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Schönau A, Goering S, Versalovic E, Montes N, Brown T, Dasgupta I, Klein E. Asking questions that matter – Question prompt lists as tools for improving the consent process for neurotechnology clinical trials. Front Hum Neurosci 2022; 16:983226. [PMID: 35966997 PMCID: PMC9372354 DOI: 10.3389/fnhum.2022.983226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
Implantable neurotechnology devices such as Brain Computer Interfaces (BCIs) and Deep Brain Stimulators (DBS) are an increasing part of treating or exploring potential treatments for neurological and psychiatric disorders. While only a few devices are approved, many promising prospects for future devices are under investigation. The decision to participate in a clinical trial can be challenging, given a variety of risks to be taken into consideration. During the consent process, prospective participants might lack the language to consider those risks, feel unprepared, or simply not know what questions to ask. One tool to help empower participants to play a more active role during the consent process is a Question Prompt List (QPL). QPLs are communication tools that can prompt participants and patients to articulate potential concerns. They offer a structured list of disease, treatment, or research intervention-specific questions that research participants can use as support for question asking. While QPLs have been studied as tools for improving the consent process during cancer treatment, in this paper, we suggest they would be helpful in neurotechnology research, and offer an example of a QPL as a template for an informed consent tool in neurotechnology device trials.
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Affiliation(s)
- Andreas Schönau
- Department of Philosophy, University of Washington, Seattle, WA, United States
- *Correspondence: Andreas Schönau,
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Erika Versalovic
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Natalia Montes
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Tim Brown
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | | | - Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Abstract
Implantable brain-computer interfaces (BCIs) are being developed to restore speech capacity for those who are unable to speak. Patients with locked-in syndrome or amyotrophic lateral sclerosis could be able to use covert speech – vividly imagining saying something without actual vocalisation – to trigger neural controlled systems capable of synthesising speech. User control has been identified as particularly pressing for this type of BCI. The incorporation of machine learning and statistical language models into the decoding process introduces a contribution to (or ‘shaping of’) the output that is beyond the user’s control. Whilst this type of ‘shared control’ of BCI action is not unique to speech BCIs, the automated shaping of what a user ‘says’ has a particularly acute ethical dimension, which may differ from parallel concerns surrounding automation in movement BCIs. This paper provides an analysis of the control afforded to the user of a speech BCI of the sort under development, as well as the relationships between accuracy, control, and the user’s ownership of the speech produced. Through comparing speech BCIs with BCIs for movement, we argue that, whilst goal selection is the more significant locus of control for the user of a movement BCI, control over process will be more significant for the user of the speech BCI. The design of the speech BCI may therefore have to trade off some possible efficiency gains afforded by automation in order to preserve sufficient guidance control necessary for users to express themselves in ways they prefer. We consider the implications for the speech BCI user’s responsibility for produced outputs and their ownership of token outputs. We argue that these are distinct assessments. Ownership of synthetic speech concerns whether the content of the output sufficiently represents the user, rather than their morally relevant, causal role in producing that output.
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Abstract
Neural devices have the capacity to enable users to regain abilities lost due to disease or injury - for instance, a deep brain stimulator (DBS) that allows a person with Parkinson's disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies' capacity to maintain or restore their capabilities, the neuroethics literature is replete with examples of concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person's brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issue - responsibility, privacy, authenticity, or trust - selectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an "Agency Map" which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual's experience of agency.
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Affiliation(s)
| | | | | | | | - Eran Klein
- University of Washington
- Oregon Health and Science University
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Schönau A. The Spectrum of Responsibility Ascription for End Users of Neurotechnologies. NEUROETHICS-NETH 2021; 14:423-435. [DOI: 10.1007/s12152-021-09460-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Brain-machine interfaces (BMIs), which enable a two-way flow of signals, information, and directions between human neurons and computerized machines, offer spectacular opportunities for therapeutic and consumer applications, but they also present unique dangers to the safety, privacy, psychological health, and spiritual well-being of their users. The sale of these devices as commodities for profit exacerbates such issues and may subject the user to an unequal exchange with corporations. Catholic healthcare professionals and bioethicists should be especially concerned about the implications for the essential dignity of the persons using the new BMIs. Summary The commercial sale of brain-machine interfaces (BMIs) generates and exacerbates problems for end-users' safety, psychological health, and spiritual well-being.
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Steinert S, Friedrich O. Wired Emotions: Ethical Issues of Affective Brain-Computer Interfaces. SCIENCE AND ENGINEERING ETHICS 2020; 26:351-367. [PMID: 30868377 PMCID: PMC6978299 DOI: 10.1007/s11948-019-00087-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 01/24/2019] [Indexed: 05/28/2023]
Abstract
Ethical issues concerning brain-computer interfaces (BCIs) have already received a considerable amount of attention. However, one particular form of BCI has not received the attention that it deserves: Affective BCIs that allow for the detection and stimulation of affective states. This paper brings the ethical issues of affective BCIs in sharper focus. The paper briefly reviews recent applications of affective BCIs and considers ethical issues that arise from these applications. Ethical issues that affective BCIs share with other neurotechnologies are presented and ethical concerns that are specific to affective BCIs are identified and discussed.
