NEUROSEC

Arianna Manzini

Position: DPhil Student

University of Oxford Profile

Email: arianna.manzini@wolfson.ox.ac.uk

Project(s): Becoming Good: Early Intervention and Moral Development in Psychiatry (BeGOOD)

Citizens EIE

Arianna is a Wellcome Trust-funded DPhil student at Oxford, supervised by Prof. Ilina Singh (Department of Psychiatry) and Dr Nina Hallowell (Ethox Centre). Within the BeGOOD team, her research is an empirical bioethics study situated at the intersection between the ethics of neuropsychiatric genomics, the scholarship on biological citizenship, and the literature on childhood participation. Her thesis uses autism genomics as a case study to investigate the moral attitudes that young people, i.e. ‘developing’ genomic citizens, hold in the context of the application of genomic science to psychiatric conditions. Arianna developed the methodological design of her research in consultation with the NeurOx Young People’s Advisory Group, which she has contributed to set up as part of Citizens: EIE, and she conducted focus groups with young people between 13-18 years old, recruited from schools and youth groups in the UK

Arianna holds an undergraduate degree in Philosophy from Università Vita-Salute San Raffaele, Milan (2014); an MA in Philosophy, Politics, and Economics of Health from University College London (2015); and an Erasmus Mundus MSc in Bioethics from KU Leuven (2016).

Publications

  • Parental Responsibility in the Context of Neuroscience and Genetics, by Kristien Hens, Daniela Cutas, and Dorothee Horstkötter. Cham, Switzerland: Springer International Publishing; 2017. 246 pp.

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  • Can Your Phone Be Your Therapist? Young People’s Ethical Perspectives on the Use of Fully Automated Conversational Agents (Chatbots) in Mental Health Support.

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    Over the last decade, there has been an explosion of digital interventions that aim to either supplement or replace face-to-face mental health services. More recently, a number of automated conversational agents have also been made available, which respond to users in ways that mirror a real-life interaction. What are the social and ethical concerns that arise from these advances? In this article, we discuss, from a young person's perspective, the strengths and limitations of using chatbots in mental health support. We also outline what we consider to be minimum ethical standards for these platforms, including issues surrounding privacy and confidentiality, efficacy, and safety, and review three existing platforms (Woebot, Joy, and Wysa) according to our proposed framework. It is our hope that this article will stimulate ethical debate among app developers, practitioners, young people, and other stakeholders, and inspire ethically responsible practice in digital mental health.

  • Co-producing research with youth: The NeurOx young people’s advisory group model.

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    Objective

    In this paper, we provide a step-by-step model, grounded in our own experience of setting up and coordinating the Oxford Neuroscience, Ethics and Society Young People's Advisory Group (NeurOx YPAG). This group supports studies at the intersection of ethics, mental health and novel technologies. Our model covers the following stages: deciding on the fit for co-production, recruiting participants, developing collective principles of work, running a meeting and evaluating impact.

    Results

    We emphasize that throughout this process, researchers should take a critical stance by reflecting on whether a co-production model fits their research scope and aims; ensuring (or aspiring to) representativeness within the group; valuing different kinds of expertise; and undertaking on-going evaluations on the impact of the group on both the young people and the research.

    Conclusion

    Adopting a critical and reflective attitude can increase researchers' capacity to engage youth in democratic and inclusive ways, and to produce research outputs that are aligned with the target audience's needs and priorities.

  • Ethical dimensions of translational developmental neuroscience research in autism.

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    Background

    Since the 1990s, increasing research has been devoted to the identification of biomarkers for autism to help attain more objective diagnosis; enable early prediction of prognosis; and guide individualized intervention options. Early studies focused on the identification of genetic variants associated with autism, but more recently, research has expanded to investigate neurodevelopmental markers. While ethicists have extensively discussed issues around advances in autism genomics, much less ethical scrutiny has focused on research on early neurodevelopment and on the interventions being developed as a result.

    Objectives

    We summarize the current state of the science on the identification of early markers for autism and its potential clinical applications, before providing an overview of the ethical issues arising from increasing understanding of children's neurodevelopment in very early life.

    Results

    Advances in the understanding of brain and behavioral trajectories preceding later autism diagnosis raise ethical concerns around three themes: (a) New models for understanding autism; (b) Risks and benefits of early identification and intervention; and (c) Communication of early concerns to families. These ethical issues should be further investigated in research conducted in partnership with autistic people and their families.

    Conclusions

    This paper highlights the need for ethical scrutiny of early neurodevelopmental research in autism. Scrutiny requires expertise and methods from the basic sciences and bioethics, as well as constructive collaborations among autistic people, their parents, and autism researchers to anticipate early interventions that serve the community's interests and accommodate the varied experiences and preferences of people on the spectrum and their families.

  • Is coercion ever beneficent? Public health ethics in early intervention and prevention for mental health

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    Early intervention in mental health seeks to improve the wellbeing of as many people as possible, by intervening at an early stage in the onset of illness, or by taking preventative action in ‘at risk’ populations. The paradigm is rhetorically powerful, and it is easy to talk in terms of it helping to deliver rights to health and realise social justice. However, in spite – or perhaps because – of the apparently unarguable desirability of such goals, it is harder to discuss rights to dissent. In this respect the risk of coercion is an issue that should be discussed, especially because of the stigmatizing effect that the labelling associated with early intervention may have in mental health contexts. Here we explore this issue, with a particular focus on its practical and ethical implications in relation to UK policy for treating Attention Deficit Hyperactivity Disorder and mild Conduct Disorder in young people.