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My work in ethics has been informed by my work on the nature of the human person, epistemology and measurement, disability, and compassionate love.
I was one of the first to teach a course in Neuroethics to undergraduates. This field requires attention both to major philosophical and theological questions as well as to the technical findings of neuroscience.
If you feel like fighting fire with fire, remember real firefighters use water.
I like stability, and I often stick with something too long because I don’t want to wimp out. This quote from John Henry Newman is good for me to hear. He changed from one church to another, and also knew that all religious institutions need to change to be alive. Change is an important part of being alive. The world is not static, and we cannot be either. It may be uncomfortable to change, but if we do not remain open to change, we are just not going to be able to engage fully in this wild world.
“To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit to too many projects, to want to help everyone in everything is itself to succumb to the violence of our times.” – Thomas Merton
It is delusional to think that we are fully self-sufficient. Last Saturday I led an all-day retreat on “Flourishing in Difficult Circumstances.” One thing we talked about was how the sense of total self-sufficiency is a delusion, one that is prevalent in our western culture. One of my Power Point slides was this drawing I did long ago….I found it folded up in my files, and I recently hung it up in my study. Of course the importance of personal responsibility cannot be undervalued, but difficult circumstances can vividly remind us of how we all do need help.
Jean Vanier inspires me. He started the L’Arche communities. They bring people who are marginalized and restless from lack of community and care, together with those who learn to care for them. They especially create small caring communities for those who have developmental disabilities.
I met Jean Vanier over 30 years ago while living in Belfast, Northern Ireland. A small room of about 20 people had gathered to hear him speak and talk with him. Meeting him made a strong impression on me, and I followed up by reading anything by him I could get my hands on. He was from an important political family in Canada, had served in the Navy in WWII, and then pursued a PhD in philosophy. It was after this that he came to establish the L’Arche communities. As he spoke of the gift that those who had mental developmental disabilities were to him in his life, it helped me to see that what I had most valued in myself up to that time, my intellectual abilities, were not the most important thing in my life. The communities he started were based on mutual respect – those with developmental disabilities have things to share with us, things they can teach us, things they can give us. His life demonstrated how he really valued all people. We all have different gifts, and discovering those is an opportunity for each of us.
In addition to his writings on disability and community, he has also described human freedom in ways that I have found worth pondering. In his book, Being Human, he wrote: “Aristotle talks of our passions as being like a horse which has a life of its own. We are riders who have to take into account the life of the horse in order to guide it where we want it to go. We are not called to suppress our passions or compulsions, nor to confront them head on, nor to be governed by them, but to orient them in the direction we want to go….We set out on the road to freedom when we no longer let our compulsions or passions govern us. We are freed when we begin to put justice, heartfelt relationships, and the service of others and of truth over and above our own needs for love and success or our fears of failure….”
I discussed “Unconditional Love,” on “Philosophy Talks” Radio Program, Stanford University, December 9, 2012. Available as a podcast on itunes or at http://philosophytalk.org/
Metaphor and the Self: A Role for the Arts in Understanding Suffering and Treating the Person in Distress, Lynn Underwood, International Neuroethics Conference, Brain Matters 3: Values at the Crossroads of Neurology, Psychiatry, and Psychology, October 24-25, 2012
Research shows that the metaphors we use affect our behaviors and attitudes in significant ways. (Holding a cup of hot coffee rather than a cold drink can cause us to have a more friendly attitude towards those we meet; Boroditsky’s work showing how reading about a description of crime as a virus rather than a beast can influence our decisions on the best ways to control the same criminal behaviors.) These effects usually happen implicitly – we are not aware of them. The machine metaphor recurs in our descriptions of the brain and the overall functioning of the body and has become an automatic default. It can be useful in simplifying complex systems, and medical training encourages this. Even efforts to promote humanism in medicine slide in this direction, as communication, empathy and ethical decisions are formulated in mechanistic terms.
This kind of thinking can get in the way when we treat conditions for which no “physical” cause can be found. Self-reports made by the person and their experiences of suffering are essential to the identification of the roots of the problems and opportunities for treatment. However if one buys into the machine metaphor too much, the experience of the person is given less weight in the overall assessment, while objective features such as brain scans, blood chemistry and physiologically evident symptoms are given the final say. Measurements based solely on a machine model lead to interventions that presuppose a kind of person that is incongruous with the way we live our lives, and what is most important to us.
