Bioethics of the brain: A conversation with a Catholic neurosurgeon

How can rapid advancements in medical technology, questions about the criteria for brain death and the rise of transhumanism be considered within a Catholic framework? Charlie Camosy recently spoke on this topic with Gabriel LeBeau, a second-year neurosurgery resident at the University of Kansas Medical Center, who has had the bioethics of the brain on his mind for a while now with an interest in brain-machine interfaces, neurotechnology and cerebrovascular neurosurgery.

-- Charles Camosy: Can you tell us a bit about your Catholic journey and how it led to doing a residency in neurosurgery?

-- Gabriel LeBeau: I was born and raised a Catholic, particularly in the Catholic charismatic movement. My family was devout, and I am deeply indebted to my parents for fostering the gift of faith.

I grew up in Arizona but decided to go to Benedictine College for undergraduate studies in Atchison, Kansas. This college experience deeply solidified my Catholic identity and married my desire for excellence with the Catholic intellectual and moral tradition. I was a philosophy major, and also pursued medical school and had always been drawn to biomedical ethics.

As I advanced in my philosophy studies, philosophical psychology, questions of free will, the difference between the brain, the mind and the soul, mind-body duality, etc., gripped me the most. I was blessed to be accepted into medical school at the University of Kansas School of Medicine, and it was these philosophical interests that drove me to be interested in specialties dealing with the brain.

While in medical school, I was blessed to be mentored by a deeply Catholic neurosurgeon, Dr. Paul Camarata. He helped foster and support my interests in neurosurgery as well as my identity as a Catholic in that space. His care for patients, commitment to the faith and operative excellence gave me the confidence to pursue neurosurgery as my specialty of choice.

Neurosurgery is a surgical specialty that deals with pathologies and emergencies affecting the central and peripheral nervous system -- meaning the brain, the spine and nerves. Patients present with symptoms that affect their sense of identity, autonomy and many other factors that are central to the human condition. Oftentimes, these pathologies come without warning and in the setting of an emergency, and can often be fatal or life-altering without intervention.

I believe the Catholic moral tradition, guided by the spiritual and corporal works of mercy, is essential to my training and future practice as a neurosurgeon in taking care of these patients and families.

-- Camosy: Thanks for joining our cohort on transhumanism and the human body organized by University of Southern California's Institute for Advanced Catholic Studies. You've provided an invaluable perspective. Can you share one brain-related insight you've had from our time together?

-- LeBeau: It is tough to only share one brain-related insight, because there have been many. One that comes to mind relates particularly to brain-computer interfaces. The cohort specifically is looking at the philosophy (or movement) of transhumanism and its impact in multiple spheres.

One area of impact would be in the neurotechnology space, which is closely related to neurosurgery. Brain-machine interfaces have the potential to help patients with debilitating situations, such as total quadriplegia, regain meaningful autonomy. The idea is that the brain is healthy in this group of patients, the pathology these patients suffer from is affecting the connections of the brain to the rest of the body.

Through a brain-machine interface, a device can be implanted into the brain, which would in turn collect and synthesize neural data in a computer to produce an actionable output, such as moving a robotic arm, or having autonomy over the actions of a computer or other device.

There are many models of this with early success, such as patients regaining ownership of their businesses, operating prosthetic limbs and many more exciting developments. A once untreatable situation has now become within the realm of neurosurgical intervention. Notable industries pursuing this space are Neuralink and Synchron.

As with many technologies, this innovation can be used for many purposes. In the current models, brain-computer interfaces are intended to restore a patient's autonomy and to improve quality of life in what was once considered an untreatable condition.

However, these same devices, with the same technology, could be used with a "transhumanist" mentality -- to implant these devices into a healthy patient with the intent of enhancement. This cohort has scrutinized the philosophical and ethical implications of such a use, and, importantly, has engaged with both academic and industry leaders in the neurosurgical world, with successful interdisciplinary dialogue. The neurosurgical space is becoming more aware of the ethical implications of these devices through the work of this cohort.

-- Camosy: As you know, I've had questions about the relationship of the brain to self-awareness and, ultimately, to human life and death itself. Do you think there are questions worth asking here?

-- LeBeau: Yes, there are certainly questions worth asking here. There seems to be in the scientific and medical community a bias that the brain and the mind are synonymous. Given this assumption, the perceived value of a person often falls on the functionality of their brain.

Philosophically, there are important questions to ask here, namely, if it's true that the brain and the mind are synonymous, and what is the best way to characterize that relationship.

Many books have been written embarking upon this very question, but what I can speak to is that in the operations I assist in as a resident (awake brain tumor surgeries, seizure resection surgeries), one can remove large and important parts of the brain and the mind remains seemingly intact post-operatively.

However, practically speaking, I see the implications of the notion that the brain, mind and value of a person are synonymous most poignantly in the "brain death" delineation, and the rationale behind the classification in the first place.

-- Camosy: A related issue also haunts me: I worry we've become lazy and imprecise in thinking about the "What is death?" question in part because we want to fudge on the answer in order to procure more organs for transplant. What on-the-ground insights do you have into this issue?

-- LeBeau: From the outset, I would say that "brain death," or "death by neurologic criteria," in our experience has no true clinical utility aside from organ procurement.

In the field of neurosurgery we encounter many patients and their families in the wake of neurologically devastating injury. After all options are put in front of the family, to do surgery or to not, decisions are made without "brain death" to withdraw extraordinary care and allow their loved one to succumb to the natural process. Brain-death testing in no way aids in this process at our hospital, for nearly every single case.

Now enter the brain death conversation. At each hospital in the region, for every patient who fits a certain neurologic presentation criteria -- I believe it's Glasgow Coma Scale of five or less at our hospital -- the local organ-transplant network gets automatically notified.

At times, although rare, the organ-procurement representative speaks to the family before the physician has a chance to. I have heard language from a representative in a situation where a young person attempted to take their own life with a firearm to the head whereby it was said, "your son's death can mean something." This is not physician-driven, nor do many physicians of all creeds appreciate the eagerness of the organ-procurement industry.

Other concerns I have are discussed in the medical literature, including work published in The Annals of Thoracic Surgery and The American Journal of Transplantation.

It is important to note that there are active efforts to "maintain the permanence of death principle" in donation after circulatory death. In this case, the patient dies of cardiac arrest and is declared dead. When being revived for surgical procurement, important arteries to the brain are clamped, with the idea that the person will maintain the permanence of death by preventing any blood flow to the brain.

Essentially by this method, the death of the patient is ensured, and that any reviving efforts do not accidentally revive the patient as a whole. This, and many other aspects of the organ-donation industry, is controversial and must be looked at closely. There are many other examples and ideas to discuss down the line.