Neurotechnology Research Paper

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Abstract

Neuroscientific research has iteratively engaged ever more advanced technology and techniques to achieve an enhanced understanding and capability to access and affect the structure and functions of the brain. Neuroscience and neurotechnology should not be viewed as distinct entities, but rather as a reciprocal enterprise (i.e., what has been referred to as neuroscience and technology, neuroS/T) that is being rapidly and broadly translated for applications and use in medicine, public life, and international relations and global security. NeuroS/T research and its applications give rise to a number of neuroethical issues, questions, and problems. Three core issues and three major questions fostered by neuroS/T are presented, and approaches to addressing and resolving these issues are offered, with a view toward revisiting and perhaps revising extant ethical principles so as to develop a more cosmopolitan, yet community-sensitive and responsive neuroethics that is viable in international contexts.

Introduction

This essay presents current progress and developments in assessment and interventional neurotechnology. Neuroethical issues arising in and from neurotechnological research and its translation in medicine, public life, and national security are detailed, and key questions generated by these issues are posed. Neuroethics as a field and set of practices is defined, and approaches to addressing and resolving neuroethical issues and questions are discussed.

History And Development Of Neuroscience And Neurotechnology

Building upon studies of the late nineteenth and twentieth centuries, the past 20 years of neuroscientific research has iteratively engaged ever more advanced technology and techniques to achieve an enhanced understanding and capability to access and affect the structure and functions of the brain. Fuelled by ongoing governmental and commercial support, contemporary brain science is advancing on an international and multidimensional scale through projects such as the European Union’s Human Brain Project and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative in the USA. Neuroscience employs “tools-to-theory/ theory-to-tools” heuristics that results in the rapid development of new ideas, concepts, methods, devices, and abilities. Thus, neuroscience and neurotechnology should not be viewed as distinct entities but rather as a reciprocal enterprise (i.e., what has been referred to as neuroscience and technology, neuroS/T) that is being rapidly and broadly translated for applications and use in medicine, public life, and international relations and global security. Such growth is evidenced by an almost linear rise (of more than 70 %) in the number of research and clinical studies reported in the international peer-reviewed literature during the 10-year period from 2000 to 2010 (Giordano 2012a).

Current NeuroS/T

In general, neuroS/T could be defined as those methods and devices that are utilized to assess, access, and/or affect neural systems. These can be broadly categorized as assessment and interventional neuroS/T. Assessment neuroS/T includes different types of neuroimaging: basic and more advanced forms of encephalography, genomic/ genetic and proteomic methods, and neuropsychiatric biomarker assays. Interventional neuroS/T includes neuroand psychotropic agents and novel pharmaceutical methods; transcranial and in-dwelling neuromodulatory devices; peripheral neural stimulators; neural cell, tissue, and genetic implants and transplants; and neuraland brainmachine interfaced neuroprosthetic systems.

Certainly there is much that neuroS/T has achieved, but there is much that remains as yet unaccomplished, in part due to existing constraints and limitations of the tools and technologies themselves. Some of these constraints may be mitigated, if not overcome, through the process of advanced integrative scientific convergence (AISC) – a synthetic approach that explicitly seeks to foster innovative use of knowledge, skill, and tool sets in order to develop novel means of addressing and solving current impediments to scientific progress (Vaseashta 2012). This is crucial for progress because the current utility of neuroS/T can be limited by factors including (1) temporal and/or spatial constraints (e.g., as occurs in functional magnetic resonance imaging [fMRI] and forms of electroencephalography [EEG]), (2) difficulties of assimilating differing types and levels of data (e.g., from neuroimaging, neurogenetic, and neurological recording studies) to allow statistically relevant and valid comparative and/or normative inferences, (3) a lack of specificity of action and effect (e.g., as has been noted in transcranial electrical stimulation [tES]), and (4) the size and configurations of certain in-dwelling devices (e.g., as used in deep brain stimulation [DBS] and intraneural recording). Thus, AISC may generate new opportunities and trajectories for neuroS/T use in both research and practice.

Neuroethical Issues

Like so many aspects of human endeavor, neuroS/T is developed and employed to advance knowledge and capability in order to fortify human survival, if not flourishing. Given that flourishing may be defined as strivings for the good(s) of life, it then becomes important to address and examine if and how neuroS/T can, and should (or should not), be employed to obtain such goods. This situates any consideration of neuroS/T research and application squarely within the realm of neuroethics.

As a field, neuroethics is devoted to two main tasks: (1) studies of the neurobiological substrates and processes operative in proto-moral, moral, and ethical cognition, emotions, and actions (i.e., the so-called neuroscience of ethics) and (2) the ethical issues fostered by neuroS/T research and uses in medicine, public life, national security, intelligence, and defense (i.e., the “ethics of neuroscience,” Roskies (2002)). Arguably, these are complementary in that any use of neuroS/T must first be scrutinized and analyzed to evaluate the validity, viability, probity, problems and value of the techniques, and technologies employed.

