The latest findings in neuroscience are increasingly affecting the justice system in America. Owen Jones, professor of law and biology at Vanderbilt University, explores where neurolaw is making its mark and where the discipline is heading.
One significant finding from MRI scanners is that the adolescent brain continues to develop right into the early- and mid-twenties. The fact that we are not ‘adults’ at age 18 is having big repercussions in the legal system.
In San Francisco, the entire way that young offenders of crimes such as armed robbery up to the age of 25 are treated is adapting to the brain data.
More and more, neuroscientists are testifying in courts, often to mitigate sentences including the death penalty in juveniles. Other times, they highlight rare brain abnormalities that cause violent and antisocial behaviour, which helps justify a lighter sentence.
However, young brains are still malleable. In Wisconsin, brain imaging of juvenile prisoners can detect psychopathic markers. Once identified, staff can employ techniques to de-programme those antisocial traits and rehabilitate prisoners to ready them for, they hope, a crime-free life outside.
And this is simply the first generation of neurolaw – where to next?
From the programme’s website:
Since losing her husband to a terminal illness, and watching his kidneys fail, Pamela has felt a burning desire to try to help someone else escape a similar fate.
A year after his death, she writes to her local hospital to ask if she can become an ‘altruistic’ donor, and donate one of her kidneys to a stranger. To her horror, she receives a letter back saying that she is ‘too old’. Undeterred, she approaches a transplant surgeon at another hospital, and he agrees to see her.
To the surgeon, Pamela appears fit and extremely determined. But for a potential donor, she’s also rather unusual – she’s eighty two years old.
Should Pamela be allowed to donate? What are the risks to her – both of the operation itself, and of being left with only one kidney? And, if the team allow her to donate, who should receive such an elderly organ?
Inside the Ethics Committee
From the programme’s website:
Monty has double pneumonia and is in intensive care. A ventilator is breathing for him and he’s sedated so that he can tolerate a breathing tube in his throat. Given the risks associated with being intubated in this way, the team are keen to get him off the ventilator as soon as possible, so that he can start breathing for himself.
After several days of antibiotics, Monty improves. So they stop the sedation, wake him up, and remove the breathing tube. The plan is for Monty to wear a mask to support his breathing until he is strong enough to breathe for himself.
But Monty is autistic, and as soon as the mask is placed on his face, he pushes it away. The nurses put it back on, but again he bats it off. The nurses persist, but Monty struggles and lashes out at them. Exhausted, he starts going blue. Fearing for Monty’s life, the team re-sedate him and put him back on the ventilator.
As his life hangs in the balance, what lengths should the medical team go to to get Monty to accept the life-saving treatment he is struggling against? Should they physically restrain him?
Joan Bakewell chairs the discussion between medical and ethical experts.
Doctor – Tell Me The Truth
BBC Radio 4, Monday 20 and 27 February 2012, 20.00-20.30. I expect episode 1 will be available via the iPlayer shortly
Each year between 45,000 and 98,000 Americans die because of the treatment they receive in hospital. In Doctor, Tell Me The Truth, Professor James Reason discovers how encouraging doctors to admit their mistakes has improved patient safety. He hears from Rick Boothman and Darrell Campbell at the University of Michigan, the creators of a programme where doctors have to be open about their errors. They describe the previous ‘deny-and-defend’ attitude in which the hospital would stonewall any complaints made against them and contrast this with the present system in which investigations into errors can be started even before the patient comes round from their anaesthetic. We hear moving stories about face-to-face apologies from patients, doctors and lawyers.
In the second part of Doctor Tell Me The Truth Prof Reason asks whether the University of Michigan programme could work in the NHS. Peter Walsh from Action Against Medical Accidents tells him of cases where doctors have been prevented from admitting their mistakes at the insistence of their managers. He introduces us to ‘Robbie’s Law’, named after a boy who died as a result of medical malpractice, a piece of proposed legislation now being examined in the House of Lords which would require all NHS hospitals to adopt an open disclosure policy. Academics David Studdert and Alan Kalachian ask whether such a policy is legally enforceable or even desirable. Sir Liam Donaldson, a former Chief Medical Officer, tells us of his attempts to promote openness in the NHS and we hear from Robbie Powell’s father who tells us that his twenty year legal battle could have been avoided if the doctors had only admitted their mistakes and apologised.