While new generations of implantable brain computer interface devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results (...) show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent—predictive and advisory—BCI technologies essential to prevent potential iatrogenic harms. (shrink)

The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin (‘incision’) or inserting an object into the body (‘insertion’). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical (...) interventions—namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness. We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account. (shrink)

This paper argues that the question, ‘where are virtues?’ demands a response from virtue theorists. Despite the polarizing nature of debates about the relevance of empirical work in psychology for virtue theory, I first show that there is widespread agreement about the underlying structure of virtue. Namely, that virtues are comprised of cognitive and affective processes. Next, I show that there are well-developed arguments that cognitive processes can extend beyond the agent. Then, I show that there are similarly well-developed arguments (...) that affective processes can extend beyond the agent. I then introduce three cases to establish that these cognitive and affective processes are relevantly similar to the cognitive and affective processes countenanced by plausible theories of virtue. Finally, I conclude that virtue theorists must abandon default internalism, the view that the cognitive and affective processes comprising virtues are internal to the agent. (shrink)

The possibility of neurotechnological interference with our brain and mind raises questions about the moral rights that would protect against the (mis)use of these technologies. One such moral right that has received recent attention is the right to mental integrity. Though the metaphysical boundaries of the mind are a matter of live debate, most defences of this moral right seem to assume an internalist (brain-based) view of the mind. In this article, we will examine what an extended account of the (...) mind might imply for the right to mental integrity and the protection it provides against neurotechnologies. We argue that, on an extended account of the mind, the scope of the right to mental integrity would expand significantly, implying that neurotechnologies would no longer pose a uniquely serious threat to the right. In addition, some neurotechnologies may even be protected by the right to mental integrity, as the technologies would becomepart ofthe mind. We conclude that adopting an extended account of the mind has significant implications for the right to mental integrity in terms of its protective scope and capacity to protect against neurotechnologies, demonstrating that metaphysical assumptions about the mind play an important role in determining the moral protection provided by the right. (shrink)

What is the ethical impact of artificial intelligence assistants on human lives, and specifically how much do they threaten our individual autonomy? Recently, as part of forming an ethical framework for thinking about the impact of AI assistants on our lives, John Danaher claims that if the external automaticity generated by the use of AI assistants threatens our autonomy and is therefore ethically problematic, then the internal automaticity we already live with should be viewed in the same way. He takes (...) advantage of this paradox of internal automaticity to downplay the threats of external automaticity to our autonomy. We respond in this paper by challenging the legitimacy of the paradox. While Danaher assumes that internal and external automaticity are roughly equivalent, we argue that there are reasons why we should accept a large degree of internal automaticity, that it is actually essential to our sense of autonomy, and as such it is ethically good; however, the same does not go for external automaticity. Therefore, the similarity between the two is not as powerful as the paradox presumes. In conclusion, we make practical recommendations for how to better manage the integration of AI assistants into society. (shrink)

What makes something a part of my body, for moral purposes? Is the body defined naturalistically: by biological relations, or psychological relations, or some combination of the two? This paper approaches this question by considering a borderline case: the status of prostheses. I argue that extant accounts of the body fail to capture prostheses as genuine body parts. Nor, however, do they provide plausible grounds for excluding prostheses, without excluding some paradigm organic parts in the process. I conclude by suggesting (...) that embodiment is moralized all the way down: to be a body part is to be the sort of thing that ought to be protected, in a certain way, by social practices. (shrink)

Medical devices are often referred to as being invasive or non-invasive. Though invasiveness is relevant, and central, to how devices are understood and regarded in medicine and bioethics, a consensus concept or definition of invasiveness is lacking. To begin to address this problem, this essay explores four possible descriptive meanings of invasiveness: how devices are introduced to the body, where they are located in the body, whether they are foreign to the body, and how they change the body. An argument (...) is offered that invasiveness is not purely descriptive, but implicates normative concepts of danger, intrusion, and disruption. In light of this, a proposal is offered for how to understand use of the concept of invasiveness in discussions of medical devices. (shrink)

This paper brings together several strands of thought from both the analytic and phenomenological traditions in order to critically examine accounts of cognitive enhancement that rely on the idea of cognitive extension. First, I explain the idea of cognitive extension, the metaphysics of mind on which it depends, and how it has figured in recent discussions of cognitive enhancement. Then, I develop ideas from Husserl that emphasize the agential character of thought and the distinctive way that conscious thoughts are related (...) to one another. I argue that these considerations are necessary for understanding why forms of cognitive extension may diminish our cognitive lives in different ways. This does not lead to a categorical rejection of cognitive enhancement as unethical or bad for human flourishing, but does warrant a conservative approach to the design and implementation of cognitive artifacts. (shrink)

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsory medical interventions. (shrink)

Ethical analyses of biomedical human enhancement often consider the issue of authenticity — to what degree can the accomplishments of those utilizing biomedical enhancements be considered authentic or worthy of praise? As research into Brain-Computer Interface technology progresses, it may soon be feasible to create a BCI device that enhances or augments natural human intelligence through some invasive or noninvasive biomedical means. In this article we will review currently existing BCI technologies and to what extent these can be said to (...) enhance or augment the capabilities of the respective users, describe one hypothetical type of BCI device that could augment or enhance a specific aspect of human knowledge — namely, mathematical ability, and relate these concepts to the active externalism view of the extended mind as espoused by Clark and Chalmers in order to argue that knowledge of mathematics derived from the usage of a BCI and the application thereof constitutes authentic knowledge and achievement. (shrink)

