In recent decades, advances in structural and functional brain imaging have identified brain abnormalities associated with psychiatric disorders. This surge in knowledge about the biological underpinnings of psychiatric constructs including psychosis and psychopathy is potentially useful for improving treatment and diagnosis, but also necessitates the consideration of its ethical implications. More recent studies highlight the power of brain imaging as a potential early diagnostic aid for schizophrenia, raising issues about the desirability of this information for individuals, services and society. More fundamentally, the increasing emphasis on the biological component of psychiatric disorders may change the way patients view themselves and their potential for recovery, and alter stigmatisation by others. The association of particular imaging findings with psychopathy and antisocial personality disorder gives rise to even more complex ethical implications involving accountability and diminished responsibility. Mitigating evidence based on brain scans is being used in court cases already, despite several methodological and fundamental problems. These include the translation from scientific group-bases analysis to individuals, the misleading and “seductive allure” of brain images to the layperson, and the difficulty of providing definitive evidence for brain-behaviour causality. In sum, progress in brain imaging alters our notion of psychiatric disorders and opens new possibilities for applications, whether or not ethically or scientifically justified. In order to avoid hampering a potentially positive impact of this progress on patients and wider society, it is important that the ethical implications are considered in time, by all parties involved.
