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van Stuijvenberg OC, Broekman MLD, Wolff SEC, Bredenoord AL, Jongsma KR. Developer perspectives on the ethics of AI-driven neural implants: a qualitative study. Sci Rep 2024; 14:7880. [PMID: 38570593 PMCID: PMC10991497 DOI: 10.1038/s41598-024-58535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/01/2024] [Indexed: 04/05/2024] Open
Abstract
Convergence of neural implants with artificial intelligence (AI) presents opportunities for the development of novel neural implants and improvement of existing neurotechnologies. While such technological innovation carries great promise for the restoration of neurological functions, they also raise ethical challenges. Developers of AI-driven neural implants possess valuable knowledge on the possibilities, limitations and challenges raised by these innovations; yet their perspectives are underrepresented in academic literature. This study aims to explore perspectives of developers of neurotechnology to outline ethical implications of three AI-driven neural implants: a cochlear implant, a visual neural implant, and a motor intention decoding speech-brain-computer-interface. We conducted semi-structured focus groups with developers (n = 19) of AI-driven neural implants. Respondents shared ethically relevant considerations about AI-driven neural implants that we clustered into three themes: (1) design aspects; (2) challenges in clinical trials; (3) impact on users and society. Developers considered accuracy and reliability of AI-driven neural implants conditional for users' safety, authenticity, and mental privacy. These needs were magnified by the convergence with AI. Yet, the need for accuracy and reliability may also conflict with potential benefits of AI in terms of efficiency and complex data interpretation. We discuss strategies to mitigate these challenges.
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Affiliation(s)
- Odile C van Stuijvenberg
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
| | - Marike L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
| | - Samantha E C Wolff
- Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
| | - Karin R Jongsma
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
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2
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Bergeron D, Iorio-Morin C, Bonizzato M, Lajoie G, Orr Gaucher N, Racine É, Weil AG. Use of Invasive Brain-Computer Interfaces in Pediatric Neurosurgery: Technical and Ethical Considerations. J Child Neurol 2023; 38:223-238. [PMID: 37116888 PMCID: PMC10226009 DOI: 10.1177/08830738231167736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/11/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
Invasive brain-computer interfaces hold promise to alleviate disabilities in individuals with neurologic injury, with fully implantable brain-computer interface systems expected to reach the clinic in the upcoming decade. Children with severe neurologic disabilities, like quadriplegic cerebral palsy or cervical spine trauma, could benefit from this technology. However, they have been excluded from clinical trials of intracortical brain-computer interface to date. In this manuscript, we discuss the ethical considerations related to the use of invasive brain-computer interface in children with severe neurologic disabilities. We first review the technical hardware and software considerations for the application of intracortical brain-computer interface in children. We then discuss ethical issues related to motor brain-computer interface use in pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel of experts in fields related to brain-computer interface (functional and restorative neurosurgery, pediatric neurosurgery, mathematics and artificial intelligence research, neuroengineering, pediatric ethics, and pragmatic ethics), we then formulate initial recommendations regarding the clinical use of invasive brain-computer interfaces in children.
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Affiliation(s)
- David Bergeron
- Division of Neurosurgery, Université de Montréal, Montreal, Québec, Canada
| | | | - Marco Bonizzato
- Electrical Engineering Department, Polytechnique Montréal, Montreal, Québec, Canada
- Neuroscience Department and Centre
interdisciplinaire de recherche sur le cerveau et l’apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Lajoie
- Mathematics and Statistics Department, Université de Montréal, Montreal, Québec, Canada
- Mila - Québec AI Institute, Montréal,
Québec, Canada
| | - Nathalie Orr Gaucher
- Department of Pediatric Emergency
Medicine, CHU Sainte-Justine, Montréal, Québec, Canada
- Bureau de l’Éthique clinique, Faculté
de médecine de l’Université de Montréal, Montreal, Québec, Canada
| | - Éric Racine
- Pragmatic Research Unit, Institute de
Recherche Clinique de Montréal (IRCM), Montreal, Québec, Canada
- Department of Medicine and Department
of Social and Preventative Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexander G. Weil
- Division of Neurosurgery, Department
of Surgery, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Département de
Pédiatrie, Université de Montréal, Montreal, Québec, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec, Canada
- Brain and Development Research Axis,
CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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3
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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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Gilbert F, Cook M, O’Brien T, Illes J. Embodiment and Estrangement: Results from a First-in-Human "Intelligent BCI" Trial. SCIENCE AND ENGINEERING ETHICS 2019; 25:83-96. [PMID: 29129011 PMCID: PMC6418065 DOI: 10.1007/s11948-017-0001-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/31/2017] [Indexed: 05/21/2023]
Abstract
While new generations of implantable brain computer interface (BCI) devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent-predictive and advisory-BCI technologies essential to prevent potential iatrogenic harms.
