Recommendations for Responsible Development and Application of Neurotechnologies

Exploring the intersection of brain-computer interfaces and traditional, complementary, and integrative medicine

Brain-computer interfaces (BCIs) represent a transformative innovation in healthcare, enabling direct communication between the brain and external devices. This educational article explores the potential intersection of BCIs and traditional, complementary, and integrative medicine (TCIM). BCIs have shown promise in enhancing mind-body practices such as meditation, while their integration with energy-based therapies may offer novel insights and measurable outcomes. Emerging advancements, including artificial intelligence-enhanced BCIs, hold potential for improving personalization and expanding the therapeutic efficacy of TCIM interventions. Despite these opportunities, integrating BCIs with TCIM presents considerable ethical, cultural, and practical challenges. Concerns related to informed consent, cultural sensitivity, data privacy, accessibility, and regulatory frameworks must be addressed to ensure responsible implementation. Interdisciplinary collaboration among relevant stakeholders, including TCIM and conventional practitioners, researchers, and policymakers among other relevant stakeholders is crucial for developing integrative healthcare models that balance innovation with patient safety and respect for diverse healing traditions. Future directions include expanding evidence bases to validate TCIM practices through BCI-enhanced research, fostering equitable access to neurotechnological advancements, and promoting global ethical guidelines to navigate complex sociocultural dynamics. BCIs have the potential to revolutionize TCIM, offering novel solutions for complex health challenges and fostering a more inclusive, integrative approach to healthcare, provided that they are utilized responsibly and ethically.

Recent applications of EEG-based brain-computer-interface in the medical field

Brain-computer interfaces (BCIs) represent an emerging technology that facilitates direct communication between the brain and external devices. In recent years, numerous review articles have explored various aspects of BCIs, including their fundamental principles, technical advancements, and applications in specific domains. However, these reviews often focus on signal processing, hardware development, or limited applications such as motor rehabilitation or communication. This paper aims to offer a comprehensive review of recent electroencephalogram (EEG)-based BCI applications in the medical field across 8 critical areas, encompassing rehabilitation, daily communication, epilepsy, cerebral resuscitation, sleep, neurodegenerative diseases, anesthesiology, and emotion recognition. Moreover, the current challenges and future trends of BCIs were also discussed, including personal privacy and ethical concerns, network security vulnerabilities, safety issues, and biocompatibility.

Semantic language decoding across participants and stimulus modalities

Brain decoders that reconstruct language from semantic representations have the potential to improve communication for people with impaired language production. However, training a semantic decoder for a participant currently requires many hours of brain responses to linguistic stimuli, and people with impaired language production often also have impaired language comprehension. In this study, we tested whether language can be decoded from a goal participant without using any linguistic training data from that participant. We trained semantic decoders on brain responses from separate reference participants and then used functional alignment to transfer the decoders to the goal participant. Cross-participant decoder predictions were semantically related to the stimulus words, even when functional alignment was performed using movies with no linguistic content. To assess how much semantic representations are shared between language and vision, we compared functional alignment accuracy using story and movie stimuli and found that performance was comparable in most cortical regions. Finally, we tested whether cross-participant decoders could be robust to lesions by excluding brain regions from the goal participant prior to functional alignment and found that cross-participant decoders do not depend on data from any single brain region. These results demonstrate that cross-participant decoding can reduce the amount of linguistic training data required from a goal participant and potentially enable language decoding from participants who struggle with both language production and language comprehension.

Regulating neural data processing in the age of BCIs: Ethical concerns and legal approaches

Brain-computer interfaces (BCIs) have seen increasingly fast growth under the help from AI, algorithms, and cloud computing. While providing great benefits for both medical and educational purposes, BCIs involve processing of neural data which are uniquely sensitive due to their most intimate nature, posing unique risks and ethical concerns especially related to privacy and safe control of our neural data. In furtherance of human right protection such as mental privacy, data laws provide more detailed and enforceable rules for processing neural data which may balance the tension between privacy protection and need of the public for wellness promotion and scientific progress through data sharing. This article notes that most of the current data laws like GDPR have not covered neural data clearly, incapable of providing full protection in response to its specialty. The new legislative reforms in the U.S. states of Colorado and California made pioneering advances to incorporate neural data into data privacy laws. Yet regulatory gaps remain as such reforms have not provided special additional rules for neural data processing. Potential problems such as static consent, vague research exceptions, and loopholes in regulating non-personal neural data need to be further addressed. We recommend relevant improved measures taken through amending data laws or making special data acts.

Electroencephalography-Based Brain-Computer Interfaces in Rehabilitation: A Bibliometric Analysis (2013-2023)

EEG-based Brain-Computer Interfaces (BCIs) have gained significant attention in rehabilitation due to their non-invasive, accessible ability to capture brain activity and restore neurological functions in patients with conditions such as stroke and spinal cord injuries. This study offers a comprehensive bibliometric analysis of global EEG-based BCI research in rehabilitation from 2013 to 2023. It focuses on primary research and review articles addressing technological innovations, effectiveness, and system advancements in clinical rehabilitation. Data were sourced from databases like Web of Science, and bibliometric tools (bibliometrix R) were used to analyze publication trends, geographic distribution, keyword co-occurrences, and collaboration networks. The results reveal a rapid increase in EEG-BCI research, peaking in 2022, with a primary focus on motor and sensory rehabilitation. EEG remains the most commonly used method, with significant contributions from Asia, Europe, and North America. Additionally, there is growing interest in applying BCIs to mental health, as well as integrating artificial intelligence (AI), particularly machine learning, to enhance system accuracy and adaptability. However, challenges remain, such as system inefficiencies and slow learning curves. These could be addressed by incorporating multi-modal approaches and advanced neuroimaging technologies. Further research is needed to validate the applicability of EEG-BCI advancements in both cognitive and motor rehabilitation, especially considering the high global prevalence of cerebrovascular diseases. To advance the field, expanding global participation, particularly in underrepresented regions like Latin America, is essential. Improving system efficiency through multi-modal approaches and AI integration is also critical. Ethical considerations, including data privacy, transparency, and equitable access to BCI technologies, must be prioritized to ensure the inclusive development and use of these technologies across diverse socioeconomic groups.

