Substantial discussion in the neuroethical literature has addressed the possibility that deep brain stimulation (DBS) and adaptive DBS (aDBS) could result in changes in personality, agency, and ide...

The mental prosthesis model (Silvers and Francis 2009) suggests that interpersonal “prosthetic” thinking could support decision making for people with limited cognitive capacities, and positions th...

We share Nair-Collins and Joffe's (2023) concern with the accuracy of the “whole brain-death” diagnosis, which fails to take into account current understandings of residual brain function (neurohor...

Nair-Collins and Joffe (2023) highlighted the noncongruence between the language of the Uniform Determination of Death Act (UDDA) and the accepted brain death bedside testing standard by showing th...

Neuroethicists have paid significant attention to reports of personality changes in patients being treated with deep brain stimulation (DBS), to the point where some have suggested that theoretical...

Medical decision-making on behalf of intellectually and developmentally disabled (IDD) patients amounts to a critical challenge, one which has been widely discussed by bioethicists, medical, and le...

We join McCarthy and Howard (2023) in advocating supported decision-making for patients with diminished mental capacity that meaningfully expands the role of trustees beyond merely channeling the i...

It is a tale of two Pfizers. In 2018 they abandoned research into the leading cause of dementia, Alzheimer’s Disease (AD) (Hawkes 2018). In 2021, they developed the first vaccine for Covid-19 to re...

Nair-Collins and Joffe (2023) highlight the complexities inherent to the clinical diagnosis of death by neurologic criteria and inconsistencies between legal, scientific, and clinical standards for...

The question of whether Deep Brain Stimulation (DBS), as open-loop, closed-loop or adaptative technology, induces unwanted effects on patients’ personality is still an ongoing multidisciplinary deb...

The potential psychosocial effects of neurotechnology, particularly deep brain stimulation (DBS), have been at the center of a contentious debate within neuroethics. Many scholars have argued that...

The brain is a complex and fascinating organ that plays a crucial role in shaping individuality. Despite years of research, both the physical brain and the metaphysical mind remain mysterious, espe...

As Nair-Collins and Joffe note, the concern that our tests for brain death do not successfully show that all brain functions have stopped is not new (Nair-Collins and Joffe 2023). As our abilities...

Recent debate has arisen in the neuroethics literature on the extent to which deep brain stimulation (DBS) may cause changes to core personal traits. This has prompted calls for more empirical data...

In October 2022, I had the privilege of joining Hank Greely on the opening panel of the annual International Neuroethics Society (INS) meeting in Montréal, Tiohtiá:ke, situated on the traditional t...

McCarthy and Howard (2023) develop an ethical case for supported decision-making in medical contexts, mainly building upon the republican ideal of non-domination. Their theoretical inquiry is of mu...

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

-/- Zuk et al. (2023) examined researchers’ views on how deep brain stimulation may impact patients’ personality, mood, and behaviour (PMB). The team found that experts vary substantially in the notion of personality they employ. However, despite noting the lack of conceptual precision, no attempt was made at scientifically defining any of the involved concepts, so that the results of the different interviews remain largely incommensurable. In this comment, I am doing the interpretative work that the authors should have undertaken (...) following the descriptive part of the paper: first, disentangling the PMB cluster by defining what exactly constitutes personality, mood, and behaviour; and secondly, conceptualising the notion of personality change. I am arguing that what sets personality changes apart from other modifications is diachronic persistence. (shrink)

Brain death, or death by neurological criteria (BD/DNC) is the permanent loss of brain function as defined by an unresponsive coma, loss of brainstem reflexes, and the ability to breathe without me...

The classification of preserved hypothalamic activity in brain death and brainstem death as functional or nonfunctional has become a subject of debate. While proponents of the neurological criterio...

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

McCarthy and Howard (2023) present a “Non-Domination” approach to supported decision-making, specially to help intellectually and developmentally disabled (IDD) patients rather than “Mental Prosthe...

The definition of “personality” and related concepts is both unclear and not unified among medical, scientific, humanities and social sciences experts (i.e., essentialist, dynamic view of self, nar...

The findings identified by Zuk et al. (2023) demonstrate the importance of understanding personality, mood, and behavior (PMB) as theory and value-laden concepts. Although their research covered bo...

The 30th anniversary of the first DBS surgery of the subthalamic nucleus (STN) for Parkinson’s disease was celebrated in Grenoble this June. Since this initial surgery, the application of DBS has e...