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Affiliation(s)
- F. Gilbert
- Centre for Sensorimotor Neural Engineering, Department of Philosophy, University of Washington, Seattle, WA USA
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC USA
- Australian Research Council DECRA Fellow, University of Tasmania, Hobart, Australia
| | - M. Cook
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Department of Neurology, St. Vincent’s Hospital, Melbourne, Australia
| | - T. O’Brien
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - J. Illes
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC USA
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Rommelfanger K, Jeong SJ, Ema A, Fukushi T, Kasai K, Ramos K, Salles A, Singh I, Amadio J, Bi GQ, Boshears PF, Carter A, Devor A, Doya K, Garden H, Illes J, Johnson LSM, Jorgenson L, Jun BO, Lee I, Michie P, Miyakawa T, Nakazawa E, Sakura O, Sarkissian H, Sullivan LS, Uh S, Winickoff D, Wolpe PR, Wu KCC, Yasamura A, Zheng JC. Neuroethics Questions to Guide Ethical Research in the International Brain Initiatives. Neuron 2018; 100:19-36. [DOI: 10.1016/j.neuron.2018.09.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
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Burwell S, Sample M, Racine E. Ethical aspects of brain computer interfaces: a scoping review. BMC Med Ethics 2017; 18:60. [PMID: 29121942 PMCID: PMC5680604 DOI: 10.1186/s12910-017-0220-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain-Computer Interface (BCI) is a set of technologies that are of increasing interest to researchers. BCI has been proposed as assistive technology for individuals who are non-communicative or paralyzed, such as those with amyotrophic lateral sclerosis or spinal cord injury. The technology has also been suggested for enhancement and entertainment uses, and there are companies currently marketing BCI devices for those purposes (e.g., gaming) as well as health-related purposes (e.g., communication). The unprecedented direct connection created by BCI between human brains and computer hardware raises various ethical, social, and legal challenges that merit further examination and discussion. METHODS To identify and characterize the key issues associated with BCI use, we performed a scoping review of biomedical ethics literature, analyzing the ethics concerns cited across multiple disciplines, including philosophy and medicine. RESULTS Based on this investigation, we report that BCI research and its potential translation to therapeutic intervention generate significant ethical, legal, and social concerns, notably with regards to personhood, stigma, autonomy, privacy, research ethics, safety, responsibility, and justice. Our review of the literature determined, furthermore, that while these issues have been enumerated extensively, few concrete recommendations have been expressed. CONCLUSIONS We conclude that future research should focus on remedying a lack of practical solutions to the ethical challenges of BCI, alongside the collection of empirical data on the perspectives of the public, BCI users, and BCI researchers.
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Affiliation(s)
- Sasha Burwell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada
| | - Matthew Sample
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada.,Departments of Neurology and Neurosurgery, Experimental Medicine and Biomedical Ethics Unit, McGill University, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada. .,Department of Experimental Medicine, McGill University, Montréal, Canada. .,Department of Medicine and Department of Social and Preventative Medicine, Université de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada. .,Departments of Neurology and Neurosurgery, Experimental Medicine and Biomedical Ethics Unit, McGill University, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada.
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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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Attiah MA, Farah MJ. Minds, motherboards, and money: futurism and realism in the neuroethics of BCI technologies. Front Syst Neurosci 2014; 8:86. [PMID: 24860445 PMCID: PMC4030132 DOI: 10.3389/fnsys.2014.00086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark A. Attiah
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
- Center for Neuroscience & Society, University of PennsylvaniaPhiladelphia, PA, USA
| | - Martha J. Farah
- Center for Neuroscience & Society, University of PennsylvaniaPhiladelphia, PA, USA
- Department of Psychology, University of PennsylvaniaPhiladelphia, PA, USA
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