Mental integrity, autonomy, and fundamental interests

Many technology ethicists hold that the time has come to articulate neurorights: our normative claims vis-à-vis our brains and minds. One such claim is the right to mental integrity ('MI'). I begin by considering some paradigmatic threats to MI (§1) and how the dominant autonomy-based conception ('ABC') of MI attempts to make sense of them (§2). I next consider the objection that the ABC is overbroad in its understanding of what threatens MI and suggest a friendly revision to the ABC that addresses the objection (§3). I then consider a second objection: that the ABC cannot make sense of the MI of the non-autonomous This objection appears fatal even to the revised ABC (§4). On that basis, I develop an alternative conception on which MI is grounded in a plurality of simpler capacities, namely, those for affect, cognition, and volition Each of these more basic capacities grounds a set of fundamental interests, and they are for that reason worthy of protection even when they do not rise to the level of complexity necessary for autonomy (§5). This yields a fully general theory of MI that accounts for its manifestations in both the autonomous and the non-autonomous.

Neurotechnologies, Ethics, and the Limits of Free Will

This article delves into the implications of neurotechnologies for the philosophical debates surrounding free will and moral responsibility. Tracing the concept from ancient religious and philosophical roots, we discuss how recent neurotechnological advancements (e.g. optogenetics, fMRI and machine learning, predictive diagnostics, et al.) challenge traditional notions of autonomy. Although neurotechnologies aim to enhance autonomy in the strict sense - as self-determination - they risk reducing or changing the broader notion of autonomy, which involves personal authenticity. We also submit that, in a world with an altered or limited concept of free will, humans should still be held accountable for actions executed through their bodies. By examining the dynamic between choice and responsibility, we emphasize the shift in technology ethics, moral philosophy, and the broader legal landscape in response to the advancement of neurotechnologies. By bringing the neurotechnological innovations into the world, neuroscientists not only change the technological landscape but also partake in long-standing moral narratives about freedom, justice, and responsibility.

Neuroethics and AI ethics: a proposal for collaboration

The scientific relationship between neuroscience and artificial intelligence is generally acknowledged, and the role that their long history of collaboration has played in advancing both fields is often emphasized. Beyond the important scientific insights provided by their collaborative development, both neuroscience and AI raise a number of ethical issues that are generally explored by neuroethics and AI ethics. Neuroethics and AI ethics have been gaining prominence in the last few decades, and they are typically carried out by different research communities. However, considering the evolving landscape of AI-assisted neurotechnologies and the various conceptual and practical intersections between AI and neuroscience-such as the increasing application of AI in neuroscientific research, the healthcare of neurological and mental diseases, and the use of neuroscientific knowledge as inspiration for AI-some scholars are now calling for a collaborative relationship between these two domains. This article seeks to explore how a collaborative relationship between neuroethics and AI ethics can stimulate theoretical and, ideally, governance efforts. First, we offer some reasons for calling for the collaboration of the ethical reflection on neuroscientific innovations and AI. Next, we explore some dimensions that we think could be enhanced by the cross-fertilization between these two subfields of ethics. We believe that considering the pace and increasing fusion of neuroscience and AI in the development of innovations, broad and underspecified calls for responsibility that do not consider insights from different ethics subfields will only be partially successful in promoting meaningful changes in both research and applications.

Cardiac arrest and cardiopulmonary resuscitation in the next decade: Predicting and shaping the impact of technological innovations

INTRODUCTION

Cardiac arrest (CA) is the third leading cause of death, with persistently low survival rates despite medical advancements. This article evaluates the potential of emerging technologies to enhance CA management over the next decade, using predictions from the AI tools ChatGPT-4 and Gemini Advanced.

METHODS

We conducted an exploratory literature review to envision the future of cardiopulmonary arrest (CA) management. Utilizing ChatGPT-4 and Gemini Advanced, we predicted implementation timelines for innovations in early recognition, CPR, defibrillation, and post-resuscitation care. We also consulted the AI to assess the consistency and reproducibility of the predictions.

RESULTS

We extrapolate that healthcare may embrace new technologies, such as comprehensive monitoring of vital signs to activate the emergency system (wireless detectors, smart speakers, and wearable devices), use new innovative early CPR and early AED devices (robot CPR, wearable AEDs, and immersive reality), and post-resuscitation care monitoring (brain-computer interface). These technologies could enhance timely life-saving interventions for cardiac arrest. However, there are many ethical and practical challenges, particularly in maintaining patient privacy and equity. The two AI tools made different predictions, with a horizon for implementation ranging between three and eight years.