Visual art, film and literature can give insight into the nature of the human person that offers alternative metaphors for the human person, and opens opportunities for creative approaches to treatment and evaluation of outcomes. This presentation would elaborate on those, and give specific examples of how they can help yield more effective treatments and decisionmaking.
Ethical Implications of the Daily Spiritual Experience Scale, Bioethics Grand Rounds, Cleveland Clinic, September 11, 2012.
Recent research has asserted the value of incorporating the spiritual orientation, concerns and needs of the patient into the healthcare relationship, and accreditation requires attention to this aspect of the patient. Doing so raises a number of ethical issues, however. Use of the 16 questions from the Daily Spiritual Experience Scale (DSES) can help the health professional avoid some of these ethical problems by 1) focusing on experiences rather than beliefs, 2) using questions validated cross-culturally, 3) opening avenues for communication and understanding, and 4) emphasizing the spiritual aspect of life as a part of the whole person, rather than reducing it to a tool for improving physical health. The DSES questions also assist the professional in better delivering competent care that addresses this complex component of the human person.
The DSES is a 16-item, psychometrically validated scale, used in over 100 published studies and translated into over 20 languages. It measures reported frequency of such ordinary spiritual experiences as awe, compassionate love, mercy, divine closeness, sense of spiritual support, gratitude, and deep inner peace in daily life (www.dsescale.org). The research involved in its development used ethical principles such as respect for diversity to construct a scale that would reach many people substantively. It was based on extensive international qualitative research in multiple cultures, ages and socioeconomic status. It functions well for people from the various major religious traditions as well as for those who call themselves spiritual but not religious, and atheists. Higher scores have been linked with happiness, life satisfaction, less addictive behaviors, less depression and anxiety, better health behaviors, self-efficacy, less burnout, and improved relationships.
INTD 381: Introduction Neuroethics
Introduction to Neuroethics
Professor Lynn Underwood
Time: 9 30-12 30 Mon Tues Thurs Friday
Ethical issues that relate to our brains and nervous systems are becoming of increasing importance not just for health professionals but for us all. In this class we will engage with ethical issues arising from new discoveries and technologies in Neuroscience and Cognitive Psychology. We will consider implications for individual action and general policies. We will be exposed to the technologies, philosophical assumptions, and conclusions of the research. Topics introduced will include: moral decision-making and the brain; the interpretation of insights provided by neural imaging (e.g. brain scans); legal responsibility and mental illness; pain and suffering; the effects of psychologically potent drugs and technologies and their appropriate use; the role of and appropriate use of enhancement of mental functioning via drugs and other technologies; and ethics of and mechanisms of brain manipulation by marketing, the media, and other non-medical sources. We will also reflect on how the scientific findings and potential interventions, when combined with other sources of knowledge, have implications for what it means to be human. The text for the course will be “Neuroethics: Defining the Issues in Theory, Practice, and Policy” edited by J. Illes. Films and websites will also be used for resources – one film introducing some basics of brain science through narratives of those suffering from brain diseases ( such as depression, Alzheimers, ADHD and schizophrenia), and a fictional film, “Eternal Sunshine of the Spotless Mind”. A class trip or visit from a professional in the field, such as a neurosurgeon or clinical bioethicist is planned. Grades will be based on class participation, short essays and class presentations, a final project (either a researched essay or a creative narrative project), and final essay exam.
Goals of Course:
To engage with the ethical issues that are arising in Neuroscience and Cognitive psychology
To develop opinions about where you stand on various complex issues in this field
To be able to articulate stands regarding policy options
To come to a clearer understanding of what exactly it means to be human by combining the findings of Neuroscience with those in other areas of knowledge
Neuroethics: Defining the Issues in Theory, Practice, and Policy,J Illes (editor), Oxford University Press, NY, 2006.