In this light, current neuroethical issues arising in and from neuroS/T research and use include:

  1. The validity and relative value of using various forms of neuroS/T assessment (such as neuroimaging, neurogenetics, biomarker evaluation) to define, describe, and/or predict patterns, of thought, emotionality, and behaviors.

This incurs consequences in medicine and public health (as relates to predicting dispositions to potential neurological and/or psychiatric disorders), law (as regards using neuroS/T to define capability and culpability), and sociopolitical standards and actions (by using neurocentric criteria to establish norms and then basing social, economic, and politico-legal treatment of individuals and groups upon these definitions and distinctions).

NeuroS/T-based assessments have been shown to be useful in experimental, and certain clinical and social applications, by illustrating particular functional and dysfunctional parameters of brain structure and activity. However, these approaches also incur a number of potentially controversial issues and questions, based, at least in part, upon the capabilities and limitations of the techniques themselves. For example, neuroimaging technologies and techniques (e.g., positron emission tomography [PET], functional magnetic resonance imaging [fMRI], diffusion tensor imaging [DTI], and diffusion kurtosis imaging [DKI]) tend to have rather good spatial resolution, but less than optimal temporal resolution. In contrast, physiological measures (e.g., quantitative encephalography [qEEG] and magneto encephalography [MEG]) have very good temporal resolution, but generally restricted spatial precision (Glabus 2014). Genomic and genetic assessments may be viable in assessing certain predispositions to patterns of neural structure and function, but direct prediction of resulting phenotypes can be difficult (if not impossible) given the diversity of interacting biological and environmental factors affecting physical expression (Potter 2010).

The utility and applicability of these approaches are credible if and only if the constraints and underlying assumptions (and mis-assumptions) are acknowledged and accounted for in any and all attempts to apply said techniques – especially in situations such as social norming and/or law that are beyond the research or restricted clinical realm. Can scanning the brain be used to “read minds”? Can genes and phenotypes be analyzed to predict future thoughts and actions? No. At least not to the extent depicted in fictional accounts that tend to prompt public fears (Giordano et al. 2014). Are current efforts in neuroS/T on a path to such possibilities? Perhaps, and this fosters something of a paradox: given (a) trends in, and relative speed of, neuroS/T advancement, and (b) recent events of social violence, there is a pervasive – if not increasingly strong – call from the public (as well as certain professional and government sectors) to “do something” and employ imaging and genetic neuroS/T to define, describe, and predict who will be most likely to commit acts of aggression or violence.

At the same time, there is an equally strong fear that such neuroS/T will be used to probe consciousness and usurp personal privacy and individual autonomy (Giordano et al. 2014). How can a balance be struck between calls for protection and equivocal calls for privacy? Of concern is that various groups, if not society at large, might lose sight of the real capabilities and limitations of such neuroS/T and imprudently employ them in ways beyond their actual current technological capacities. Moreover, the growing availability of, and reliance upon, neuroS/T for assessment might then instigate a more widespread use of neuroS/T for cognitive, emotional, and/or behavioral control (Wurzman and Giordano 2014).

  1. The potential use and misuse of interventional neuroS/T (such as novel drugs, tES, transcranial magnetic stimulation – TMS, DBS, and gene and tissue transplants and implants) to affect fundamental aspects of personality or “the self” as defined in first-, second-, or third-person perspectives.

Might neuroS/T be used to change subjective experience by altering mental representations of past and present, so as to affect thought, feelings, and actions in the future? Recent work in tES, TMS, DBS, and optogenetics is impressive and can be seen as taking ardent steps toward altering cognitive functions, emotional reactivity, and behavior. These studies are indeed important, but here too it is equally important to be cautious in parsing fact from hype.

Altering brain activity to change cognitive and emotional states is not a new approach, even in the brain sciences. What is new is the specificity and precision enabled by state-of-theart neuroS/T. For example, the use of selective pharmacological agents, tES or TMS, and DBS is all currently possible. There is building motivation and impetus to use these forms of neuroS/T to augment cognitive, emotional, and decisional abilities, in this way affect performance in learning and memory and acquisition of knowledge and skill, and alter “talent,” “sensitivity,” and perhaps “morality” – however defined (Savulescu and Bostrom 2009). But what contexts of use will be deemed appropriate, and what – and whose – criteria will provide the metrics of need or value for such use? On the one hand, these applications of neuroS/T can be seen as providing new means – and levels – of individual and/or group improvement. On the other, these same approaches could be leveraged to enforce medicolegal and political standards and norms. In both scenarios, economics will likely influence how – and to whom – various techniques and technologies would be provided.