CONCLUSION

Integrating advanced monitoring technologies and AI-driven tools offers hope in improving CA management. A balanced approach involving rigorous scientific validation and ethical oversight is necessary. Collaboration among technologists, medical professionals, ethicists, and policymakers is crucial to use these innovations ethically to reduce CA incidence and enhance outcomes. Further research is needed to enhance the reliability of AI predictive capabilities.

Applying the IEEE BRAIN neuroethics framework to intra-cortical brain-computer interfaces

Objective. Brain-computer interfaces (BCIs) are neuroprosthetic devices that allow for direct interaction between brains and machines. These types of neurotechnologies have recently experienced a strong drive in research and development, given, in part, that they promise to restore motor and communication abilities in individuals experiencing severe paralysis. While a rich literature analyzes the ethical, legal, and sociocultural implications (ELSCI) of these novel neurotechnologies, engineers, clinicians and BCI practitioners often do not have enough exposure to these topics.Approach. Here, we present the IEEE Neuroethics Framework, an international, multiyear, iterative initiative aimed at developing a robust, accessible set of considerations for diverse stakeholders.Main results. Using the framework, we provide practical examples of ELSCI considerations for BCI neurotechnologies. We focus on invasive technologies, and in particular, devices that are implanted intra-cortically for medical research applications.Significance. We demonstrate the utility of our framework in exposing a wide range of implications across different intra-cortical BCI technology modalities and conclude with recommendations on how to utilize this knowledge in the development and application of ethical guidelines for BCI neurotechnologies.

Developer perspectives on the ethics of AI-driven neural implants: a qualitative study

Convergence of neural implants with artificial intelligence (AI) presents opportunities for the development of novel neural implants and improvement of existing neurotechnologies. While such technological innovation carries great promise for the restoration of neurological functions, they also raise ethical challenges. Developers of AI-driven neural implants possess valuable knowledge on the possibilities, limitations and challenges raised by these innovations; yet their perspectives are underrepresented in academic literature. This study aims to explore perspectives of developers of neurotechnology to outline ethical implications of three AI-driven neural implants: a cochlear implant, a visual neural implant, and a motor intention decoding speech-brain-computer-interface. We conducted semi-structured focus groups with developers (n = 19) of AI-driven neural implants. Respondents shared ethically relevant considerations about AI-driven neural implants that we clustered into three themes: (1) design aspects; (2) challenges in clinical trials; (3) impact on users and society. Developers considered accuracy and reliability of AI-driven neural implants conditional for users' safety, authenticity, and mental privacy. These needs were magnified by the convergence with AI. Yet, the need for accuracy and reliability may also conflict with potential benefits of AI in terms of efficiency and complex data interpretation. We discuss strategies to mitigate these challenges.

Understanding the Ethical Issues of Brain-Computer Interfaces (BCIs): A Blessing or the Beginning of a Dystopian Future?

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.

Brain Data in Context: Are New Rights the Way to Mental and Brain Privacy?

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to "mental privacy." In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are-at least for now-no different from those raised by other well-understood data collection technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum's "contextual integrity" theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts-healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy.

What an International Declaration on Neurotechnologies and Human Rights Could Look like: Ideas, Suggestions, Desiderata

International institutions such as UNESCO are deliberating on a new standard setting instrument for neurotechnologies. This will likely lead to the adoption of a soft law document which will be the first global document specifically tailored to neurotechnologies, setting the tone for further international or domestic regulations. While some stakeholders have been consulted, these developments have so far evaded the broader attention of the neuroscience, neurotech, and neuroethics communities. To initiate a broader debate, this target article puts to discussion twenty-five considerations and desiderata for recognition by a future instrument. They are formulated at different levels of abstraction, from the big picture to technical details, seek to widen the perspective of preparatory reports and transcend the narrow debate about "neurorights" which overshadows many richer and more relevant aspects. These desiderata are not an exhaustive enumeration but a starting point for discussions about what deserves and what requires protection by an international instrument.

Chilean Supreme Court ruling on the protection of brain activity: neurorights, personal data protection, and neurodata

This paper discusses a landmark ruling by the Chilean Supreme Court of August 9, 2023 dealing with the right to mental privacy, originated with an action for constitutional protection filed on behalf of Guido Girardi Lavin against Emotiv Inc., a North American company based in San Francisco, California that is commercializing the device "Insight." This wireless device functions as a headset with sensors that collect information about the brain's electrical activity (i.e., neurodata). The discussion revolves around whether neurodata can be considered personal data and whether they could be classified into a special category. The application of the present legislation on data (the most obsolete, such as the Chilean law, and the most recent EU law) does not seem adequate to protect neurodata. The use of neurodata raises ethical and legal concerns that are not fully addressed by current regulations on personal data protection. Despite not being necessarily considered personal data, neurodata represent the most intimate aspects of human personality and should be protected in light of potential new risks. The unique characteristics of neurodata, including their interpretive nature and potential for revealing thoughts and intentions, pose challenges for regulation. Current data protection laws do not differentiate between different types of data based on their informational content, which is relevant for protecting individual rights. The development of new technologies involving neurodata requires particular attention and careful consideration to prevent possible harm to human dignity. The regulation of neurodata must account for their specific characteristics and the potential risks they pose to privacy, confidentiality, and individual rights. The answer lies in the reconfiguration of human rights known as "neurorights" that goes beyond the protection of personal data.

