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Deli A, Green AL. Deep Brain Stimulation for Consciousness Disorders; Technical and Ethical Considerations. NEUROETHICS-NETH 2024; 17:35. [PMID: 39091894 PMCID: PMC11289033 DOI: 10.1007/s12152-024-09570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
Disorders of Consciousness (DoC) result in profound functional impairment, adversely affecting the lives of a predominantly younger patient population. Currently, effective treatment options for those who have reached chronicity (prolonged symptom duration over 4 weeks) are extremely limited, with the majority of such cases facing life-long dependence on carers and a poor quality of life. Here we briefly review the current evidence on caseload, diagnostic and management options in the United Kingdom (UK), United States of America (USA) and the European Union (EU). We identify key differences as well as similarities in these approaches across respective healthcare systems, highlighting unmet needs in this population. We subsequently present past efforts and the most recent advances in the field of surgical modulation of consciousness through implantable neurostimulation systems. We examine the ethical dilemmas that such a treatment approach may pose, proposing mediating solutions and methodological adjustments to address these concerns. Overall, we argue that there is a strong case for the utilisation of deep brain stimulation (DBS) in the DoC patient cohort. This is based on both promising results of recent clinical trials as well as technological developments. We propose a revitalization of surgical neuromodulation for DoC with a multicenter, multidisciplinary approach and strict monitoring guidelines, in order to not only advance treatment options but also ensure the safeguarding of patients' welfare and dignity.
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Affiliation(s)
- Alceste Deli
- Nuffield Department of Surgical Sciences and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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2
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Zohny H, Savulescu J. When Two Become One: Singular Duos and the Neuroethical Frontiers of Brain-to-Brain Interfaces. Camb Q Healthc Ethics 2024:1-13. [PMID: 38606432 DOI: 10.1017/s0963180124000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Advances in brain-brain interface technologies raise the possibility that two or more individuals could directly link their minds, sharing thoughts, emotions, and sensory experiences. This paper explores conceptual and ethical issues posed by such mind-merging technologies in the context of clinical neuroethics. Using hypothetical examples along a spectrum from loosely connected pairs to fully merged minds, the authors sketch out a range of factors relevant to identifying the degree of a merger. They then consider potential new harms like loss of identity, psychological domination, loss of mental privacy, and challenges for notions of autonomy and patient benefit when applied to merged minds. While radical technologies may seem to necessitate new ethical paradigms, the authors suggest the individual-focus underpinning clinical ethics can largely accommodate varying degrees of mind mergers so long as individual patient interests remain identifiable. However, advanced decisionmaking and directives may have limitations in addressing the dilemmas posed. Overall, mind-merging possibilities amplify existing challenges around loss of identity, relating to others, autonomy, privacy, and the delineation of patient interests. This paper lays the groundwork for developing resources to address the novel issues raised, while suggesting the technologies reveal continuity with current healthcare ethics tensions.
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Affiliation(s)
- Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Chen Su Lan Centennial Professor in Medical Ethics, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Uehiro Chair in Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
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3
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Ishida S, Nishitsutsumi Y, Kashioka H, Taguchi T, Shineha R. A comparative review on neuroethical issues in neuroscientific and neuroethical journals. Front Neurosci 2023; 17:1160611. [PMID: 37781239 PMCID: PMC10536163 DOI: 10.3389/fnins.2023.1160611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
This study is a pilot literature review that compares the interest of neuroethicists and neuroscientists. It aims to determine whether there is a significant gap between the neuroethical issues addressed in philosophical neuroethics journals and neuroscience journals. We retrieved 614 articles from two specialist neuroethics journals (Neuroethics and AJOB Neuroscience) and 82 neuroethics-focused articles from three specialist neuroscience journals (Neuron, Nature Neuroscience, and Nature Reviews Neuroscience). We classified these articles in light of the neuroethical issue in question before we compared the neuroethical issues addressed in philosophical neuroethics with those addressed by neuroscientists. A notable result is a parallelism between them as a general tendency. Neuroscientific articles cover most neuroethical issues discussed by philosophical ethicists and vice versa. Subsequently, there are notable discrepancies between the two bodies of neuroethics literature. For instance, theoretical questions, such as the ethics of moral enhancement and the philosophical implications of neuroscientific findings on our conception of personhood, are more intensely discussed in philosophical-neuroethical articles. Conversely, neuroscientific articles tend to emphasize practical questions, such as how to successfully integrate ethical perspectives into scientific research projects and justifiable practices of animal-involving neuroscientific research. These observations will help us settle the common starting point of the attempt at "ethics integration" in emerging neuroscience, contributing to better governance design and neuroethical practice.