This harkens a bit of sci-fi (e.g., the Hollywood films Terminal Man, A Clockwork Orange, Eternal Sunshine of the Spotless Mind, and Limitless) and is reflective of public sentiment, at least to some extent. Without doubt, there are situations that might justify the use of neuroS/T to alter if not eradicate memories (e.g., traumatic events, profoundly sad or disturbing experiences, etc.), change cognitions and emotions (e.g., depressive disorder, post-traumatic stress syndrome, and other anxiety disorders), and alter behavior (e.g., florid psychopathy and overt interpersonal aggression and violence), and such use could be seen in a positive, therapeutic light. However, this same capability could also be used in ways that might – and perhaps should – be viewed as far more controversial, such as in interrogations, intelligence operations, and even certain contexts of what is construed to be “public safety” (Giordano et al. 2014).

But assume that the use of neuroS/T could be confined to the clinical milieu; it is still important to consider why, when, in whom, and how particular techniques and technologies will be used, the consequences, and continuity of care. Each and all of these contingencies are vital to obtaining informed consent. As well, it is questionable how “informed” consent can really be, given the nascence of this neuroS/T (Giordano 2015).

Yet, this need not impede further studies and use in practice; as a matter of fact, the only way to fortify determinations of benefits, burdens, risks, and harms is through ongoing research. And animal research alone will be insufficient, given that most of the contestable issues regarding the use of neuroS/T center upon the assessment and control of human mental function. Of course, many potential side and adverse effects will be reduced through the careful design and conduct of any such studies. Still, the fact that this research investigates and employs heretofore unknown interactions between neuroS/T and the brain creates strong probability that unanticipated outcomes can and will occur, and thus, it will be important to address and manage these unintended effects. While this may be relatively easy once a standard of care has been established within single payer and nationally subsidized healthcare systems, it could prove to be problematic within multiple party payer systems (such as that of the USA), and this might necessitate revision of medical economics to accommodate the trend and trajectories of cutting-edge neuroS/T and its translations into clinical contexts (Gunduz et al. 2014).

It is unrealistic to expect that the use of neuroS/ T will be limited to the clinical arena, and at present EEG-based neurofeedback, tES and TMS are being used in extra-clinical settings to affect vigilance, information acquisition and retrieval, arousal/relaxation, and emotionality. What type or extent of interventions constitute treatment (of “abnormalities,” e.g., if said norms are neuroscientifically defined) versus enhancements (and how far can and should brain functions and human performance be enhanced)? Might there be some “middle ground”– such as socially sanctioned and justifiable “enablement” (a term developed by our group) – in which key individuals in select professions (e.g., peace officers, fire fighters, physicians, airline pilots, soldiers, etc.) might receive neuroS/T augmentation of those capabilities that are deemed crucial to upholding their social status as protectors of the polis? What professions might be appropriate? And what happens if these individuals can no longer perform such duties or are no longer in such jobs?

Should they then be “disenabled,” or will their altered capabilities render them misfit for other aspects of society? How will these “disenabled” individuals be cared for? Who will decide? Who will pay?

  1. Commercialization and global leveraging of neuroS/T.

Recent reports estimate that neuroS/T generates over $150 billion/year in revenues (NeuroInsights 2015). The market pull of neuroS/T that may be publically viewed or construed (via advertising) to be of high value (e.g., for cognitive, emotional, or behavioral alteration) may prompt further penetrance into the consumer sphere with increased potential for inapt use. This could foster issues of commercial liability and indemnification, which might easily establish default reliance upon Caveat Emptor as an undergirding ethico-legal precept. Moreover, current predictions posit a greater than 60 % increase in neuroS/T research, development, and translational application(s) within the next 10 years, with Asian and South American efforts becoming equal to, if not surpassing, US and European output (NeuroInsights 2015). This establishes brain science as a major economic factor and force affecting power distributions upon the world stage of the forthcoming decade. Therefore, it will become important – and necessary – to consider and acknowledge the needs and values of other, non-Western nations and groups when examining and articulating neuroethical issues and their possible resolution(s).

Such leveraging of brain science is not limited to the portfolios of international economics; it is also crucial to consider the use of neuroS/T in military operations. The formal definition of a weapon as “a means of contending against another” would warrant more accurate insight to the ways that neuroS/T might be employed to foster improved perception and understanding of factors that spawn cognitive and emotional precipitants of aggression and violence. In an optimistic, but nonetheless pragmatic view, neuroS/T could be employed in such ways to defer conflict. But human history and contemporary events prompt reexamination of the viability of weaponizable neuroS/T to incur sickness and death and to negatively impact local, national, and international public health (Wurzman and Giordano 2014).

