Foreword: Imagining a New Era of Neuroimaging, Neuroethics, and Neurolaw

The human brain has been at the center of medicolegal debates since the late 1960s, when efforts began to develop an alternative definition of death: one centered on brain function instead of heart and lung function. Technological developments and new surgical techniques made this new definition of death, sometimes called "brain death," seem necessary. Mechanical ventilation, a technology that allows respiration and therefore heartbeat to continue after the brain ceases functioning, and heart transplantation, which requires a corpse with a beating heart as a donor, necessitated the definitional alternative. Irreversible cessation of all functions of the brain has been accepted both medically and legally as confirming the death of an individual. The medicolegal discussions have since concentrated on examination of the brain in living humans. This year's Symposium issue of the American Journal of Law & Medicine, "Brain Imaging and the Law," is devoted to the legal implications of rapidlydeveloping imaging technology that goes beyond structural imaging of the brain to display a representation of brain functioning. As with contemporary medicolegal and bioethical literature on the implications of genetic engineering and nanotechnology, there is much imagination, hype, and even science fiction in this new arena, dubbed "neurolaw."1 There is also, nonetheless, significant technological wizardry. Although functional neuroimaging is not ready for routine courtroom use, the Journal's editors who selected this topic, and recruited the authors of the articles in this issue, chose wisely. Serious reflection, and even imaginative speculation, on what new brain imaging technologies can and cannot tell us, and of what legal use they may be in the future, are essential to adequately prepare for a future filled with more and more colorful and compelling images of the human brain. Ronald Cranford, M.D., to whom this issue is dedicated, was perhaps the nation's leading mediator between neuroscience and the law. Shortly bifore his death on May 31, 2006, Ron, a neurologist by specialty, agreed to write for this Symposium Issue. His planned article would have, among other things, traced the legal developments in brain imaging and other diagnostic techniques utilized by experts testifying in major "right to die" cases from 1977 to 2006. His plan was to concentrate on ten of those cases that he helped frame, which in turn defined his own medicolegal career. I met Ron at an American Society of Law and Medicine meeting in Detroit in 1979, and worked with him on a variety of issues over the following decades. This work included defining the role of ethics committees and ethics consultation in formulating hospital policies on brain-death determinations, Do Not Resuscitate orders, living wills, and health care proxies; and more specifically on persistent and permanent vegetative states, and how medical determinations should inform ethical and legal decision-making.2 We did not always agree, but I always found his insights and arguments coherent, constructive, and patient and family-focused. The American Society of Law, Medicine & Ethics was very fortunate to have Ron serve as both its president and longtime board member. He personified how physicians and lawyers should work together to support families caught up in the medicolegal controversies of our day, as well as how our professions can work together to advance public policy in ways that neither profession can do alone. In the context of this symposium issue, we are all fortunate that Ron summarized his major conclusions from his life in the clinic and in the courtroom in a speech at a Boston University conference on the Terri Schiavo case on March 31, 2006, just two months before his death.3 His presentation was videotaped and is easily accessible.4 What made Ron exceptional was not just his medical knowledge and experience-although he was unsurpassed in the areas of persistent and permanent vegetative states. …