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)

Recent achievements in rehabilitative robotics modify essential parameters of the human body, such as motility. Exoskeletons used for persons with neurological impairments like spinal cord injury and stroke enter this category by rehabilitating and assisting damaged motor patterns, achievements thought impossible until not long ago. Unlike other examples leading to similar dysfunctions, such as diseases or tumors, the experience of an accident causing a spinal cord injury or the occurrence of a cerebrovascular accident is sudden and perceived as a radical (...) event. This often leads to deep consequences for one’s own body capacities. Exoskeletons attempt to alter this condition, contributing to forge a temporary abled body, although this currently happens in the restricted space of a clinic or a lab and under very controlled conditions for the predominance of users. Using qualitative empirical material from an ongoing study in sociology, including expert and narrative interviews as well as ethnographic visits in labs and centers that design and test exoskeletons, this article addresses the challenges and gains that people with stroke and spinal cord injury experience during their training with exoskeletons. The discussed cases contribute to reassess categories from the phenomenological paradigm, disability studies, and the role medical technologies play in contemporary body worlds. (shrink)

The primary goal of this essay is to provide a comprehensive overview and analysis of the various relations between material artifacts and the embodied mind. A secondary goal of this essay is to identify some of the trends in the design and use of artifacts. First, based on their functional properties, I identify four categories of artifacts co-opted by the embodied mind, namely (1) embodied artifacts, (2) perceptual artifacts, (3) cognitive artifacts, and (4) affective artifacts. These categories can overlap and (...) so some artifacts are members of more than one category. I also identify some of the techniques (or skills) we use when interacting with artifacts. Identifying these categories of artifacts and techniques allows us to map the landscape of relations between embodied minds and the artifactual world. Second, having identified categories of artifacts and techniques, this essay then outlines some of the trends in the design and use of artifacts, focussing on neuroprosthetics, brain-computer interfaces, and personalisation algorithms nudging their users towards particular epistemic paths of information consumption. (shrink)

The field of Neuro-Engineering seems to be on the fast track towards accomplishing its ultimate goal of potentially replacing the nervous system in the face of disease. Meanwhile, the patients and professionals involved are continuously dealing with human bodily experience and especially how neuro-engineering devices could become part of a user’s body schema: the domain of ‘embodied phenomenology’. This focus on embodiment, however, is not sufficiently reflected in the current literature on ethical and philosophical issues in neuro-engineering. In this article (...) we will focus on this lacuna by explaining existing data on neuro-engineering user’s experiences by using phenomenological concepts such as transparency and the concepts that may facilitate this: functionality, sensorimotor feedback and affective tolerance. By introducing and applying these concepts to four real life case examples, we will discuss practical implications and guidelines which can contribute to the actual success of incorporation of the device by the patient. First, we will discuss the importance of a ‘Patient Preference Diagnosis’, which can serve as a way to prepare the patient for the existential reorientation involved in the process. In addition, a Patient Transparency Diagnosis during and after such a process is also relevant when wanting to provide the medical field in general with feedback, and the patient in particular with possibilities to fine-tune the device. From these practical guidelines we will conclude that the phenomenological approach can be very valuable when applied to the field of neuro-engineering. (shrink)

In this article, we explore how deep brain stimulation (DBS) devices designed to “close the loop”—to automatically adjust stimulation levels based on computational algorithms—may risk taking the individual agent “out of the loop” of control in areas where (at least apparent) conscious control is a hallmark of our agency. This is of particular concern in the area of psychiatric disorders, where closed-loop DBS is attracting increasing attention as a therapy. Using a relational model of identity and agency, we consider whether (...) DBS designed for psychiatric regulation may require special attention to agency. To do this, we draw on philosophical work on relational identity and agency, connecting it with reports from people using first-generation DBS devices for depression and obsessive-compulsive disorder. We suggest a way to extend a notion of relational agency to encompass neural devices. (shrink)