Neuroethical Questions

From these issues arise three major – and interrelated – neuroethical questions and debates: First is what we – as individuals, communities, organizations, nations, and perhaps even a species – will do with the information and capability conferred by neuroS/T and what we will do about the capability and information we lack (and by extension, whether we will be insightful and exercise sufficient judgment to know the difference). In other words, will we be (a) sufficiently pragmatic in our assessment of neuroS/T to recognize the actual strengths and limitations of these approaches and (b) sufficiently prudent in the ways we use and limit the outcomes and products of these approaches to leverage medical, social, economic, legal, and even political effects and power?

Second is whether neuroS/T developed and articulated under current funding initiatives will be translated into clinical care and/or publicly viable – and sound – use within a reasonable window of time or whether these approaches are so nascent as to remain ineffectual in enabling brain science as a broadly applied public good. This is a double-edged sword; while there is a need for concern about not translating neuroS/T research into clinical care, it is equally important to be concerned about exaggerated claims of benefit, as well as underestimations of potentially adverse effects that prompt over expedience in moving novel neuroS/T to the clinical forefront.

Third is how assessment and interventional neuroS/T can, should, and/or should not be used to define, predict, and change the cognitive, emotional, and behavioral states, conditions, and manifestations that are associated with various brain structures and functions. Of course, this incurs a host of derivative issues, questions, and problems, including if and how neuroS/T-based or neuroS/T-derived information might be used to establish neurocentric criteria for normality and abnormality; what thresholds (of both neuroS/T accuracy and neurobiological function) will be employed to initiate medical, socio-legal, and/or political actions; and if and how various types of neuroS/T will be utilized to execute such actions (by changing thoughts, emotions, beliefs, and actions).

Neuroethics In Practice

A simple precautionary stance is untenable when addressing these questions for two principal reasons: First is the momentum of progress of neuroS/T is such that it will be very difficult to slow or stop. Second is that neuroS/T research, applications, and market viability have become global in articulation and effect, making precautions somewhat relative and proscriptions problematic (Giordano 2012b; 2015; Lanzilao et al. 2013). In other words, neuroS/T research and its application are happening and will continue to happen. However, a “wait until it happens” attitude toward addressing neuroethico legal and social issues created by neuroS/T is cavalier, if not dangerous. Going forward it will be essential to assume more of a preparatory posture, wherein the neuroethical tasks will be to (1) realistically assess the neuroS/T that is available at present and in the near future; (2) model trajectories for use, misuse, and effect; and taking these together (3) develop guidelines and approaches that will be necessary to identify, address, and either prevent problems or resolve them at their inception or early in their development (Giordano 2012b).

To establish insights to those ways that neuroS/ T will generate neuroethico-legal and social issues writ large (i.e., on a community, public, and/or national/international scale), it is necessary to appraise what areas and types of neuroS/T are being subsidized, fortified, and advanced and to gauge how such technological developments will affect local, regional, national, and global societies, economics, and politics (Swetnam et al. 2013). Determining neuroethical issues, questions, and problems writ somewhat smaller (i.e., on the individual and defined group level) requires a methodological approach to posing key questions framed within defined contingencies and contexts (Giordano 2015).

Developing neuroethical guidelines and providing neuroethical recommendations for policies will require taking sociocultural contingencies and exigencies of various stake and shareholders in neuroS/T into accord. Extant ethical concepts will need to be revisited, and may need to be revised, and in some cases embellished or replaced in light of new and deepening understanding of the brain, new capabilities of neuroS/T, and widening use of these techniques and technologies by individuals and groups with differing needs and values (Lanzilao et al. 2013).

Conclusion

As a wok in progress, the field of neuroethics will require dedicated efforts toward formation of working groups, ongoing discourse, formulation of methods and protocols, and establishment of standards and guidelines. The proactive work of groups such as the Nuffield Council of Bioethics (in the UK), Presidential Commission for the Study of Bioethical Issues, and Defense Advanced Research Projects Agency’s (DARPA) Neuroscience Ethics’ Legal and Social Issues Advisory Panel (in the USA) is notable and encouraging in its explicit dedication to these issues, both in acknowledgment of neuroS/T progress to date and in advance of major incentivized programs in brain research.

Further efforts along these lines will be vital. Without doubt, neuroS/T can and will affect if not change the human predicament of suffering and pain, will affect the human condition, and may alter the human being – and conceptualizations of what it means to be human or a person. That neuroS/T becomes a salient and powerful reality –and force – that will affect the human prospect of the twenty-first century society is inevitable. How this force is to be realized remains to be determined and remains subject to our insight, pragmatism, and prudence.

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