Note: this is a repost of an essay I wrote in 2020 for an NIH Neuroethics essay copmetition

Mind Over Matter: Neuroethical Considerations of Neurotechnology

🧠>⚡ NIH BRAIN Initiative Neuroethics essay by Claire Wang. (References below)

Neuroscientists are driven to understand a three-pound mass of neurons and glia pondering the morality and risks of studying themselves. Neuroethics is a broad field, yet evaluating the risks and benefits of brain-computer interfaces (BCIs) is a timely and critical topic due to the rapid development of technologies, including implants and wearables electronics. Here, I will focus on technologies that afford multidimensional biometric recordings through electrophysiological neural links which measure brain, skin, and heart activity alongside gesture and behavior tracking in human patients, such as invasive neural recordings from deep brain stimulation (DBS). As if from science fiction, procedures that involve surgical implantation of small wires that are precisely positioned in a patient’s brain are becoming increasingly common practice. These sensors record neuronal activity and allow modulation of physiological responses through synaptic potentiation or depression, giving researchers a mechanistic view of neuropsychiatric pathophysiology. However, this view alone is not enough to make any impactful decisions because a person is more than the sum of their neural activity. Given the incredible technological advances of the last decade, there is immense potential to change how we view concerns about patient autonomy, dependence, emotional and behavioral regulation, and ultimately, which disorders justify treatment with invasive surgery. If we can successfully resolve these neuroethical uncertainties, neurotechnology can revolutionize therapeutics for debilitating brain disorders.

There are a number of reasons that BCIs have long been considered a means of improving our lives. Golan Trevize, in Isaac Asimov’s “Foundation’s Edge”, connects with a BCI that allows him to smoothly pilot the ship. This fictionalized BCI is now a present day reality and these technologies have helped millions of patients manage a myriad of neurological diseases, most notably Parkinson’s disease (PD) and epilepsy, both of which have seen progressive improvements in treatments. And while we have also seen major improvements in treating psychiatric diseases, we must take a more inclusive view of the epistemology of human behavior in order to treat the full spectrum of neural pathologies. Furthermore, ongoing progress towards elective neurology and neural enhancement makes it important to consider the ethical implications of treating or enhancing individuals with BCIs and beyond.

While fictional, Asimov’s spaceship highlighted issues with BCI ownership. A critical neuroethical question is where to draw the line between a patient’s autonomy and the control that a neurotechnology exerts. The patient might be the obvious “owner” of the implant, but they are unable to control how it functions, without outside approval or help, and should they have the right to? As more corporations take interest in neurological technology, there is a rising trend towards company-owned implants. Currently, Neuralink is a company planning to release technology that even those without disorders can benefit from. Furthermore, who really owns the implant and who can decide the functionality of the implant remains to be established. Global neural communication can also pose serious risks to individual liberties, including emotional manipulation, data leaks, and reliance. These risks require society to determine regulations for technologies concurrent with their development.

Regulations are a crucial first step to ensuring ethical use of this technology. To begin, there should be standard methods to calculate the extent of stimulation. In PD, it is possible to calibrate stimulation based on the level of dopaminergic degeneration, but for mood disorders, not only is it unclear the required level of stimulation, all feedback is self-reported, making it exceedingly challenging to find a clear biomarker delimiting typical and atypical behaviors. What makes such treatment so risky is that the treatment becomes an integral facet of their life. The patient becomes more and more “dependent” on stimulation and their brain’s electrical tolerance for exogenous electrical stimulation increases. Just as many pharmaceutical drugs start out as viable medical treatments but lose effectiveness overtime, overzealous use of procedures or stimulation could result in a widespread epidemic of reliance on implants. Since neuroscientists have not fully reached an understanding of neuroplasticity, it is impossible to predict how DBS may affect a patient in the long term or make any models of the impact of the implant.

Given that implants hold the potential to not only stimulate but also measure brain activity highlights the concern that this information may be used for nefarious reasons. For example, in the Suthana Lab, I use deep brain implants to study patients with PTSD in order to inform stimulation approaches to treating their symptoms. This research can minimize patient suffering by regulating avoidance and other behaviors, which may prove to be instrumental in enabling these patients to live more complete lives. From the data collected, companies can make predictions about product releases and changes. There may even be surveys in the future where patients are asked to look at two images and their brain activity is measured to gauge the effectiveness of advertisements. In fact, researchers at UC Berkeley have already been able to use blood oxygenation data to reconstruct film clips that patients were watching, albeit unclearly. Implants may even soon be able to project images and sounds into their minds, raising a major ethical red flag.

