1
|
Livanis E, Voultsos P, Vadikolias K, Pantazakos P, Tsaroucha A. Understanding the Ethical Issues of Brain-Computer Interfaces (BCIs): A Blessing or the Beginning of a Dystopian Future? Cureus 2024; 16:e58243. [PMID: 38745805 PMCID: PMC11091939 DOI: 10.7759/cureus.58243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
In recent years, scientific discoveries in the field of neuroscience combined with developments in the field of artificial intelligence have led to the development of a range of neurotechnologies. Advances in neuroimaging systems, neurostimulators, and brain-computer interfaces (BCIs) are leading to new ways of enhancing, controlling, and "reading" the brain. In addition, although BCIs were developed and used primarily in the medical field, they are now increasingly applied in other fields (entertainment, marketing, education, defense industry). We conducted a literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to provide background information about ethical issues related to the use of BCIs. Among the ethical issues that emerged from the thematic data analysis of the reviewed studies included questions revolving around human dignity, personhood and autonomy, user safety, stigma and discrimination, privacy and security, responsibility, research ethics, and social justice (including access to this technology). This paper attempts to address the various aspects of these concerns. A variety of distinct ethical issues were identified, which, for the most part, were in line with the findings of prior research. However, we identified two nuances, which are related to the empirical research on ethical issues related to BCIs and the impact of BCIs on international relationships. The paper also highlights the need for the cooperation of all stakeholders to ensure the ethical development and use of this technology and concludes with several recommendations. The principles of bioethics provide an initial guiding framework, which, however, should be revised in the current artificial intelligence landscape so as to be responsive to challenges posed by the development and use of BCIs.
Collapse
Affiliation(s)
- Efstratios Livanis
- Department of Accounting and Finance, University of Macedonia, Thessaloniki, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics) School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Konstantinos Vadikolias
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupoli, GRC
| | - Panagiotis Pantazakos
- Department of Philosophy, School of Philosophy, National and Kapodistrian University of Athens, Athens, GRC
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| | - Alexandra Tsaroucha
- Postgraduate Program on Bioethics, School of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| |
Collapse
|
2
|
Klein E, Kinsella M, Stevens I, Fried-Oken M. Ethical issues raised by incorporating personalized language models into brain-computer interface communication technologies: a qualitative study of individuals with neurological disease. Disabil Rehabil Assist Technol 2024; 19:1041-1051. [PMID: 36403143 PMCID: PMC10351684 DOI: 10.1080/17483107.2022.2146217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the views of individuals with neurodegenerative diseases about ethical issues related to incorporating personalized language models into brain-computer interface (BCI) communication technologies. METHODS Fifteen semi-structured interviews and 51 online free response surveys were completed with individuals diagnosed with neurodegenerative disease that could lead to loss of speech and motor skills. Each participant responded to questions after six hypothetical ethics vignettes were presented that address the possibility of building language models with personal words and phrases in BCI communication technologies. Data were analyzed with consensus coding, using modified grounded theory. RESULTS Four themes were identified. (1) The experience of a neurodegenerative disease shapes preferences for personalized language models. (2) An individual's identity will be affected by the ability to personalize the language model. (3) The motivation for personalization is tied to how relationships can be helped or harmed. (4) Privacy is important to people who may need BCI communication technologies. Responses suggest that the inclusion of personal lexica raises ethical issues. Stakeholders want their values to be considered during development of BCI communication technologies. CONCLUSIONS With the rapid development of BCI communication technologies, it is critical to incorporate feedback from individuals regarding their ethical concerns about the storage and use of personalized language models. Stakeholder values and preferences about disability, privacy, identity and relationships should drive design, innovation and implementation.IMPLICATIONS FOR REHABILITATIONIndividuals with neurodegenerative diseases are important stakeholders to consider in development of natural language processing within brain-computer interface (BCI) communication technologies.The incorporation of personalized language models raises issues related to disability, identity, relationships, and privacy.People who may one day rely on BCI communication technologies care not just about usability of communication technology but about technology that supports their values and priorities.Qualitative ethics-focused research is a valuable tool for exploring stakeholder perspectives on new capabilities of BCI communication technologies, such as the storage and use of personalized language models.