Additional readings: Two overview articles from Trends in Cognitive Science will be sent via email as attachments. There may be additional readings on Sakai, in the library, on the web, or sent to you via email. One key article will be: Farah, Martha J., Neuroethics: the practical and the philosophical, Trends in Cognitive Science 9:1, 2005. P 34-40
Also we will read and watch various stories in books and articles of those with Neuro and Cognitive impairments.
Monday Tuesday Thursday Friday
April 17 Film
April 18 Ethics overview
April 21 Brain disease overview
April 22 Film discussion
April 23 text/readings 2
April 24 discussion
April 25 Articles/Chapters as assigned
April 28 Articles/Chapters as assigned
April 29 Alzheimer’s Chapter 7
April 30 text/readings
May 1 Neurosurgery – Class visit Clinical Ethicist
May 2 Final readings/discussion
May 6 last dayProjects
May 7 Exam
Weighting of assignments:
40% Class attendance, participation in discussion, quizzes, essays, and brief presentations
30% Final Project
30% Final Essay Exam
Final Project: This will be discussed more fully in class. However, you will take a key issue from class or readings. You will draw from the text and articles, do outside research, take a stand on how it needs to be addressed, and describe impact and relevance for action. You may also draw on philosophy, religious studies, literature, visual art, and film to more clearly make your points. This can be a didactic or a creative work. Use APA format for project if in didactic format. You will present on your project in class and lead discussion on the topic.
Using the Daily Spiritual Experience Scale to Improve Patient Care. Psychiatry Conference: Sympozion National al ARSP cu Participare Internationala. Lynn Underwood. Sponsored invitation to speak. Targu Mures, Romania. 31 May – 3 June, 2012.
Spiritual and religious issues and values can influence how people cope with disease, make decisions, and behave in ways that affect their health. Spiritual and religious attitudes help to shape how people view the world and what they consider important. They can provide resources for patients to draw on. These may be particularly salient for them in the midst of mental illness, chronic disease, addiction, times of medical crisis, and at end-of-life. It is often challenging to communicate with patients about religious and spiritual values and issues without running headlong into beliefs that may polarize conversation and empathic understanding, and limit the caregiver’s capacity to attend to patient needs and desires.
The Daily Spiritual Experiences Scale (DSES) is a 16-item psychometrically validated scale that measures the frequency of ordinary experiences such as awe, compassionate love, mercy, divine closeness, sense of spiritual support, gratitude, and deep inner peace in daily life ( www.dsescale.org ). The DSES was constructed based on extensive qualitative research in multiple cultures, religions and secular settings. It has been used in over 100 published studies, answered by many thousands of people, put on longitudinal health studies, and translated into over 20 languages. It is linked to outcomes such as less addictive behaviors, better mood, improved relationships, decreased hospital stays, positive health behaviors, and diminished burnout. It has been used extensively in medicine, psychiatry, psychology and social work research. It functions well for people from various major religious backgrounds as well as for those who call themselves spiritual but not religious. It does not reduce the spiritual to vague positive features, rather it allows for the kinds of experiences that encompass religious and spiritual depth. It is not only a potential mediating variable but also a measure of a significant component of quality of life for many.
This presentation will discuss ways in which the scale can be used in health-care settings to enhance the caregivers’ capacity to communicate with the patient and to help those who are ill to mobilize their own spiritual and religious resources to better cope with illness. Another use of the scale is as a self-exploration tool for caregivers themselves using a structured method to enhance self-understanding and their ability to communicate with others different from themselves. Scores have predicted less burnout in a large hospital system in Hong Kong, as well as in a study of those in the US working in palliative care.
In addition to describing its use in research, and how spiritual experience interacts with biology, this presentation will describe how this psychometrically validated set of 16 questions can be used as a clinical tool to improve patient care.
Enhancing Communication and Understanding in Health Care, October 20, 2012, American Society for Bioethics and Humanities, Lynn Underwood, Washington D.C.
Spiritual and religious issues and values often influence how people cope with disease, make decisions, and behave in ways that affect their health. These may be particularly salient for them in chronic disease, mental health, addiction, times of medical crisis, and at end-of-life. It is often challenging to communicate with patients about religious and spiritual values and issues of importance without running headlong into beliefs that may polarize conversation and empathic understanding, and limit the caregiver’s capacity to attend to patient needs and desires.
