tDCS for Memory Enhancement: Analysis of the Speculative Aspects of Ethical Issues

Stakeholder perspectives on non-invasive brain stimulation

Non-invasive brain stimulation (NIBS) techniques such as transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) have made great progress in recent years and offer boundless potential for the neuroscientific research and treatment of disorders. However, the possible use of NIBS devices for neuro-doping and neuroenhancement in healthy individuals and the military are poorly regulated. The great potentials and diverse applications can have an impact on the future development of the technology and society. This participatory study therefore aims to summarize the perspectives of different stakeholder groups with the help of qualitative workshops. Nine qualitative on-site and virtual workshops were conducted in the study with 91 individuals from seven stakeholder groups: patients, students, do-it-yourself home users of tDCS, clinical practitioners, industry representatives, philosophers, and policy experts. The co-creative and design-based workshops were tailored to each group to document the wishes, fears, and general comments of the participants. The outlooks from each group were collected in written form and summarized into different categories. The result is a comprehensive overview of the different aspects that need to be considered in the field of NIBS. For example, several groups expressed the wish for home-based tDCS under medical supervision as a potential therapeutic intervention and discussed the associated technical specifications. Other topics that were addressed were performance enhancement for certain professional groups, training requirements for practitioners, and questions of agency, among others. This qualitative participatory research highlights the potential of tDCS and repetitive TMS as alternative therapies to medication, with fewer adverse effects and home-based use for tDCS. The ethical and societal impact of the abuse of NIBS for non-clinical use must be considered for policy-making and regulation implementations. This study adds to the neuroethical debate on the responsible use and application of NIBS technologies, taking into consideration the different perspectives of important stakeholders in the field.

Ethical Issues in Memory Modification Technology: A Scoping Review

Memory modification technology (MMT) refers to the use of neurotechnologies to intervene in memories. Many scholars have reflected on the ethical issues in MMT, but a comprehensive review of this topic has not been seen. This article presents the first scoping review study of ethical issues in MMT using a bibliometric and systematic approach. After thorough examination, 133 records of key literature are included in this scoping review. Six core ethical themes are extracted: (1) self, identity, and authenticity; (2) autonomy and informed consent; (3) welfare and happiness; (4) safety and risks; (5) responsibility and obligation; (6) social and legal justice. More detailed analyses are conducted on the moral stances and reasons held by different scholars concerning these ethical themes. As can be seen, current debates exhibit certain shortcomings, including ambiguous ethical concepts and a restricted scope of analysis. Therefore, we call for deeper reflections on the philosophical foundations, more precise definitions of ethical terms, and more comprehensive examinations of neurotechnological applications, in order to better address the ethical challenges in the future.

Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives

Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.

Probing the Promises of Noninvasive Transcranial Electrical Stimulation for Boosting Mental Performance in Sports

While the importance of physical abilities is noncontested to perform in elite sport, more focus has recently been turned toward cognitive processes involved in sport performance. Practicing any sport requires a high demand of cognitive functioning including, but not limited to, decision-making, processing speed, working memory, perceptual processing, motor functioning, and attention. Noninvasive transcranial electrical stimulation (tES) has recently attracted considerable scientific interest due to its ability to modulate brain functioning. Neuromodulation apparently improves cognitive functions engaged in sports performance. This opinion manuscript aimed to reveal that tES is likely an adjunct ergogenic resource for improving cognitive processes, counteracting mental fatigue, and managing anxiety in elite athletes. Nevertheless, the first evidence is insufficient to guarantee its real effectiveness and benefits. All tES techniques could be add-ons to make performance-related cognitive functions more efficient and obtain better results. Modulating inhibitory control through tES over the frontal cortex might largely contribute to the improvement of mental performance. Nevertheless, studies in elite athletes are required to assess the long-term effects of tES application as an ergogenic aid in conjunction with other training methods (e.g., neurofeedback, mental imagery) where cognitive abilities are trainable.

