A 68-year-old man who had never gambled before in his life developed a new and escalating interest in gambling, losing more than $200,000 over six months. During this time he also started cheating on his wife and would leave town unexpectedly for days. Interestingly, several months before this change in behavior he was started on pramipexole, a relatively new and effective drug for Parkinson’s disease. His symptoms were well-controlled on this drug. Upon learning of his new gambling habit, his neurologist decreased his pramipexole dose by 50 percent. He stopped gambling shortly thereafter and denied feeling the need to engage in any more compulsive behaviors.

The interesting thing in this story of a drug-causing compulsive gambling and a “loss of will power” is that pramipexole is known to target specifically the D3 dopamine receptor. Such specific pinpointing of brain areas related to certain behaviors raises certain questions. Could we manipulate these receptors with different medications to help those with gambling or other addictions? Is a person responsible for her actions if it is an uncontrollable side effect of her Parkinson’s medication? Is all compulsive behavior related to some “chemical imbalance” or is there still such a thing as being “weak-willed”?

These are the questions addressed by neuroethics, a field that encompasses the wide range of ethical issues emerging from the recent advances in clinical and basic neuroscience. These include the ethical problems raised by advances in functional neuroimaging, brain implants, brain-machine interfaces, and psychopharmacology as well as by our growing understanding of the neural bases of behavior, personality, consciousness, and states of spiritual transcendence. These issues concern significant issues at the core of how we understand what it means to be human. Our brain is more directly related to our notions of self than any other part of our body.

Through advances in neuroimaging such as functional magnetic resonance imaging (fMRI), we are getting closer to being able to “read someone’s mind.” Currently researchers can use fMRI to infer psychological states and traits. Brainbased lie detection is not widely utilized by law-enforcement agencies, but new techniques of recording brainwaves (EEG-based event-related potentials, ERPs) can detect “guilty knowledge” and have been proposed as a tool to screen for terrorists.

In 2004 a young quadriplegic man had his brain plugged into a computer using BrainGate, a brain-machine interface made by a company called Cyberkinetics. With BrainGate he can move a robotic arm, move a cursor on a screen, even beat people at Pong, just by using his brain. So far, the information only flows one way, but what about uploading information to the brain? Deep brain stimulation is already being used to treat Parkinson’s disease, but what about certain dementias, such as Alzheimer’s disease? Could we augment memory by stimulating certain areas of the brain? If so, could we increase the memory of normal individuals, or should we?

Psychopharmacology has allowed us to manipulate our moods, perceptions, behaviors, and cognitive abilities. Concerns about drugs like Prozac and Ritalin being overprescribed have long raised questions about what kind of emotions and behaviors a “normal” life is supposed to entail. Newer drugs with the potential to significantly enhance cognitive abilities, such as modafinil (Provigil) raise a host of new questions. After thirty-seven hours with no sleep, pilots taking Provigil made significantly fewer errors on a flight simulator than those taking a placebo. What ambitious, sleep-deprived college student or surgery resident wouldn’t want that extra edge? One could even argue that if these medications have been shown to decrease errors, then surgeons and pilots should be on them. Provigil seems to be able to increase concentration even in nonsleep-deprived individuals, making it beneficial not only as a treatment but also as an enhancement. But what does that do to the dignity of human effort? Don’t we generally value unenhanced accomplishments over enhanced ones?

The ultimate issue addressed by neuroethics is the question of free will. The kind of knowledge yielded by these advances in the neurosciences tends toward a view of reductionistic materialism. It seems that we can reduce behaviors down to their physiological and chemical components. Wasn’t our sixty-eight-year-old compulsive gambler a slave to his neurochemical milieu? It seems so. Yet so much of our society is founded on the concept of autonomous persons exercising free will. Perhaps our scientific methodology has led to a Procrustean understanding of the mind. Or perhaps we need to rethink what it means to exercise mind over matter.