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Livanis E, Voultsos P, Vadikolias K, Pantazakos P, Tsaroucha A. Understanding the Ethical Issues of Brain-Computer Interfaces (BCIs): A Blessing or the Beginning of a Dystopian Future? Cureus 2024; 16:e58243. [PMID: 38745805 PMCID: PMC11091939 DOI: 10.7759/cureus.58243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
In recent years, scientific discoveries in the field of neuroscience combined with developments in the field of artificial intelligence have led to the development of a range of neurotechnologies. Advances in neuroimaging systems, neurostimulators, and brain-computer interfaces (BCIs) are leading to new ways of enhancing, controlling, and "reading" the brain. In addition, although BCIs were developed and used primarily in the medical field, they are now increasingly applied in other fields (entertainment, marketing, education, defense industry). We conducted a literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to provide background information about ethical issues related to the use of BCIs. Among the ethical issues that emerged from the thematic data analysis of the reviewed studies included questions revolving around human dignity, personhood and autonomy, user safety, stigma and discrimination, privacy and security, responsibility, research ethics, and social justice (including access to this technology). This paper attempts to address the various aspects of these concerns. A variety of distinct ethical issues were identified, which, for the most part, were in line with the findings of prior research. However, we identified two nuances, which are related to the empirical research on ethical issues related to BCIs and the impact of BCIs on international relationships. The paper also highlights the need for the cooperation of all stakeholders to ensure the ethical development and use of this technology and concludes with several recommendations. The principles of bioethics provide an initial guiding framework, which, however, should be revised in the current artificial intelligence landscape so as to be responsive to challenges posed by the development and use of BCIs.
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Affiliation(s)
- Efstratios Livanis
- Department of Accounting and Finance, University of Macedonia, Thessaloniki, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics) School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Konstantinos Vadikolias
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupoli, GRC
| | - Panagiotis Pantazakos
- Department of Philosophy, School of Philosophy, National and Kapodistrian University of Athens, Athens, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Alexandra Tsaroucha
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
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Boulingre M, Portillo-Lara R, Green RA. Biohybrid neural interfaces: improving the biological integration of neural implants. Chem Commun (Camb) 2023; 59:14745-14758. [PMID: 37991846 PMCID: PMC10720954 DOI: 10.1039/d3cc05006h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Implantable neural interfaces (NIs) have emerged in the clinic as outstanding tools for the management of a variety of neurological conditions caused by trauma or disease. However, the foreign body reaction triggered upon implantation remains one of the major challenges hindering the safety and longevity of NIs. The integration of tools and principles from biomaterial design and tissue engineering has been investigated as a promising strategy to develop NIs with enhanced functionality and performance. In this Feature Article, we highlight the main bioengineering approaches for the development of biohybrid NIs with an emphasis on relevant device design criteria. Technical and scientific challenges associated with the fabrication and functional assessment of technologies composed of both artificial and biological components are discussed. Lastly, we provide future perspectives related to engineering, regulatory, and neuroethical challenges to be addressed towards the realisation of the promise of biohybrid neurotechnology.
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Affiliation(s)
- Marjolaine Boulingre
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Roberto Portillo-Lara
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Rylie A Green
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
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King BJ, Read GJM, Salmon PM. Identifying risk controls for future advanced brain-computer interfaces: A prospective risk assessment approach using work domain analysis. APPLIED ERGONOMICS 2023; 111:104028. [PMID: 37148587 DOI: 10.1016/j.apergo.2023.104028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
Brain-computer interface (BCI) technologies are progressing rapidly and may eventually be implemented widely within society, yet their risks have arguably not yet been comprehensively identified, nor understood. This study analysed an anticipated invasive BCI system lifecycle to identify the individual, organisational, and societal risks associated with BCIs, and controls that could be used to mitigate or eliminate these risks. A BCI system lifecycle work domain analysis model was developed and validated with 10 subject matter experts. The model was subsequently used to undertake a systems thinking-based risk assessment approach to identify risks that could emerge when functions are either undertaken sub-optimally or not undertaken at all. Eighteen broad risk themes were identified that could negatively impact the BCI system lifecycle in a variety of unique ways, while a larger number of controls for these risks were also identified. The most concerning risks included inadequate regulation of BCI technologies and inadequate training of BCI stakeholders, such as users and clinicians. In addition to specifying a practical set of risk controls to inform BCI device design, manufacture, adoption, and utilisation, the results demonstrate the complexity involved in managing BCI risks and suggests that a system-wide coordinated response is required. Future research is required to evaluate the comprehensiveness of the identified risks and the practicality of implementing the risk controls.