The ubiquity of the fallacy of composition in cognitive enhancement and in education

Research into cognitive enhancement is highly controversial, and arguments for and against it have failed to identify the logical fallacy underlying this debate: the fallacy of composition. The fallacy of composition is a lesser-known fallacy of ambiguity, but it has been explored and applied extensively to other fields, including economics. The fallacy of composition, which occurs when the characteristics of the parts of the whole are incorrectly extended to apply to the whole itself, and the conclusion is false, should be addressed in the debate on cognitive enhancement and within education. Within cognitive enhancement, the premise that individual distinct cognitive processes can be enhanced by cognitive enhancers leads to the conclusion that they must enhance cognition overall, and this idea is pervasive in the literature. If the goal of cognitive enhancement is to enhance cognition or learning, and not merely individual cognitive processes, then this is a clear example of the fallacy of composition. The ambiguity of "cognitive," "cognition," and "enhancement" only perpetuates this fallacy and creates more confusion surrounding the purposes and goals of enhancement. Identifying this fallacy does not threaten the existing body of research; however, it provides a novel framework to explore new avenues for research, education, and enhancement, particularly through education reform initiatives. Education enhances and facilitates learning, and improvements to education could be considered cognitive enhancements. Furthermore, the same fallacy is ubiquitous in education; educators commit it by "teaching to the test" and prioritizing memorization over generalizable skills such as critical thinking and problem solving. We will explore these new avenues for research and highlight principles of learning success from other disciplines to create a clearer understanding of the means and ends of cognitive enhancement. Recognizing the pervasiveness of composition fallacy in cognitive enhancement and education will lead to greater clarity of normative positions and insights into student learning that steer away from fallacious reasoning.

The public impact of academic and print media portrayals of TMS: shining a spotlight on discrepancies in the literature

Background

Transcranial magnetic stimulation (TMS) is an FDA approved treatment for major depression, migraine, obsessive compulsive disorder, and smoking addiction. TMS has gained popular media support, but media coverage and commercial reporting of TMS services may be contributing to the landscape of ethical issues.

Methods

We explore the differences between the academic and print media literature portrayals of TMS to evaluate their ethical impact for the public. We performed a comprehensive literature review using PubMed and NexisUni databases to evaluate the literature available on TMS from 2014 to 2019. Our sample consisted of 1632 academic articles and 468 print media articles for a total of 2100 articles. We then coded each article for seven specific top-level codes: (1) type of source, (2) year of publication, (3) purpose of TMS application, (4) age of subjects, (5) population, (6) overall tone, and (7) specification of TMS parameters. We also made some additional notes of the TMS parameters where specified and the breakdown of mental health applications.

Results

Our results indicated several discrepancies between the academic and the print media reporting about TMS technology, particularly with regards to tone and specificity. Namely, the academic sample was largely neutral and specific about the parameters under which TMS was being applied, while the print media sample was heavily optimistic and presented the application of TMS with far less specificity. There was some convergence between the two samples, such as the focus of both on therapy as the predominant TMS application.

Conclusions

We call upon the academic community to increase scrutiny of TMS services in order to ensure that people’s knowledge of health technologies is not unduly influenced by sensational claims and a general lack of adequate information.

Acceptability of Neuroscientific Interventions in Education

Researchers are increasingly applying neuroscience technologies that probe or manipulate the brain to improve educational outcomes. However, their use remains fraught with ethical controversies. Here, we investigate the acceptability of neuroscience applications to educational practice in two groups of young adults: those studying bioscience who will be driving future basic neuroscience research and technology transfer, and those studying education who will be choosing among neuroscience-derived applications for their students. Respondents rated the acceptability of six scenarios describing neuroscience applications to education spanning multiple methodologies, from neuroimaging to neuroactive drugs to brain stimulation. They did so from two perspectives (student, teacher) and for three recipient populations (low-achieving, high-achieving students, students with learning disabilities). Overall, the biosciences students were more favorable to all neuroscience applications than the education students. Scenarios that measured brain activity (i.e., EEG or fMRI) to assess or predict intellectual abilities were deemed more acceptable than manipulations of mental activity by drug use or stimulation techniques, which may violate body integrity. Enhancement up to the norm for low-achieving students and especially students with learning disabilities was more favorably viewed than enhancement beyond the norm for high-achieving students. Finally, respondents rated neuroscientific applications to be less acceptable when adopting the perspective of a teacher than that of a student. Future studies should go beyond the acceptability ratings collected here to delineate the role that concepts of access, equity, authenticity, agency and personal choice play in guiding respondents' reasoning.

Ethical Aspects of BCI Technology: What Is the State of the Art?

Brain–Computer Interface (BCI) technology is a promising research area in many domains. Brain activity can be interpreted through both invasive and non-invasive monitoring devices, allowing for novel, therapeutic solutions for individuals with disabilities and for other non-medical applications. However, a number of ethical issues have been identified from the use of BCI technology. In this paper, we review the academic discussion of the ethical implications of BCI technology in the last five years. We conclude that some emerging applications of BCI technology—including commercial ventures that seek to meld human intelligence with AI—present new and unique ethical concerns. Further, we seek to understand how academic literature on the topic of BCIs addresses these novel concerns. Similar to prior work, we use a limited sample to identify trends and areas of concern or debate among researchers and ethicists. From our analysis, we identify two key areas of BCI ethics that warrant further research: the physical and psychological effects of BCI technology. Additionally, questions of BCI policy have not yet become a frequent point of discussion in the relevant literature on BCI ethics, and we argue this should be addressed in future work. We provide guiding questions that will help ethicists and policy makers grapple with the most important issues associated with BCI technology.

