of these technologies. Direct brain interventions have the potential to impact not just what a patient has but who they are and who they could become. Further, receiving an assessment for a preclinical or prodromal state has potential to impact perceptions about capacity, autonomy and personhood and could become entangled with stigma and discrimination. Exploring ethical issues alongside and integrated into the experimental design and research of these technologies is critical. This review will highlight ethical issues attendant to the current and near future states of preclinical detection across the life span, specifically as it relates to autism spectrum disorder (ASD), schizophrenia, and Alzheimer’s disease.