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

Invasive implantable neurotechnologies capable of simultaneously altering and recording neural activity are no longer the exclusive province of science fiction but a looming reality that will revolutionize medical practice. These advancements, particularly in their memory-altering capabilities, herald a vast array of opportunities for addressing the complex landscape of neurodegenerative and psychiatric conditions linked to memory impairments. However, the panoply of ethical implications arising from such a novel neurotechnology remains relatively unexplored by the neuroethics literature. This study examines and contrasts the potential ethical implications of memory modification treatment via implantable neurotechnologies. The study contends that undesired side effects resulting from memory modulation can lead to significant identity harms, disrupting the coherence of self-narratives and impinging on our authenticity. To evince the practical impact of this moral argument, the study conducts a practical ethical assessment of how employing implantable neurotechnologies to modulate memory may jeopardize (i) our moral responsiveness to events and core system of values and (ii) the emotional component associated with the altered memory. From a first-person standpoint, changes to the way we reasonably feel and react to past events and future intentions may be deemed ethically problematic as these profound changes can yield significant moral disruptions and negatively impact our personal lives and interpersonal relationships. In addition, the study discusses further ethical conundrums from a third-person perspective as these disruptions can inhibit social activism against structural injustices, thereby hindering societal progress. Thus, taking into account this societal dimension is paramount when evaluating the ethical permissibility of memory modification procedures.

Virtual emotions and Criminal Law

This article examines the role that Criminal Law should play in regulating the non-therapeutic use of immersive Virtual Reality (VR), specifically its massive use by consumers. The starting point has been to consider VR as an intermediate risk scenario, for the purposes of Criminal Law, between the criminality entirely generated in the physical world and that developed in the 2D digital environments [cybercrimes and criminality linked to social networks and persuasive Artificial Intelligence (AI)]. Firstly, specialize literature has been analyzed to establish the nature of virtual reality. From a technical standpoint, virtual reality is a neurotechnology infused with high-risk artificial intelligence; an inseparable synthesis of non-invasive neurotechnology and a set of AI systems, considered high-risk for the fundamental rights of citizens. From the perspective of its functioning, VR is a "transformative" neurotechnology capable of altering what people perceive as reality. This is possible, because its realism lies in the emotional immersion of the user in the virtual experience, similarly to how our brain functions. Therefore, the key idea in the immersive functioning of virtual reality is its capacity to evoke and modify human emotions, which results its greater harmful potential compared to the 2D environment. From there, three central and specific areas of (legally unaddressed) risk arise: (1) the special comprehensive nature of the data collected and stored during its use; (2) its ability to mentally reproduce the "physical" experience of the avatar in the user; and (3) its significant capacity to manipulate individuals. Secondly, the paper examines both the reported cases and the foreseeable criminality in virtual worlds or "proto-metaverse," focusing on the three risk areas, and exemplifying them with attacks on mental privacy, sexual freedom, and consumer manipulation. Finally, it is proposed that Criminal Law should also intervene (as soon as possible) to define the "red lines" of massive virtual reality use by citizens. With a democratic and human-centered approach, a basic legal framework is outlined for the criminalization of specific harms and risks associated with virtual reality, adapting the existing legal framework as necessary.

Advocating for neurodata privacy and neurotechnology regulation

The ability to record and alter brain activity by using implantable and nonimplantable neural devices, while poised to have significant scientific and clinical benefits, also raises complex ethical concerns. In this Perspective, we raise awareness of the ability of artificial intelligence algorithms and data-aggregation tools to decode and analyze data containing highly sensitive information, jeopardizing personal neuroprivacy. Voids in existing regulatory frameworks, in fact, allow unrestricted decoding and commerce of neurodata. We advocate for the implementation of proposed ethical and human rights guidelines, alongside technical options such as data encryption, differential privacy and federated learning to ensure the protection of neurodata privacy. We further encourage regulatory bodies to consider taking a position of responsibility by categorizing all brain-derived data as sensitive health data and apply existing medical regulations to all data gathered via pre-registered neural devices. Lastly, we propose that a technocratic oath may instill a deontology for neurotechnology practitioners akin to what the Hippocratic oath represents in medicine. A conscientious societal position that thoroughly rejects the misuse of neurodata would provide the moral compass for the future development of the neurotechnology field.

Contextual and Cultural Perspectives on Neurorights: Reflections Toward an International Consensus

The development and use of advanced and innovative neuroscience, neurotechnology and some forms of artificial intelligence have exposed potential threats to the human condition, including human rights. As a result, reconceptualizing or creating human rights (i.e. neurorights) has been proposed to address specific brain and mind issues like free will, personal identity and cognitive liberty. However, perceptions, interpretations and meanings of these issues-and of neurorights-may vary between countries, contexts and cultures, all relevant for an international-consensus definition and implementation of neurorights. Thus, we encourage reflecting on the proactive inclusion of transnational, cross-cultural and contextual considerations and concerns to contribute to the global discourse. This inclusion does not mean endorsing ethical relativism but rather a call to foster a universal understanding of key concepts and concerns. Including contextual and cultural perspectives may truly anticipate global concerns which could be addressed while developing and implementing neurorights. Consequently, any ethical and/or legal regulatory framework(s) for the translational and transnational use of advanced neuroscience, neurotechnology and some forms of artificial intelligence intended to protect and safeguard human dignity should be contextually and culturally mindful, responsible, respectful and inclusive of not only human rights and fundamental freedoms but also of neurocognitive cultural diversity.

