The ethics of brain–computer interfaces - Nature

Interface technologies are divided into those that 'read' the brain to record brain activity and decode its meaning, and those that 'write' to ... Skiptomaincontent Thankyouforvisitingnature.com.YouareusingabrowserversionwithlimitedsupportforCSS.Toobtain thebestexperience,werecommendyouuseamoreuptodatebrowser(orturnoffcompatibilitymodein InternetExplorer).Inthemeantime,toensurecontinuedsupport,wearedisplayingthesitewithoutstyles andJavaScript. Advertisement nature outlook article Theethicsofbrain–computerinterfaces DownloadPDF DownloadPDF Ahelmetcontainingabrain–computerinterfacethatenablesthewearertoselectsymbolsonascreenusingbrainactivity.Credit:Jean-PierreClatot/AFP/Getty “Itbecomespartofyou,”Patient6said,describingthetechnologythatenabledher,after45yearsofsevereepilepsy,tohaltherdisablingseizures.Electrodeshadbeenimplantedonthesurfaceofherbrainthatwouldsendasignaltoahand-helddevicewhentheydetectedsignsofimpendingepilepticactivity.Onhearingawarningfromthedevice,Patient6knewtotakeadoseofmedicationtohaltthecomingseizure. PartofNatureOutlook:Thebrain “Yougrowgraduallyintoitandgetusedtoit,soitthenbecomesapartofeveryday,”shetoldFredericGilbert,anethicistwhostudiesbrain–computerinterfaces(BCIs)attheUniversityofTasmaniainHobart,Australia.“Itbecameme,”shesaid.GilbertwasinterviewingsixpeoplewhohadparticipatedinthefirstclinicaltrialofapredictiveBCItohelpunderstandhowlivingwithacomputerthatmonitorsbrainactivitydirectlyaffectsindividualspsychologically1.Patient6’sexperiencewasextreme:GilbertdescribesherrelationshipwithherBCIasa“radicalsymbiosis”.Symbiosisisaterm,borrowedfromecology,thatmeansanintimateco-existenceoftwospeciesformutualadvantage.Astechnologistsworktowardsdirectlyconnectingthehumanbraintocomputers,itisincreasinglybeingusedtodescribehumans’potentialrelationshipwithartificialintelligence.Interfacetechnologiesaredividedintothosethat‘read’thebraintorecordbrainactivityanddecodeitsmeaning,andthosethat‘write’tothebraintomanipulateactivityinspecificregionsandaffecttheirfunction.Commercialresearchisopaque,butscientistsatsocial-mediaplatformFacebookareknowntobepursuingbrain-readingtechniquesforuseinheadsetsthatwouldconvertusers’brainactivityintotext.AndneurotechnologycompaniessuchasKernelinLosAngeles,California,andNeuralink,foundedbyElonMuskinSanFrancisco,California,predictbidirectionalcouplinginwhichcomputersrespondtopeople’sbrainactivityandinsertinformationintotheirneuralcircuitry.Thisworkisbeingwatchedkeenlybyresearchersinneuroethics—asubfieldofbioethicsthathasemergedinthepast15yearstoensurethattechnologiesthatdirectlyaffectthebrainaredevelopedinanethicalmanner.“Wedon’twanttobethewatchdogofneuroscienceortopolicehowneurotechnologyshouldbedeveloped,”saysneuroethicistMarcelloIencaattheSwissFederalInstituteofTechnologyinZurich.Instead,thoseinthefieldwanttoseeethicsintegratedintotheinitialdesignanddevelopmentstagesofsuchtechnologies,tomaximizetheirbenefitandtoidentifyandminimizetheirpotentialharm—whethertoindividualsortowidersociety.Neuroethicistshaveanincreasinglywell-establishedpresenceinclinicalsettings,wheretheyworkwithscientists,engineersanddoctorswhoaredevelopingtechnologicalapproachestotreatingneuropsychiatricdiseases.Theyarefollowingcloselytheevolvinguseofelectrodesthatareimplantedinthebraintomanipulateneuralactivity—abasicformofbrain-writingtechnology—toquellthemanifestationsofconditionssuchasParkinson’sdiseaseandepilepsy.Theyarealsoworkinginlaboratoriesthataredevelopingbrain-readingtechnologiestoenablepeoplewhoareparalysedtocontrolprostheticlimbsandtogeneratespeechbythought.Already,itisclearthatmeldingdigitaltechnologieswithhumanbrainscanhaveprovocativeeffects,notleastonpeople’sagency—theirabilitytoactfreelyandaccordingtotheirownchoices.Althoughneuroethicists’priorityistooptimizemedicalpractice,theirobservationsalsoshapethedebateaboutthedevelopmentofcommercialneurotechnologies.ChangingmindsInthelate1980s,scientistsinFranceinsertedelectrodesintothebrainsofpeoplewithadvancedParkinson’sdisease.Theyaimedtopasselectricalcurrentsthroughregionsthattheythoughtwerecausingtremors,tosuppresslocalneuralactivity.Thisdeep-brainstimulation(DBS)couldbearrestinglyeffective:violent,debilitatingtremorsoftensubsidethemomentthattheelectrodesareactivated.TheUSFoodandDrugAdministrationapprovedtheuseofDBSinpeoplewithParkinson’sdiseasein1997.Sincethen,thetechnologyhascometobeusedinotherconditions:DBShasbeenapprovedtotreatobsessivecompulsivedisorderandepilepsy,andisbeinginvestigatedforuseinmental-healthconditionssuchasdepressionandanorexia.Becauseitisatechnologythatcanpowerfullychangeactivityintheorganthatgeneratesoursenseofpersonhood,DBSelicitsconcernsthatothertreatmentsdonot.“Itraisesquestionsaboutautonomybecauseit’sdirectlymodulatingthebrain,”saysHannahMaslen,aneuroethicistattheUniversityofOxford,UK.ReportshavesurfacedaboutaminorityofpeoplewhoundergoDBSforParkinson’sdiseasebecominghypersexual,ordevelopingotherimpulse-controlissues.OnepersonwithchronicpainbecamedeeplyapatheticafterDBStreatment.“DBSisveryeffective,”Gilbertsays,“tothepointthatitcandistortpatients’perceptionsofthemselves.”SomepeoplewhoreceivedDBSfordepressionorobsessivecompulsivedisorderreportedthattheirsenseofagencyhadbecomeconfused2.“Youjustwonderhowmuchisyouanymore,”saidone.“Howmuchofitismythoughtpattern?HowwouldIdealwiththisifIdidn’thavethestimulationsystem?Youkindoffeelartificial.”Neuroethicistsbegantonotethecomplexnatureofthetherapy’ssideeffects.“Someeffectsthatmightbedescribedaspersonalitychangesaremoreproblematicthanothers,”saysMaslen.Acrucialquestioniswhetherthepersonwhoisundergoingstimulationcanreflectonhowtheyhavechanged.Gilbert,forinstance,describesaDBSpatientwhostartedtogamblecompulsively,blowinghisfamily’ssavingsandseemingnottocare.Hecouldonlyunderstandhowproblematichisbehaviourwaswhenthestimulationwasturnedoff.Suchcasespresentseriousquestionsabouthowthetechnologymightaffectaperson’sabilitytogiveconsenttobetreated,orfortreatmenttocontinue.IfthepersonwhoisundergoingDBSishappytocontinue,shouldaconcernedfamilymemberordoctorbeabletooverrulethem?Ifsomeoneotherthanthepatientcanterminatetreatmentagainstthepatient’swishes,itimpliesthatthetechnologydegradespeople’sabilitytomakedecisionsforthemselves.Itsuggeststhatifapersonthinksinacertainwayonlywhenanelectricalcurrentalterstheirbrainactivity,thenthosethoughtsdonotreflectanauthenticself.Suchdilemmasarethorniestunderconditionsinwhichtheexplicitgoaloftreatmentistochangetraitsorbehavioursthatcontributetoaperson’ssenseofidentity,suchasthoseassociatedwiththemental-healthconditionanorexianervosa.