Collapse
Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
| | - Michelle Kinsella
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| | - Ian Stevens
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR USA
| | - Melanie Fried-Oken
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| |
Collapse
|
3
|
King BJ, Read GJM, Salmon PM. Identifying risk controls for future advanced brain-computer interfaces: A prospective risk assessment approach using work domain analysis. APPLIED ERGONOMICS 2023; 111:104028. [PMID: 37148587 DOI: 10.1016/j.apergo.2023.104028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
Brain-computer interface (BCI) technologies are progressing rapidly and may eventually be implemented widely within society, yet their risks have arguably not yet been comprehensively identified, nor understood. This study analysed an anticipated invasive BCI system lifecycle to identify the individual, organisational, and societal risks associated with BCIs, and controls that could be used to mitigate or eliminate these risks. A BCI system lifecycle work domain analysis model was developed and validated with 10 subject matter experts. The model was subsequently used to undertake a systems thinking-based risk assessment approach to identify risks that could emerge when functions are either undertaken sub-optimally or not undertaken at all. Eighteen broad risk themes were identified that could negatively impact the BCI system lifecycle in a variety of unique ways, while a larger number of controls for these risks were also identified. The most concerning risks included inadequate regulation of BCI technologies and inadequate training of BCI stakeholders, such as users and clinicians. In addition to specifying a practical set of risk controls to inform BCI device design, manufacture, adoption, and utilisation, the results demonstrate the complexity involved in managing BCI risks and suggests that a system-wide coordinated response is required. Future research is required to evaluate the comprehensiveness of the identified risks and the practicality of implementing the risk controls.
Collapse
Affiliation(s)
- Brandon J King
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia.
| | - Gemma J M Read
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia; School of Health, University of the Sunshine Coast, Australia. https://twitter.com/gemma_read
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Australia. https://twitter.com/DrPaulSalmon
| |
Collapse
|
4
|
Towards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations. J Neurol 2023; 270:1323-1336. [PMID: 36450968 PMCID: PMC9971103 DOI: 10.1007/s00415-022-11464-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022]
Abstract
Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain-computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.
Collapse
|
5
|
Williams SC, Horsfall HL, Funnell JP, Hanrahan JG, Schaefer AT, Muirhead W, Marcus HJ. Neurosurgical Team Acceptability of Brain-Computer Interfaces: A Two-Stage International Cross-Sectional Survey. World Neurosurg 2022; 164:e884-e898. [PMID: 35623610 PMCID: PMC10444691 DOI: 10.1016/j.wneu.2022.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Invasive brain-computer interfaces (BCIs) require neurosurgical implantation, which confers a range of risks. Despite this situation, no studies have assessed the acceptability of invasive BCIs among the neurosurgical team. This study aims to establish baseline knowledge of BCIs within the neurosurgical team and identify attitudes toward different applications of invasive BCI. METHODS A 2-stage cross-sectional international survey of the neurosurgical team (neurosurgeons, anesthetists, and operating room nurses) was conducted. Results from the first, qualitative, survey were used to guide the second-stage quantitative survey, which assessed acceptability of invasive BCI applications. Five-part Likert scales were used to collect quantitative data. Surveys were distributed internationally via social media and collaborators. RESULTS A total of 108 qualitative responses were collected. Themes included the promise of BCIs positively affecting disease targets, concerns regarding stability, and an overall positive emotional reaction to BCI technology. The quantitative survey generated 538 responses from 32 countries. Baseline knowledge of BCI technology was poor, with 9% claiming to have a good or expert knowledge of BCIs. Acceptability of invasive BCI for rehabilitative purposes was >80%. Invasive BCI for augmentation in healthy populations divided opinion. CONCLUSIONS The neurosurgical team's view of the acceptability of invasive BCI was divided across a range of indications. Some applications (e.g., stroke rehabilitation) were viewed as more appropriate than other applications (e.g., augmentation for military use). This range in views highlights the need for stakeholder consultation on acceptable use cases along with regulation and guidance to govern initial BCI implantations if patients are to realize the potential benefits.