Modified Neuropixels probes for recording human neurophysiology in the operating room

Neuropixels are silicon-based electrophysiology-recording probes with high channel count and recording-site density. These probes offer a turnkey platform for measuring neural activity with single-cell resolution and at a scale that is beyond the capabilities of current clinically approved devices. Our team demonstrated the first-in-human use of these probes during resection surgery for epilepsy or tumors and deep brain stimulation electrode placement in patients with Parkinson's disease. Here, we provide a better understanding of the capabilities and challenges of using Neuropixels as a research tool to study human neurophysiology, with the hope that this information may inform future efforts toward regulatory approval of Neuropixels probes as research devices. In perioperative procedures, the major concerns are the initial sterility of the device, maintaining a sterile field during surgery, having multiple referencing and grounding schemes available to de-noise recordings (if necessary), protecting the silicon probe from accidental contact before insertion and obtaining high-quality action potential and local field potential recordings. The research team ensures that the device is fully operational while coordinating with the surgical team to remove sources of electrical noise that could otherwise substantially affect the signals recorded by the sensitive hardware. Prior preparation using the equipment and training in human clinical research and working in operating rooms maximize effective communication within and between the teams, ensuring high recording quality and minimizing the time added to the surgery. The perioperative procedure requires ~4 h, and the entire protocol requires multiple weeks.

A comparative review on neuroethical issues in neuroscientific and neuroethical journals

This study is a pilot literature review that compares the interest of neuroethicists and neuroscientists. It aims to determine whether there is a significant gap between the neuroethical issues addressed in philosophical neuroethics journals and neuroscience journals. We retrieved 614 articles from two specialist neuroethics journals (Neuroethics and AJOB Neuroscience) and 82 neuroethics-focused articles from three specialist neuroscience journals (Neuron, Nature Neuroscience, and Nature Reviews Neuroscience). We classified these articles in light of the neuroethical issue in question before we compared the neuroethical issues addressed in philosophical neuroethics with those addressed by neuroscientists. A notable result is a parallelism between them as a general tendency. Neuroscientific articles cover most neuroethical issues discussed by philosophical ethicists and vice versa. Subsequently, there are notable discrepancies between the two bodies of neuroethics literature. For instance, theoretical questions, such as the ethics of moral enhancement and the philosophical implications of neuroscientific findings on our conception of personhood, are more intensely discussed in philosophical-neuroethical articles. Conversely, neuroscientific articles tend to emphasize practical questions, such as how to successfully integrate ethical perspectives into scientific research projects and justifiable practices of animal-involving neuroscientific research. These observations will help us settle the common starting point of the attempt at "ethics integration" in emerging neuroscience, contributing to better governance design and neuroethical practice.

Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'

The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.

Neuroethical implications of focused ultrasound for neuropsychiatric illness

BACKGROUND

MR-guided focused ultrasound is a promising intervention for treatment-resistant mental illness, and merits contextualized ethical exploration in relation to more extensive ethical literature regarding other psychosurgical and neuromodulation treatment options for this patient population. To our knowledge, this topic has not yet been explored in the published literature.

OBJECTIVE

The purpose of this paper is to review and discuss in detail the neuroethical implications of MR-guided focused ultrasound for neuropsychiatric illness as an emerging treatment modality.

METHODS

Due to the lack of published literature on the topic, the approach involved a detailed survey and review of technical and medical literature relevant to focused ultrasound and established ethical issues related to alternative treatment options for patients with treatment-resistant, severe and persistent mental illness. The manuscript is structured according to thematic and topical findings.

RESULTS

This technology has potential benefits for patients suffering with severe mental illness, compared with established alternatives. The balance of technical, neuroscientific and clinical considerations should inform ethical deliberations. The nascent literature base, nuances in legal classification and permissibility depending upon jurisdiction, influences of past ethical issues associated with alternative treatments, tone and framing in media articles, and complexity of clinical trials all influence ethical assessment and evaluations of multiple stakeholders. Recommendations for future research are provided based on these factors.

CONCLUSION

Salient ethical inquiry should be further explored by researchers, clinicians, and ethicists in a nuanced manner methodologically, one which is informed by past and present ethical issues related to alternative treatment options, broader psychiatric treatment frameworks, pragmatic implementation challenges, intercultural considerations, and patients' ethical concerns.

Semantic reconstruction of continuous language from non-invasive brain recordings

A brain-computer interface that decodes continuous language from non-invasive recordings would have many scientific and practical applications. Currently, however, non-invasive language decoders can only identify stimuli from among a small set of words or phrases. Here we introduce a non-invasive decoder that reconstructs continuous language from cortical semantic representations recorded using functional magnetic resonance imaging (fMRI). Given novel brain recordings, this decoder generates intelligible word sequences that recover the meaning of perceived speech, imagined speech and even silent videos, demonstrating that a single decoder can be applied to a range of tasks. We tested the decoder across cortex and found that continuous language can be separately decoded from multiple regions. As brain-computer interfaces should respect mental privacy, we tested whether successful decoding requires subject cooperation and found that subject cooperation is required both to train and to apply the decoder. Our findings demonstrate the viability of non-invasive language brain-computer interfaces.