The Daily Spiritual Experiences Scale (DSES) is a 16-item psychometrically validated scale that measures the frequency of ordinary experiences such as awe, compassionate love, mercy, divine closeness, sense of spiritual support, gratitude, and deep inner peace in daily life (www.dsescale.org). The DSES was constructed based on extensive qualitative research in multiple cultures. It has been used in over 100 published studies, included in the General Social Survey and longitudinal health studies, and translated into over 20 languages. It is linked to outcomes such as less addictive behaviors, better mood, decreased hospital stays, positive health behaviors, and diminished burnout. It has been used extensively in medicine, psychiatry, psychology and social work research. It functions well for people from various major religious backgrounds as well as for those who call themselves spiritual but not religious, and atheists. It does not reduce the spiritual to vague positive features, rather it allows for the kinds of experiences that encompass religious and spiritual depth. It is not only a potential mediating variable but also a measure of a significant component of quality of life for many.
This presentation will discuss ways in which the scale can be used in secular health-care settings to enhance the caregiver’s capacity to communicate with the patient and to help those who are ill to mobilize their own spiritual and religious resources to better cope with illness. Another use of the scale is as a self-exploration tool for caregivers themselves using a structured method to enhance self-understanding and their ability to communicate with others different from themselves. Scores have predicted less burnout in a large hospital system in Hong Kong, as well as in a study of those working in palliative care. This presentation will describe how this psychometrically validated set of 16 questions can be used.
The Science of Compassionate Love: Research, Theory, and Applications. Fehr. B. Sprecher, S, Underwood, LG, eds. Oxford England, Malden Mass: Wiley-Blackwell. 2009.
Altruism and Altruistic Love: Science, Philosophy, and Religion in Dialogue Post, SG, Underwood, LG, Schloss, JP, Hurlbut, WB, eds., Oxford University Press, 2002.
“Interviews with Trappist Monks as a Contribution to Research Methodology in the Investigation of Compassionate Love.” Underwood LG Journal for the Theory of Social Behavior, 35:3 (September, 2005), 285-302.
“Altruistic Love – Compassionate Love”. Underwood, L. In Harry T. Reis & Susan Sprecher (Eds.), Encyclopedia of Human Relationships. Thousand Oaks, CA: Sage. (2009)
“Chapter 1: Compassionate love: A framework for research” Underwood, Lynn G. in Fehr, Sprecher and Underwood The Science of Compassionate Love: Theory Research and Applications, Blackwell. Wiley- Blackwell. Malden Massachusetts, Oxford, England 2009.
“Giving of Self for the Good of the Other: Science Research on Compassionate Love and Spirituality” Underwood, Lynn G. in The Love that Does Justice, Edwards, Michael and Post Stephen (eds), Cleveland, Ohio 2008, p 133-138.
“Compassionate Love,” in Post, Stephen G. ed. 2004. Encyclopedia of Bioethics, 3rd edition. New York: Macmillan Reference USA, 483-488.
“The Human Experience of Compassionate Love: Conceptual Mapping and Data from Selected Studies”, in Post, SG, Underwood, LG, Schloss, JP, Hurlbut, WB, eds. Altruism and Altruistic Love: Science, Philosophy, and Religion in Dialogue, 2002. New York City: Oxford University Press. 72-88.
“Concluding Summary and Future Research Needs on Altruism and Altruistic Love,” with Post, SG in ibid. 3-12, 379-386.
Neuroethics, the Arts and the Nature of the Human Person. Lynn Underwood. Medical Humanities Conference, Western Michigan University, Kalamazoo, Michigan, September 29-30 2011.
The arts and humanities are essential to effectively grapple with the questions that arise from advances in neuroscientific technologies and treatments. They are essential for medical practitioners as they make treatment and policy decisions. But even those not professionally involved with health care need the arts and humanities as we make decisions about what kinds of pharmaceutical and neurosurgical interventions are appropriate for ourselves and those we care for, policy decisions regarding issues such as human responsibility within health care and criminal justice, and decisions about how to regulate and respond to marketing of neurotechnologies of various kinds.
