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van Velthoven EAM, van Stuijvenberg OC, Haselager DRE, Broekman M, Chen X, Roelfsema P, Bredenoord AL, Jongsma KR. Ethical implications of visual neuroprostheses-a systematic review. J Neural Eng 2022; 19. [PMID: 35475424 DOI: 10.1088/1741-2552/ac65b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/08/2022] [Indexed: 11/12/2022]
Abstract
Objective. The aim of this review was to systematically identify the ethical implications of visual neuroprostheses.Approach. A systematic search was performed in both PubMed and Embase using a search string that combined synonyms for visual neuroprostheses, brain-computer interfaces (BCIs), cochlear implants (CIs), and ethics. We chose to include literature on BCIs and CIs, because of their ethically relavant similarities and functional parallels with visual neuroprostheses.Main results. We included 84 articles in total. Six focused specifically on visual prostheses. The other articles focused more broadly on neurotechnologies, on BCIs or CIs. We identified 169 ethical implications that have been categorized under seven main themes: (a) benefits for health and well-being; (b) harm and risk; (c) autonomy; (d) societal effects; (e) clinical research; (f) regulation and governance; and (g) involvement of experts, patients and the public.Significance. The development and clinical use of visual neuroprostheses is accompanied by ethical issues that should be considered early in the technological development process. Though there is ample literature on the ethical implications of other types of neuroprostheses, such as motor neuroprostheses and CIs, there is a significant gap in the literature regarding the ethical implications of visual neuroprostheses. Our findings can serve as a starting point for further research and normative analysis.
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Affiliation(s)
- E A M van Velthoven
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - O C van Stuijvenberg
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - D R E Haselager
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - M Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurosurgery, Leiden Medical Center, Leiden, The Netherlands
| | - X Chen
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - P Roelfsema
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands.,Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - A L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - K R Jongsma
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
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Bosteels S, Vandenbroeck M, Van Hove G. Saving Deaf Children? Screening for Hearing loss as a Public-interest Case. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:109-121. [PMID: 27761875 DOI: 10.1007/s11673-016-9752-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
New-born screening programs for congenital disorders and chronic disease are expanding worldwide and children "at risk" are identified by nationwide tracking systems at the earliest possible stage. These practices are never neutral and raise important social and ethical questions. An emergent concern is that a reflexive professionalism should interrogate the ever earlier interference in children's lives. The Flemish community of Belgium was among the first to generalize the screening for hearing loss in young children and is an interesting case to study the public justification of early interventions for families with deaf children. This article uses a critical lens to study the archive of the government child healthcare organization in Flanders in order to uncover underlying constructions of childhood, deafness, and preventive health. We focus on two interrelated themes. The first is the notion of exclusion of the human factor through the mediation of technology. The second is the idea of deafness as endangering a healthy development, an impairment that can nevertheless be treated if detected early enough. It is argued that, since deafness cannot be viewed as a life-threatening condition, the public interest which is implicitly defended is not the rescue of deaf children rather the exclusion of otherness.
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Affiliation(s)
- Sigrid Bosteels
- Department of Social Work and Social Pedagogy, Howest University College/Ghent University, Rijselstraat 5, 8200, Brugge, Belgium.
| | - Michel Vandenbroeck
- Department of Social Work and Social Pedagogy, Ghent University, Henri Dunantlaan 2, 9000, Gent, Belgium
| | - Geert Van Hove
- Department of Special Needs Education, Ghent University, Begijnhoflaan 464, 9000, Gent, Belgium
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Lysdahl KB, Hofmann B. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment. GMS HEALTH TECHNOLOGY ASSESSMENT 2016; 12:Doc01. [PMID: 27066147 PMCID: PMC4811193 DOI: 10.3205/hta000124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA) literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1) multiple and changing perspectives, 2) indeterminate phenomena, 3) uncertain causality, 4) unpredictable outcome, and 5) ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.
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Affiliation(s)
| | - Bjørn Hofmann
- Centre for Medical Ethics, University of Oslo, Oslo, Norway; The Norwegian University of Science and Technology, Gjøvik, Norway
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Lee J. Cochlear Implantation, Enhancements, Transhumanism and Posthumanism: Some Human Questions. SCIENCE AND ENGINEERING ETHICS 2016; 22:67-92. [PMID: 25962718 DOI: 10.1007/s11948-015-9640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/09/2015] [Indexed: 05/28/2023]
Abstract
Biomedical engineering technologies such as brain-machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: will everyone be enhanced? Will we be "human" if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism's reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation's unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation-and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis.
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Affiliation(s)
- Joseph Lee
- Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Pass L, Graber AD. Informed Consent, Deaf Culture, and Cochlear Implants. THE JOURNAL OF CLINICAL ETHICS 2015. [DOI: 10.1086/jce2015263219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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