Neuroethics at 15: The Current and Future Environment for Neuroethics

Bioethics and Neurosurgery: An Overview of Existing and Emerging Topics for the Practicing Neurosurgeon

Neurosurgery is a field with complex ethical issues. In this article, we aim to provide an overview of key and emerging ethical issues in neurosurgery with a focus on issues relevant to practicing neurosurgeons. These issues include those of informed consent, capacity, clinical trials, emerging neurotechnology, innovation, equity and justice, and emerging bioethics areas including community engagement and organizational ethics. We argue that bioethics can help neurosurgeons think about and address these issues, and, in turn, the field of bioethics can benefit from engagement by neurosurgeons. Several ideas for increasing engagement in bioethics are proposed.

East Asian perspective of responsible research and innovation in neurotechnology

After more than half a century of research and development (R&D), Brain-computer interface (BCI)-based Neurotechnology continues to progress as one of the leading technologies of the 2020 s worldwide. Various reports and academic literature in Europe and the United States (U.S.) have outlined the trends in the R&D of neurotechnology and the consideration of ethical issues, and the importance of the formulation of ethical principles, guidance and industrial standards as well as the development of relevant human resources has been discussed. However, limited number studies have focused on neurotechnology R&D, the dissemination of neuroethics related to the academic foundation advancing the discussion on ethical principles, guidance and standards or human resource development in the Asian region. This study fills in this gap in understanding of Eastern Asian (China, Korea and Japan) situation based on the participation in activities to develop ethical principles, guidance, and industrial standards for appropriate use of neurotechnology, in addition to literature survey and clinical registries' search investigation reflecting the trends in neurotechnology R&D as well as its social implication in Asian region. The current study compared the results with the situation in Europa and the U.S. and discussed issues that need to be addressed in the future and discussed the significance and potential of corporate consortium initiatives in Japan and examples of ethics and governance activities in Asian Countries.

Ethical issues in direct-to-consumer healthcare: A scoping review

An increasing number of health products and services are being offered on a direct-to-consumer (DTC) basis. To date, however, scholarship on DTC healthcare products and services has largely proceeded in a domain-specific fashion, with discussions of relevant ethical challenges occurring within specific medical specialties. The present study therefore aimed to provide a scoping review of ethical issues raised in the academic literature across types of DTC healthcare products and services. A systematic search for relevant publications between 2011-2021 was conducted on PubMed and Google Scholar using iteratively developed search terms. The final sample included 86 publications that discussed ethical issues related to DTC healthcare products and services. All publications were coded for ethical issues mentioned, primary DTC product or service discussed, type of study, year of publication, and geographical context. We found that the types of DTC healthcare products and services mentioned in our sample spanned six categories: neurotechnology (34%), testing (20%), in-person services (17%), digital health tools (14%), telemedicine (13%), and physical interventions (2%). Ethical arguments in favor of DTC healthcare included improved access (e.g., financial, geographical; 31%), increased autonomy (29%), and enhanced convenience (16%). Commonly raised ethical concerns included insufficient regulation (72%), questionable efficacy and quality (70%), safety and physical harms (66%), misleading advertising claims (56%), and privacy (34%). Other frequently occurring ethical concerns pertained to financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Our findings offer insights into the cross-cutting ethical issues associated with DTC healthcare and underscore the need for increased interdisciplinary communication to address the challenges they raise.

One hundred years of neurosciences in the arts and humanities, a bibliometric review

BACKGROUND

Neuroscientific approaches have historically triggered changes in the conception of creativity and artistic experience, which can be revealed by noting the intersection of these fields of study in terms of variables such as global trends, methodologies, objects of study, or application of new technologies; however, these neuroscientific approaches are still often considered as disciplines detached from the arts and humanities. In this light, the question arises as to what evidence the history of neurotechnologies provides at the intersection of creativity and aesthetic experience.

METHODS

We conducted a century-long bibliometric analysis of key parameters in multidisciplinary studies published in the Scopus database. Screening techniques based on the PRISMA method and advanced data analysis techniques were applied to 3612 documents metadata from the years 1922 to 2022. We made graphical representations of the results applying algorithmic and clusterization processes to keywords and authors relationships.

RESULTS

From the analyses, we found a) a shift from a personality-focus quantitative analysis to a field-focus qualitative approach, considering topics such as art, perception, aesthetics and beauty; b) The locus of interest in fMRI-supported neuroanatomy has been shifting toward EEG technologies and models based on machine learning and deep learning in recent years; c) four main clusters were identified in the study approaches: humanistic, creative, neuroaesthetic and medical; d) the neuroaesthetics cluster is the most central and relevant, mediating between creativity and neuroscience; e) neuroaesthetics and neuroethics are two of the neologism that better characterizes the challenges that this convergence of studies will have in the next years.

CONCLUSIONS

Through a longitudinal analysis, we evidenced the great influence that neuroscience is having on the thematic direction of the arts and humanities. The perspective presented shows how this field is being consolidated and helps to define it as a new opportunity of great potential for future researchers.