In the article “The Socio-Political Roles of Neuroethics and the Case of Klotho,” we proposed a socio-political approach to neuroethics, inspired by John Rawls’s roles for political philosophy. In...

Zuk et al. (2023) explore personality, mood, and behavioral (PMB) changes in DBS and aDBS, though have not invoked what is known about the similarities and differences for other available brain sti...

Nair-Collins and Joffe (2023) rightly call attention to an incompatibility between brain-based criteria for death, as defined by the Uniform Determination of Death Act (UDDA), and what the current...

In their most informative text, Zuk et al. (2023) describe the perspectives researchers take on DBS and aDBS when discussing changes in patients’ personality, mood, or behavior. To this end, Zuk et...

McCarthy and Howard (2023) advocate for supported decision making for patients with intellectual and developmental disabilities (IDD). Departing from the “mental prosthesis” model of supported deci...

The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A (...) smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term ‘personality,’ while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. (shrink)

In their latest target article, Zilio and Lavazza (2023) major claim is that research on human cerebral organoids (HCOs) must take into account whether they can acquire sentience or a primitive for...

It is widely agreed that possession of consciousness contributes to an entity’s moral status, even if it is not necessary for moral status (Levy and Savulescu 2009). An entity is considered to have...

Palermos’s (2023) concept of “mental data” is appreciated as advancing fresh considerations in urgent discourse on mental privacy. However, it is suggested that the proposal for an ontologically di...

Due to their contested ethical and legal status, human cerebral organoids (HCOs) have become the subject of one of the most rapidly expanding debates in the recent bioethics literature. There is no...

Peterson et al. (2023) identify two potential uses of psychedelic drugs in Alzheimer’s disease and related disorders (AD/ADRD). The first is to treat depression and anxiety that commonly occur afte...

People crossing the border into the United States or Canada may find their electronic devices subject to search. Border agents can require travelers to unlock their devices, and then browse through...

The possibility that human cerebral organoids (HCOs) develop consciousness is one of the main concerns driving current ethical discourse. Evaluating existing evidence, Zilio and Lavazza (2023) in t...

In this issue, Joshua Shepherd (2023) offers defensible argument for broader consideration of cognitive and psychological features viable and valuable for sentiments about and interactions with non...

This special issue of AJOB Neuroscience explores a number of ethical questions emerging from some of the most recent results of research on consciousness, including its moral interpretation, its te...

In “Journeying to Ixtlan,” Peterson and colleagues (2023) evaluate some of the potential ethical implications of treating Alzheimer’s disease (AD) with psychedelic medicines. In this commentary, I...

Professors Hildt (2023), Shepherd (2023), and Zilio and Lavazza (2023) jointly considered the ethical and philosophical implications of acknowledging non-human (e.g., machine) consciousness. Althou...

In their paper, Hildt (2023) surveys several socio-ethical and regulatory issues arising from research into, and the potential emergence of, artificial consciousness—synthetic beings with a claim t...

The recent article “The Prospects of Artificial Consciousness: Ethical Dimensions and Concerns” by Elisabeth Hildt (2023) in the AJOB Neuroscience presents a thorough examination of the ethical imp...

Intellectual property (IP) offices and courts around the world are debating whether machines are similar enough to humans in terms of their consciousness and creativity to be eligible for inventors...

Elizabeth Hildt’s (2023) notion of human-like artificial consciousness (AC) is vulnerable to several objections. First, she ties it to traits such as subjectivity and to capacities for rationality,...

Can machines be conscious and what would be the ethical implications? This article gives an overview of current robotics approaches toward machine consciousness and considers factors that hamper an understanding of machine consciousness. After addressing the epistemological question of how we would know whether a machine is conscious and discussing potential advantages of potential future machine consciousness, it outlines the role of consciousness for ascribing moral status. As machine consciousness would most probably differ considerably from human consciousness, several complex questions (...) must be addressed, including what forms of machine consciousness would be morally relevant forms of consciousness, and what the ethical implications of morally relevant forms of machine consciousness would be. While admittedly part of this reflection is speculative in nature, it clearly underlines the need for a detailed conceptual analysis of the concept of artificial consciousness and stresses the imperative to avoid building machines with morally relevant forms of consciousness. The article ends with some suggestions for potential future regulation of machine consciousness. (shrink)

Peterson et al. (2023) present a range of ethical issues that arise when considering the use of psychedelic substances within medicine. But psychedelics are, by their nature, boundary-dissolving, a...