Natural Language Processing Markers for Psychosis and Other Psychiatric Disorders: Emerging Themes and Research Agenda From a Cross-Linguistic Workshop

This workshop summary on natural language processing (NLP) markers for psychosis and other psychiatric disorders presents some of the clinical and research issues that NLP markers might address and some of the activities needed to move in that direction. We propose that the optimal development of NLP markers would occur in the context of research efforts to map out the underlying mechanisms of psychosis and other disorders. In this workshop, we identified some of the challenges to be addressed in developing and implementing NLP markers-based Clinical Decision Support Systems (CDSSs) in psychiatric practice, especially with respect to psychosis. Of note, a CDSS is meant to enhance decision-making by clinicians by providing additional relevant information primarily through software (although CDSSs are not without risks). In psychiatry, a field that relies on subjective clinical ratings that condense rich temporal behavioral information, the inclusion of computational quantitative NLP markers can plausibly lead to operationalized decision models in place of idiosyncratic ones, although ethical issues must always be paramount.

Lifting as we climb: Experiences and recommendations from women in neural engineering

Neural engineering is an emerging and multidisciplinary field in which engineering approaches are applied to neuroscience problems. Women are underrepresented in engineering fields, and indeed in science, technology, engineering, and mathematics (STEM) fields generally. Underrepresentation of women is particularly notable at later academic career stages, suggesting that even though women are interested in the field, barriers exist that ultimately cause them to leave. Here, we investigate many of the obstacles to women's success in the field of neural engineering and provide recommendations and materials to overcome them. We conducted a review of the literature from the past 15 years regarding the experiences of women in academic careers, as well as reports on the number of women in fields closely related to neural engineering from the National Science Foundation (NSF) and the American Society for Engineering Education (ASEE). Additionally, we interviewed six women in neural engineering who are involved in initiatives and outreach concerning the inclusion and experiences of women in engineering. Throughout the literature and interviews, we identified common themes spanning the role of identity and confidence, professional relationships, career-related hurdles, and personal and professional expectations. We explore each of these themes in detail and provide resources to support the growth of women as they climb within the field of neural engineering.

Neurotechnology to reduce recidivism: Ethical and legal challenges

Crime comes with enormous costs, not only financial but also in terms of loss of mental and physical health and, in some cases, even loss of life. Recidivism is responsible for a considerable percentage of the crimes, and therefore, society deems reducing recidivism a priority. To reduce recidivism, several types of interventions can be used, such as education and employment-focused rehabilitation programs which are intended to improve psychological and social factors. Another way to prevent reoffending is to influence the offender's brain functions. For example, medication can be offered to treat delusions or to diminish sexual drive. In the near future, innovative neurotechnologies are expected to improve prediction and prevention of reoffending. Potential positive effects of such neurotechniques include a safer society and earlier release of prisoners who are no longer "at high risk" to relapse into criminal behavior. Meanwhile, employing these neurotechniques in the criminal justice system raises fundamental concerns, for example, about autonomy, privacy and mental integrity. This chapter aims to identify some of the ethical and legal challenges of using neurotechnologies to reduce recidivism.

Emulating future neurotechnology using magic

Recent developments in neuroscience and artificial intelligence have allowed machines to decode mental processes with growing accuracy. Neuroethicists have speculated that perfecting these technologies may result in reactions ranging from an invasion of privacy to an increase in self-understanding. Yet, evaluating these predictions is difficult given that people are poor at forecasting their reactions. To address this, we developed a paradigm using elements of performance magic to emulate future neurotechnologies. We led 59 participants to believe that a (sham) neurotechnological machine could infer their preferences, detect their errors, and reveal their deep-seated attitudes. The machine gave participants randomly assigned positive or negative feedback about their brain's supposed attitudes towards charity. Around 80% of participants in both groups provided rationalisations for this feedback, which shifted their attitudes in the manipulated direction but did not influence donation behaviour. Our paradigm reveals how people may respond to prospective neurotechnologies, which may inform neuroethical frameworks.

Brain augmentation and neuroscience technologies: current applications, challenges, ethics and future prospects

Ever since the dawn of antiquity, people have strived to improve their cognitive abilities. From the advent of the wheel to the development of artificial intelligence, technology has had a profound leverage on civilization. Cognitive enhancement or augmentation of brain functions has become a trending topic both in academic and public debates in improving physical and mental abilities. The last years have seen a plethora of suggestions for boosting cognitive functions and biochemical, physical, and behavioral strategies are being explored in the field of cognitive enhancement. Despite expansion of behavioral and biochemical approaches, various physical strategies are known to boost mental abilities in diseased and healthy individuals. Clinical applications of neuroscience technologies offer alternatives to pharmaceutical approaches and devices for diseases that have been fatal, so far. Importantly, the distinctive aspect of these technologies, which shapes their existing and anticipated participation in brain augmentations, is used to compare and contrast them. As a preview of the next two decades of progress in brain augmentation, this article presents a plausible estimation of the many neuroscience technologies, their virtues, demerits, and applications. The review also focuses on the ethical implications and challenges linked to modern neuroscientific technology. There are times when it looks as if ethics discussions are more concerned with the hypothetical than with the factual. We conclude by providing recommendations for potential future studies and development areas, taking into account future advancements in neuroscience innovation for brain enhancement, analyzing historical patterns, considering neuroethics and looking at other related forecasts.