Collapse
Affiliation(s)
- Simon C Williams
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom.
| | - Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Jonathan P Funnell
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - John G Hanrahan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Andreas T Schaefer
- The Francis Crick Institute, Sensory Circuits and Neurotechnology Laboratory, London, United Kingdom; Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - William Muirhead
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Hani J Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| |
Collapse
|
6
|
Sun Y, Shen A, Sun J, Du C, Chen X, Wang Y, Pei W, Gao X. Minimally Invasive Local-Skull Electrophysiological Modification With Piezoelectric Drill. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2042-2051. [PMID: 35857723 DOI: 10.1109/tnsre.2022.3192543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The research on non-invasive BCI is nowadays hitting the bottleneck due to the humble quality of scalp EEG signals. Whereas invasive solutions that offer higher signal quality in contrast are suffocated in their spreading because of the potential surgical complication and health risks caused by electrode implantation. Therefore, it puts forward a necessity to explore a scheme that could both collect high-quality EEG signals and guarantee high-level operation safety.This study proposed a Minimally Invasive Local-skull Electrophysiological Modification method to improve scalp EEG signals qualities at specific brain regions. Six eight-month-old SD rats were used for in vivo verification experiment. A hole with a diameter of about 500 micrometers was drilled in the skull above the visual cortex of rats. Significant changes in rsEEG and SSVEP signals before and after modification were observed. After modification, the skull impedance of rats decreases by about 84 %, the average maximum bandwidth of rsEEG increase by 57 %, and the broadband SNR of SSVEP is increased by 5.13 dB. The time of piezoelectric drilling operation is strictly controlled under 30 seconds for each rat to prevent possible brain damage from overheating. Compared with traditional invasive procedures such as ECoG, Minimally Invasive Local-skull Electrophysiological Modification operation time is shorter and no electrode implantation is needed while it remarkably boosts the scalp EEG signal quality. This technical solution has the potential to replace the use of ECoG in certain application scenarios and further invigorate studies in the field of scalp EEG in the future.
Collapse
|
7
|
Zhang K, Xu G, Du C, Wu Y, Zheng X, Zhang S, Han C, Liang R, Chen R. Weak Feature Extraction and Strong Noise Suppression for SSVEP-EEG Based on Chaotic Detection Technology. IEEE Trans Neural Syst Rehabil Eng 2021; 29:862-871. [PMID: 33872154 DOI: 10.1109/tnsre.2021.3073918] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Brain computer interface (BCI) is a novel communication method that does not rely on the normal neural pathway between the brain and muscle of human. It can transform mental activities into relevant commands to control external equipment and establish direct communication pathway. Among different paradigms, steady-state visual evoked potential (SSVEP) is widely used due to its certain periodicity and stability of control. However, electroencephalogram (EEG) of SSVEP is extremely weak and companied with multi-scale and strong noise. Existing algorithms for classification are based on the principle of template matching and spatial filtering, which cannot obtain satisfied performance of feature extraction under the multi-scale noise. Especially for the subjects produce weak response for external stimuli in EEG representation, i.e., BCI-Illiteracy subject, traditional algorithms are difficult to recognize the internal patterns of brain. To address this issue, a novel method based on Chaos theory is proposed to extract feature of SSVEP. The rule of this method is applying the peculiarity of nonlinear dynamics system to detect feature of SSVEP by judging the state changes of chaotic systems after adding weak EEG. To evaluate the validity of proposed method, this research recruit 32 subjects to participate the experiment. All subjects are divided into two groups according to the preliminary classification accuracy (mean acc >70% or < 70%) by canonical correlation analysis and we define the accuracy above 70% as group A (normal subjects), below 70% as group B (BCI-Illiteracy). Then, the classification accuracy and information transmission rate of two groups are verified using Chaotic theory. Experimental results show that all classification methods using in our study achieve good performance for normal subjects while chaos obtain excellent performance and significant improvements than traditional methods for BCI-Illiteracy.
