The Effects of Closed-Loop Brain Implants on Autonomy and Deliberation: What are the Risks of Being Kept in the Loop?

Gilbert, Frédéric; O’Brien, Terence J.; Cook, Mark

doi:10.1017/s0963180117000640

Cited by 42 publications

(17 citation statements)

References 28 publications

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“…Further neuroethical research is needed more than ever, especially in a context where novel generation of DBS systems including closed-loop, artificially intelligent implants, and brain-computer interfaces are being developed. [78][79][80][81][82][83][84][85] Whether or not these emerging neurotechnologies will affect PIAAAS is still uncharted territory.…”

Section: Resultsmentioning

confidence: 99%

Deflating the “DBS causes personality changes” bubble

2018

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The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention putative DBS-induced changes to patients' postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS.

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Section: Resultsmentioning

confidence: 99%

Deflating the “DBS causes personality changes” bubble

2018

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“…With respect to "intelligent" BCI systems, there is currently a debate on whether (and if so to which degree) keeping humans, whether the users themselves or others (for example a therapist), "in the loop" may help to preserve accountability and strengthen the autonomy of the subject in such systems. 90 Using opaque, black-box algorithms for online data analysis in hybrid VR-EEG/ VR-BCI systems could create similar problems of accountability that would be particularly precarious if such systems are developed (and marketed) for medical use. This again poses a challenge to regulatory bodies to closely scrutinize the transparency of such systems and develop rules and guidelines for the necessary levels of algorithmic transparency, perhaps adapted to the potential medical risks of any particular clinical application.…”

Section: Accountability Of "Intelligent" Closed-loop Vr Systems: Keepmentioning

confidence: 99%

Neurophilosophical and Ethical Aspects of Virtual Reality Therapy in Neurology and Psychiatry

Kellmeyer¹

2018

Camb Q Healthc Ethics

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Highly immersive virtual reality (VR) systems have been introduced into the consumer market in recent years. The improved technological capabilities of these systems as well as the combination with biometric sensors, for example electroencephalography (EEG), in a closed-loop hybrid VR-EEG, opens up a range of new potential medical applications. This article first provides an overview of the past and current clinical applications of VR systems in neurology and psychiatry and introduces core concepts in neurophilosophy and VR research (such as agency, trust, presence, and others). Then, important adverse effects of highly immersive VR simulations and the ethical implications of standalone and hybrid VR systems for therapy in neurology and psychiatry are highlighted. These new forms of VR-based therapy may strengthen patients in exercising their autonomy. At the same time, however, these emerging systems present ethical challenges, for example in terms of moral and legal accountability in interactions involving "intelligent" hybrid VR systems. A user-centered approach that is informed by the target patients' needs and capabilities could help to build beneficial systems for VR therapy.

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“…Two studies published after the completion of our data collection and review, specifically by Gilbert et al, questioned users with implanted BCIs for the treatment of epilepsy. These studies yielded valuable insights regarding control and self-perception [92] as well as autonomy and deliberation processes [93]. This step would be crucial in working to close the research gap outlined above.…”

Section: Discussionmentioning

confidence: 99%

Using brain-computer interfaces: a scoping review of studies employing social research methods

Kögel¹,

Schmid²,

Jox³

et al. 2019

BMC Med Ethics

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Background The rapid expansion of research on Brain-Computer Interfaces (BCIs) is not only due to the promising solutions offered for persons with physical impairments. There is also a heightened need for understanding BCIs due to the challenges regarding ethics presented by new technology, especially in its impact on the relationship between man and machine. Here we endeavor to present a scoping review of current studies in the field to gain insight into the complexity of BCI use. By examining studies related to BCIs that employ social research methods, we seek to demonstrate the multitude of approaches and concerns from various angles in considering the social and human impact of BCI technology. Methods For this scoping review of research on BCIs’ social and ethical implications, we systematically analyzed six databases, encompassing the fields of medicine, psychology, and the social sciences, in order to identify empirical studies on BCIs. The search yielded 73 publications that employ quantitative, qualitative, or mixed methods. Results Of the 73 publications, 71 studies address the user perspective. Some studies extend to consideration of other BCI stakeholders such as medical technology experts, caregivers, or health care professionals. The majority of the studies employ quantitative methods. Recurring themes across the studies examined were general user opinion towards BCI, central technical or social issues reported, requests/demands made by users of the technology, the potential/future of BCIs, and ethical aspects of BCIs. Conclusions Our findings indicate that while technical aspects of BCIs such as usability or feasibility are being studied extensively, comparatively little in-depth research has been done on the self-image and self-experience of the BCI user. In general there is also a lack of focus or examination of the caregiver’s perspective. Electronic supplementary material The online version of this article (10.1186/s12910-019-0354-1) contains supplementary material, which is available to authorized users.

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The Effects of Closed-Loop Brain Implants on Autonomy and Deliberation: What are the Risks of Being Kept in the Loop?

Abstract: Neuroethics Now welcomes articles addressing the ethical application of neuroscience in research and patient care, as well as its impact on society.

Cited by 42 publications

References 28 publications

Deflating the “DBS causes personality changes” bubble

Deflating the “DBS causes personality changes” bubble

Neurophilosophical and Ethical Aspects of Virtual Reality Therapy in Neurology and Psychiatry

Using brain-computer interfaces: a scoping review of studies employing social research methods

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