When actions are mediated by means of a brain-computer interface, it seems that we cannot assess whether the user is culpable for the ac- tion without determining whether the brain-computer interface correctly decoded the intentions of the user. Here I argue that this requirement is confused. I also argue that, at least for the purposes of assessing moral culpability, BCI-mediated action should be viewed on the model of action mediated by ordinary (albeit complex) tools.

Connecting human minds to various technological devices and applications through brain-computer interfaces (BCIs) affords intriguingly novel ways for humans to engage and interact with the world. Not only do BCIs play an important role in restorative medicine, they are also increasingly used outside of medical or therapeutic contexts (e.g., gaming or mental state monitoring). A striking peculiarity of BCI technology is that the kind of actions it enables seems to differ from paradigmatic human actions, because, effects in (...) the world are brought about by devices such as robotic arms, prosthesis, or other machines, and their execution runs through a computer directed by brain signals. In contrast to usual forms of action, the sequence does not need to involve bodily or muscle movements at all. A motionless body, the epitome of inaction, might be acting. How do theories of action relate to such BCI-mediated forms of changing the world? We wish to explore this question through the lenses of three perspectives on agency: subjective experience of agency, philosophical action theory, and legal concepts of action. Our analysis pursues three aims: First, we shall discuss whether and which BCI-mediated events qualify as actions, according to the main concepts of action in philosophy and law. Secondly, en passant, we wish to highlight the ten most interesting novelties or peculiarities of BCI-mediated movements. Thirdly, we seek to explore whether these novel forms of movement may have consequences for concepts of agency. More concretely, we think that convincing assessments of BCI-movements require more fine-grained accounts of agency and a distinction between various forms of control during movements. In addition, we show that the disembodied nature of BCI-mediated events causes troubles for the standard legal account of actions as bodily movements. In an exchange with views from philosophy, we wish to propose that the law ought to reform its concept of action to include some, but not all, BCI-mediated events and sketch some of the wider implications this may have, especially for the venerable legal idea of the right to freedom of thought. In this regard, BCIs are an example of the way in which technological access to yet largely sealed-off domains of the person may necessitate adjusting normative boundaries between the personal and the social sphere. (shrink)

The brain–computer interface (BCI) has made remarkable progress in the bridging the divide between the brain and the external environment to assist persons with severe disabilities caused by brain impairments. There is also continuing philosophical interest in BCIs which emerges from thoughtful reflection on computers, machines, and artificial intelligence. This article seeks to apply BCI perspectives to examine, challenge, and work towards a possible resolution to a persistent problem in the mind–body relationship, namely dualism. The original (...) humanitarian goals of BCIs and the technological inventiveness result in BCIs being surprisingly useful. We begin from the neurologically impaired person, the problems encountered, and some pioneering responses from computers and machines. Secondly, the interface of mind and brain is explored via two points of clarification: direct and indirect BCIs, and the nature of thoughts. Thirdly, dualism is beset by mind–body interaction difficulties and is further questioned by the phenomena of intentions, interactions, and technology. Fourthly, animal minds and robots are explored in BCI settings again with relevance for dualism. After a brief look at other BCIs, we conclude by outlining a future BCI philosophy of brain and mind, which might appear ominous and could be possible. (shrink)

A brain-computer interface is a rapidly evolving neurotechnology connecting the human brain with a computer. In its classic form, brain activity is recorded and used to control external devices like protheses or wheelchairs. Thus, BCI users act with the power of their thoughts. While the initial development has focused on medical uses of BCIs, non-medical applications have recently been gaining more attention, for example in automobiles, airplanes, and the entertainment context. However, the attitudes of the (...) general public towards BCIs have hardly been explored. Among the general population in Germany aged 18–65 years, a representative online survey with 20 items was conducted in summer 2018 and analysed by descriptive statistics. The survey assessed: affinity for technology; previous knowledge and experience concerning BCIs; the attitude towards ethical, social and legal implications of BCI use and demographic information. Our results indicate that BCIs are a unique and puzzling way of human–machine interaction. The findings reveal a positive view and high level of trust in BCIs on the one hand but on the other hand a wide range of ethical and anthropological concerns. Agency and responsibility were clearly attributed to the BCI user. The participants’ opinions were divided regarding the impact BCIs have on humankind. In summary, a high level of ambivalence regarding BCIs was found. We suggest better information of the public and the promotion of public deliberation about BCIs in order to ensure responsible development and application of this potentially disruptive technology. (shrink)

Brain-computer interfaces (BCIs) are being investigated as an access pathway to communication for individuals with physical disabilities, as the technology obviates the need for voluntary motor control. However, to date, minimal research has investigated the use of BCIs for children. Traditional BCI communication paradigms may be suboptimal given that children with physical disabilities may face delays in cognitive development and acquisition of literacy skills. Instead, in this study we explored emotional state as an alternative access pathway to (...) communication. We developed a pediatric BCI to identify positive and negative emotional states from changes in hemodynamic activity of the prefrontal cortex (PFC). To train and test the BCI, 10 neurotypical children aged 8–14 underwent a series of emotion-induction trials over four experimental sessions (one offline, three online) while their brain activity was measured with functional near-infrared spectroscopy (fNIRS). Visual neurofeedback was used to assist participants in regulating their emotional states and modulating their hemodynamic activity in response to the affective stimuli. Child-specific linear discriminant classifiers were trained on cumulatively available data from previous sessions and adaptively updated throughout each session. Average online valence classification exceeded chance across participants by the last two online sessions (with 7 and 8 of the 10 participants performing better than chance, respectively, in Sessions 3 and 4). There was a small significant positive correlation with online BCI performance and age, suggesting older participants were more successful at regulating their emotional state and/or brain activity. Variability was seen across participants in regards to BCI performance, hemodynamic response, and discriminatory features and channels. Retrospective offline analyses yielded accuracies comparable to those reported in adult affective BCI studies using fNIRS. Affective fNIRS-BCIs appear to be feasible for school-aged children, but to further gauge the practical potential of this type of BCI, replication with more training sessions, larger sample sizes, and end-users with disabilities is necessary. (shrink)