If “on what matters” captures Parfit’s search for objective moral truths (Parfit 2011), perhaps “on who matters (and why)” might be a working title for Shepherd’s enquiry into the moral status of n...

In his paper “Non-human moral status: problems with phenomenal consciousness,” Joshua Shepherd emphasized an objectivist understanding of welfare to establish the moral status of non-human entities...

The article “Consciousness in a Bioreactor? Science and Ethics of Potentially Conscious Human Cerebral Organoids” (Zillo and Lavazza 2023) presents a thoughtful discussion on the potential ethical...

Peterson et al. (2023) write that there’s “a rich philosophical debate on the nature of authenticity in dementia” involving the relationship of identity and autonomy. I explore this with Jaworska’s...

Numerous and diverse discussions about moral status have taken place over the years. However, this concept was not born until the moral weight of non-human entities was raised. Animal ethics, for i...

In a recent article, Joshua Shepherd identifies six problems with attributing moral status to nonhumans on the basis of consciousness (Shepherd 2023). In this commentary, I want to draw out yet ano...

Hildt (2023) considers the topic of machine consciousness and the ethical implications of artificial entities, such as robots, possessing different forms of consciousness. Her paper recommends that...

In the target article, Zilio and Lavazza (2023) persuasively argue that an ontological analysis of human cerebral organoids (HCOs) is necessary to identify their moral status. Although they also pr...

In their target article, Peterson et al. discuss the intriguing prospect of using psychedelics as a treatment for patients with Alzheimer’s Disease and Related Dementias (AD/ADRD) (Peterson et al....

It has been recently suggested that if the Extended Mind thesis is true, mental privacy might be under serious threat. In this paper, I look into the details of this claim and propose that one way of dealing with this emerging threat requires that data ontology be enriched with an additional kind of data—viz., mental data. I explore how mental data relates to both data and metadata and suggest that, arguably, and by contrast with these existing categories of informational content, (...) mental data should not be merely legally protected. Rather, if we value mental privacy as we know it, technological measures should be employed to ensure that one’s mental data are practically—not just legally—impossible for others to obtain. (shrink)

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

While the developers of the “Ixtlan Basic Kit” promise a curative treatment taking advantage of increased neuroplasticity for targeting the underlying neurological causes of Alzheimer's disease and...

One important discussion raised in this special issue on the ethical spectrum of consciousness involves the possibility of providing machines with human mind-like capabilities to the point of allow...

Peterson et al. (2023) identify important ethical issues that are relevant to psychedelic therapy and research in various clinical populations and contexts. This is certainly the case in palliative...

Shepherd (2023) is concerned about the moral status of nonhumans and argues that consciousness-based approaches to moral status are inadequate to guide policy decisions. Consciousness-based approac...

Dementia is an ever-growing public health concern with significant impact on the quality of life of older adults and their families (Aranda et al. 2021). Research continues to investigate treatment...

Consciousness-based approaches to non-human moral status maintain that consciousness is necessary for (some degree or level of) moral status. While these approaches are intuitive to many, in this paper I argue that the judgment that consciousness is necessary for moral status is not secure enough to guide policy regarding non-humans, that policies responsive to the moral status of non-humans should take seriously the possibility that psychological features independent of consciousness are sufficient for moral status. Further, I illustrate some practical consequences (...) of calling consciousness-based views into question. (shrink)

Peterson et al. (2023) outline a broad ethics agenda for imminent research on psychedelic agents for Alzheimer’s disease and related dementias (AD/ADRD) by acknowledging the therapeutic promise of...

In a recent article, Spyridon Palermos claims there is a significant difference between ordinary data (“the contents of electronic communications”) and mental data (Palermos 2023). He defines “ment...

Organoids, in general, have become an established theme in bioethics. However, brain organoids are almost unique due to the vital and symbolic nature of the organ they reproduce, albeit partially,...

Recent scientific and technological developments enable the generation of increasingly sophisticated organoids: three-dimensional, lab-grown stem cell-based entities that model human organs anatomi...

The last decade has seen an explosion of interest in the possibility of suffering in nonhumans, including animals only very distantly related to us, as well as artificial intelligence systems. Much...

By introducing the concept of “mental data,” Palermos (2023) highlights an underappreciated aspect of data ethics that policymakers would do well to heed. Sweeping artificial intelligence (AI) legi...