Collapse
|
8
|
Kawala-Sterniuk A, Browarska N, Al-Bakri A, Pelc M, Zygarlicki J, Sidikova M, Martinek R, Gorzelanczyk EJ. Summary of over Fifty Years with Brain-Computer Interfaces-A Review. Brain Sci 2021; 11:43. [PMID: 33401571 PMCID: PMC7824107 DOI: 10.3390/brainsci11010043] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
Over the last few decades, the Brain-Computer Interfaces have been gradually making their way to the epicenter of scientific interest. Many scientists from all around the world have contributed to the state of the art in this scientific domain by developing numerous tools and methods for brain signal acquisition and processing. Such a spectacular progress would not be achievable without accompanying technological development to equip the researchers with the proper devices providing what is absolutely necessary for any kind of discovery as the core of every analysis: the data reflecting the brain activity. The common effort has resulted in pushing the whole domain to the point where the communication between a human being and the external world through BCI interfaces is no longer science fiction but nowadays reality. In this work we present the most relevant aspects of the BCIs and all the milestones that have been made over nearly 50-year history of this research domain. We mention people who were pioneers in this area as well as we highlight all the technological and methodological advances that have transformed something available and understandable by a very few into something that has a potential to be a breathtaking change for so many. Aiming to fully understand how the human brain works is a very ambitious goal and it will surely take time to succeed. However, even that fraction of what has already been determined is sufficient e.g., to allow impaired people to regain control on their lives and significantly improve its quality. The more is discovered in this domain, the more benefit for all of us this can potentially bring.
Collapse
Affiliation(s)
- Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland; (N.B.); (M.P.); (J.Z.)
| | - Natalia Browarska
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland; (N.B.); (M.P.); (J.Z.)
| | - Amir Al-Bakri
- Department of Biomedical Engineering, College of Engineering, University of Babylon, 51001 Babylon, Iraq;
| | - Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland; (N.B.); (M.P.); (J.Z.)
- Department of Computing and Information Systems, University of Greenwich, London SE10 9LS, UK
| | - Jaroslaw Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland; (N.B.); (M.P.); (J.Z.)
| | - Michaela Sidikova
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University Ostrava—FEECS, 708 00 Ostrava-Poruba, Czech Republic; (M.S.); (R.M.)
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University Ostrava—FEECS, 708 00 Ostrava-Poruba, Czech Republic; (M.S.); (R.M.)
| | - Edward Jacek Gorzelanczyk
- Department of Theoretical Basis of BioMedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Institute of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- Babinski Specialist Psychiatric Healthcare Center, Outpatient Addiction Treatment, 91-229 Lodz, Poland
- The Society for the Substitution Treatment of Addiction “Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| |
Collapse
|
9
|
A comprehensive assessment of Brain Computer Interfaces: Recent trends and challenges. J Neurosci Methods 2020; 346:108918. [PMID: 32853592 DOI: 10.1016/j.jneumeth.2020.108918] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/15/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND An uninterrupted channel of communication and control between the human brain and electronic processing units has led to an increased use of Brain Computer Interfaces (BCIs). This article attempts to present an all-encompassing review on BCI and the scientific advancements associated with it. The ultimate goal of this review is to provide a general overview of the BCI technology and to shed light on different aspects of BCIs. This review also underscores the applications, practical challenges and opportunities associated with BCI technology, which can be used to accelerate future developments in this field. METHODS This review is based on a systematic literature search for tracking down the relevant research annals and proceedings. Using a methodical search strategy, the search was carried out across major technical databases. The retrieved records were screened for their relevance and a total of 369 research chronicles were engulfed in this review based on the inclusion criteria. RESULTS This review describes the present scenario and recent advancements in BCI technology. It also identifies several application areas of BCI technology. This comprehensive review provides evidence that, while we are getting ever closer, significant challenges still exist for the development of BCIs that can seamlessly integrate with the user's biological system. CONCLUSION The findings of this review confirm the importance of BCI technology in various applications. It is concluded that BCI technology, still in its sprouting phase, requires significant explorations for further development.
Collapse
|
10
|
Kögel J, Jox RJ, Friedrich O. What is it like to use a BCI? - insights from an interview study with brain-computer interface users. BMC Med Ethics 2020; 21:2. [PMID: 31906947 PMCID: PMC6945485 DOI: 10.1186/s12910-019-0442-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background The 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. Methods We 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. Results BCI 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. Conclusions BCI 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.