Brain–computer interfacing (BCI) aims at directly capturing brain activity in order to enable a user to drive an application such as a wheelchair without using peripheral neural or motor systems. Low signal to noise ratio’s, low processing speed, and huge intra- and inter-subject variability currently call for the addition of intelligence to the applications, in order to compensate for errors in the production and/or the decoding of brain signals. However, the combination of minds and machines through (...) BCI’s and intelligent devices (IDs) can affect a user’s sense of agency. Particularly confusing cases can arise when the behavioral control switches implicitly from user to ID. I will suggest that in such situations users may be insecure about the extent to which the resulting behavior, whether successful or unsuccessful, is genuinely their own. Hence, while performing an action, a user of a BCI–ID may be uncertain about being the agent of the act. Several cases will be examined and some implications for (legal) responsibility (e.g. establishing the presence of a ‘guilty mind’) are discussed. (shrink)

The article shows where the argument of responsibility-gap regarding brain-computer interfaces acquires its plausibility from, and suggests why the argument is not plausible. As a way of an explanation, a distinction between the descriptive third-person perspective and the interpretative first-person perspective is introduced. Several examples and metaphors are used to show that ascription of agency and responsibility does not, even in simple cases, require that people be in causal control of every individual detail involved in an event. Taking (...) up the current debate on liability in BCI use, the article provides and discusses some rules that should be followed when potentially harmful BCI-based devices are brought from the laboratory into everyday life. (shrink)

A brain-computer interface designed to restore motor function detects neural activity related to intended movement and thereby enables a person to control an external device, for example, a robotic limb, or even their own body. It would seem legitimate, therefore, to describe a BCI as a system that translates thought into action. This paper argues that present BCI-mediated behavior fails to meet the conditions of intentional physical action as proposed by causal and non-causal theories of action. First, according (...) to the causal theory of action physical actions are bodily movements that are causally related to a person’s intentions. It can be argued, however, that the proximate cause of action in present BCI-mediated behavior is not the person’s intention, and that the behavior fails to meet the conditions of reliability, sensitivity and difference-making. Second, BCI-mediated behavior can be accommodated by a Volitionist account of action if we can equate imagining movement with trying to move. The argument presented is that the novelty, and limited functionality and sensory feedback of present BCIs challenges this equation. (shrink)

Neural devices have the capacity to enable users to regain abilities lost due to disease or injury – for instance, a deep brain stimulator (DBS) that allows a person with Parkinson’s disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies’ capacity to maintain or restore their capabilities, the neuroethics literature is replete (...) with examples of concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person’s brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issue – responsibility, privacy, authenticity, or trust – selectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an “Agency Map” which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual’s experience of agency. (shrink)

Can one be fooled into believing that one intended an action that one in fact did not intend? Past experimental paradigms have demonstrated that participants, when provided with false perceptual feedback about their actions, can be fooled into misperceiving the nature of their intended motor act. However, because veridical proprioceptive/perceptual feedback limits the extent to which participants can be fooled, few studies have been able to answer our question and induce the illusion to intend. In a novel paradigm addressing this (...) question, participants were instructed to move a line on the computer screen by use of a phony brain–computer interface. Line movements were actually controlled by computer program. Demonstrating the illusion to intend, participants reported more intentions to move the line when it moved frequently than when it moved infrequently. Consistent with ideomotor theory, the finding illuminates the intimate liaisons among ideomotor processing, the sense of agency, and action production. (shrink)

Brain-computer interfaces (BCIs) are devices primarily intended to allow agents to use prosthetic body parts, wheelchairs, and other mechanisms by forming intentions or performing certain mental actions. In this paper I illustrate how the use of BCIs leads to two unique and unrecognized problems of moral luck. In short, it seems that agents who depend upon BCIs for bodily movement or the use of other mechanisms (henceforth “BCI-agents”) may end up deserving of blame and legal punishment more so (...) than standard counterparts simply due to factors beyond their control. My aim is to explore whether we can avoid the implication that BCI-agents are subject to these unique sources of moral luck. In doing so I offer a number of possible solutions and then defend one of these solutions as the best. As it turns out, the solution I defend addresses both problems of moral luck at once and has broader implications for theorizing about moral luck as well as the epistemic condition on moral responsibility. (shrink)

An ongoing debate in the philosophy of action concerns the prevalence of moral luck: instances in which an agent’s moral responsibility is due, at least in part, to factors beyond his control. I point to a unique problem of moral luck for agents who depend upon Brain Computer Interfaces (BCIs) for bodily movement. BCIs may misrecognize a voluntarily formed distal intention (e.g., a plan to commit some illicit act in the future) as a control command to perform some (...) overt behavior now. If so, then BCI-agents may be deserving of punishment for the unlucky but foreseeable outcomes of their voluntarily formed plans, whereas standard counterparts who abandon their plans are not. However, it seems that the only relevant difference between BCI-agents and their standard counterparts is just a matter of luck. I briefly sketch different solutions that attempt to avoid this type of moral luck, while remaining agnostic on whether any succeeds. If none of these solutions succeeds, then there may be a unique type of moral luck that is unavoidable with respect to deserving punishment for certain BCI-mediated behaviors. (shrink)