The goal of this paper is to develop a systematic taxonomy of cognitive artifacts, i.e., human-made, physical objects that functionally contribute to performing a cognitive task. First, I identify the target domain by conceptualizing the category of cognitive artifacts as a functional kind: a kind of artifact that is defined purely by its function. Next, on the basis of their informational properties, I develop a set of related subcategories in which cognitive artifacts with similar properties can be grouped. In this (...) taxonomy, I distinguish between three taxa, those of family, genus, and species. The family includes all cognitive artifacts without further specifying their informational properties. Two genera are then distinguished: representational and non-representational (or ecological) cognitive artifacts. These genera are further divided into species. In case of representational artifacts, these species are iconic, indexical, or symbolic. In case of ecological artifacts, these species are spatial or structural. Within species, token artifacts are identified. The proposed taxonomy is an important first step towards a better understanding of the range and variety of cognitive artifacts and is a helpful point of departure, both for conceptualizing how different artifacts augment or impair cognitive performance and how they transform and are integrated into our cognitive system and practices. (shrink)

What are the possible varieties of cognition-artifact relations, and which dimensions are relevant for exploring these varieties? This question is answered in two steps. First, three levels of functional and informational integration between human agent and cognitive artifact are distinguished. These levels are based on the degree of interactivity and direction of information flow, and range from monocausal and bicausal relations to continuous reciprocal causation. In these levels there is a hierarchy of integrative processes in which there is an increasing (...) degree of hybridization. Therefore, from a functional and informational level of abstraction, it becomes increasingly difficult to distinguish between agent and artifact in this hierarchy. Second, a multidimensional matrix for exploring cognition-artifact relations is sketched. The dimensions in the matrix include reliability, durability, trust, procedural and representational transparency, individualization, bandwidth, speed of information flow, distribution of computation, and cognitive and artifactual transformation. Together, these dimensions constitute a multidimensional space in which particular cognition-artifact relations can be located. The higher a particular cognition-artifact relation scores on these dimensions, the more integration and hybridization occurs, and the more tightly coupled the overall system is. It is then better, for explanatory reasons, to see agent and artifact as one cognitive system with a distributed informational architecture. (shrink)

There is no systematic knowledge about how individuals with Locked-in Syndrome experience their situation. A phenomenology of LIS, in the sense of a description of subjective experience as lived by the ill persons themselves, does not yet exist as an organized endeavor. The present article takes a step in that direction by reviewing various materials and making some suggestions. First-person narratives provide the most important sources, but very few have been discussed. LIS barely appears in bioethics and neuroethics. Research on (...) Quality of Life provides relevant information, one questionnaire study explores the sense of personal continuity in LIS patients, and LIS has been used as a test case of theories in “embodied cognition” and to explore issues in the phenomenology of illness and communication. A systematic phenomenology of LIS would draw on these different areas: while some deal directly with subjective experience, others throw light on its psychological, sociocultural and materials conditions. Such an undertaking can contribute to the improvement of care and QOL, and help inform philosophical questions, such as those concerning the properties that define persons, the conditions of their identity and continuity, or the dynamics of embodiment and intersubjectivity. (shrink)