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Affiliation(s)
- Shu Ishida
- Graduate School of Life Sciences, Tohoku University, Sendai, Japan
| | - Yu Nishitsutsumi
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Hideki Kashioka
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Takahisa Taguchi
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Ryuma Shineha
- Research Center on Ethical, Legal, and Social Issues, Osaka University, Suita, Japan
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Zohny H, Lyreskog DM, Singh I, Savulescu J. The Mystery of Mental Integrity: Clarifying Its Relevance to Neurotechnologies. NEUROETHICS-NETH 2023; 16:20. [PMID: 37614938 PMCID: PMC10442279 DOI: 10.1007/s12152-023-09525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
The concept of mental integrity is currently a significant topic in discussions concerning the regulation of neurotechnologies. Technologies such as deep brain stimulation and brain-computer interfaces are believed to pose a unique threat to mental integrity, and some authors have advocated for a legal right to protect it. Despite this, there remains uncertainty about what mental integrity entails and why it is important. Various interpretations of the concept have been proposed, but the literature on the subject is inconclusive. Here we consider a number of possible interpretations and argue that the most plausible one concerns neurotechnologies that bypass one's reasoning capacities, and do so specifically in ways that reliably lead to alienation from one's mental states. This narrows the scope of what constitutes a threat to mental integrity and offers a more precise role for the concept to play in the ethical evaluation of neurotechnologies.
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Affiliation(s)
- Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - David M. Lyreskog
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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5
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Rainey S. Neurorights as Hohfeldian Privileges. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-023-09515-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractThis paper argues that calls for neurorights propose an overcomplicated approach. It does this through analysis of ‘rights’ using the influential framework provided by Wesley Hohfeld, whose analytic jurisprudence is still well regarded in its clarificatory approach to discussions of rights. Having disentangled some unclarities in talk about rights, the paper proposes the idea of ‘novel human rights’ is not appropriate for what is deemed worth protecting in terms of mental integrity and cognitive liberty. That is best thought of in terms of Hohfeld’s account of ‘right’ as privilege. It goes on to argue that as privileges, legal protections are not well suited to these cases. As such, they cannot be ‘novel human rights’. Instead, protections for mental integrity and cognitive liberty are best accounted for in terms of familiar and established rational and discursive norms. Mental integrity is best thought of as evaluable in terms of familiar rational norms, and cognitive freedom is constrained by appraisals of sense-making. Concerns about how neurotechnologies might pose particular challenges to mental integrity and cognitive liberty are best protected through careful use of existing legislation on data protection, not novel rights, as it is via data that risks to integrity and liberty are manifested.
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Harris AR, Walker MJ, Gilbert F. Ethical and regulatory issues of stem cell-derived 3-dimensional organoid and tissue therapy for personalised regenerative medicine. BMC Med 2022; 20:499. [PMID: 36575403 PMCID: PMC9795739 DOI: 10.1186/s12916-022-02710-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Regenerative medicine has the potential to treat genetic disorders and replace damaged or missing tissue. The use of donor or animal tissue raises many well-known issues, including limited tissue availability, the possibility of rejection and patient infection. Stem cell therapy raised hope of overcoming these issues, but created new risks including tumour formation and limited benefit if the desired target tissue does not form. The recent development of 3-dimensional tissues, including organoids, allows the creation of more complex tissues for personalised regenerative medicine. METHODS This article details the potential health risks of 3-dimensional organoid and tissue therapy versus dissociated stem cell therapy. The current ethical and regulatory issues surrounding 3-dimensional organoid and tissue therapy are presented with a focus on the highly influential FDA and International Society of Stem Cell Research (ISSCR) guidelines. CONCLUSIONS The potential use of 3-dimensional organoid and tissue therapy may deliver greater patient benefits than other regenerative medicine approaches, but raises new health and ethical risks. Preclinical testing of these therapies will not mitigate some of their risks; they may only be understood after first-in-human trials. The potential irreversibility and high risk of these therapies affects how clinical trials should be structured, including post-trial care for participants.
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Affiliation(s)
- Alexander R Harris
- Department of Biomedical Engineering, University of Melbourne, Melbourne, 3010, Australia.
| | - Mary Jean Walker
- Department of Politics, Media, and Philosophy, La Trobe University, Bundoora, Victoria, 3086, Australia
| | - Frederic Gilbert
- Ethics Lab, School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
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Rainey S. Speaker Responsibility for Synthetic Speech Derived from Neural Activity. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:503-515. [PMID: 36333930 DOI: 10.1093/jmp/jhac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article provides analysis of the mechanisms and outputs involved in language-use mediated by a neuroprosthetic device. It is motivated by the thought that users of speech neuroprostheses require sufficient control over what their devices externalize as synthetic speech if they are to be thought of as responsible for it, but that the nature of this control, and so the status of their responsibility, is not clear.