Presentations of the extended mind thesis are often ambiguous between two versions of that thesis. According to the first, the extension of mind consists in the supervenience base of human individuals’ mental states extending beyond the skull and into artifacts in the outside world. According to a second interpretation, human individuals sometimes participate in broader cognitive systems that are themselves the subjects of extended mental states. This ambiguity, I suggest, contributes to several of the most serious criticisms of the extended (...) mind thesis, for these criticisms only apply to the first interpretation of the thesis. In what follows, I argue that several significant objections to the extended mind thesis fail to undermine the latter interpretation of that thesis. Having defended the second interpretation, I argue that the extension of mind does not involve the extension of self. Consequently, the subject of extended mental states is not the same individual whose causal coupling with external artifacts gives rise to extended mentality. (shrink)

Biomedical engineering technologies such as brain–machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: (...) will everyone be enhanced? Will we be “human” if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism’s reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation’s unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation—and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis. (shrink)

Novel neurotechnologies, like deep brain stimulation and brain‐computer interface, offer great hope for treating, curing, and preventing disease, but raise important questions about effects these devices may have on human identity, authenticity, and autonomy. After briefly assessing recent narrative work in these areas, we show that agency is a phenomenon key to all three goods and highlight the ways in which neural devices can help to draw attention to the relational nature of our agency. Drawing on insights from disability theory, (...) we argue that neural devices provide a kind of agential assistance, similar to that provided by caregivers, family, and others. As such, users and devices participate in a kind of co‐agency. We conclude by suggesting the need for developing relational agency‐competencies—skills for reflecting on the influence of devices on agency, for adapting to novel circumstances ushered in by devices, and for incorporating the feedback of loved ones and others about device effects on agency. (shrink)

Novel neurotechnologies like deep brain stimulation and brain-computer interfaces promise clinical benefits for severely suffering patients. Nevertheless, such electroceuticals raise several ethical issues on different levels: while on the level of clinical neuroethics issues with direct relevance for diagnosis and treatment have to be discussed, on the level of research neuroethics questions regarding research and development of these technological devices like investigating new targets and different diseases as well as thorough inclusion criteria are dealt with. On the level of theoretical (...) neuroethics more general questions are examined including anthropological considerations on “normal” human functioning as well as implications on personality, personal identity and authenticity. This paper presents a brief review on ethical issues of deep brain stimulation and brain computer interfacing and simultaneously introduces to this themed issue with thirteen contributions dealing from different perspectives with ethical implications of electroceuticals for the human brain. (shrink)

This paper investigates the notion of ‘distributed cognition’—the idea that entities external to one’s organic brain participate in one’s overall cognitive functioning—and the challenges it poses to the notion of personhood. Related to this is also a consideration of the ever-increasing ways in which neuroprostheses replace and functionally replicate organic parts of the brain. However, the literature surrounding such issues has tended to take an almost exclusively physicalist approach. The common assumption is that, given that non-physicalist theories (chiefly, dualism, and (...) hylomorphism) postulate some form of immaterial ‘soul’, then they are immune from the challenges that these advances in cognitive science pose. The first aim of this paper, therefore, is to argue that this is not the case. The second aim of this paper is to attempt to elucidate a route available for the non-physicalists that will allow them to accept the notion of distributed cognition. By appealing to an Aristotelian framework, I propose that the non-physicalist can accept the notion of distributed cognition by appealing to the notion of ‘unitary life’ which I introduce, as well as to Aristotle’s dichotomy between active and passive mind. (shrink)

The adaptive BCI known as ‘closed-loop deep brain stimulation’ (clDBS) is a device that stimulates the brain in order to prevent pathological neural activity and automatically adjusts stimulation levels based on computational algorithms that detect or predict those pathological processes. One of the prominent ethical concerns raised by clDBS is that, by inhibiting or modulating the undesirable neural states of a cognitive agent automatically, the device potentially undermines her autonomy. It has been argued that clDBS is not a threat because (...) autonomy is fundamentally relational, i.e., it essentially depends on external (e.g., social or cultural) factors. If the relational approach to autonomy includes human-computer interaction, then the mechanisms of clDBS, even if external to the brain and exerting some degree of control over the individual, may support her autonomy. However, DBS applications are substantially different from one another, each involving a specific neurological or psychiatric condition, neural target, mechanism and symptom(s), and therefore at least some of them may not fit into the relational analysis. I examine different clDBS applications for treatment resistant depression and claim that while internal capsule/ventral striatum (VC/VS) clDBS is a case of relational autonomy, subgenual cingulate gyrus (Cg25) clDBS is not. Autonomy (relational or otherwise) requires some degree of self-regulation of our motivational states, which is supported by VC/VS DBS but is absent in Cg25 DBS. In Cg25 DBS the device itself directly influences motivational states, thus substituting or overriding (instead of supporting) the auto-regulatory cognitive processes required for autonomous action. (shrink)

Several authors have recently claimed that we each possess a right against interference with our minds. However, it remains unclear how this claim is to be justified. I offer a novel argument in defence of it. The argument is intuitive—appealing centrally to intuitions regarding cases—and abductive—taking the form of an inference to the best explanation; I offer a series of cases involving intuitively wrongful interventions, argue that five somewhat promising attempts to account for the wrongfulness of these interventions leave some (...) of this wrongfulness unexplained, and show that my proposed alternative explanation, which invokes a right against mental interference, can account for this residual wrongfulness. (shrink)