The problem of deviant causal chains is a classic challenge in the philosophy of action. According to the causal theory of action (CTA), an event qualifies as an action if it is caused by the agent’s intention. In cases of deviant causal chains, this condition is met, but the agent loses control of the situation. To address this, theorists suggest that the intention must cause the action “in the right way”. However, defining what constitutes the “right way” is difficult, as (...) the distinction between having and not having control can be subtle. In this paper, I demonstrate that brain-computer interfaces (BCIs) provide important insights into basic causal deviance. I examine how existing strategies might account for deviant causation in BCI use and highlight their challenges. I advocate for reliability strategies—approaches that focus on identifying which causal pathways reliably connect an agent’s intentions to their outcomes. Additionally, I compare two BCIs that differ in their sources of occasional malfunction. I argue that the presence of causal deviance in a given case depends on the boundaries of the system that enables action. Such boundary analysis is unnecessary for bodily movements; however, for basic actions performed through a machine, it becomes essential. (shrink)

Brain-Computer Interface (BCI) research and (future) applications raise important ethical issues that need to be addressed to promote societal acceptance and adequate policies. Here we report on a survey we conducted among 145 BCI researchers at the 4th International BCI conference, which took place in May–June 2010 in Asilomar, California. We assessed respondents’ opinions about a number of topics. First, we investigated preferences for terminology and definitions relating to BCIs. Second, we assessed respondents’ expectations on the marketability of (...) different BCI applications (BCIs for healthy people, BCIs for assistive technology, BCIs-controlled neuroprostheses and BCIs as therapy tools). Third, we investigated opinions about ethical issues related to BCI research for the development of assistive technology: informed consent process with locked-in patients, risk-benefit analyses, team responsibility, consequences of BCI on patients’ and families’ lives, liability and personal identity and interaction with the media. Finally, we asked respondents which issues are urgent in BCI research. (shrink)

BackgroundThe neurotechnology behind brain-computer interfaces (BCIs) raises various ethical questions. The ethical literature has pinpointed several issues concerning safety, autonomy, responsibility and accountability, psychosocial identity, consent, privacy and data security. This study aims to assess BCI users’ experiences, self-observations and attitudes in their own right and looks for social and ethical implications.MethodsWe conducted nine semi-structured interviews with BCI users, who used the technology for medical reasons. The transcribed interviews were analyzed according to the Grounded Theory coding method.ResultsBCI users (...) perceive themselves as active operators of a technology that offers them social participation and impacts their self-definition. Each of these aspects bears its own opportunities and risks. BCIs can contribute to retaining or regaining human capabilities. At the same time, BCI use contains elements that challenge common experiences, for example when the technology is in conflict with the affective side of BCI users. The potential benefits of BCIs are regarded as outweighing the risks in that BCI use is considered to promote valuable qualities and capabilities. BCI users appreciate the opportunity to regain lost capabilities as well as to gain new ones.ConclusionsBCI users appreciate the technology for various reasons. The technology is highly appreciated in cases where it is beneficial in terms of agency, participation and self-definitions. Rather than questioning human nature, the technology can retain and restore characteristics and abilities which enrich our lives. (shrink)

Intelligent neurotechnology is an emerging field that combines neurotechnologies like brain-computer interface (BCI) with artificial intelligence. This paper introduces a capability framework to assess the responsible use of intelligent BCI systems and provide practical ethical guidance. It proposes two tests, the threshold and flourishing tests, that BCI applications must meet, and illustrates them in a series of cases. After a brief introduction (Section 1), Section 2 sets forth the capability view and the two tests. It illustrates the threshold (...) test using examples from clinical medicine of BCI applications that enable patients with profound disabilities to function at a threshold level through computer mediation. Section 3 illustrates the flourishing test by exploring possible future applications of BCI involving neuroenhancements for healthy people, using examples adapted from research currently underway in the US military. Section 3 applies a capability lens to a complex case involving dual effects, both therapeutic and non-therapeutic, showing how the threshold and flourishing tests resolve the case. Section 4 replies to three objections: neurorights are the best tool for assessing BCI; the two tests are moving targets; and the analysis utilizes a capability view to do work it is not designed for. The paper concludes that a capability view offers unique advantages and gives practical guidance for evaluating the responsible use of present and future BCI applications. Extrapolating from our analysis may help guide other emerging technologies, such as germline gene editing, expected to impact central human capabilities. (shrink)

Technologies controlled directly by the brain are being developed, evolving based on insights gained from neuroscience, and rehabilitative medicine. Besides neuro-controlled prosthetics aimed at restoring function lost somehow, technologies controlled via brain-computer interfaces (BCIs) may also extend a user’s horizon of action, freed from the need for bodily movement. Whilst BCI-mediated action ought to be, on the whole, treated as conventional action, law and policy ought to be amended to accommodate BCI action by broadening the definition of (...) action as “willed bodily movement”. Moreover, there are some dimensions of BCI mediated action that are significantly different to conventional cases. These relate to control. Specifically, to limits in both controllability of BCIs via neural states, and in foreseeability of outcomes from such actions. In some specific type of case, BCI-mediated action may be due to different ethical evaluation from conventional action. (shrink)