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Meeres J, Hariz M. Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature. Stereotact Funct Neurosurg 2022; 100:143-155. [PMID: 34979516 DOI: 10.1159/000521130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Up to 30% of patients with post-traumatic stress disorder (PTSD), especially combat veterans, remain refractory to conventional treatment. For them, deep brain stimulation (DBS) has been suggested. Here, we review the literature on animal models of PTSD in which DBS has been used to treat PTSD-type behavior, and we review and discuss patient reports of DBS for PTSD. METHODS A broad search was performed to find experimental animal articles and clinical reports on PubMed, Ovid MEDLINE, Cochrane Library, and PsycINFO, using combinations and variations of search words pertinent to DBS and PTSD. RESULTS The search yielded 30 articles, 24 on DBS in rat models of PTSD, and 6 publications between 2016 and 2020 reporting on a total of 3 patients. DBS in rat models targeted 4 brain areas: medial prefrontal cortex (mPFC), ventral striatum, amygdala, and hippocampus. Clinical publications reported on 2 male combat veterans who received DBS in basolateral amygdala, and 1 female with PTSD due to domestic abuse, who received DBS of mPFC. All 3 patients benefitted to various extents from DBS, at follow-ups of 4 years, 6 months, and 7 months, respectively. CONCLUSIONS PTSD is the only potential clinical indication for DBS that shows extensive animal research prior to human applications. Nevertheless, DBS for PTSD remains highly investigational. Despite several years of government funding of DBS research in view of treating severe PTSD in combat veterans, ethical dilemmas, recruitment difficulties, and issues related to use of DBS in such a complex and heterogenous disorder remain prevalent.
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Affiliation(s)
- Jennifer Meeres
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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Holmen SJ. A note on psychological continuity theories of identity and neurointerventions. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107492. [PMID: 34172524 DOI: 10.1136/medethics-2021-107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
An important concern sometimes voiced in the neuroethical literature is that swift and radical changes to the parts of a person's mental life essential for sustaining his/her numerical identity can result in the person ceasing to exist-in other words, that these changes may disrupt psychological continuity. Taking neurointerventions used for rehabilitative purposes as a point of departure, this short paper argues that the same radical alterations of criminal offenders' psychological features which under certain conditions would result in a disruption of numerical identity (and, thus, the killing of the offender) can be achieved without these having any effect on numerical identity. Thus, someone interested in making radical alterations to offenders' psychology can avoid the charge that this would kill the offenders, while still achieving a radical transformation of them. The paper suggests that this possibility makes the question of what kinds of qualitive alterations to offenders' identity are morally permissible (more?) pressing, but then briefly highlights some challenges for arguments against making radical qualitative identity alterations to offenders.
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Affiliation(s)
- Sebastian Jon Holmen
- Department for Philosophy and Science Studies, Roskilde University, Roskilde, Denmark
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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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Rainey S, Erden YJ. Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence. SCIENCE AND ENGINEERING ETHICS 2020; 26:2439-2454. [PMID: 32632783 PMCID: PMC7550307 DOI: 10.1007/s11948-020-00240-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The incorporation of neural-based technologies into psychiatry offers novel means to use neural data in patient assessment and clinical diagnosis. However, an over-optimistic technologisation of neuroscientifically-informed psychiatry risks the conflation of technological and psychological norms. Neurotechnologies promise fast, efficient, broad psychiatric insights not readily available through conventional observation of patients. Recording and processing brain signals provides information from 'beneath the skull' that can be interpreted as an account of neural processing and that can provide a basis to evaluate general behaviour and functioning. But it ought not to be forgotten that the use of such technologies is part of a human practice of neuroscience informed psychiatry. This paper notes some challenges in the integration of neural technologies into psychiatry and suggests vigilance particularly in respect to normative challenges. In this way, psychiatry can avoid a drift toward reductive technological approaches, while nonetheless benefitting from promising advances in neuroscience and technology.
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Affiliation(s)
- Stephen Rainey
- Oxford Uehiro Centre for Practical Ethics, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK.
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Pugh J. Clarifying the Normative Significance of 'Personality Changes' Following Deep Brain Stimulation. SCIENCE AND ENGINEERING ETHICS 2020; 26:1655-1680. [PMID: 32189235 PMCID: PMC7286862 DOI: 10.1007/s11948-020-00207-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/29/2020] [Indexed: 05/11/2023]
Abstract
There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self (PIAAAS). For example, some patients undergoing DBS for Parkinson's Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient's dispositional, emotional and behavioural states, in so far as dysfunctions in these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment.
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Affiliation(s)
- Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK.
