Ethical issues with brain-computer interfaces

INTRODUCTION Brain-computer interfaces (BCIs), or brain-machine interfaces (BMIs) involve real-time direct connections between the brain and a computer (Kubler, 2009; Wolpaw and Wolpaw, 2011). Bidirectional feedback between the user and the system produces physical changes that can restore some degree of motor or communicative control for individuals with lost limbs, extensive paralysis or who are significantly neurologically compromised (Hochberg et al., 2006, 2012). In these respects, a BCI can enable an individual with severe brain or bodily injury to regain some degree of agency. By providing the subject with the relevant type of feedback, the device may enable her to translate an intention into an action despite the inability to perform voluntary bodily movements. There are two types of feedback with a BCI. The first concerns feedback about the outcome of a self-initiated, BCI-mediated action, such as moving a computer cursor or robotic arm. It provides only indirect feedback about brain activity. The second type concerns direct feedback about the level of brain activity itself. The first is more pertinent to the potential to restore some behavior control in the sense that one can perceive the success or failure of their mental act. Although it is still at an early stage of development, an EEGor fMRI-based BCI might also enable minimally conscious individuals or those with complete locked-in syndrome to communicate wishes about medical treatment when they are unable to do this verbally or gesturally (Sellers, 2013). These applications of interface technology raise a number of ethical issues (McCullagh et al., 2014), three of which I will discuss in this article. First, in some cases patients’ and caregivers’ expectations about recovering motor function with a BCI might not be reasonable given the cognitive challenges in operating the system. This might result in psychological harm when the subject’s desires and intentions to produce actions fail to be realized. Second, the different types of electrodes used to detect and respond to motor cortical neural signals involve different levels of invasiveness and different benefit-risk ratios that have to be weighed with a view to the probable success or failure of the technique. Third, the use of a BCI for communication in neurologically compromised patients prompts the question of whether their responses would be evidence of the capacity to make informed decisions about their care.