Neural engineers and clinicians are starting to translate advances in electrodes, neural computation, and signal processing into clinically useful devices to allow control of wheelchairs, spellers, prostheses, and other devices. In the process, large amounts of brain data are being generated from participants, including intracortical, subdural and extracranial sources. Brain data is a vital resource for BCI research but there are concerns about whether the collection and use of this data generates risk to privacy. Further, the nature of (...) BCI research involves understanding and making inferences about device users’ mental states, thoughts, and intentions. This, too, raises privacy concerns by providing otherwise unavailable direct or privileged access to individuals mental lives. And BCI-controlled prostheses may change the way clinical care is provided and the type of physical access caregivers have to patients. This, too, has important privacy implications. I In this chapter we examine several of these privacy concerns in light of prominent views of the nature and value of privacy. We argue that increased scrutiny needs to be paid to privacy concerns arising from Big Data and decoding of mental states, but that BCI research may also provide opportunity for individuals to enhance their privacy. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large (...) number of subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

A co-actor’s intentionality has been suggested to be a key modulating factor for joint action effects like the joint Simon effect (JSE). However, in previous studies intentionality has often been confounded with agency defined as perceiving the initiator of an action as being the causal source of the action. The aim of the present study was to disentangle the role of agency and intentionality as modulating factors of the JSE. In Experiment 1, participants performed a joint go/nogo Simon task next (...) to a co-actor who either intentionally controlled a response button with own finger movements (agency+/intentionality+) or who passively placed the hand on a response button that moved up and down on its own as triggered by computer signals (agency-/intentionality-). In Experiment 2, we included a condition in which participants believed that the co-actor intentionally controlled the response button with a Brain-Computer Interface while placing the response finger clearly besides the response button, so that the causal relationship between agent and action effect was perceptually disrupted (agency-/intentionality+). As a control condition, the response button was computer controlled while the co-actor placed the response finger besides the response button (agency-/intentionality-). We observed a JSE when the co-actor responded intentionally and the causal relationship between co-actor and action effect could be perceived, but not when the co-actor did not respond intentionally and the causal relationship was disrupted (Experiment 1). When the intentionality of the co-actor was maintained but the perception of the causal relationship between co-actor and action effect destroyed, the JSE was absent (Experiment 2). Our findings clearly indicate a vital role of a co-actor’s agency for the JSE and suggest that the ascription of agency is strongly perceptually grounded. (shrink)

Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these (...) challenges and make recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices. (shrink)

Brain–computer interfacing technologies are used as assistive technologies for patients as well as healthy subjects to control devices solely by brain activity. Yet the risks associated with the misuse of these technologies remain largely unexplored. Recent findings have shown that BCIs are potentially vulnerable to cybercriminality. This opens the prospect of “neurocrime”: extending the range of computer-crime to neural devices. This paper explores a type of neurocrime that we call brain-hacking as it aims at the (...) illicit access to and manipulation of neural information and computation. As neural computation underlies cognition, behavior and our self-determination as persons, a careful analysis of the emerging risks of malicious brain-hacking is paramount, and ethical safeguards against these risks should be considered early in design and regulation. This contribution is aimed at raising awareness of the emerging risk of malicious brain-hacking and takes a first step in developing an ethical and legal reflection on those risks. (shrink)

Brain Computer Interfaces (BCIs) enable one to control peripheral ICT and robotic devices by processing brain activity on-line. The potential usefulness of BCI systems, initially demonstrated in rehabilitation medicine, is now being explored in education, entertainment, intensive workflow monitoring, security, and training. Ethical issues arising in connection with these investigations are triaged taking into account technological imminence and pervasiveness of BCI technologies. By focussing on imminent technological developments, ethical reflection is informatively grounded into realistic protocols (...) of brain-to-computer communication. In particular, it is argued that human-machine adaptation and shared control distinctively shape autonomy and responsibility issues in current BCI interaction environments. Novel personhood issues are identified and analyzed too. These notably concern (i) the “sub-personal” use of human beings in BCI-enabled cooperative problem solving, and (ii) the pro-active protection of personal identity which BCI rehabilitation therapies may afford, in the light of so-called motor theories of thinking, for the benefit of patients affected by severe motor disabilities. (shrink)

In a recent article, Jecker and Ko propose that a capabilities approach can be useful as an ethical framework for evaluating the use of BCI applications. Jecker and Ko defend this application, in part, because a capabilities list is not necessarily unchanging, but can account for rapid enhancements in human abilities. In this commentary, I argue that, though the capabilities approach is provisional, its primary relevance for BCI emerges from the ways in which capabilities remain constant amidst changing human abilities.

Rainey et al. (forthcoming) discuss the complications that arise with assigning responsibility for brain computer interface (BCI)-mediated actions. Because BCI-mediated actions can differ from non-BCI-mediated actions in terms of control and foreseeability, the authors suggest that our ethical and legal evaluation of these actions may differ in important ways. While we take no issue with the authors’ discussion or conclusion, we also recognize the difficulty of grappling with the relationship between control, foreseeability, and moral responsibility practices, even without (...) the additional complications introduced by BCI-mediation. In this commentary, we therefore consider BCI-mediated action against the backdrop of a different--perhaps less murky--normative framework: blame. (shrink)

Moral issues arise not only when neural technology directly influences and affects people’s lives, but also when the impact of its interventions indirectly conceptualizes the mind in new, and unexpected ways. It is the case that theories of consciousness, theories of subjectivity, and third person perspective on the brain provide rival perspectives addressing the mind. Through a review of these three main approaches to the mind, and particularly as applied to an “extended mind”, the paper identifies a major area (...) of transformation in philosophy of action, which is understood in terms of additional epistemic devices—including a legal perspective of regulating the human–machine interaction and a personality theory of the symbiotic connection between human and machine. I argue this is a new area of concern within philosophy, which will be characterized in terms of self-objectification, which becomes “alienation” following Ernst Kapp’s philosophy of technology. The paper argues that intervening in the brain can affect how we conceptualize the mind and modify its predicaments. (shrink)

