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)

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)

Personhood is ascribed on others, such that someone who is recognized to be a person is bestowed with certain civil rights and the right to decision making. A rising question is how severely brain-injured patients who regain consciousness can also regain their personhood. The case of patients with locked-in syndrome is illustrative in this matter. Upon restoration of consciousness, patients with LIS find themselves in a state of profound demolition of their bodily functions. From the third-person perspective, it can be (...) expected that LIS patients might experience a differential personal identity and may lose their status as persons. However, from the patients’ perspective, it is uncontested that they retain their personal identity and that they consider themselves to be persons. We here include results from a survey with patients with LIS aimed at identifying the primary expectations of patients for their care by non-medical professionals. Based on these first-hand reports, we argue that personhood in LIS is progressively regained as the widening circle of others recognizes them as persons. (shrink)

Personhood is ascribed on others, such that someone who is recognized to be a person is bestowed with certain civil rights and the right to decision making. A rising question is how severely brain-injured patients who regain consciousness can also regain their personhood. The case of patients with locked-in syndrome is illustrative in this matter. Upon restoration of consciousness, patients with LIS find themselves in a state of profound demolition of their bodily functions. From the third-person perspective, it can be (...) expected that LIS patients might experience a differential personal identity and may lose their status as persons. However, from the patients’ perspective, it is uncontested that they retain their personal identity and that they consider themselves to be persons. We here include results from a survey with patients with LIS aimed at identifying the primary expectations of patients for their care by non-medical professionals. Based on these first-hand reports, we argue that personhood in LIS is progressively regained as the widening circle of others recognizes them as persons. (shrink)

Embodied approaches in cognitive science hold that the body is crucial for cognition. What this claim amounts to, however, still remains unclear. This paper contributes to its clarification by confronting three ways of understanding embodiment—the sensorimotor approach, extended cognition and enactivism—with Locked-in syndrome. LIS is a case of severe global paralysis in which patients are unable to move and yet largely remain cognitively intact. We propose that LIS poses a challenge to embodied approaches to cognition requiring them to make explicit (...) the notion of embodiment they defend and its role for cognition. We argue that the sensorimotor and the extended functionalist approaches either fall short of accounting for cognition in LIS from an embodied perspective or do it too broadly by relegating the body only to a historical role. Enactivism conceives of the body as autonomous system and of cognition as sense-making. From this perspective embodiment is not equated with bodily movement but with forms of agency that do not disappear with body paralysis. Enactivism offers a clarifying perspective on embodiment and thus currently appears to be the framework in embodied cognition best suited to address the challenge posed by LIS. (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 this paper I explore systematically the relationship between Brain-Computer Interfaces (BCIs) and their human users from a phenomenological and cognitive perspective. First, I functionally decompose BCI systems and develop a typology in which I categorize BCI applications with similar functional properties into three categories, those with (1) motor, (2) virtual, and (3) linguistic applications. Second, developing and building on the notions of an embodied tool and cognitive tool, I analyze whether these distinct BCI applications can be seen as bodily (...) or cognitive extensions. Contrary to some recent philosophical claims, I will argue that, although BCI technology may have the potential to become bodily and cognitive extensions for skilled users, at this stage they are not. And while the electrodes may to a variable degree be transparent and incorporated in the body schema, the BCI system as a whole is not. Moreover, BCIs do not have a functional role characteristic for cognition and are therefore not cognitive extensions. Third, based on concepts from the distributed cognition framework, I give a number of suggestions to improve the interface design of linguistic applications, i.e. BCIs that allow its user to spell words by selecting letters on a screen. These suggestions may result in cognitive extension and would enhance the autonomy and quality of life of its users. In sum, in this paper I develop a typology, analysis and critique on the current philosophical debate on BCIs, thereby providing a richer conceptual understanding of BCI systems which allows me to offer some suggestions for improving the interface design of linguistic applications. (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)

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)

Cognitive neuroscience has been driven by the idea that by reductionist analysis of mechanisms within a solitary brain one can best understand how the human mind is constituted and what its nature is. The brain thus came to appear as the creator of the mind and the experienced world. In contrast, the paper argues for an ecological view of mind and brain as both being embedded in the relation of the living organism and its environment. This approach is crucially dependent (...) on a developmental perspective: the brain is conceived as a plastic system of open loops that are formed in the process of life and closed to full functional cycles in every interaction with the environment. Each time a new disposition of coherent neural activity is formed through repeated experience, structures of the mind are imprinted onto the brain. The brain becomes a mediating organ or a window to the mind, for it is structured by the mind itself. (shrink)