Towards an understanding of global brain data governance: ethical positions that underpin global brain data governance discourse

Introduction

The study of the brain continues to generate substantial volumes of data, commonly referred to as "big brain data," which serves various purposes such as the treatment of brain-related diseases, the development of neurotechnological devices, and the training of algorithms. This big brain data, generated in different jurisdictions, is subject to distinct ethical and legal principles, giving rise to various ethical and legal concerns during collaborative efforts. Understanding these ethical and legal principles and concerns is crucial, as it catalyzes the development of a global governance framework, currently lacking in this field. While prior research has advocated for a contextual examination of brain data governance, such studies have been limited. Additionally, numerous challenges, issues, and concerns surround the development of a contextually informed brain data governance framework. Therefore, this study aims to bridge these gaps by exploring the ethical foundations that underlie contextual stakeholder discussions on brain data governance.

Method

In this study we conducted a secondary analysis of interviews with 21 neuroscientists drafted from the International Brain Initiative (IBI), LATBrain Initiative and the Society of Neuroscientists of Africa (SONA) who are involved in various brain projects globally and employing ethical theories. Ethical theories provide the philosophical frameworks and principles that inform the development and implementation of data governance policies and practices.

Results

The results of the study revealed various contextual ethical positions that underscore the ethical perspectives of neuroscientists engaged in brain data research globally.

Discussion

This research highlights the multitude of challenges and deliberations inherent in the pursuit of a globally informed framework for governing brain data. Furthermore, it sheds light on several critical considerations that require thorough examination in advancing global brain data governance.

The evolution of Big Data in neuroscience and neurology

Neurological diseases are on the rise worldwide, leading to increased healthcare costs and diminished quality of life in patients. In recent years, Big Data has started to transform the fields of Neuroscience and Neurology. Scientists and clinicians are collaborating in global alliances, combining diverse datasets on a massive scale, and solving complex computational problems that demand the utilization of increasingly powerful computational resources. This Big Data revolution is opening new avenues for developing innovative treatments for neurological diseases. Our paper surveys Big Data's impact on neurological patient care, as exemplified through work done in a comprehensive selection of areas, including Connectomics, Alzheimer's Disease, Stroke, Depression, Parkinson's Disease, Pain, and Addiction (e.g., Opioid Use Disorder). We present an overview of research and the methodologies utilizing Big Data in each area, as well as their current limitations and technical challenges. Despite the potential benefits, the full potential of Big Data in these fields currently remains unrealized. We close with recommendations for future research aimed at optimizing the use of Big Data in Neuroscience and Neurology for improved patient outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40537-023-00751-2.

Stakeholders' Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey

BACKGROUND

Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders' perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI).

METHODS

We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs.

RESULTS

Participants' ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies.

CONCLUSIONS

To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.

"They Are Invasive in Different Ways.": Stakeholders' Perceptions of the Invasiveness of Psychiatric Electroceutical Interventions

Medical interventions are usually categorized as "invasive" when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention.

Public attitudes towards neurotechnology: Findings from two experiments concerning Brain Stimulation Devices (BSDs) and Brain-Computer Interfaces (BCIs)

This study contributes to the emerging literature on public perceptions of neurotechnological devices (NTDs) in their medical and non-medical applications, depending on their invasiveness, framing effects, and interindividual differences related to personal needs and values. We conducted two web-based between-subject experiments (2×2×2) using a representative, nation-wide sample of the adult population in Germany. Using vignettes describing how two NTDs, brain stimulation devices (BSDs; NExperiment 1 = 1,090) and brain-computer interfaces (BCIs; NExperiment 2 = 1,089), function, we randomly varied the purpose (treatment vs. enhancement) and invasiveness (noninvasive vs. invasive) of the NTD, and assessed framing effects (variable order of assessing moral acceptability first vs. willingness to use first). We found a moderate moral acceptance and willingness to use BSDs and BCIs. Respondents preferred treatment over enhancement purposes and noninvasive over invasive devices. We also found a framing effect and explored the role of personal characteristics as indicators of personal needs and values (e.g., stress, religiosity, and gender). Our results suggest that the future demand for BSDs or BCIs may depend on the purpose, invasiveness, and personal needs and values. These insights can inform technology developers about the public's needs and concerns, and enrich legal and ethical debates.

Of Ethical Frameworks and Neuroethics in Big Neuroscience Projects: A View from the HBP

The recently published BRAIN 2.0 Neuroethics Report offers a very helpful overview of the possible ethical, social, philosophical, and legal issues raised by neuroscience in the context of BRAIN's research priorities thus contributing to the attempt to develop ethically sound neuroscience. In this article, we turn to a running theme of the document: the need for an ethical framework for the BRAIN Initiative and for further integration of neuroethics and neuroscience. We assess some of the issues raised and provide an explanation of how we have addressed them in the Human Brain Project. We offer our experience in the HBP as a potential contribution to the international debate about neuroethics in the big brain initiatives. Our hope is that among other things, the type of exchange proposed by this AJOB special issue will prove productive in further identifying and discussing the issues and in inspiring appropriate solutions.

Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities

Social distancing measures due to the COVID-19 pandemic have accelerated the adoption and implementation of digital mental health tools. Psychiatry and therapy sessions are being conducted via videoconferencing platforms, and the use of digital mental health tools for monitoring and treatment has grown. This rapid shift to telehealth during the pandemic has given added urgency to the ethical challenges presented by digital mental health tools. Regulatory standards have been relaxed to allow this shift to socially distanced mental health care. It is imperative to ensure that the implementation of digital mental health tools, especially in the context of this crisis, is guided by ethical principles and abides by professional codes of conduct. This paper examines key areas for an ethical path forward in this digital mental health revolution: privacy and data protection, safety and accountability, and access and fairness.