Developments in neurotechnology took a leap forward with the demonstration of the first Brain to Brain Interface (BBI). BBIs enable direct communication between two brains via a Brain Computer Interface (BCI) and bypasses the peripheral nervous system. This discovery promises new possibilities for future battlefield technology. As battlefield technology evolves, it is more likely to place greater demands on future soldiers. Future soldiers are more likely to process large amounts of data derived from an extensive networks (...) of humans and machines. This raises several ethical and philosophical concerns. This paper will look at BBI technology in current stages of research, future BBI applications in the military and how the potential use of BBIs in military operations challenges the way we understand the concept of responsibility. In this paper, I propose that an individual connected to a BBI ought not to be held fully responsible for her actions. The justification for this proposition is based on three key points such as an individual connected to a BBI does not have the ability to act freely, has a diminished sense of self-agency and may not be able to demonstrate authenticity of the thoughts and memories generated when connected to the interface. (shrink)

A brain-computer interface technology that can decode the neural signals associated with attempted but unarticulated speech could offer a future efficient means of communication for people with severe motor impairments. Recent demonstrations have validated this approach. Here we assume that it will be possible in future to decode imagined (i.e., attempted but unarticulated) speech in people with severe motor impairments, and we consider the characteristics that could maximize the social utility of a BCI for communication. As a social (...) interaction, communication involves the needs and goals of both speaker and listener, particularly in contexts that have significant potential consequences. We explore three high-consequence legal situations in which neurally-decoded speech could have implications:Testimony, where decoded speech is used as evidence;Consent and Capacity, where it may be used as a means of agency and participation such as consent to medical treatment; andHarm, where such communications may be networked or may cause harm to others. We then illustrate how design choices might impact the social and legal acceptability of these technologies. (shrink)

Abstract:Brain–computer interfaces (BCIs) can enable communication for persons in severe paralysis including locked-in syndrome (LIS); that is, being unable to move or speak while aware. In cases of complete loss of muscle control, termed “complete locked-in syndrome,” a BCI may be the only viable solution to restore communication. However, a widespread ignorance regarding quality of life in LIS, current BCIs, and their potential as an assistive technology for persons in LIS, needlessly causes a harmful situation for this cohort. (...) In addition to their medical condition, these persons also face social barriers often perceived as more impairing than their physical condition. Through social exclusion, stigmatization, and frequently being underestimated in their abilities, these persons are being locked out in addition to being locked-in. In this article, we (1) show how persons in LIS are being locked out, including how key issues addressed in the existing literature on ethics, LIS, and BCIs for communication, such as autonomy, quality of life, and advance directives, may reinforce these confinements; (2) show how these practices violate the United Nations Convention on the Rights of Persons with Disabilities, and suggest that we have a moral responsibility to prevent and stop this exclusion; and (3) discuss the role of BCIs for communication as one means to this end and suggest that a novel approach to BCI research is necessary to acknowledge the moral responsibility toward the end users and avoid violating the human rights of persons in LIS. (shrink)

To assess—from a qualitative perspective—the perceptions and attitudes of Spanish rehabilitation professionals (e.g. rehabilitation doctors, speech therapists, physical therapists) about Brain–Computer Interface (BCI) technology. A qualitative, exploratory and descriptive study was carried out by means of interviews and analysis of textual content with mixed generation of categories and segmentation into frequency of topics. We present the results of three in-depth interviews that were conducted with Spanish speaking individuals who had previously completed a survey as part of a larger, (...) 3-country/language, survey on BCI perceptions. 11 out of 15 of these Spanish respondents (survey) either strongly or somewhat accept the use of BCI in rehabilitation therapy. However, the results of our three in-depth interviews show how, due to a strong inertia of attitudes and perceptions about BCI technology, most professionals feel reluctant to use BCI technology in their daily practice (interview). (shrink)

Brain-Computer Interface is a set of technologies that are of increasing interest to researchers. BCI has been proposed as assistive technology for individuals who are non-communicative or paralyzed, such as those with amyotrophic lateral sclerosis or spinal cord injury. The technology has also been suggested for enhancement and entertainment uses, and there are companies currently marketing BCI devices for those purposes as well as health-related purposes. The unprecedented direct connection created by BCI between human brains and computer (...) hardware raises various ethical, social, and legal challenges that merit further examination and discussion. To identify and characterize the key issues associated with BCI use, we performed a scoping review of biomedical ethics literature, analyzing the ethics concerns cited across multiple disciplines, including philosophy and medicine. Based on this investigation, we report that BCI research and its potential translation to therapeutic intervention generate significant ethical, legal, and social concerns, notably with regards to personhood, stigma, autonomy, privacy, research ethics, safety, responsibility, and justice. Our review of the literature determined, furthermore, that while these issues have been enumerated extensively, few concrete recommendations have been expressed. We conclude that future research should focus on remedying a lack of practical solutions to the ethical challenges of BCI, alongside the collection of empirical data on the perspectives of the public, BCI users, and BCI researchers. (shrink)

Since the 1960s, scientists, engineers, and healthcare professionals have developed brain–computer interface (BCI) technologies, connecting the user’s brain activity to communication or motor devices. This new technology has also captured the imagination of publics, industry, and ethicists. Academic ethics has highlighted the ethical challenges of BCIs, although these conclusions often rely on speculative or conceptual methods rather than empirical evidence or public engagement. From a social science or empirical ethics perspective, this tendency could be considered problematic and (...) even technocratic because of its disconnect from publics. In response, our trinational survey (Germany, Canada, and Spain) reports public attitudes toward BCIs (N = 1,403) on ethical issues that were carefully derived from academic ethics literature. The results show moderately high levels of concern toward agent-related issues (e.g., changing the user’s self) and consequence-related issues (e.g., new forms of hacking). Both facets of concern were higher among respondents who reported as female or as religious, while education, age, own and peer disability, and country of residence were associated with either agent-related or consequence-related concerns. These findings provide a first look at BCI attitudes across three national contexts, suggesting that the language and content of academic BCI ethics may resonate with some publics and their values. (shrink)

I use a hypothetical case study of a woman who replaces here biological arms with prostheses controlled through a brain–computer interface the explore how a BCI might interpret and misinterpret intentions. I define pre-veto intentions and post-veto intentions and argue that a failure of a BCI to differentiate between the two could lead to some troubling legal and ethical problems.