Human cerebral organoids are three-dimensional biological cultures grown in the laboratory to mimic as closely as possible the cellular composition, structure, and function of the corresponding organ, the brain. For now, cerebral organoids lack blood vessels and other characteristics of the human brain, but are also capable of having coordinated electrical activity. They have been usefully employed for the study of several diseases and the development of the nervous system in unprecedented ways. Research on human cerebral organoids is proceeding at (...) a very fast pace and their complexity is bound to improve. This raises the question of whether cerebral organoids will also be able to develop the unique feature of the human brain, consciousness. If this is the case, some ethical issues would arise. In this article, we discuss the necessary neural correlates and constraints for the emergence of consciousness according to some of the most debated neuroscientific theories. Based on this, we consider what the moral status of a potentially conscious brain organoid might be, in light of ethical and ontological arguments. We conclude by proposing a precautionary principle and some leads for further investigation. In particular, we consider the outcomes of some very recent experiments as entities of a potential new kind. (shrink)

Medical interventions are usually categorized as “invasive” when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric (...) electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention. (shrink)

In their recent target article, Bluhm et al. (2023) discuss the construct of “invasiveness” as it relates to medical treatments, and in particular to treatments that affect brain function. Cruciall...

Bluhm et al.’s (2023) qualitative study on psychiatric electroceutical interventions describes several types and characteristics of invasiveness identified by psychiatrists and people living with a...

In their paper, “Closed-Loop Neuromodulation and Self-Perception in Clinical Treatment of Refractory Epilepsy,” Haeusermann et al. (2023) note that although responsive neurostimulation (RNS) data v...

Haeusermann et al. (Citation2023) draw three overall conclusions from their study on closed loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. The first is that closed-loop neuromodulation devices did not substantially change epileptic patient’s personalities or self-perception postoperatively. The second is that some patients and caregivers attributed observed changes in personality and self-perception to the epilepsy itself and not to the DBS treatments. The third is that the devices provided participants with novel ways to make sense of their (...) illness. These findings further demonstrate a misalignment between some neuroethicists’ concerns about putative postoperative changes to personality, and the empirical evidence for such changes. Haeusermann et al. nonetheless concede that “neurotechnology directed at persisting rather than episodic clinical phenomena could have greater implications for personality or self-perception, either because they operate more continuously or are directed at clinical phenomena that are more stably integrated into patients’ self-concepts” (41). We acknowledge that the hypothesis that participants did not report changes because they were only episodically and not continually stimulated offers an interesting line for future investigation. Nonetheless, we would like to propose that potential postoperative personality changes might be correlated with the pathophysiology itself, rather than the stimulation effects of the technology. Generally, we advance the view that unintended effects solely induced by the technology cannot be excluded per se. Regardless, this comment aims to highlight that ethicists’ starting premise should be that patients suffering from diverse pathophysiology, or patients who are treated with stimulation in different brain regions and with differing parameters, would likely not react in the same way to treatment. (shrink)

Haeusermann et al. (2023) provide a valuable ethnographic window into how RNS device users understand themselves in relation to refractory epilepsy, the medications for it, and the use of the impla...

Background: Newer “closed-loop” neurostimulation devices in development could, in theory, induce changes to patients’ personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment.Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program and (...) collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception.Results: Participants generally did not attribute changes in patients’ personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients’ experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians.Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients’ illness experiences and social circumstances. (shrink)

Bluhm et al. (2023) identify invasiveness as a genus with multiple species: a treatment protocol or intervention can be invasive along physical, emotional, or lifestyle dimensions. They also identi...

Medical interventions are usually categorized as “invasive” when they involve piercing the skin or inserting an object into the body. However, the findings of Bluhm and collaborators (2023) (hencef...

Major depression is among the most common, challenging and disabling conditions. It is highly heterogeneous, affects patients throughout the lifespan and, in up to one-third of people affected, res...

While the various therapeutic neurotechnologies currently in development—TMS, tDCS, and related treatment modalities—have the potential to greatly augment the treatment of a spectrum of diseases an...

Bluhm et al. (2023) interviewed psychiatrists, patients with depression, and members of the public and concluded that participants recognized multiple categories of invasiveness, including emotiona...

Do neuromodulation technologies change patients’ personal identities? Haeusermann et al. claim that there is not enough evidence to support this worry. In their study, participants, following a res...

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. (shrink)