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Desmoulin-Canselier S. DBS: a compelling example for ethical and legal reflection-a French perspective on ethical and legal concerns about DBS. Monash Bioeth Rev 2020; 38:15-34. [PMID: 32335863 DOI: 10.1007/s40592-020-00111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Deep brain stimulation (DBS) is an approved treatment for neurological diseases and a promising one for psychiatric conditions, which may produce spectacular results very quickly. It is also a powerful tool for brain research and exploration. Beyond an overview of the ethical and legal literature on this topic, this paper aims at showing that DBS is a compelling example for ethical-legal reflection, as it combines a highly technical surgical procedure, a complex active medical device and neuromodulation of the human brain to restore lost abilities caused by a chronic and evolving disease. Some of the ethical and legal issues raised by DBS are not specific, but shed new light on medical ethics and law. Others are more DBS-specific, as they are linked to the intricacies of research and treatment, to the need to tune the device, to the patients' control over the device and its effects and to the involvement of family caregivers.
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Affiliation(s)
- Sonia Desmoulin-Canselier
- NormaStim Program ANR14-CE30-0016, University of Nantes (UMR 6297 DCS), Nantes, France. .,Laboratoire Droit et Changement Social, UMR CNRS 6297: Faculté de Droit de Nantes, Chemin de la Censive du Tertre, BP 8130744 313, Nantes Cedex 3, France.
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Varelius J. Can self-validating neuroenhancement be autonomous? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:51-59. [PMID: 31144095 PMCID: PMC7039850 DOI: 10.1007/s11019-019-09905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Consider that an individual improves her capacities by neuroscientific means. It turns out that, besides altering her in the way(s) she intended, the enhancement also changes her personality in significant way(s) she did not foresee. Yet the person endorses her new self because the neuroenhancement she underwent changed her. Can the person's approval of her new personality be autonomous? While questions of autonomy have already gathered a significant amount of attention in philosophical literature on human enhancement, the problem just described-henceforth referred to as the question whether self-validating neuroenhancement can be autonomous-would not appear to have received due consideration. This article takes a step towards remedying the shortage. I start by explicating the main points of departure of its argument. In the subsequent sections of the article, I consider several possible reasons for deeming self-validating neuroenhancement incompatible with autonomy. On the basis of the consideration, I propose that self-validating neuroenhancement can be autonomous.
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Affiliation(s)
- Jukka Varelius
- Department of Philosophy, Contemporary History, and Political Science, University of Turku, 20014, Turku, Finland.
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Brown T. Building Intricate Partnerships with Neurotechnology: Deep Brain Stimulation and Relational Agency. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2020. [DOI: 10.3138/ijfab.13.1.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Deep Brain Stimulation (DBS) is an FDA-approved treatment for symptoms of motor disorders—with experimental use for psychiatric disorders. DBS, however, causes a variety of side effects. Moral philosophers question DBS’s influence on users’ experiences of authenticity, identity, and/or autonomy. These characterizations of DBS, however, may not make sense of how DBS complicates, rather than simply impedes or bolsters, users’ abilities to exercise agency. Empirical work exploring DBS users’ lived-experiences and feminist accounts of relational autonomy demonstrate that the issues users face are better characterized in terms of the user’s relationship to their stimulator, that is, in terms of “relational agency.”
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Gilbert F, Brown, Dasgupta, Martens, Klein, Goering. An Instrument to Capture the Phenomenology of Implantable Brain Device Use. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Zuk P, Lázaro-Muñoz G. DBS and Autonomy: Clarifying the Role of Theoretical Neuroethics. NEUROETHICS-NETH 2019; 14:83-93. [DOI: 10.1007/s12152-019-09417-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bigenwald A, Chambon V. Criminal Responsibility and Neuroscience: No Revolution Yet. Front Psychol 2019; 10:1406. [PMID: 31316418 PMCID: PMC6610327 DOI: 10.3389/fpsyg.2019.01406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022] Open
Abstract
Since the 1990's, neurolaw is on the rise. At the heart of heated debates lies the recurrent theme of a neuro-revolution of criminal responsibility. However, caution should be observed: the alleged foundations of criminal responsibility (amongst which free will) are often inaccurate and the relative imperviousness of its real foundations to scientific facts often underestimated. Neuroscientific findings may impact on social institutions, but only insofar as they also engage in a political justification of the changes being called for, convince populations, and take into consideration the ensuing consequences. Moreover, the many limits of neuroscientific tools call for increased vigilance when, if ever, using neuroscientific evidence in a courtroom. In this article, we aim at setting the basis for future sound debates on the contribution of neuroscience to criminal law, and in particular to the assessment of criminal responsibility. As such, we provide analytical tools to grasp the political and normative nature of criminal responsibility and review the current or projected use of neuroscience in the law, all the while bearing in mind the highly publicized question: can neuroscience revolutionize criminal responsibility? Answering this question implicitly requires answering a second question: should neuroscience revolutionize the institution of criminal responsibility? Answering both, in turn, requires drawing the line between science and normativity, revolution and dialogue, fantasies and legitimate hopes.