If data usage remains unregulated, implants could be remotely controlled with rather simple stimulation protocols to influence emotional responses to lived experience. According to a survey of the 299 North American neurosurgeons, 56.8% found that it was ethical to apply mind-altering DBS to reduce the sex drive of sex offenders who request such an operation. This may seem acceptable, but in 1970, Dr. Robert Heath of Tulane University, utilized electrostimulation to convert a “homosexual and vagrant of many years” to “rightness.” Moreover, the patient was essentially forced to participate in the experiment or go to prison. While that blatant transgression of human rights is luckily now a thing of the past, patients are still stuck between a rock and a hard place. For these patients all other treatments have likely failed, so choosing to undergo implantation would put them at risk of exploitation.

In preparation for this neuro-technological revolution, we must preemptively consider these risks before the technology is developed in order to have ethics codes and contingencies in place. New discoveries in neurosurgical research can lead to great improvements for treating patients broadly, but measuring success based on whether or not someone can become phenotypically neurotypical is fundamentally flawed. We should not further stigmatize people for having a disorder by requiring an implant, and we should not discriminate against populations based on whether or not they have an enhancing stimulator or Neuralink installed.

References

Foster, C. G. (1991). Research ethics. Journal of Medical Ethics, 17(1), 45-45. doi:10.1136/jme.17.1.45; Pugh, “No going back? Reversibility and why it matters for deep brain stimulation” https://jme.bmj.com/content/45/4/225

Costandi, M., Moheb Costandi on Aug 2, 2, O., & Neuroscientist/writer. Author of Neuroplasticity (MIT Press. (2019, September 09). The Shocking Thing About the Brain. Retrieved October 31, 2020, from https://neo.life/2018/08/the-shocking-thing-about-the-brain/

The New Era of Neuromodulation, Virtual Mentor. 2015; 17(1):74-81. doi: 10.1001/virtualmentor.2015.17.1.oped2-1501.

Sonia Desmoulin-Canselier. Ethical and Legal Issues in Deep Brain Stimulation: An Overview. Neurological Disorders & Epilepsy Journal. 2018; 1(2):118 https://scientificliterature.org/Neurologicaldisorders/Neurologicaldisorders-18-118.pdf

Ishmael Bradley-24th, W. (2011, November 23). Ethical Considerations on the Use of Fear in Public Health Campaigns. Retrieved October 31, 2020, from https://www.clinicalcorrelations.org/2011/11/23/ethical-considerations-on-the-use-of-fear-in-public-health-campaigns/

Suthana, N., Aghajan, Z., Mankin, E., & Lin, A. (2018, November 19). Reporting Guidelines and Issues to Consider for Using Intracranial Brain Stimulation in Studies of Human Declarative Memory. Retrieved October 20, 2020, from https://www.frontiersin.org/articles/10.3389/fnins.2018.00905/full

Topalovic, U., Aghajan, Z., Villaroman, D., Hiller, S., Christov-Moore, L., Wishard, T., Suthana, N. (2020, September 17). Wireless Programmable Recording and Stimulation of Deep Brain Activity in Freely Moving Humans. https://www.sciencedirect.com/science/article/abs/pii/S0896627320306528?dgcid=coauthor

Spiegel, A. (2019, March 29). Deep Brain Stimulation: Remote Control Brain. https://www.npr.org/2019/03/29/707908959/deep-brain-stimulation-remote-control-brain

Asimov, I. (2004). Foundation’s Edge, Vol I-IV. New York, New York: Bantan Books.

Yasmin Anwar, M., & Anwar, Y. (2016, March 24). Scientists use brain imaging to reveal the movies in our mind. Retrieved from https://news.berkeley.edu/2011/09/22/brain-movies/

Horgan, J. (2017, October 13). Bizarre Brain-Implant Experiment Sought to “Cure” Homosexuality. Retrieved November 02, 2020, from https://blogs.scientificamerican.com/cross-check/bizarre-brain-implant-experiment-sought-to-cure-homosexuality/

Thanks

Thanks for reading! Please credit if you share or cite, my twitter is @clairebookworm1!