This abstract presents a novel brain-computer interface (BCI) framework to control a prosthetic leg, for the rehabilitation of patients suffering from locomotive disorders, using functional near-infrared spectroscopy (fNIRS). fNIRS signals corresponding to walking intention and rest are used to initiate and stop the gait cycle and a nonlinear proportional derivative computed torque controller (PD-CTC) with gravity compensation is used to control torques of hip and knee joints for minimization of position error. The brain signals of walking intention (...) and rest tasks are acquired from primary motor cortex in the left hemisphere for nine subjects. After acquiring brain signals, in order to remove motion artifacts and physiological noises, the performance of six different filters i.e. Kalman, Wiener, Gaussian, hemodynamic response filter (hrf), Band-pass and finite impulse response, is evaluated. Afterwards, six different features are extracted from oxygenated hemoglobin signals and their different combinations were used for classification. The classification performance of five different classifiers i.e. artificial neural network, quadratic discriminant analysis, linear discriminant analysis (LDA), Naïve Bayes and support vector machine (SVM) is used. The classification accuracies obtained from SVM using hrf filter are significantly higher (p < 0.005) than the other combinations of classifier and filters. These accuracies are 77.5%, 72.5%, 68.3%, 74.2%, 73.3%, 80.8%, 65%, 76.7%, and 86.7% for all nine subjects. The control commands generated using classifier initiate and stop the gait cycle of the prosthetic leg whose knee and hip torques are controlled using PD-CTC to minimize position error. The proposed scheme can be effectively used for neurofeedback training and rehabilitation of lower limb amputation of paralyzed patients. (shrink)

In research involving patients with implantable brain–computer interfaces (BCIs), there is a regulatory gap concerning post-trial responsibilities and duties of sponsors and investigators towards implanted patients. In this article, we analyse the case of patient R, who underwent non-voluntary explantation of an implanted BCI, causing a discontinuation in her sense of agency and self. To clarify the post-trial duties and responsibilities involved in this case, we first define the ontological status of the BCI using both externalist (EXT) (...) and internalist (INT) theories of cognition. We then give particular focus to the theories of extended and embedded cognition, hence considering the BCI either as a constitutive component of the patient’s mind or as a causal supporter of her brain-based cognitive capacities. We argue that patient R can legitimately be considered both as an embedded and extended cognitive agent. Then, we analyse whether the non-voluntary explantation violated patient R’s (neuro)rights to cognitive liberty, mental integrity, psychological continuity and mental privacy. We analyse whether and how different mental ontologies may imply morally relevant differences in interpreting these prima facie neurorights violations and the correlational duties of sponsors and investigators. We conclude that both mental ontologies support the identification of emerging neurorights of the patient and give rise to post-trial obligations of sponsors and investigators to provide for continuous technical maintenance of implanted BCIs that play a significant role in patients’ agency and sense of self. However, we suggest that externalist mental ontologies better capture patient R’s self-conception and support the identification of a more granular form of mental harm and associated neurorights violation, thus eliciting stricter post-trial obligations. (shrink)

Brain-computer interfaces allow agents to control computers without moving their bodies. The agents imagine certain things and the brain-computer interfaces read the concomitant neural activity and operate the computer accordingly. But the use of brain-computer interfaces is problematic for criminal law, which requires that someone can only be found criminally responsible if they have satisfied the actus reus requirement: that the agent has performed some (suitably specified) conduct. Agents who affect the world using (...) brain-computer interfaces do not obviously perform any conduct, so when they commit crimes using brain-computer interfaces it is unclear how they have satisfied actus reus. Drawing on a forthcoming paper by Allan McCay, I suggest three potential accounts of the conduct that satisfies actus reus: the agent’s neural firings, his mental states, and the electronic activity in his brain-computer interface. I then present two accounts which determine how actus reus may be satisfied – one a counterfactual and the other a minimal sufficiency account. These accounts are lent plausibility because they are analogous to the but-for and NESS (Necessary Element in a Sufficient Set) tests for causation which are generally accepted tests for causation in legal theory. I argue that due to the determinations of these accounts and considerations regarding the relationship between the mind and brain, actus reus is satisfied by either the agent’s neural activity or brain-computer interface electrical activity. Which of these satisfies actus reus is determined by how well the brain-computer interface is functionally integrated with the agent. (shrink)

This Master’s thesis explores the relationship between Brain-Computer Interfaces (BCIs) and their human users from a functional, epistemological and phenomenological perspective. The analysis has four steps. I start out with a technical description of BCI systems in which I conceptually analyze different types of BCI applications. This results in the development of a taxonomy of applications which is the point of departure for further philosophical analysis. Thereafter, I explore the functional relationship between BCI applications and their users. That (...) is to say, I analyze functions of BCI applications, relate them to abilities of their users and explore how they extend these abilities. After that, the epistemological relation between BCI systems and their users is conceptualized by analyzing how they contribute to cognitive processes of their users, which is done by using the distributed cognition framework. And lastly, a postphenomenological framework is adapted to investigate how BCIs mediate the experiences of their users. This thesis ends with a reflection in which (1) possible developments in BCI research are placed in a broader historical-anthropological perspective, and (2) a moral consideration is given on the desirability of BCIs. (shrink)