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Affiliation(s)
- Brandon J King
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia.
| | - Gemma J M Read
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia; School of Health, University of the Sunshine Coast, Australia. https://twitter.com/gemma_read
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia. https://twitter.com/DrPaulSalmon
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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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Thompson K. Committing Crimes with BCIs: How Brain-Computer Interface Users can Satisfy Actus Reus and be Criminally Responsible. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09416-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Abstract
Brain-computer interfaces (BCIs) can enable communication for persons in severe paralysis including locked-in syndrome (LIS); that is, being unable to move or speak while aware. In cases of complete loss of muscle control, termed "complete locked-in syndrome," a BCI may be the only viable solution to restore communication. However, a widespread ignorance regarding quality of life in LIS, current BCIs, and their potential as an assistive technology for persons in LIS, needlessly causes a harmful situation for this cohort. In addition to their medical condition, these persons also face social barriers often perceived as more impairing than their physical condition. Through social exclusion, stigmatization, and frequently being underestimated in their abilities, these persons are being locked out in addition to being locked-in. In this article, we (1) show how persons in LIS are being locked out, including how key issues addressed in the existing literature on ethics, LIS, and BCIs for communication, such as autonomy, quality of life, and advance directives, may reinforce these confinements; (2) show how these practices violate the United Nations Convention on the Rights of Persons with Disabilities, and suggest that we have a moral responsibility to prevent and stop this exclusion; and (3) discuss the role of BCIs for communication as one means to this end and suggest that a novel approach to BCI research is necessary to acknowledge the moral responsibility toward the end users and avoid violating the human rights of persons in LIS.
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Kambouris ME, Markogiannakis A, Arabatzis M, Manoussopoulos Y, Kantzanou M, Velegraki A. Wireless electrostimulation: a new approach in combating infection? Future Microbiol 2017; 12:255-265. [DOI: 10.2217/fmb-2017-0157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Electrostimulation (ES), hitherto successfully employed in wound treatment, has shown potential in antimicrobial applications, suggesting its use as synergistic to or replacement of antibiotics. The differential susceptibility of pathogens and host tissue and organs to various ES modalities might allow selective use against specific infections. The use of ES is cheaper in terms of development/testing, routine application and environmental footprint. If extensive substitution of chemical compounds is achieved, the development of resistance might be reversed through negative selection. A promising setup of ES seems to be the noncontact current transfer, due to low amperage similar to innate bioelectricity, painlessness, simple logistics and low risk for treatment-caused infection.
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Affiliation(s)
| | | | - Michael Arabatzis
- Mycology Research Laboratory, Department of Microbiology, Medical School, National and Kapodistrian University of Athens 11527, Greece
| | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, National Retrovirus Reference Center, Medical School, National and Kapodistrian University of Athens 11527, Greece
| | - Aristea Velegraki
- Mycology Research Laboratory, Department of Microbiology, Medical School, National and Kapodistrian University of Athens 11527, Greece
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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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Brain-brain integration in 2035: metaphysical and ethical implications. JOURNAL OF INFORMATION COMMUNICATION & ETHICS IN SOCIETY 2015. [DOI: 10.1108/jices-10-2014-0042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this study is to think ahead into the year 2035 and reflect on the ethical implications of brain-to-brain linking.
Design/methodology/approach
– Philosophical argument.
Findings
– It is quite likely that the direction of technological research today is heading toward a closer integration of mind and machine in 2035. What is interesting is that the integration also makes mind-mind or brain-brain integration possible too. There is nothing in principle that would prevent hooking up more than one brain to a machine, or connecting two or more brains together to harness their processing power to tackle a very complicated task. If that happens, the whole notion of what it is to be an individual and a self will have to be rethought. I have offered a way in which that can be done: Instead of viewing the self as being contained in a closed space traditionally defined by the skin, the self can expand outside of the skin and merge temporarily with other selves too. This also has profound implications on the notion of privacy, especially on how it is conceptualized and justified.
Research limitations/implications
– This research is limited to theoretical argumentation only. It relies on the current empirical and scientific investigations that are going on at the moment and provide ethical reflections on them.
Practical implications
– We need to anticipate technological innovations to be more proactive in deliberating and formulating policy and ethical guidelines; otherwise, ethicists will just muse after the fact, implying that there is nothing further to be done.
Social implications
– Brain-to-brain linking has tremendous social implications, so is the ethical reflection on the issue.
Originality/value
– Argument purporting to show the specific content in ethical guidelines on brain-to-brain interlinking based on the metaphysics of the self that is directly implicated by the technology has not been done before, according to the author’s best knowledge.
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