Collapse
Affiliation(s)
- Johannes Kögel
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, 80336, Munich, Germany.
| | - Ralf J Jox
- Clinical Ethics Unit and Institute of Humanities in Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Avenue de Provence 82, CH-1007, Lausanne, Switzerland
| | - Orsolya Friedrich
- Institute of Philosophy, Faculty of Cultural and Social Sciences, FernUniversität in Hagen, Universitätsstr. 33, 58097, Hagen, Germany
| |
Collapse
|
11
|
Kögel J, Schmid JR, Jox RJ, Friedrich O. Using brain-computer interfaces: a scoping review of studies employing social research methods. BMC Med Ethics 2019; 20:18. [PMID: 30845952 PMCID: PMC6407281 DOI: 10.1186/s12910-019-0354-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background The rapid expansion of research on Brain-Computer Interfaces (BCIs) is not only due to the promising solutions offered for persons with physical impairments. There is also a heightened need for understanding BCIs due to the challenges regarding ethics presented by new technology, especially in its impact on the relationship between man and machine. Here we endeavor to present a scoping review of current studies in the field to gain insight into the complexity of BCI use. By examining studies related to BCIs that employ social research methods, we seek to demonstrate the multitude of approaches and concerns from various angles in considering the social and human impact of BCI technology. Methods For this scoping review of research on BCIs’ social and ethical implications, we systematically analyzed six databases, encompassing the fields of medicine, psychology, and the social sciences, in order to identify empirical studies on BCIs. The search yielded 73 publications that employ quantitative, qualitative, or mixed methods. Results Of the 73 publications, 71 studies address the user perspective. Some studies extend to consideration of other BCI stakeholders such as medical technology experts, caregivers, or health care professionals. The majority of the studies employ quantitative methods. Recurring themes across the studies examined were general user opinion towards BCI, central technical or social issues reported, requests/demands made by users of the technology, the potential/future of BCIs, and ethical aspects of BCIs. Conclusions Our findings indicate that while technical aspects of BCIs such as usability or feasibility are being studied extensively, comparatively little in-depth research has been done on the self-image and self-experience of the BCI user. In general there is also a lack of focus or examination of the caregiver’s perspective. Electronic supplementary material The online version of this article (10.1186/s12910-019-0354-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Johannes Kögel
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany.
| | - Jennifer R Schmid
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
| | - Ralf J Jox
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
| | - Orsolya Friedrich
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
| |
Collapse
|
12
|
Ethical Considerations in Ending Exploratory Brain-Computer Interface Research Studies in Locked-in Syndrome. Camb Q Healthc Ethics 2018; 27:660-674. [PMID: 30198467 DOI: 10.1017/s0963180118000154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain-computer interface (BCI) is a promising technology for restoring communication in individuals with locked-in syndrome (LIS). BCI technology offers a potential tool for individuals with impaired or absent means of effective communication to use brain activity to control an output device such as a computer keyboard. Exploratory studies of BCI devices for communication in people with LIS are underway. Research with individuals with LIS presents not only technological challenges, but ethical challenges as well. Whereas recent attention has been focused on ethical issues that arise at the initiation of studies, such as how to obtain valid consent, relatively little attention has been given to issues at the conclusion of studies. BCI research in LIS highlights one such challenge: How to decide when an exploratory BCI research study should end. In this article, we present the case of an individual with presumed LIS enrolled in an exploratory BCI study. We consider whether two common ethical frameworks for stopping randomized clinical trials-equipoise and nonexploitation-can be usefully applied to elucidating researcher obligations to end exploratory BCI research. We argue that neither framework is a good fit for exploratory BCI research. Instead, we apply recent work on clinician-researcher fiduciary obligations and in turn offer some preliminary recommendations for BCI researchers on how to end exploratory BCI studies.
