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)

From epileptic seizures to depressive symptoms, predictive neurotechnologies are used for a large range of applications. In this article we focus on advisory devices; namely, predictive neurotechnology programmed to detect specific neural events (e.g., epileptic seizure) and advise users to take necessary steps to reduce or avoid the impact of the forecasted neuroevent. Receiving advise from a predictive device is not without ethical concerns. The problem with predictive neural devices, in particular advisory ones, is the risk of seeing one’s autonomous (...) choice supplanted by the predictions instead of being supplemented by it. For users, there is a potential shift from being assisted by the system to being over-dependent on the technology. In other terms, it introduces ethical issues associated with epistemic dependency. In this article, we examine the notion of epistemic authority in relation to predictive neurotechnologies. Section 1 of our article explores and defines the concept of epistemic authority. In section 2, we illustrate how predictive devices are best conceived of as epistemic authorities and we explore the subject-device epistemic relationship. In section 3, we spell out the risk of harms interconnected with epistemic deferral. We conclude by stressing a set of preliminary measures to prepare users for the authoritative nature of predictive devices. (shrink)

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 ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

We ordinarily think of the mind as private, “inside,” and accessible only to the person whose mind it is, and that the integrity of the mind is threatened by “outside” intervention. The prospect that neurotechnologies could be developed that are able to “read” our brains and directly manipulate our thoughts and feelings is, therefore, alarming to many. Implicit behind this sense of alarm is the view that, unlike other types of manipulation and persuasion that depend for their success on rational (...) autonomy, direct interventions into the brain uniquely undermine this autonomy. According to the Extended Mind Thesis (EMT), there is no necessary reason why mental states and processes must be realized by internal neural states. External artifacts can constitute part of a coupled cognitive system if these artifacts play the same functional role as internal states and processes. Interventions into these artifacts could, therefore, be considered direct interventions into the mind. If we alarmed by the threat to mental integrity posed by neurotechnology, then it is likely that we will be aghast at the idea that the mind can extend beyond the brain. For intuitively, extending the mind beyond the brain makes the mind more vulnerable to invasion. This paper argues that this fear may be misplaced. Specifically, the paper argues: (i) the most relevant processes to mental integrity are conscious, personal-level processes, (ii) the types of processes that can be extended according to the most influential account of EMT are unconscious, non-occurrent, and subpersonal processes, therefore (iii) the threat posed to mental integrity by neurotechnology if EMT is adopted may be quite modest. (shrink)

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 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. (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...