Brain-computer interfaces (BCIs) are an emerging and converging technology that translates the brain activity of its user into command signals for external devices, ranging from motorized wheelchairs, robotic hands, environmental control systems, and computer applications. In this paper I functionally decompose BCI systems and categorize BCI applications with similar functional properties into three categories, those with (1) motor, (2) virtual, and (3) linguistic applications. I then analyse the relationship between these distinct BCI applications and their users (...) from an epistemological and phenomenological perspective. Specifically, I analyse functional properties of BCIs in relation to the abilities (particularly motor behaviour and communication) of their human users, asking how they may or may not extend these abilities. This includes a phenomenological analysis of whether BCIs are experienced as transparent extensions. Contrary to some recent philosophical claims, I conclude that, although BCIs have the potential to become bodily as well as cognitive extensions for skilled users, at this stage they are not. And while the electrodes and signal processor may to a variable degree be transparent and incorporated, the BCI system as a whole is not. Contemporary BCIs are difficult to use. Most systems only work in highly controlled laboratory settings, require a high amount of training and concentration, have very limited control options, have low and variable information transfer rates, and effector motions are often slow, clumsy and sometimes unsuccessful. These drawbacks considerably limit their possibilities for transparency and incorporation into either the body schema or cognitive system which is essential for bodily and cognitive extension. Current BCIs can therefore only be seen as a weak or metaphorical extension of the human central nervous system. To increase their potential for cognitive extension, I give suggestions for improving the interface design of what I refer to as linguistic applications. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability (...) to enact intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

New brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome, characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics (...) committees should be aware of and prepared to handle ethical issues unique to these totally locked-in patients. Several thought experiments are discussed, to highlight potential ethical dilemmas surrounding surrogate decision-making, autonomy, end-of-life care, and pediatric care, which will be unique to total LIS patients. These, along with other ethical problems especially relevant to total LIS patients, merit further discussion among physicians, researchers, ethicists and hospital ethics committees, to facilitate consensus regarding these issues, and improve patient care. (shrink)

Resumen Las interfaces cerebro-computadora (ICCs) son tecnologías que proveen herramientas para la comunicación entre el ser humano y las computadoras. Dado que las nuevas técnicas asociadas a ICCs podrían influir en la autorregulación emocional, la memoria autobiográfica, el sentido del yo, la identidad, la autonomía, la autenticidad y las atribuciones de responsabilidad presentan importantes objeciones éticas. Entender las consecuencias a largo plazo de estas nuevas tecnologías puede ser difícil. Por lo tanto, los aspectos éticos vinculados a las ICCs necesitan ser (...) continuamente revisados a la par de los avances técnicos en el área. El personalismo ontológicamente fundado se ha formalizado como un camino de reflexión que tiene como referencia una antropología que defiende el valor de la vida física corpórea, la relación libertad-responsabilidad y la adecuada interacción individuo y sociedad y brinda pautas éticas que permitan formular normas de conducta acordes con la dignidad de la persona humana. Por lo tanto, en este artículo se aplican los principios de la bioética personalista al ámbito de las ICCs, de modo tal de dar directrices generales para la acción que puedan contribuir a elaborar un juicio ético acerca del desarrollo y uso de estas neurotecnologías. Abstract Brain-computer interfaces (BCIs) are technologies that provide tools for communication between humans and computers. Since the new techniques associated with BCIs could influence emotional self-regulation, autobiographical memory, sense of self, identity, autonomy, authenticity, and attributions of responsibility present important ethical objections. Understanding the long-term consequences of these innovative technologies can be difficult. Therefore, the ethical aspects linked to BCIs need to be continuously reviewed in line with technical advances in the area. Ontologically grounded personalism has been formalized as a path of reflection that has as its reference an anthropology that defends the value of corporeal physical life, the relationship between freedom and responsibility, and the appropriate interaction between the individual and society. This approach provides ethical guidelines for the formulation of norms of conduct in accordance with the dignity of the human person. Therefore, in this article, the principles of personalist bioethics are applied to the field of BCIs, in order to provide general guidelines for action that can contribute to the elaboration of an ethical judgment about the development and use of these neurotechnologies. (shrink)

Emerging neurotechnologies, such as brain-computer interfaces, interact closely with a user’s body by enabling actions controlled with brain activity. This can have a profound impact on the user’s experience of movement, the sense of agency and other body-and action-related aspects. In this introduction to the special issue “Mechanized Brains, Embodied Technologies”, we reflect on the relationships between embodiment, movement and agency that are addressed in the collected papers.