“If,beforeDBS,apatientsays,‘I’msomebodywhovaluesbeingthinoverallotherthings,’andthenyoustimulatethemandtheirbehaviouroroutlookismodified,”Maslensays,“it’simportanttoknowwhethersuchchangesareendorsedbythepatient.”Shesuggeststhatwhenthechangesalignwiththerapeuticobjectives,“ItisperfectlycoherentthatapatientcouldbehappywiththewaysinwhichDBSchangesthem.”SheandotherresearchersareworkingtodesignbetterconsentprotocolsforDBS,includingextensiveconsultationsinwhichallpossibleoutcomesandsideeffectsareexploredindepth.ReadingthebrainToobserveapersonwithtetraplegiabringingadrinktotheirmouthusingaBCI-controlledroboticarmisspectacular.Thisrapidlyadvancingtechnologyworksbyimplantinganarrayofelectrodeseitheronorinaperson’smotorcortex—abrainregioninvolvedinplanningandexecutingmovements.Theactivityofthebrainisrecordedwhiletheindividualengagesincognitivetasks,suchasimaginingthattheyaremovingtheirhand,andtheserecordingsareusedtocommandtheroboticlimb. ElectrodesfordeepbrainstimulationimplantedinapersonwhohasParkinson’sdisease.Credit:ZEPHYR/SPL Ifneuroscientistscouldunambiguouslydiscernaperson’sintentionsfromthechatteringelectricalactivitythattheyrecordinthebrain,andthenseethatitmatchedtheroboticarm’sactions,ethicalconcernswouldbeminimized.Butthisisnotthecase.Theneuralcorrelatesofpsychologicalphenomenaareinexactandpoorlyunderstood,whichmeansthatsignalsfromthebrainareincreasinglybeingprocessedbyartificialintelligence(AI)softwarebeforereachingprostheses.PhilippKellmeyer,aneurologistandneuroethicistattheUniversityofFreiburg,Germany,saysthatapplyingAIandmachine-learningalgorithmstoanalysinganddecodingneuralactivityhas“turbochargedthewholefield”.Hehighlightswork,publishedinApril,inwhichsuchsoftwareinterpretedneuralactivitythatoccurredwhilepeoplewithepilepsysilentlymouthedwords,andthenusedthisinformationtogeneratesyntheticspeechsounds3.“Twoorthreeyearsago,”hesays,“we’dhavesaideitherthatwouldneverbepossible,oritwasatleast20yearsaway.”But,hesays,usingAItoolsalsointroducesethicalissuesofwhichregulatorshavelittleexperience.Machine-learningsoftwarelearnstoanalysedatabygeneratingalgorithmsthatcannotbepredictedandthataredifficult,orimpossible,tocomprehend.Thisintroducesanunknownandperhapsunaccountableprocessbetweenaperson’sthoughtsandthetechnologythatisactingontheirbehalf.DevelopersarerealizingthatprosthesesworkmoreefficientlywhencertaincomputationsarelefttoBCIdevices,andwhenthesedevicestrytopredictwhattheuserwilldonext.Thebenefitsofoffloadingcomputationsareobvious.Seeminglysimpleactssuchaspickingupacupofcoffeeareactuallyhighlycomplex:peoplesubconsciouslyexecutemanycomputations.Fittingprostheseswithsensorsandmechanismsforautonomouslygeneratingcoherentmovementsmakesiteasierforuserstoperformtasks.Butthisalsomeansthatmuchofwhatroboticlimbsdoisnotactuallydirectedbytheuser.Thepredictivenatureofsomealgorithmsusedtohelppeopleoperateprosthesesleadstofurtherconcerns.Predictivetextgeneratorsthatarefoundinmobilephoneshighlightthisissue:theycanbeuseful,time-savingtools,butanyonewhohassentanunintendedmessageowingtoanerrantauto-correctorauto-fillfunctionknowshowthingscangowrong.Suchalgorithmslearnfrompreviousdataandguideuserstowardsdecisionsonthebasisofwhattheyhavedoneinthepast.Butifanalgorithmconstantlysuggestsauser’snextwordoraction,andtheusermerelyapprovesthatoption,theauthorshipofamessageormovementwillbecomeambiguous.