Practical problems in medical ethics: III. Taking the sting out of memory

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We are now at the end of this week’s special series considering three case studies in medical ethics as proposed recently by my colleague at City College, Jeff Blustein. We started out by examining a case of unexpected finding of non-paternity, continuing with an instance of wanting a baby to be deaf by design. For this last installment we are going to examine a situation that involves taking the sting out of painful memories.

As usual, before we proceed, let me remind you of the six criteria that my colleague suggested in order to arrive at a good philosophical evaluation of the case studies:

1. Formulate the problem. This is not always as easy as it sounds, as there may be more than one way to formulate the problem itself, before we even begin to consider possible answers.

2. Consider the relevant information. If there are critical pieces of information that are missing, articulate why they are relevant to the ethical analysis, and what follows from the fact that they are currently missing.

3. Refer to the ethical principles involved. An ethical dilemma arises when some values dictate incompatible courses of action, and it is not immediately obvious which should take priority.

4. Review alternative courses of action. Consider the possible alternatives, compare the range of outcomes against relevant principles and values. Keep in mind that it may be necessary to accept trade-offs.

5. Suggest an ethical solution. Consider the solution that appears to be best, all things considered, that is, taking into account all the various ethical principles at stake in the case.

6. Suggest how to best implement the proposed solution. Who, how, where, and when?

And now the case. Gregor, a 53 year old Chechnyan immigrant, is visiting a hospital at the behest of his employer, a taxi company. Recently, he has shown symptoms of PTSD — flashbacks, depression, and hyper-vigilance. Once triggered, he hyperventilates and feels “paralyzed” by fear, he is frozen and can’t move. As a taxi driver, he is of course liable for any damages to the car and patrons. Because of this, his concerned employer connects him with a free consultation and the local university hospital’s immigrant trauma unit.

At the consultation, Gregor reveals a history of trauma — severe experiences at the start of the troubles in his home country, time spent in refugee camps, and a move to Seattle in 1994. He has already tried various treatments for PTSD, including several kinds of medications, but they were not effective. The hospital is running a study that tests deep brain stimulation (DBS) for treatment of PTSD that is resistant to other approaches. The DBS research team stresses that his memories will not be erased completely, but their impact may be “softened” and they may be less vivid and strong.

His wife encourages Gregor to enroll in the study. His son Ivan, however, does not support the DBS study. Not only is he concerned for his father’s well-being (after all, the DBS is part of a research study), he is also worried that the implant may alter his father’s memories of the traumatic events, and thinks that those memories are an important part of his father’s life narrative. Ivan works as an activist, and has often brought Gregor along to meetings with other refugees and concerned citizens to share his story. Ivan is worried that his father’s ability to effectively communicate the devastation wrought by the Russian invasion of his country and its aftermath will be lost if his memories of the events are dampened. Ivan fears that Gregor will lose the power of his memories to protest against the occupation of his country by Russia, even as his mental health may improve.

With his family split on this decision, Gregor takes a break from work to consider his options. Here, then, are some pertinent questions:

Should Gregor undergo the DBS treatment? Why or why not?

Do Gregor’s memories give him the ability to motivate others the way Ivan claims they do? How might this be compromised if he undergoes the DBS treatment?

Should we be able to adjust our memories using technology? Are there other ways to adjust our memories, and are these any more (or less) problematic?

If you’ve read the previous two installments, you know that I had strong immediate intuitions about the two cases. Having strong intuitions, of course, doesn’t mean one is right, which is why I checked those intuitions against an explicit philosophical reasoning. Some of my colleagues, and readers, disagreed with my conclusions. Which is the point of this exercise, to strengthen our collective muscles in ethical judgment.

Here, though, I don’t have an immediate reaction strongly leaning one way or the other. I can certainly see Gregor’s wife’s concern about the practicalities of her husband being impaired at his job by the PTSD, and therefore her suggestion to undergo the experimental procedure.

But I can also just as easily — perhaps slightly more easily, in fact — see Ivan’s point about the personal and social impact of taking the emotional sting out of one’s memories. (I don’t buy, by contrast, his concern with the fact that the procedure is experimental: if his father were suffering, say, from a tumor, he almost certainly would not raise that particular objection.)

I don’t know about you, but the case immediately brought to my mind the movie “Eternal Sunshine of the Spotless Mind,” with Jim Carrey and Kate Winslet, in which a couple undergoes a medical procedure to have each other erased from their memories when their relationship turns sour. The general problem here, of course, is the one raised by my colleague Jeff’s last question: should we be able to adjust our memories using technology? I lean toward no, for a couple of reasons. First, because there are less intrusive approaches that often do work, like cognitive behavioral therapy. Second, and most importantly, because our memories, and the emotions attached to them, are a fundamental component of the fabric of our lives. Begin to tamper with them, and you are literally not going to be who you were.

That said, as both a philosopher and a scientist I have to raise two additional points. One has to do with the concept of personal identity. “Who you are” isn’t exactly the most straightforward of the questions. Is our personal identity bound up in our memories, in our personality, in our spatio-temporal continuity as physical beings, in all of the above, in something else? Here is an article that will allow you to appreciate just how complex the issue actually is. My personal opinion is that all three the above mentioned criteria play a role in shaping who we are, with empirical evidence leaning toward the overriding importance of personality (or character) over that of memory. When the relatives of patients affected by different types of dementia were asked whether they recognized their relatives, those whose loves ones had lost memories but otherwise behaved as their previous selves had no hesitation to say that these were the same people. Not so the relatives of patients who had retained their memories but whose personality, as expressed in their behavior, seemed to be altered.

The second point is that, from a purely neurobiological perspective, “memories” themselves are a complex construct of the human brain, not at all simple recordings of facts, like the ones we may reliably retrieve from a computer chip. Indeed, memories are actually reconstructed every time we think of a particular situation, and the emotions associated with them are generated anew. Which is why memories are naturally altered through time, on the basis, in part, of new experiences and the memories and emotions that they, in turn, evoke. Here is a good article going in depth into the complexities of human memory.

So, what do you think Gregor should do, then?

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