Neuroplasticity as a Foundation for Decision-Making in Space

This is an exploratory review of two very recent, intersecting segments of space science: neuroplasticity in space, and decision-making in space. The high level of neuroplasticity in humans leads to unfortunate neurological and physical deconditioning while the body adjusts to the new space environment. However, neuroplasticity may also allow recovery and continued functioning of decision-making at a level necessary for mission completion. Cosmic radiation, microgravity, heightened levels of carbon dioxide in spacecraft, and other factors are being explored as root causes of neurological and physical deconditioning in space. The goal of this paper is to explore some of the lines of causation that show how these factors affect the capacity of humans to make decisions in space. Either alone or in groups, it remains essential that humans retain an ability to make decisions that will save lives, protect equipment, complete missions, and return safely to Earth. A final section addresses healthcare, medical intervention, and remediation that could help to "harness" neuroplasticity before, during, and after spaceflight. The dual nature of human neuroplasticity renders it both a cause of problems and also potentially the foundation of remediation. The future of research on both neuroplasticity and human decision-making promises to be full of surprises, both welcome and otherwise. It is an exciting time in research on space medicine.

The Metaverse as a virtual form of data-driven smart cities: the ethics of the hyper-connectivity, datafication, algorithmization, and platformization of urban society

Recent advances in computing and immersive technologies have provided Meta (formerly Facebook) with the opportunity to leapfrog or expedite its way of thinking and devising a global computing platform called the “Metaverse”. This hypothetical 3D network of virtual spaces is increasingly shaping alternatives to the imaginaries of data-driven smart cities, as it represents ways of living in virtually inhabitable cities. At the heart of the Metaverse is a computational understanding of human users’ cognition, emotion, motivation, and behavior that reduces the experience of everyday life to logic and calculative rules and procedures. This implies that human users become more knowable and manageable and their behavior more predictable and controllable, thereby serving as passive data points feeding the AI and analytics system that they have no interchange with or influence on. This paper examines the forms, practices, and ethics of the Metaverse as a virtual form of data-driven smart cities, paying particular attention to: privacy, surveillance capitalism, dataveillance, geosurveillance, human health and wellness, and collective and cognitive echo-chambers. Achieving this aim will provide the answer to the main research question driving this study: What ethical implications will the Metaverse have on the experience of everyday life in post-pandemic urban society? In terms of methodology, this paper deploys a thorough review of the current status of the Metaverse, urban informatics, urban science, and data-driven smart cities literature, as well as trends, research, and developments. We argue that the Metaverse will do more harm than good to human users due to the massive misuse of the hyper-connectivity, datafication, algorithmization, and platformization underlying the associated global architecture of computer mediation. It follows that the Metaverse needs to be re-cast in ways that re-orientate in how users are conceived; recognize their human characteristics; and take into account the moral values and principles designed to realize the benefits of socially disruptive technologies while mitigating their pernicious effects. This paper contributes to the academic debates in the emerging field of data-driven smart urbanism by highlighting the ethical implications posed by the Metaverse as speculative fiction that illustrates the concerns raised by the pervasive and massive use of advanced technologies in data-driven smart cities. In doing so, it seeks to aid policy-makers in better understanding the pitfalls of the Metaverse and their repercussions upon the wellbeing of human users and the core values of urban society. It also stimulates prospective research and further critical perspectives on this timely topic.

Neuroderecho y envejecimiento: una aproximación bioética a la mejora cognitiva

Los avances de la neurociencia están determinando cambios decisivos en la vida de las personas, aunque también en campo de la ética y del derecho. En este contexto, el desarrollo y las aplicaciones neurotecnológicas aparecen llamados a mejorar la calidad de vida y el bienestar de los seres humanos, de un modo particular en la población mayor, en la medida en que medios como la tecnología de mejora se configuran como herramientas eficaces en el combate frente al deterioro de las funciones cognitivas. Sin embargo, el empleo de tales recursos puede generar riesgos para la intimidad y la integridad mental humana, lo que hace necesario el reconocimiento de neuroderechos, a fin de evitar injerencias no consentidas.

Addressing neuroethics issues in practice: Lessons learnt by tech companies in AI ethics

Neurotechnologies raise ethical concerns overlapping with those of other technologies, like artificial intelligence (AI). We discuss how to leverage the experience and lessons learnt by tech companies addressing AI ethics issues to accelerate going from neuroethics principles to scaled neuroethical industry practice.

The science and engineering behind sensitized brain-controlled bionic hands

Advances in our understanding of brain function, along with the development of neural interfaces that allow for the monitoring and activation of neurons, have paved the way for brain-machine interfaces (BMIs), which harness neural signals to reanimate the limbs via electrical activation of the muscles or to control extracorporeal devices, thereby bypassing the muscles and senses altogether. BMIs consist of reading out motor intent from the neuronal responses monitored in motor regions of the brain and executing intended movements with bionic limbs, reanimated limbs, or exoskeletons. BMIs also allow for the restoration of the sense of touch by electrically activating neurons in somatosensory regions of the brain, thereby evoking vivid tactile sensations and conveying feedback about object interactions. In this review, we discuss the neural mechanisms of motor control and somatosensation in able-bodied individuals and describe approaches to use neuronal responses as control signals for movement restoration and to activate residual sensory pathways to restore touch. Although the focus of the review is on intracortical approaches, we also describe alternative signal sources for control and noninvasive strategies for sensory restoration.