“Atsomepoint,”Kellmeyersays,“youhavetheseverystrangesituationsofsharedorhybridagency.”Partofthedecisioncomesfromtheuser,andpartcomesfromthealgorithmofthemachine.“Itopensupaproblem—anaccountabilitygap.”MaslenisconfrontingthisproblemaspartofacollaborativeprojectcalledBrainCom,fundedbytheEuropeanUnion,thatisdevelopingspeechsynthesizers.Suchtechnologyhastoaccuratelyvocalizewhatuserswanttosaytobeuseful.Toguardagainsterrors,userscouldbegiventheopportunitytoapproveeachwordforbroadcast—althoughconstantlyandcovertlyrelayingspeechfragmentstotheuserforreviewmightmakeforacumbersomesystem.Safeguardssuchasthiswouldbeespeciallyimportantifdevicesstruggledtodistinguishbetweenneuralactivityintendedforspeechandthatwhichunderliesprivatethought.Societalnormsrequirethatthefundamentalboundarybetweenprivatethoughtandoutwardbehaviourbeprotected.Reading,writingandresponsibilityBecausethesymptomsofmanybraindiseasescomeandgo,brain-monitoringtechniquesareincreasinglybeingusedtodirectlycontrolDBSelectrodessothatstimulationisprovidedonlywhenneeded.Recordingelectrodes—suchasthosethatwarnedPatient6ofimpendingseizures—trackbrainactivitytodeterminewhensymptomsarehappeningorareabouttooccur.Ratherthanmerelyalertingtheusertotheneedtotakeaction,theytriggerastimulatingelectrodetonullifythisactivity.Ifaseizureisprobable,DBSquietensthecausativeactivity;iftremor-relatedactivityincreases,DBSsuppressestheunderlyingcause.Suchaclosed-loopsystemwasapprovedbytheFoodandDrugAdministrationforepilepsyin2013,andsuchsystemsforParkinson’sdiseaseareedgingclosertotheclinic.Forneuroethicists,oneconcernisthatinsertingadecision-makingdeviceintosomeone’sbrainraisesquestionsaboutwhetherthatpersonremainsself-governing,especiallywhentheseclosed-loopsystemsincreasinglyuseAIsoftwarethatautonomouslyadaptsitsoperations.Inthecaseofadeviceformonitoringbloodglucosethatautomaticallycontrolsinsulinreleasetotreatdiabetes,suchdecision-makingonbehalfofapatientisuncontroversial.Butwell-intentionedinterventionsinthebrainmightnotalwaysbewelcome.Forinstance,apersonwhousesaclosed-loopsystemtomanageamooddisordercouldfindthemselvesunabletohaveanegativeemotionalexperience,eveninasituationinwhichitwouldbeconsiderednormal,suchasafuneral.“Ifyouhaveadevicethatconstantlystepsupinyourthinkingordecision-making,”saysGilbert,“itmightcompromiseyouasanagent.”Theepilepsy-managementdeviceusedbyPatient6andtheotherrecipientsthatGilbertinterviewedwasdesignedtokeeppatientsincontrolbysoundingawarningaboutimpendingseizures,whichenabledthepatienttochoosewhethertotakemedication.Despitethis,forfiveofthesixrecipients,thedevicebecameamajordecision-makerintheirlives.Oneofthesixtypicallyignoredthedevice.Patient6cametoacceptitasanintegralpartoftheirnewself,whereasthreerecipients,withoutfeelingthattheirsenseofselfhadbeenfundamentallyshifted,werehappytorelyonthesystem.However,anotherwasplungedintodepression,andreportedthattheBCIdevice“mademefeelIhadnocontrol”.