: This paper uses Extended Mind Theory to explore Brain-Computer Interfaces, demonstrating how this conceptual framework provides a wide-ranging interpretation of the potential integration of user and computer. After a preliminary analysis of first- and second-wave EMT arguments and other pragmatic criteria, I present BCI technology, addressing the issues that arise. Can BCIs extend our mental processes and to what degree? What EMT criteria should be applied to this technology? What is the role of the body in the process of (...) integrating user and computer? What are current limits to complete cognitive and bodily extension by BCIs? In line with this discussion, I suggest a pluralist approach to BCIs, allowing for specific and appropriate application of the various models and paradigms. I also advocate greater focus on the integration of body and tool, primarily for clinical purposes, but also for applications that will meet daily needs in the future. Keywords : Extended Mind; Brain-Computer Interface; Embodiment; Parity Principle; Cognitive Artefacts. Mente estesa e brain-computer interface. Un approccio pluralista all’integrazione uomo-macchina Riassunto: Il presente articolo fa uso della Extended Mind Theory per indagare le Brain-Computer Interfaces, dimostrando che questo framework concettuale offre un’interpretazione ad ampio raggio della potenziale integrazione tra utente e computer. Dopo un’analisi preliminare degli argomenti della EMT di prima e seconda generazione e altri criteri pragmatici, presenterò la tecnologia delle BCIs, affrontando alcune questioni a essa collegate. Le BCIs possono estendere i nostri processi mentali e fino a che punto? Quali criteri della EMT dovrebbero essere applicati a questa tecnologia? Qual è il ruolo del corpo nel processo di integrazione utente-computer? Quali sono gli attuali limiti per completare l’estensione cognitiva e corporea da parte delle BCIs? In linea con questa discussione, suggerirò un approccio pluralistico alle BCIs che permetta un’applicazione specifica e appropriata dei vari modelli e paradigmi. Sosterrò inoltre la necessità di una maggiore attenzione all’integrazione tra corpo e strumento, principalmente per scopi clinici ma anche per applicazioni future che soddisfino le esigenze quotidiane. Parole chiave: Mente estesa; Brain-Computer Interface ; Incorporamento; Principio di Parità; Artefatti cognitivi. (shrink)

This paper looks to phenomenology and enactive cognition in order to shed light on the self and sense of self of patients with locked-in syndrome. It critically discusses the concept of the minimal self, both in its phenomenological and ontological dimension. Ontologically speaking, the self is considered to be equal to a person’s sensorimotor embodiment. This bodily self also grounds the minimal sense of self as being a distinct experiential subject. The view from the minimal bodily self presupposes that sociality (...) comes after the self, or that in other words, the essence of self remains independent of our social interactions and relations. In this paper, I rely on the idea of enactive autonomy and Heidegger’s and Merleau-Ponty’s views of human existence as primordially social, to argue for the contrary. The self is fundamentally relational and this is also reflected at the level of the subjective experience of being a self. I indicate how a strong relational view of selfhood can serve as a preliminary heuristic to make sense of the situation of the patient with LIS and conclude with some practical implications concerning patient autonomy, our ethical responsibility toward the patient, and the possibilities for improving the life of patients with LIS. (shrink)

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)

Four previous papers in this journal have discussed the role of Brain-Computer Interfaces in the lives of Locked-In Syndrome patients in terms of the four “E” frameworks for cognition – extended, embedded, embodied, and enactive cognition. This paper argues that in the light of more recent literature on these 4E frameworks, none of the four papers has taken quite the right approach to deciding which, if any, of the E frameworks is the best one for the job. More specifically, I (...) argue for an approach that is pragmatist rather than purely metaphysical, pluralist rather than monist, and perhaps most importantly, local to particular research programmes, rather than about BCIs in general. The paper will outline this approach, then illustrate it with reference to a particular research programme which tackles the issue of BCI communication for patients in Complete Locked-In Syndrome. (shrink)

In the spirit of Slavoj Žižek’s book, Hegel in a Wired Brain, this article asks how the questions central to Hans-Georg Gadamer’s philosophical hermeneutics are changed and complicated by the possibility of brain-to-brain communication and the datafication of thought made potential through brain-computer interfaces. By taking a phenomenological approach to understanding the nature of communication through a technology that does not require language for the transmission of ideas, this article explores how BCI communication confronts the ontological character of interpretation as (...) presented by Gadamer while also juxtaposing how the insights of Gadamer and Heidegger concerning temporality problematize materialist foundations of BCI communication. In the final analysis, it is argued that thought only becomes meaningful in accord with the temporality of Dasein and that hermeneutics remains central in BCI communication because the material replication of thought does not overcome the particular temporalities of historically effected consciousnesses. (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)