Collapse
|
13
|
Taherian S, Davies TC. Caregiver and special education staff perspectives of a commercial brain-computer interface as access technology: a qualitative study. BRAIN-COMPUTER INTERFACES 2018. [DOI: 10.1080/2326263x.2018.1505191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sarvnaz Taherian
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - T. Claire Davies
- Faculty of Engineering and Applied Science, Queens University, Kingston, Ontario, Canada
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Brown T, Thompson MC, Herron J, Ko A, Chizeck H, Goering S. Controlling our brains – a case study on the implications of brain-computer interface-triggered deep brain stimulation for essential tremor. BRAIN-COMPUTER INTERFACES 2016. [DOI: 10.1080/2326263x.2016.1207494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Timothy Brown
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Margaret C. Thompson
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Jeffrey Herron
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Howard Chizeck
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
- Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, USA
- Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA
| |
Collapse
|
16
|
Specker Sullivan L, Illes J. Beyond ‘communication and control’: towards ethically complete rationales for brain-computer interface research. BRAIN-COMPUTER INTERFACES 2016. [DOI: 10.1080/2326263x.2016.1213603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Specker Sullivan
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
- Center for Sensorimotor Neural Engineering, University of Washington, Box 37, 1414 NE 42nd Street Suite 204, Seattle, WA 98105-6271, USA
- Department of Philosophy, University of Washington, USA
| | - Judy Illes
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
17
|
Klein E, Goering S, Gagne J, Shea CV, Franklin R, Zorowitz S, Dougherty DD, Widge AS. Brain-computer interface-based control of closed-loop brain stimulation: attitudes and ethical considerations. BRAIN-COMPUTER INTERFACES 2016. [DOI: 10.1080/2326263x.2016.1207497] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Eran Klein
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sara Goering
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Josh Gagne
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Conor V. Shea
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Franklin
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Samuel Zorowitz
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Darin D. Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alik S. Widge
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Boston, MA, USA
| |
Collapse
|
18
|
Klein E, Ojemann J. Informed consent in implantable BCI research: identification of research risks and recommendations for development of best practices. J Neural Eng 2016; 13:043001. [PMID: 27247140 DOI: 10.1088/1741-2560/13/4/043001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Implantable brain-computer interface (BCI) research promises improvements in human health and enhancements in quality of life. Informed consent of subjects is a central tenet of this research. Rapid advances in neuroscience, and the intimate connection between functioning of the brain and conceptions of the self, make informed consent particularly challenging in BCI research. Identification of safety and research-related risks associated with BCI devices is an important step in ensuring meaningful informed consent. APPROACH This paper highlights a number of BCI research risks, including safety concerns, cognitive and communicative impairments, inappropriate subject expectations, group vulnerabilities, privacy and security, and disruptions of identity. MAIN RESULTS Based on identified BCI research risks, best practices are needed for understanding and incorporating BCI-related risks into informed consent protocols. SIGNIFICANCE Development of best practices should be guided by processes that are: multidisciplinary, systematic and transparent, iterative, relational and exploratory.
Collapse
Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA. Department of Philosophy, University of Washington, Seattle, WA, USA. Center for Sensorimotor Neural Engineering, Seattle, WA, USA
| | | |
Collapse
|
19
|
Perruchoud D, Pisotta I, Carda S, Murray MM, Ionta S. Biomimetic rehabilitation engineering: the importance of somatosensory feedback for brain-machine interfaces. J Neural Eng 2016; 13:041001. [PMID: 27221469 DOI: 10.1088/1741-2560/13/4/041001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Brain-machine interfaces (BMIs) re-establish communication channels between the nervous system and an external device. The use of BMI technology has generated significant developments in rehabilitative medicine, promising new ways to restore lost sensory-motor functions. However and despite high-caliber basic research, only a few prototypes have successfully left the laboratory and are currently home-deployed. APPROACH The failure of this laboratory-to-user transfer likely relates to the absence of BMI solutions for providing naturalistic feedback about the consequences of the BMI's actions. To overcome this limitation, nowadays cutting-edge BMI advances are guided by the principle of biomimicry; i.e. the artificial reproduction of normal neural mechanisms. MAIN RESULTS Here, we focus on the importance of somatosensory feedback in BMIs devoted to reproducing movements with the goal of serving as a reference framework for future research on innovative rehabilitation procedures. First, we address the correspondence between users' needs and BMI solutions. Then, we describe the main features of invasive and non-invasive BMIs, including their degree of biomimicry and respective advantages and drawbacks. Furthermore, we explore the prevalent approaches for providing quasi-natural sensory feedback in BMI settings. Finally, we cover special situations that can promote biomimicry and we present the future directions in basic research and clinical applications. SIGNIFICANCE The continued incorporation of biomimetic features into the design of BMIs will surely serve to further ameliorate the realism of BMIs, as well as tremendously improve their actuation, acceptance, and use.
Collapse
Affiliation(s)
- David Perruchoud
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
20
|
Nijboer F, Plass-Oude Bos D, Blokland Y, van Wijk R, Farquhar J. Design requirements and potential target users for brain-computer interfaces – recommendations from rehabilitation professionals. BRAIN-COMPUTER INTERFACES 2014. [DOI: 10.1080/2326263x.2013.877210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|