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Affiliation(s)
- Steffen Steinert
- Department of Values, Technology and Innovation, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | - Orsolya Friedrich
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336 Munich, Germany
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Thompson K. Committing Crimes with BCIs: How Brain-Computer Interface Users can Satisfy Actus Reus and be Criminally Responsible. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09416-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bublitz C, Wolkenstein A, Jox RJ, Friedrich O. Legal liabilities of BCI-users: Responsibility gaps at the intersection of mind and machine? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 65:101399. [PMID: 30449603 DOI: 10.1016/j.ijlp.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Christoph Bublitz
- Faculty of Law, Universität Hamburg, Rothenbaumchaussee 33, 20148 Hamburg, Germany.
| | - Andreas Wolkenstein
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336 Munich, Germany
| | - Ralf J Jox
- Centre Hospitalier Universitaire Vaudois (CHUV), Avenue Pierre-Decker 5, CH-1011 Lausanne, Switzerland
| | - Orsolya Friedrich
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336 Munich, Germany
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Brain–Computer Interfaces: Lessons to Be Learned from the Ethics of Algorithms. Camb Q Healthc Ethics 2018; 27:635-646. [DOI: 10.1017/s0963180118000130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract:Brain–computer interfaces (BCIs) are driven essentially by algorithms; however, the ethical role of such algorithms has so far been neglected in the ethical assessment of BCIs. The goal of this article is therefore twofold: First, it aims to offer insights into whether (and how) the problems related to the ethics of BCIs (e.g., responsibility) can be better grasped with the help of already existing work on the ethics of algorithms. As a second goal, the article explores what kinds of solutions are available in that body of scholarship, and how these solutions relate to some of the ethical questions around BCIs. In short, the article asks what lessons can be learned about the ethics of BCIs from looking at the ethics of algorithms. To achieve these goals, the article proceeds as follows. First, a brief introduction into the algorithmic background of BCIs is given. Second, the debate about epistemic concerns and the ethics of algorithms is sketched. Finally, this debate is transferred to the ethics of BCIs.
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Perruchoud D, Pisotta I, Carda S, Murray MM, Ionta S. Biomimetic rehabilitation engineering: the importance of somatosensory feedback for brain-machine interfaces. J Neural Eng 2016; 13:041001. [PMID: 27221469 DOI: 10.1088/1741-2560/13/4/041001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Brain-machine interfaces (BMIs) re-establish communication channels between the nervous system and an external device. The use of BMI technology has generated significant developments in rehabilitative medicine, promising new ways to restore lost sensory-motor functions. However and despite high-caliber basic research, only a few prototypes have successfully left the laboratory and are currently home-deployed. APPROACH The failure of this laboratory-to-user transfer likely relates to the absence of BMI solutions for providing naturalistic feedback about the consequences of the BMI's actions. To overcome this limitation, nowadays cutting-edge BMI advances are guided by the principle of biomimicry; i.e. the artificial reproduction of normal neural mechanisms. MAIN RESULTS Here, we focus on the importance of somatosensory feedback in BMIs devoted to reproducing movements with the goal of serving as a reference framework for future research on innovative rehabilitation procedures. First, we address the correspondence between users' needs and BMI solutions. Then, we describe the main features of invasive and non-invasive BMIs, including their degree of biomimicry and respective advantages and drawbacks. Furthermore, we explore the prevalent approaches for providing quasi-natural sensory feedback in BMI settings. Finally, we cover special situations that can promote biomimicry and we present the future directions in basic research and clinical applications. SIGNIFICANCE The continued incorporation of biomimetic features into the design of BMIs will surely serve to further ameliorate the realism of BMIs, as well as tremendously improve their actuation, acceptance, and use.
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Affiliation(s)
- David Perruchoud
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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Hildt E. What will this do to me and my brain? Ethical issues in brain-to-brain interfacing. Front Syst Neurosci 2015; 9:17. [PMID: 25762903 PMCID: PMC4340163 DOI: 10.3389/fnsys.2015.00017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
Recent brain-to-brain interfacing studies provide proof of principle for the feasibility of various forms of direct information transfer between two brains, and may lead to the development of new approaches involving memory, emotions, or senses. What makes brain-to-brain interfaces unique is the transfer of information representing specific messages directly from one brain to another, without involving any activity of the peripheral nervous system or senses. The article discusses ethical issues that arise in neural interfacing. The focus is on the implications that brain-to-brain interfaces may have on the individual at the recipient side.
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Affiliation(s)
- Elisabeth Hildt
- Center for the Study of Ethics in the Professions, Illinois Institute of Technology Chicago, IL, USA
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O’Brolchain F, Gordijn B. Brain–Computer Interfaces and User Responsibility. THE INTERNATIONAL LIBRARY OF ETHICS, LAW AND TECHNOLOGY 2014. [DOI: 10.1007/978-94-017-8996-7_14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Grübler G, Al-Khodairy A, Leeb R, Pisotta I, Riccio A, Rohm M, Hildt E. Psychosocial and Ethical Aspects in Non-Invasive EEG-Based BCI Research—A Survey Among BCI Users and BCI Professionals. NEUROETHICS-NETH 2013. [DOI: 10.1007/s12152-013-9179-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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