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Affiliation(s)
- Ariane Bigenwald
- Département de Philosophie, Université Paris I Panthéon Sorbonne, Paris, France
- Institut Jean Nicod (ENS – EHESS – CNRS), Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL University, Paris, France
| | - Valerian Chambon
- Institut Jean Nicod (ENS – EHESS – CNRS), Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL University, Paris, France
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Mosley PE, Robinson K, Coyne T, Silburn P, Breakspear M, Carter A. ‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09410-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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What we (Should) Talk about when we Talk about Deep Brain Stimulation and Personal Identity. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09396-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ferretti A, Ienca M. Enhanced Cognition, Enhanced Self? On Neuroenhancement and Subjectivity. JOURNAL OF COGNITIVE ENHANCEMENT 2018. [DOI: 10.1007/s41465-018-0109-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Cabrera LY, Brandt M, McKenzie R, Bluhm R. Comparison of philosophical concerns between professionals and the public regarding two psychiatric treatments. AJOB Empir Bioeth 2018; 9:252-266. [PMID: 30398397 DOI: 10.1080/23294515.2018.1512534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychiatric interventions are a contested area in medicine, not only because of their history of abuses, but also because their therapeutic goal is to affect emotions, thoughts, beliefs, and behaviors that are regarded as pathological. Because psychiatric interventions affect characteristics that seem central to who we are, they raise issues regarding identity, autonomy, and personal responsibility for one's own well-being. Our study addresses two questions: (1) Do the public and academic researchers understand the philosophical stakes of these technologies in the same way? Following from this, (2) to what extent does the specific type of psychiatric technology affect the issues these two groups raise? This study compares how ethical issues regarding neurosurgical and pharmaceutical psychiatric interventions are discussed among the public and in the professional community of academic medicine and bioethics. METHODS We analyzed (1) online public comments and (2) the medical and bioethics literature, comparing the discussions of pharmacological and neurosurgical interventions in psychiatry in each source. RESULTS Overall, the public discussed philosophical issues less frequently than academics. For the two types of psychiatric interventions, we found differences between the academic literature and public comments among all themes, except for personal responsibility. CONCLUSIONS These findings reveal some of the similarities and discrepancies in how philosophical issues associated with psychiatric treatments are discussed in professional circles and among the public. Further research into what causes these discrepancies is crucial.
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Affiliation(s)
- Laura Yenisa Cabrera
- a Center of Ethics and Humanities in the Life Sciences , Michigan State University , East Lansing , Michigan , USA
| | - Marisa Brandt
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA
| | - Rachel McKenzie
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA
| | - Robyn Bluhm
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA.,c Philosophy Department , Michigan State University , East Lansing , Michigan , USA
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Tbalvandany SS, Harhangi BS, Prins AW, Schermer MHN. Embodiment in Neuro-engineering Endeavors: Phenomenological Considerations and Practical Implications. NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9383-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pugh J, Pycroft L, Sandberg A, Aziz T, Savulescu J. Brainjacking in deep brain stimulation and autonomy. ETHICS AND INFORMATION TECHNOLOGY 2018; 20:219-232. [PMID: 30595661 PMCID: PMC6290799 DOI: 10.1007/s10676-018-9466-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
'Brainjacking' refers to the exercise of unauthorized control of another's electronic brain implant. Whilst the possibility of hacking a Brain-Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject's cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user's autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target's autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices.
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Affiliation(s)
- Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Laurie Pycroft
- Oxford Functional Neurosurgery, University of Oxford, Oxford, UK
| | - Anders Sandberg
- Future of Humanity Institute, University of Oxford, Oxford, UK
| | - Tipu Aziz
- Oxford Functional Neurosurgery, University of Oxford, Oxford, UK
| | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Viaña JNM, Gilbert F. Deep brain stimulation for people with Alzheimer's disease: Anticipating potential effects on the tripartite self. DEMENTIA 2018. [PMID: 29528701 DOI: 10.1177/1471301218761147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Memory dysfunction and cognitive impairments due to Alzheimer’s disease can affect the selfhood and identity of afflicted individuals, causing distress to both people with Alzheimer’s disease and their caregivers. Recently, a number of case studies and clinical trials have been conducted to determine the potential of deep brain stimulation as a therapeutic modality for people with Alzheimer’s disease. Some of these studies have shown that deep brain stimulation could induce flashbacks and stabilize or even improve memory. However, deep brain stimulation itself has also been attributed as a potential threat to identity and selfhood, especially when procedure-related adverse events arise. We anticipate potential effects of deep brain stimulation for people with Alzheimer’s disease on selfhood, reconciling information from medical reports, psychological, and sociological investigations on the impacts of deep brain stimulation or Alzheimer’s disease on selfhood. A tripartite model of the self that extends the scope of Rom Harré’s and Steve Sabat’s social constructionist framework was used. In this model, potential effects of deep brain stimulation for Alzheimer’s disease on Self 1 or singularity through use of first-person indexicals, and gestures of self-reference, attribution, and recognition; Self 2 or past and present attributes, knowledge of these characteristics, and continuity of narrative identity; and Self 3 or the relational and social self are explored. The ethical implications of potential effects of deep brain stimulation for Alzheimer’s disease on the tripartite self are then highlighted, focusing on adapting informed consent procedures and care provided throughout the trial to account for both positive and negative plausible effects on Self 1, Self 2, and Self 3.