“Youhavetheultimatedecision,”Gilbertsays,“butassoonasyourealizethedeviceismoreeffectiveinthespecificcontext,youwon’tevenlistentoyourownjudgement.You’llrelyonthedevice.”BeyondtheclinicThegoalofneuroethicists—tomaximizethebenefitsofemergingtechniquesandtominimizetheirharm—haslongbeenentrenchedinmedicalpractice.Thedevelopmentofconsumertechnology,bycontrast,isnotoriouslycovertandsubjectedtominimaloversight.Withtechnologycompaniesnowinvestigatingthefeasibilityofmass-marketBCIdevices,Iencathinksthatthisisanimportantmoment.“Whenatechnologyisinitsgerminalstage,”hesays,“it’sveryhardtopredicttheoutcomesofthattechnology.Butwhenthetechismature—intermsofmarketsizeorderegulation—itcanbetoosocietallyentrenchedtoimproveit.”Inhisopinion,thereisnowsufficientknowledgetoactinaninformedmanner,beforeneurotechnologyiswidelyused.OneissuethatIencaisaddressingisprivacy.“Braininformationisprobablythemostintimateandprivateofallinformation,”hesays.Digitallystoredneuraldatacouldbestolenbyhackersorusedinappropriatelybycompaniestowhomusersgrantaccess.Iencasaysthatneuroethicists’concernshaveforceddeveloperstoattendtothesecurityoftheirdevices,tomorediligentlyprotectconsumerdata,andtoceasedemandingaccesstosocial-mediaprofilesandothersourcesofpersonalinformationasaconditionofadevice’suse.Nevertheless,asconsumerneurotechnologygainssteam,ensuringthatprivacystandardsareacceptableremainsachallenge.Privacyandagencyfeatureprominentlyinrecommendationsthatarebeingproducedbyvariousworkinggroups,includinglarge-scaleneuroscienceprojectsandpanelsconvenedbyindependentbodies.ButKellmeyerthinksthatthereisstillconsiderableworktobedone.“Thematrixoftraditionalethics,whichfocusesonautonomy,justiceandrelatedconcepts,willnotbeenough,”hesays.“Wealsoneedanethicsandaphilosophyofhuman–technologyinteractions.”Manyneuroethiciststhinkthattheabilitytodirectlyaccessthebrainwillmakeitnecessarytoupdatebasichumanrights.MaslenisalreadyhelpingtoshapeBCI-deviceregulation.SheisindiscussionwiththeEuropeanCommissionaboutregulationsitwillimplementin2020thatcovernon-invasivebrain-modulatingdevicesthataresoldstraighttoconsumers.Maslenbecameinterestedinthesafetyofthesedevices,whichwerecoveredbyonlycursorysafetyregulations.Althoughsuchdevicesaresimple,theypasselectricalcurrentsthroughpeople’sscalpstomodulatebrainactivity.Maslenfoundreportsofthemcausingburns,headachesandvisualdisturbances.Shealsosaysclinicalstudieshaveshownthat,althoughnon-invasiveelectricalstimulationofthebraincanenhancecertaincognitiveabilities,thiscancomeatthecostofdeficitsinotheraspectsofcognition.MaslenandhercolleagueswroteapolicypapertargetedatEuropeanregulatorswhowerereviewingtheregulationofvariousquasi-medicalproductssuchaslaserhair-removaldevices.Theregulatorsagreedwiththepaper’srecommendations:thatthenewregulationsshouldtightensafetystandards,butalsothat(unlikeformedicaldevices)consumersshouldremainfreetodecidewhetherthedevicesbringthegainsthattheirmanufacturersclaim. MorefromNatureOutlooks Gilbert’scontinuingworkonthepsychologicaleffectsofBCIdeviceshighlightsthestakesthatareinvolvedincompaniesdevelopingtechnologiesthatcanprofoundlyshapeaperson’slife.Heisnowpreparingafollow-upreportonPatient6.Thecompanythatimplantedthedeviceinherbraintohelpfreeherfromseizureswentbankrupt.Thedevicehadtoberemoved.