A practical approach to the ethical use of memory modulating technologies

Background

Recent advancements in neuroscientific techniques have allowed us to make huge progress in our understanding of memories, and in turn has paved the way for new memory modification technologies (MMTs) that can modulate memories with a degree of precision, which was not previously possible. With advancements in such techniques, new and critical ethical questions have emerged. Understanding and framing these ethical questions within the current philosophical theories is crucial in order to systematically examine them as we translate these techniques to the clinic.

Main body

In this paper, we discuss the ethical implications of modern neuroscience techniques that aim to disrupt or enhance memories. We attempt to frame the MMTs in the context of existing ethical philosophical theories to provide a cohesive analysis of the myriad of ethical quagmires that might emerge from such technologies. We argue the application of Aristotle’s Golden Mean and multiple accounts of authenticity are useful in approaching the ethical questions surrounding MMTs. We then propose a framework in which ethical considerations can be systematically examined. Lastly, we provide caveats and considerations for the use of this framework. Overall, we provide a practical approach for the ethical use of MMTs depending on the situation.

Conclusion

While at face value, our model appears to put severe limitations on the application of MMTs, we are not completely opposed to their use, but rather our framework guides the agent to consider the implications before making any decisions. Most importantly, we argue that the use of MMTs does not reduce the responsibility of the initial decision, and the agent must accept the post-MMT self as the new “true self” regardless of the outcome. As the developmental trajectory of MMTs suggests we are getting closer to practical clinical applications, ethical concerns across a wide range of disciplines need to be addressed to develop best strategies and policies when dealing with MMTs. If this can be achieved, we believe the ethical use of MMTs is not only possible but would also be of tremendous benefit to many people suffering from memory-related mental disorders.

Prior cortical activity differences during an action observation plus motor imagery task related to motor adaptation performance of a coordinated multi-limb complex task

Motor adaptation is the ability to develop new motor skills that makes performing a consolidated motor task under different psychophysical conditions possible. There exists a proven relationship between prior brain activity at rest and motor adaptation. However, the brain activity at rest is highly variable both between and within subjects. Here we hypothesize that the cortical activity during the original task to be later adapted is a more reliable and stronger determinant of motor adaptation. Consequently, we present a study to find cortical areas whose activity, both at rest and during first-person virtual reality simulation of bicycle riding, characterizes the subjects who did and did not adapt to ride a reverse steering bicycle, a complex motor adaptation task involving all limbs and balance. The results showed that cortical activity differences during the simulated task were higher, more significant, spatially larger, and spectrally wider than at rest for good performers. In this sense, the activity of the left anterior insula, left dorsolateral and ventrolateral inferior prefrontal areas, and left inferior premotor cortex (action understanding hub of the mirror neuron circuit) during simulated bicycle riding are the areas with the most descriptive power for the ability of adapting the motor task. Trials registration Trial was registered with the NIH Clinical Trials Registry (clinicaltrials.gov), with the registration number NCT02999516 (21/12/2016).

Can a Soldier Say No to an Enhancing Intervention?

Technological advancements have provided militaries with the possibility to enhance human performance and to provide soldiers with better warfighting capabilities. Though these technologies hold significant potential, their use is not without cost to the individual. This paper explores the complexities associated with using human cognitive enhancements in the military, focusing on how the purpose and context of these technologies could potentially undermine a soldier’s ability to say no to these interventions. We focus on cognitive enhancements and their ability to also enhance a soldier’s autonomy (i.e., autonomy-enhancing technologies). Through this lens, we explore situations that could potentially compel a soldier to accept such technologies and how this acceptance could impact rights to individual autonomy and informed consent within the military. In this examination, we highlight the contextual elements of vulnerability—institutional and differential vulnerability. In addition, we focus on scenarios in which a soldier’s right to say no to such enhancements can be diminished given the special nature of their work and the significance of making better moral decisions. We propose that though in some situations, a soldier may be compelled to accept said enhancements; with their right to say no diminished, it is not a blanket rule, and safeguards ought to be in place to ensure that autonomy and informed consent are not overridden.