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Affiliation(s)
- John Noel M Viaña
- Wicking Dementia Research and Education Centre, College of Health and Medicine; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science; Philosophy and Gender Studies Program, School of Humanities, College of Arts, Law, and Education, University of Tasmania, Hobart, Australia
| | - Frederic Gilbert
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science, University of Tasmania, Hobart, Australia
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Ienca M, Andorno R. Towards new human rights in the age of neuroscience and neurotechnology. LIFE SCIENCES, SOCIETY AND POLICY 2017; 13:5. [PMID: 28444626 PMCID: PMC5447561 DOI: 10.1186/s40504-017-0050-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/20/2017] [Indexed: 05/10/2023]
Abstract
Rapid advancements in human neuroscience and neurotechnology open unprecedented possibilities for accessing, collecting, sharing and manipulating information from the human brain. Such applications raise important challenges to human rights principles that need to be addressed to prevent unintended consequences. This paper assesses the implications of emerging neurotechnology applications in the context of the human rights framework and suggests that existing human rights may not be sufficient to respond to these emerging issues. After analysing the relationship between neuroscience and human rights, we identify four new rights that may become of great relevance in the coming decades: the right to cognitive liberty, the right to mental privacy, the right to mental integrity, and the right to psychological continuity.
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Affiliation(s)
- Marcello Ienca
- Institute for Biomedical Ethics, University of Basel, Bernouillstrasse 28, 4056, Basel, Switzerland.
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Haddow G, Harmon SHE, Gilman L. Implantable Smart Technologies (IST): Defining the 'Sting' in Data and Device. HEALTH CARE ANALYSIS 2017; 24:210-27. [PMID: 26646672 PMCID: PMC4987398 DOI: 10.1007/s10728-015-0309-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments.
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Affiliation(s)
- Gill Haddow
- Science, Technology and Innovation Studies, The University of Edinburgh, Edinburgh, UK.
| | - Shawn H E Harmon
- Edinburgh Law School, The University of Edinburgh, Edinburgh, UK
| | - Leah Gilman
- Science, Technology and Innovation Studies, The University of Edinburgh, Edinburgh, UK
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Beeker T, Schlaepfer TE, Coenen VA. Autonomy in Depressive Patients Undergoing DBS-Treatment: Informed Consent, Freedom of Will and DBS' Potential to Restore It. Front Integr Neurosci 2017; 11:11. [PMID: 28642690 PMCID: PMC5462943 DOI: 10.3389/fnint.2017.00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/22/2017] [Indexed: 12/17/2022] Open
Abstract
According to the World Health Organization, depression is one of the most common and most disabling psychiatric disorders, affecting at any given time approximately 325 million people worldwide. As there is strong evidence that depressive disorders are associated with a dynamic dysregulation of neural circuits involved in emotional processing, recently several attempts have been made to intervene directly in these circuits via deep brain stimulation (DBS) in patients with treatment-resistant major depressive disorder (MDD). Given the promising results of most of these studies, the rising medical interest in this new treatment correlates with a growing sensitivity to ethical questions. One of the most crucial concerns is that DBS might interfere with patients' ability to make autonomous decisions. Thus, the goal of this article is to evaluate the impact DBS presumably has on the capacity to decide and act autonomously in patients with MDD in the light of the autonomy-undermining effects depression has itself. Following the chronological order of the procedure, special attention will first be paid to depression's effects on patients' capacity to make use of their free will in giving valid Informed Consent. We suggest that while the majority of patients with MDD appear capable of autonomous choices, as it is required for Informed Consent, they might still be unable to effectively act according to their own will whenever acting includes significant personal effort. In reducing disabling depressive symptoms like anhedonia and decrease of energy, DBS for treatment resistant MDD thus rather seems to be an opportunity to substantially increase autonomy than a threat to it.
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Affiliation(s)
- Timo Beeker
- Department of Psychiatry and Psychotherapy, Medical School Brandenburg Theodor FontaneRüdersdorf, Germany
| | - Thomas E. Schlaepfer
- Department of Interventional Biological Psychiatry, Freiburg University Medical CenterFreiburg, Germany
- Medical Faculty, Freiburg UniversityFreiburg, Germany
| | - Volker A. Coenen
- Medical Faculty, Freiburg UniversityFreiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical CenterFreiburg, Germany
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de Haan S, Rietveld E, Stokhof M, Denys D. Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations. PLoS One 2017; 12:e0175748. [PMID: 28426824 PMCID: PMC5398533 DOI: 10.1371/journal.pone.0175748] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/30/2017] [Indexed: 11/19/2022] Open
Abstract
Does DBS change a patient's personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson's disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.