“Sherefusedandresistedaslongasshecould,”saysGilbert,butultimatelyithadtogo.It’safatethathasbefallenparticipantsofsimilartrials,includingpeoplewhosedepressionhadbeenrelievedbyDBS.Patient6criedasshetoldGilbertaboutlosingthedevice.Shegrieveditsloss.“Ilostmyself,”shesaid.“Itwasmorethanadevice,”Gilbertsays.“Thecompanyownedtheexistenceofthisnewperson.” Nature571,S19-S21(2019) doi:https://doi.org/10.1038/d41586-019-02214-2ThisarticleispartofNatureOutlook:Thebrain,aneditoriallyindependentsupplementproducedwiththefinancialsupportofthirdparties.Aboutthiscontent. ReferencesGilbert,F.etal.J.Sci.Eng.Ethics25,83–96(2019).Article  GoogleScholar  Klein,E.etal.Brain-ComputerInterfaces3,140–148(2016).Article  GoogleScholar  Anumanchipalli,G.K.etal.Nature568,493–498(2019).PubMed  Article  GoogleScholar  Downloadreferences RelatedArticles Decodingtheneuroscienceofconsciousness Howtomapthebrain Thefourbiggestchallengesinbrainsimulation Neanderthalcluestobrainevolutioninhumans Exploringthehumanbrainwithvirtualreality Theforgottenpartofmemory HowAIandneurosciencedriveeachotherforwards Amorehumanapproachtoartificialintelligence Subjects Brain Technology Neuroscience Ethics Lateston: Brain Startingascientificcareerwithnarcolepsy CareerColumn20MAY22 Youngcerebrospinalfluidimprovesmemoryinoldmice News&Views11MAY22 Aswitchinneuronaldynamicsthathelpstoinitiatemovement News&Views28APR22 Technology Teachingrobotstotouch Outlook26MAY22 The6Gfrequencyswitchthatsparesscientificservices News&Views26MAY22 Transitioningorganizationstopost-quantumcryptography Perspective11MAY22 Neuroscience Divergenttranscriptionalregulationofastrocytereactivityacrossdisorders Article25MAY22 CCR5closesthetemporalwindowformemorylinking Article25MAY22 Neuropathicpaincausedbymiswiringandabnormalendorgantargeting Article25MAY22 Jobs HeadofSequencingFacility(m/f/div) MaxPlanckInstituteforMolecularGenetics(MPI-MG) Berlin,Germany PostdoctoralFellowshipsinMonitoringPatientsinEmergenciesandDisasters TheUniversityofBritishColumbia(UBC) Vancouver,Canada ResearchAssociate(f/m/d)Software-Development KarlsruheInstituteofTechnology(KIT) Karlsruhe,Germany Mechatroniker*in/Elektroniker*infürBetriebstechnik/GeräteundSystemeodervergleichbar(d/m/w),Abteilung„VacuumSystems“ HelmholtzCentreforHeavyIonResearchGmbH(GSI) Darmstadt,Germany DownloadPDF RelatedArticles Decodingtheneuroscienceofconsciousness Howtomapthebrain Thefourbiggestchallengesinbrainsimulation Neanderthalcluestobrainevolutioninhumans Exploringthehumanbrainwithvirtualreality Theforgottenpartofmemory HowAIandneurosciencedriveeachotherforwards Amorehumanapproachtoartificialintelligence Subjects Brain Technology Neuroscience Ethics SignuptoNatureBriefing Anessentialround-upofsciencenews,opinionandanalysis,deliveredtoyourinboxeveryweekday. 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