Spinal cord bioelectronic interfaces: opportunities in neural recording and clinical challenges

Bioelectronic stimulation of the spinal cord has demonstrated significant progress in restoration of motor function in spinal cord injury (SCI). The proximal, uninjured spinal cord presents a viable target for the recording and generation of control signals to drive targeted stimulation. Signals have been directly recorded from the spinal cord in behaving animals and correlated with limb kinematics. Advances in flexible materials, electrode impedance and signal analysis will allow SCR to be used in next-generation neuroprosthetics. In this review, we summarize the technological advances enabling progress in SCR and describe systematically the clinical challenges facing spinal cord bioelectronic interfaces and potential solutions, from device manufacture, surgical implantation to chronic effects of foreign body reaction and stress-strain mismatches between electrodes and neural tissue. Finally, we establish our vision of bi-directional closed-loop spinal cord bioelectronic bypass interfaces that enable the communication of disrupted sensory signals and restoration of motor function in SCI.

Novel Neurorights: From Nonsense to Substance

This paper analyses recent calls for so called “neurorights”, suggested novel human rights whose adoption is allegedly required because of advances in neuroscience, exemplified by a proposal of the Neurorights Initiative. Advances in neuroscience and technology are indeed impressive and pose a range of challenges for the law, and some novel applications give grounds for human rights concerns. But whether addressing these concerns requires adopting novel human rights, and whether the proposed neurorights are suitable candidates, are a different matter. This paper argues that the proposed rights, as individuals and a class, should not be adopted and lobbying on their behalf should stop. The proposal tends to promote rights inflationism, is tainted by neuroexceptionalism and neuroessentialism, and lacks grounding in relevant scholarship. None of the proposed individual rights passes quality criteria debated in the field. While understandable from a moral perspective, the proposal is fundamentally flawed from a legal perspective. Rather than conjuring up novel human rights, existing rights should be further developed in face of changing societal circumstances and technological possibilities.

Neuroethics in the Era of Teleneurology

The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.

On Neurorights

In recent years, philosophical-legal studies on neuroscience (mainly in the fields of neuroethics and neurolaw) have given increasing prominence to a normative analysis of the ethical-legal challenges in the mind and brain sciences in terms of rights, freedoms, entitlements and associated obligations. This way of analyzing the ethical and legal implications of neuroscience has come to be known as “neurorights.” Neurorights can be defined as the ethical, legal, social, or natural principles of freedom or entitlement related to a person’s cerebral and mental domain; that is, the fundamental normative rules for the protection and preservation of the human brain and mind. Although reflections on neurorights have received ample coverage in the mainstream media and have rapidly become a mainstream topic in the public neuroethics discourse, the frequency of such reflections in the academic literature is still relatively scarce. While the prominence of the neurorights debate in public opinion is crucial to ensure public engagement and democratic participation in deliberative processes on this issue, its relatively sporadic presence in the academic literature poses a risk of semantic-normative ambiguity and conceptual confusion. This risk is exacerbated by the presence of multiple and not always reconcilable terminologies. Several meta-ethical, normative ethical, and legal-philosophical questions need to be solved in order to ensure that neurorights can be used as effective instruments of global neurotechnology governance and be adequately imported into international human rights law. To overcome the shortcomings above, this paper attempts to provide a comprehensive normative-ethical, historical and conceptual analysis of neurorights. In particular, it attempts to (i) reconstruct a history of neurorights and locate these rights in the broader history of idea, (ii) outline a systematic conceptual taxonomy of neurorights, (iii) summarize ongoing policy initiatives related to neurorights, (iv) proactively address some unresolved ethico-legal challenges, and (v) identify priority areas for further academic reflection and policy work in this domain.

"Nothing to Lose, Absolutely Everything to Gain": Patient and Caregiver Expectations and Subjective Outcomes of Deep Brain Stimulation for Treatment-Resistant Depression

Background: How "success" is defined in clinical trials of deep brain stimulation (DBS) for refractory psychiatric conditions has come into question. Standard quantitative psychopathology measures are unable to capture all changes experienced by patients and may not reflect subjective beliefs about the benefit derived. The decision to undergo DBS for treatment-resistant depression (TRD) is often made in the context of high desperation and hopelessness that can challenge the informed consent process. Partners and family can observe important changes in DBS patients and play a key role in the recovery process. Their perspectives, however, have not been investigated in research to-date. The aim of this study was to qualitatively examine patient and caregivers' understanding of DBS for TRD, their expectations of life with DBS, and how these compare with actual experiences and outcomes. Methods: A prospective qualitative design was adopted. Semi-structured interviews were conducted with participants (six patients, five caregivers) before DBS-implantation and 9-months after stimulation initiation. All patients were enrolled in a clinical trial of DBS of the bed nucleus of the stria terminalis. Interviews were thematically analyzed with data saturation achieved at both timepoints. Results: Two primary themes identified were: (1) anticipated vs. actual outcomes, and (2) trial decision-making and knowledge. The decision to undergo DBS was driven by the intolerability of life with severe depression coupled with the exhaustion of all available treatment options. Participants had greater awareness of surgical risks compared with stimulation-related risks. With DBS, patients described cognitive, emotional, behavioral and physical experiences associated with the stimulation, some of which were unexpected. Participants felt life with DBS was like "a roller coaster ride"-with positive, yet unsustained, mood states experienced. Many were surprised by the lengthy process of establishing optimum stimulation settings and felt the intervention was still a "work in progress." Conclusion: These findings support existing recommendations for iterative informed consent procedures in clinical trials involving long-term implantation of neurotechnology. These rich and descriptive findings hold value for researchers, clinicians, and individuals and families considering DBS. Narrative accounts capture patient and family needs and should routinely be collected to guide patient-centered approaches to DBS interventions.