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Affiliation(s)
- Sanneke de Haan
- The Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Stokhof
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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Abstract
An integrated and principled neuroethics offers ethical guidelines able to transcend conventional and medical reliance on normality standards. Elsewhere we have proposed four principles for wise guidance on human transformations. Principles like these are already urgently needed, as bio- and cyberenhancements are rapidly emerging. Context matters. Neither "treatments" nor "enhancements" are objectively identifiable apart from performance expectations, social contexts, and civic orders. Lessons learned from disability studies about enablement and inclusion suggest a fresh way to categorize modifications to the body and its performance. The term "enhancement" should be broken apart to permit recognition of enablements and augmentations, and kinds of radical augmentation for specialized performance. Augmentations affecting the self, self-worth, and self-identity of persons require heightened ethical scrutiny. Reversibility becomes the core problem, not the easy answer, as augmented persons may not cooperate with either decommissioning or displacement into unaccommodating societies. We conclude by indicating how our four principles of self-creativity, nonobsolescence, empowerment, and citizenship establish a neuroethics beyond normal that is better prepared for a future in which humans and their societies are going so far beyond normal.
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Deep Brain Stimulation Through the “Lens of Agency”: Clarifying Threats to Personal Identity from Neurological Intervention. NEUROETHICS-NETH 2017. [DOI: 10.1007/s12152-016-9297-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moritz CT, Ruther P, Goering S, Stett A, Ball T, Burgard W, Chudler EH, Rao RPN. New Perspectives on Neuroengineering and Neurotechnologies: NSF-DFG Workshop Report. IEEE Trans Biomed Eng 2016; 63:1354-67. [PMID: 27008657 DOI: 10.1109/tbme.2016.2543662] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
GOAL To identify and overcome barriers to creating new neurotechnologies capable of restoring both motor and sensory function in individuals with neurological conditions. METHODS This report builds upon the outcomes of a joint workshop between the US National Science Foundation and the German Research Foundation on New Perspectives in Neuroengineering and Neurotechnology convened in Arlington, VA, USA, November 13-14, 2014. RESULTS The participants identified key technological challenges for recording and manipulating neural activity, decoding, and interpreting brain data in the presence of plasticity, and early considerations of ethical and social issues pertinent to the adoption of neurotechnologies. CONCLUSIONS The envisaged progress in neuroengineering requires tightly integrated hardware and signal processing efforts, advances in understanding of physiological adaptations to closed-loop interactions with neural devices, and an open dialog with stakeholders and potential end-users of neurotechnology. SIGNIFICANCE The development of new neurotechnologies (e.g., bidirectional brain-computer interfaces) could significantly improve the quality of life of people living with the effects of brain or spinal cord injury, or other neurodegenerative diseases. Focused efforts aimed at overcoming the remaining barriers at the electrode tissue interface, developing implantable hardware with on-board computation, and refining stimulation methods to precisely activate neural tissue will advance both our understanding of brain function and our ability to treat currently intractable disorders of the nervous system.
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Pickersgill M, Hogle L. Enhancement, ethics and society: towards an empirical research agenda for the medical humanities and social sciences. MEDICAL HUMANITIES 2015; 41:136-142. [PMID: 26260624 PMCID: PMC4717454 DOI: 10.1136/medhum-2015-010718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
For some time now, bioethicists have paid close attention to issues associated with 'enhancement'; specifically, the appropriate use and regulation of substances and artefacts understood by some to improve the functioning of human bodies beyond that associated with 'normal' function. Medical humanities scholars (aside from philosophers and lawyers) and social scientists have not been frequent participants in debates around enhancement, but could shine a bright light on the range of dilemmas and opportunities techniques of enhancement are purported to introduce. In this paper, we argue that empirical research into the notion and practice of enhancement is necessary and timely. Such work could fruitfully engage with-and further develop-existing conceptual repertoires within the medical humanities and social sciences in ways that would afford benefit to scholars in those disciplines. We maintain that empirical engagements could also provide important resources to bioethicists seeking to regulate new enhancements in ways that are sensitive to societal context and cultural difference. To this end, we outline an empirical agenda for the medical humanities and social sciences around enhancement, emphasising especially how science and technology studies could bring benefits to-and be benefitted by-research in this area. We also use the example of (pharmaceutical) cognitive enhancement to show how empirical studies of actual and likely enhancement practices can nuance resonant bioethical debates.
