Mapping the Landscape of Equitable Access to Advanced Neurotechnologies in Canada

Abstract

ABSTRACT:Geographic, social, political, and economic factors shape access to advanced neurotechnologies, yet little previous research has explored the barriers, enablers, and areas of opportunity for equitable and meaningful access for diverse patient communities across Canada. We applied a mixed-mode approach involving semi-structured interviews and rating scale questions to consult with 24 medical experts who are involved in the care of patients who undergo functional neurosurgery targeting the brain. Seven major themes emerged from the qualitative analysis: Health care system, Neurotechnology features, Patient demographics, Target condition features, Ethics, Upstream barriers and enablers, and Areas of opportunity. Descriptive statistics of the Likert-scale responses suggest that interviewees perceive a disparity between the imperative of access to advanced neurotechnologies for people living in rural and remote areas and the likelihood of achieving such access. The results depict a complex picture of access to functional neurosurgery in Canada with pockets of excellence and a motivation to improve the availability of care for vulnerable populations through the expansion of distributed care models, improved health care system efficiencies, increasing funding and support for patient travel, and increasing awareness about and advocacy for advanced neurotechnologies.

Neuro-Abilities and a Good Life

“…Topics discussed under neuroethics in recent times ranged from dealing with "existing sexist and androcentric biases within neuroscientific research" [53] and the ethics of neuroscience [54] to invasive neurotechnologies [55] and that ethics has to be included in neuro-engineering education [56]. Ethics in general has recently been covered in relation to neuro-advancements, for example, in regard to the use of neurotechnologies in education [57], human enhancement [58][59][60], equitable access to neurotechnologies [61], diversity of stakeholders [62], and socially aligned networks [63]. A recent study interviewing DIY neurohackers found the following motivations for DIY neurohacking: "In short, neurohackers might simultaneously seek to manage a physical or psychological condition and to experiment with implants that open doors, pay bills or give them new senses.…”

Ethical Imperatives for Working With Diverse Populations in Digital Research

“…Digital technologies have the capacity to ameliorate or compensate for existing racial, geographic, and socioeconomic disparities. For instance, appropriately deployed and supported telemedicine can improve the management of chronic disease and access to specialist consultations for people in rural or low-mobility populations [ 9 , 35 ]. Efforts to ameliorate racial bias in the accuracy of wearables such as pulse-oximeter accuracy, for example, require recruiting a diverse population during test and validation research [ 26 ].…”

“…For example, genomics research with indigenous communities has long been held to pose special risks to individuals and communities alike and requires enhanced protocols for collaboration, cultural competency, transparency, and community capacity building [5]. Neuroscience research has followed suit as perspectives on the brain and mind extend well beyond western concepts [6,7], and equitable access to translational interventions remains unrealized [8][9][10]. Collaborative approaches to research, including participatory action methods toward the cocreation of studies and knowledge sharing have been developed in response.…”

Neuromodulation and Opioid Use Disorder: Ethical Opportunities for Canada

“…16,17 With a worsening opioid crisis worldwide, there is an imperative to explore all promising treatments for opioid use disorder (OUD), and with the disproportionate burden among marginalised communities, understanding the ethics of implementation is a critical task to ensure that accessibility and equity, alongside cultural meaningfulness, are at the forefront of discussions. [19][20][21] Here, we examine the current state of the science and ethical considerations of neuromodulation for OUD as a case study. We focus on DBS, rTMS, transcranial direct current stimulation (tDCS) and percutaneous electrical stimulation (BRIDGE) because of evidence of their early applications in Europe and Asia, as well as their growing availability in Canada.…”