Researchers’ Ethical Concerns About Using Adaptive Deep Brain Stimulation for Enhancement

Abstract

The capacity of next-generation closed-loop or adaptive deep brain stimulation devices (aDBS) to read (measure neural activity) and write (stimulate brain regions or circuits) shows great potential to effectively manage movement, seizure, and psychiatric disorders, and also raises the possibility of using aDBS to electively (non-therapeutically) modulate mood, cognition, and prosociality. What separates aDBS from most neurotechnologies (e.g. transcranial stimulation) currently used for enhancement is that aDBS remains an invasive, surgically-implanted technology with a risk-benefit ratio significantly different when applied to diseased versus non-diseased individuals. Despite a large discourse about the ethics of enhancement, no empirical studies yet examine perspectives on enhancement from within the aDBS research community. We interviewed 23 aDBS researchers about their attitudes toward expanding aDBS use for enhancement. A thematic content analysis revealed that researchers share ethical concerns related to (1) safety and security; (2) enhancement as unnecessary, unnatural or aberrant; and (3) fairness, equality, and distributive justice. Most (70%) researchers felt that enhancement applications for DBS will eventually be technically feasible and that attempts to develop such applications for DBS are already happening (particularly for military purposes). However, researchers unanimously (100%) felt that DBS ideally should not be considered for enhancement until researchers better understand brain target localization and functioning. While many researchers acknowledged controversies highlighted by scholars and ethicists, such as potential impacts on personhood, authenticity, autonomy and privacy, their ethical concerns reflect considerations of both gravity and perceived near-term likelihood.

The Ethical Views of Turkish Researchers and the Ethics Committees on Non-Invasive Brain Stimulation

“…The ndings suggest that these results are related to "concern about abuse" [21,23] and the lack of studies directly related to the topic. This attitude seems to be quite like the researchers' attitudes found both in Riggal et al survey research with tDCS researchers, and in Kostick-Quenetet al survey research regarding the enhancement use of NIBS with DBS researchers [3,24].…”

“…Researchers also emphasize that both the indication should be proven, and patients should be provided with accurate and adequate information in clinical groups. With this approach, we understand that Turkish researchers are also aware of the existence of serious challenging situations in clinical practice, such as patients having no other option despite informed consent [24,31,32], and that they consider the basic ethical and legal requirements [26,33] based on the risk and bene t as stated in international "guidelines".…”

Neuromodulation and memory: exploring ethical ramifications in memory modification treatment via implantable neurotechnologies

“…Some might argue that it could be in an agent’s best interests to modulate a traumatic episode albeit the latter might constitute a relevant building block of their identity that could lead the individual to live an inauthentic life and lose a fragment of his narrative ( Liao and Sandberg, 2008 ). For example, a degree of identity harm may be ethically permissible on the grounds of wellbeing or a transient effect of inauthenticity might be subjectively worth the alleviation from severe mental disorders ( Kostick-Quenet and Lázaro-Muñoz, 2021 ; Kostick-Quenet et al, 2022 ). However, granting ethical priority to certain values over others would not be imperative in these scenarios but would be contingent on a case-by-case basis.…”

Adapting Ourselves, Instead of the Environment: An Inquiry into Human Enhancement for Function and Beyond

“…They justify this claim of what we would call physiological embodiment with permanent access to these technologies. While the invasiveness of specific enhancements has significant ethical and usage-related implications (Haslam et al, 2021;Ireni-Saban & Sherman, 2021;Kostick-Quenet et al, 2022;Sattler & Pietralla, 2022;Scheske & Schnall, 2012;Whitman et al, 2018), the concept of Human Enhancement extends the limits of the skin. External technologies such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) are capable of (temporarily) enhancing performance-related abilities by altering internal bodily processes (Kim et al, 2019;Luber & Lisanby, 2014;Okano et al, 2015;Patel et al, 2021), and are thus physiologically embodied.…”