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Affiliation(s)
- Martyn Pickersgill
- Usher Institute for Population Health Sciences and Informatics, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Linda Hogle
- Department of Medical History and Bioethics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Unterrainer M, Oduncu FS. The ethics of deep brain stimulation (DBS). MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:475-485. [PMID: 25597042 DOI: 10.1007/s11019-015-9622-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Deep brain stimulation (DBS) is an invasive technique designed to stimulate certain deep brain regions for therapeutic purposes and is currently used mainly in patients with neurodegenerative disorders, such as Parkinson's disease. However, DBS is also used increasingly for other experimental applications, such as the treatment of psychiatric disorders (e.g. severe depression), weight reduction. Apart from its therapeutic potential, DBS can cause severe adverse effects, some that might also have a significant impact on the patient's personality and autonomy by the external stimulation of DBS which effects lie beyond the individual's control and free will. The article's purpose is to outline the procedures of DBS currently used in therapeutic and experimental applications and to discuss the ethical concerns regarding this procedure. It will address the clinical benefit-risk-ratio, the particular ethics of research in this field, and the ethical issues raised by affecting a patient's or an individual's personality and autonomous behaviour. Moreover, a potential ethical guideline, the Ulysses contract is discussed for the field of clinical application as well as the question of responsibility.
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Affiliation(s)
| | - Fuat S Oduncu
- Division of Hematology and Oncology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstrasse 1, 80336, Munich, Germany.
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Abstract
Novel ways to intervene on brain function raise questions about agency and responsibility. Here, I discuss whether direct brain interventions, and in particular, deep brain stimulation, pose a threat to agency in individual cases, or to our general conceptualization of what it is to be a responsible agent. While I do not currently see evidence that these interventions constitute a global challenge to our concept of agency, they do have the potential to diminish agency in individuals. I consider whether the lack of evidence for a global challenge ratifies our folk conceptions, or is a necessary consequence of them. In closing, I propose that our theoretical understanding of agency and our therapeutic approaches could be improved with a more nuanced, multidimensional view of agency.
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Affiliation(s)
- Adina L Roskies
- Department of Philosophy, Dartmouth College, Thornton Hall, Hanover, NH 03755, USA
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Bertolini A. Robotic prostheses as products enhancing the rights of people with disabilities. Reconsidering the structure of liability rules. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/13600869.2015.1055659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Moutaud B. Neuromodulation Technologies and the Regulation of Forms of Life: Exploring, Treating, Enhancing. Med Anthropol 2015. [DOI: 10.1080/01459740.2015.1055355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Our think tank tasked by the Dutch Health Council, consisting of Radboud University Nijmegen Honours Academy students with various backgrounds, investigated the implications of Deep Brain Stimulation (DBS) for psychiatric patients. During this investigation, a number of methodological, ethical and societal difficulties were identified. We consider these difficulties to be a reflection of a still fragmented field of research that can be overcome with improved organization and communication. To this effect, we suggest that it would be useful to found a centralized DBS organization. Such an organization makes it possible to 1) set up and maintain a repository, 2) facilitate DBS studies with a larger sample size, 3) improve communication amongst researchers, clinicians and ethical committees, and 4) improve communication between DBS experts and the public at large.
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Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:709-16. [DOI: 10.1016/j.parkreldis.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/03/2015] [Accepted: 04/13/2015] [Indexed: 01/10/2023]
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Harmon SH, Haddow G, Gilman L. New risks inadequately managed: the case of smart implants and medical device regulation. LAW, INNOVATION AND TECHNOLOGY 2015; 7:231-252. [PMID: 28058060 PMCID: PMC5207313 DOI: 10.1080/17579961.2015.1106107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many emerging technologies are associated with 'risk'. While the concept of risk is protean, it is usually conceived of as the potential of something damaging or harmful happening. Thus, risks are a primary target of many regulatory regimes. In this article, after articulating an understanding of risk, we assess the European medical devices regulatory regime from a risk perspective, focusing on its handling of 'smart' implantable medical devices. In doing so, we discuss the empirical evidence obtained from expert participants in the Implantable Smart Technologies Project, which evidence is framed around three risk typologies: materiality, geography and modality. We conclude that none of these risks are sufficiently addressed within the existing regime, which falls down not just from a standards perspective, but also from the perspective of transparency and balance.
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Affiliation(s)
| | - Gill Haddow
- School of Social and Political Science, University of Edinburgh,
Scotland, UK
| | - Leah Gilman
- School of Social and Political Science, University of Edinburgh,
Scotland, UK
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Glannon W. Philosophical reflections on therapeutic brain stimulation. Front Comput Neurosci 2014; 8:54. [PMID: 24860490 PMCID: PMC4030150 DOI: 10.3389/fncom.2014.00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/22/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Walter Glannon
- Department of Philosophy/Arts, University of Calgary Calgary, AB, Canada
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