Also, neuroscientists and interpreters of neuroscience make claims about how ethics operates and the nature of the human person. The humanities can provide us with tools for doing the kinds of reflection necessary to effectively accept or discard these claims. The arts can help to reveal qualities and issues in novel and useful ways.
This presentation will lay out the scope of the problems, and highlight some particularly thorny issues. Also, it will outline some of the ways to engage students, those in the health sciences and others, with these topics using the humanities and arts to better equip them for the particular challenges neuroscientific knowledge and technologies have brought to the fore. In this context the presenter will draw on four years of classroom experience teaching both Neuroethics and general medical humanities using these methods.
Examination of how we envision the nature of the human person is essential to adequately address many of the issues that increasing knowledge and technology in neuroscience has raised. Film, memoir and poetry, as well as insights from philosophy and religious studies, can usefully inform our decision-making and attitudes. The visual arts, particularly portraiture and self-portraiture can give us special insight into the nature of the human person. The emergence of popular and scientific appreciation for the complexities of decision-making enable us to see why approaching a complex topic through the arts can give insight that can complement and enhance other kinds of analysis. The arts can enable us to enter into situations in ways beyond merely speculating on how we think we would feel in a given situation. Empathic engagement as well as enhanced sensibilities can result from the inclusion of the arts and humanities in these discussions.
The presentation will outline some of the issues and give specific examples of humanities and art resources that have been effectively used in teaching situations.
The Human Person: Possibilities for Flourishing in Dire Circumstances. Lynn Underwood. Hellenic Research Foundation, European Research Network. Athens, Greece, September 21, 2007.
Even in the midst of suffering there can be opportunities for the human person to flourish. Of course we do not seek suffering and continually seek to relieve the suffering of self and others. One positive aspect of dire circumstances is that various false illusions and assumptions do not hold up once exposed to situations such as disability, chronic disease, extreme suffering or experiences at end of life. These include various assumptions about apparent self-sufficiency, functionalism (seeing ourselves as “human doings” rather than “human beings”), the place of suffering, our delusions of control, and the fact of mortality. The exposure provided by dire circumstances illuminates the actual situation in such a way that the core or “heart” of the person can be more fully revealed. Science, the arts, theology, philosophy, personal experiences and relationships with others can also provide insights into the nature of the human person when in extremis that can not only help to bear the burdens found in these situations, but actually help to enable human flourishing. There emerge implications for actions that we might take to improve the lives of those in dire circumstances, help us to learn from these situations, and also better handle dire circumstances when we encounter them ourselves.
The Human Being as revealed more fully in Disability and In Extremis. Lynn Underwood. European Research Network meeting: The human person in the 21st Century. Thessaloniki, Greece, April 22-25, 2007.
Interaction with people with severe disabilities and chronic disease, people at end of life, and people in other dire circumstances can inform our understanding of the human person. This can happen through personal and professional interactions and in the context of scientific research. Direct experience of dire circumstances in our own lives can also contribute to insight. When combined with theological, philosophical and artistic explorations these interactions and experiences can lead to further reflection on the core, or “heart,” of the human being, revealing the nature of the human being more fully. This exploration could also provide us with some questions to pursue in greater depth using the tools of the sciences and the humanities.
Various illusions and assumptions do not hold up as people are exposed to situations such as disability, extreme suffering or experiences at end of life. These include assumptions concerning self-sufficiency, functionalism, the place of suffering, the ability to control and mortality. People with disabilities have learned that receiving help does not diminish who they are and that it can actually enhance the human person. Likewise, the disabled person is at a disadvantage in the world constrained by functional evaluations. This realization can expose the fundamental value of a human being as not necessarily identical with their functional status or their physical selves. Suffering can encourage people to draw on the religious sphere, and open sufferers and others to the reality of the spiritual and its intrinsic importance in life. In the process of suffering one can see more clearly that there is more to a full life than superficial happiness and the pursuit of that happiness. When disabled, suffering serious chronic disease or in other dire circumstances, it becomes obvious that we are not in control and we are forced to see that sense of control is a delusion. The realization that death is inevitable affects how someone views life itself, and the fundamental nature of the human person. Being faced with these situations in extremis can more fully reveal the full nature of the human person.