IntroductionChildren with severe physical disabilities are denied their fundamental right to move, restricting their development, independence, and participation in life. Brain-computer interfaces (BCIs) could enable children with complex physical needs to access power mobility (PM) devices, which could help them move safely and independently. BCIs have been studied for PM control for adults but remain unexamined in children. In this study, we explored the feasibility of BCI-enabled PM control for children with severe physical disabilities, assessing BCI performance, standard (...) PM skills and tolerability of BCI.Materials and methodsPatient-oriented pilot trial. Eight children with quadriplegic cerebral palsy attended two sessions where they used a simple, commercial-grade BCI system to activate a PM trainer device. Performance was assessed through controlled activation trials (holding the PM device still or activating it upon verbal and visual cueing), and basic PM skills (driving time, number of activations, stopping) were assessed through distance trials. Setup and calibration times, headset tolerability, workload, and patient/caregiver experience were also evaluated.ResultsAll participants completed the study with favorable tolerability and no serious adverse events or technological challenges. Average control accuracy was 78.3 ± 12.1%, participants were more reliably able to activate (95.7 ± 11.3%) the device than hold still (62.1 ± 23.7%). Positive trends were observed between performance and prior BCI experience and age. Participants were able to drive the PM device continuously an average of 1.5 meters for 3.0 s. They were able to stop at a target 53.1 ± 23.3% of the time, with significant variability. Participants tolerated the headset well, experienced mild-to-moderate workload and setup/calibration times were found to be practical. Participants were proud of their performance and both participants and families were eager to participate in future power mobility sessions.DiscussionBCI-enabled PM access appears feasible in disabled children based on evaluations of performance, tolerability, workload, and setup/calibration. Performance was comparable to existing pediatric BCI literature and surpasses established cut-off thresholds (70%) of “effective” BCI use. Participants exhibited PM skills that would categorize them as “emerging operational learners.” Continued exploration of BCI-enabled PM for children with severe physical disabilities is justified. (shrink)

Brain-computer interfaces are communication bridges between a human brain and external world, enabling humans to interact with their environment without muscle intervention. Their functionality, therefore, depends on both the BCI system and the cognitive capacities of the user. Motor-imagery BCIs rely on the users’ mental imagination of body movements. However, not all users have the ability to sufficiently modulate their brain activity for control of a MI-BCI; a problem known as BCI illiteracy or inefficiency. The underlying (...) mechanism of this phenomenon and the cause of such difference among users is yet not fully understood. In this study, we investigated the impact of several cognitive and psychological measures on MI-BCI performance. Fifty-five novice BCI-users participated in a left- versus right-hand motor imagery task. In addition to their BCI classification error rate and demographics, psychological measures including personality factors, affinity for technology, and motivation during the experiment, as well as cognitive measures including visuospatial memory and spatial ability and Vividness of Visual Imagery were collected. Factors that were found to have a significant impact on MI-BCI performance were Vividness of Visual Imagery, and the personality factors of orderliness and autonomy. These findings shed light on individual traits that lead to difficulty in BCI operation and hence can help with early prediction of inefficiency among users to optimize training for them. (shrink)

Brain-computer interfaces are envisioned to enable new abilities of action. This potential can be fruitful in particular when it comes to restoring lost motion or communication abilities or to implementing new possibilities of action. However, BCIs do not come without presuppositions. Applying the concept of ability expectations to BCIs, a wide range of requirements on the side of the users becomes apparent. We examined these ability expectations by taking the example of therapeutic BCI users who got enrolled into (...) BCI research studies due to particular physical conditions. Some of the expectations identified are quite explicit, like particular physical conditions and BCI “literacy”. Other expectations are more implicit, such as motivation, a high level of concentration, pain tolerance, emotion control and resources. These expectations may produce a conception of the human and a self-understanding among BCI users that objectify the body in favour of a brain-centred, cerebral notion of the subject which also plays its part in upholding a normality regime. (shrink)

Motor imagery-based brain-computer interfaces have been studied without controlling subjects’ gaze fixation position previously. The effect of gaze fixation and covert attention on the behavioral performance of BCI is still unknown. This study designed a gaze fixation controlled experiment. Subjects were required to conduct a secondary task of gaze fixation when performing the primary task of motor imagination. Subjects’ performance was analyzed according to the relationship between motor imagery target and the gaze fixation position, resulting in three BCI (...) control conditions, i.e., congruent, incongruent, and center cross trials. A group of fourteen subjects was recruited. The average group performances of three different conditions did not show statistically significant differences in terms of BCI control accuracy, feedback duration, and trajectory length. Further analysis of gaze shift response time revealed a significantly shorter response time for congruent trials compared to incongruent trials. Meanwhile, the parietal occipital cortex also showed active neural activities for congruent and incongruent trials, and this was revealed by a contrast analysis of R-square values and lateralization index. However, the lateralization index computed from the parietal and occipital areas was not correlated with the BCI behavioral performance. Subjects’ BCI behavioral performance was not affected by the position of gaze fixation and covert attention. This indicated that motor imagery-based BCI could be used freely in robotic arm control without sacrificing performance. (shrink)

Remote driving, i.e., the capacity of controlling road vehicles at a distance, is an innovative transportation technology often associated with potential ethical benefits, especially when deployed to tackle urban traffic issues. However, prospected benefits could only be reaped if remote driving can be executed in a safe and responsible way. This paper builds on notions elaborated in the philosophical literature on technological mediation to offer a systematic examination of the extent to which current and emerging Human–Machine Interfaces contribute (...) to hindering or supporting the exercise of responsibility behind the remote wheel. More specifically, the analysis discusses how video, audio, and haptic interfaces co-shape the remote driving experience and, at the same time,the operators’ capacity to drive responsibly. The multidisciplinary approach explored in this research offers a novel methodological framework to structure future empirical inquiries while identifying finely tuned multi-sensory HMIs and dedicated training as critical presuppositions to the remote drivers’ exercise of responsibility. (shrink)

Previously, we introduced a capability approach to assess the responsible use of brain-computer interface. In this commentary, we say more about the ethical basis of our capability view and respond to three objections. The first objection holds that by stressing that capability lists are provisional and subject to change, we threaten the persistence of human dignity, which is tied to capabilities. The second objection states that we conflate capabilities and abilities. The third objection claims that the goal of (...) using neuroenhancements should be preserving capabilities, not altering them. (shrink)