IJFAB: International Journal of Feminist Approaches to Bioethics

Timothy Brown's (2019) piece "Building Intricate Partnerships with Neurotechnology" makes a valuable contribution to ethical discussion of questions about human identity and agency raised by Deep Brain Stimulation (DBS). The paper brings together a number of relational approaches to narrative identity and autonomy, drawing on first-personal empirical accounts, to extend a relational account of agency to include neurostimulators. In doing so, it builds on the contributions relational approaches have made to making sense of changes to aspects of selfhood following neurological intervention while also helpfully reframing concerns away from the threat that DBS may pose to aspects of self-hood. This approach directs focus on the user in negotiation with their neurostimulator, with the aim of identifying the agential skills developed in this partnership. In this commentary, I focus on the contribution Brown's paper makes to reframing debates about the effects of DBS on selfhood and the relationship between users and their neurostimulators.

By extending a relational account of agency to neural devices, Brown's approach takes up Baylis's (2013) exhortation to view the impacts of DBS through the "lens of agency," yet also reframes Baylis's concerns about the impacts of brain stimulation as posing a "threat to agency" (525). Although Baylis, in applying a narrative relational account of identity to questions of the impacts of DBS on selfhood, dismisses claims that DBS poses a threat to identity (understood as a static and unchanging), she raises a concern that DBS may yet pose a threat to agency that can in turn threaten narrative identity. Compulsive gambling following brain stimulation is an example of when "a person's actions do not flow from her intentions and beliefs, but rather are the result of direct manipulation" (Baylis 2013, 524). In such cases, threats to agency can interfere with individuals' ability to engage in narrative self-constitution and they may, in turn, lose hold of their sense of self (Baylis 2013, 525). In cases where the source of an individual's actions may be difficult to ascertain, Baylis's approach casts DBS [End Page 162] as manipulating the user's brain: the effects of DBS (e.g., compulsive gambling) happen to the individual, rather than being the result of her deliberate action. However, as Goering et al. (2017) write in their assessment of Baylis's position: "The appeal to 'brain manipulation' renames the problem of agency but offers little help in identifying or addressing it" (66).

In contrast, "Building Intricate Partnerships with Neurotechnology" takes up this challenge to identify and address the "problem of agency." By drawing examples from first-person accounts of concerns related to ambiguous authorship and of the physical trade-offs individuals deploy when using their neurostimulator, Brown argues that the impacts of DBS on a patient's identity are better understood by recognizing how neural implants complicate a person's agency, rather than simply bolstering or impeding certain aspects of a person's identity. For Brown, it is not only an individual's disability (Parkinson's disease, for example) that complicates agency but also the neurostimulator, sometimes to the point that doing the work of an agent is precisely what must be negotiated with one's device. By extending a relational account to devices, Brown focuses attention on the struggles to achieve agency, as internalized within the individual. Part of addressing the "problem of agency" involves recasting DBS as an "external" force or threat to focus on the internal "mechanics of DBS users' confusions, negotiations, and collaborations with their neurostimulators" and the question of how users express their agency throughout (Brown 2019, 141). This approach seems more sympathetic to relational approaches to autonomy, which do not view the influence of others as an immediate threat to autonomous agency.

Brown's (2019) strategy to cast users in partnership with their implants as an approach to questions about the influence of DBS on selfhood builds on the suggestion by Goering and colleagues (2017) to view "neural devices as embodying forms of relational agency" (67). As the relational approach draws attention to the role that others, including friends and family, play in constituting...