A man with a spinal-cord injury (right) prepares for a virtual cycle race in which competitors steer avatars using brain signals. COMMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .example. Moreover, researchers can already interpret a person's neural activity from functional magnetic resonance imaging scans at a rudimentary level 1 -that the individual is thinking of a person, say, rather than a car.It might take years or even decades until BCI and other neurotechnologies are part of our daily lives. But technological developments mean that we are on a path to a world in which it will be possible to decode people's mental processes and directly manipulate the brain mechanisms underlying their intentions, emotions and decisions; where individuals could communicate with others simply by thinking; and where powerful computational systems linked directly to people's brains aid their interactions with the world such that their mental and physical abilities are greatly enhanced.Such advances could revolutionize the treatment of many conditions, from brain injury and paralysis to epilepsy and schizophrenia, and transform human experience for the better. But the technology could also exacerbate social inequalities and offer corporations, hackers, governments or anyone else new ways to exploit and manipulate people. And it could profoundly alter some core human characteristics: private mental life, individual agency and an understanding of individuals as entities bound by their bodies.It is crucial to consider the possible ramifications now.The Morningside Group comprises neuroscientists, neurotechnologists, clinicians, ethicists and machine-intelligence engineers. It includes representatives from Google and Kernel (a neurotechnology start-up in Los Angeles, California); from international brain projects; and from academic and research institutions in the United States, Canada, Europe, Israel, China, Japan and Australia. We gathered at a workshop sponsored by the US National Science Foundation at Columbia University, New York, in May 2017 to discuss the ethics of neurotechnologies and machine intelligence.We believe that existing ethics guidelines are insufficient for this realm 2 . These include the Declaration of Helsinki, a statement of ethical principles first established in 1964 for medical research involving human subjects (go.nature.com/2z262ag); the Belmont Report, a 1979 statement crafted by the US National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research (go.nature.com/2hrezmb); and the Asilomar artificial intelligence (AI) statement of cautionary principles, published early this year and signed by business leaders and AI researchers, among others (go.nature.com/2ihnqac).To begin to address this deficit, here we lay out recommendations relating to four areas of concern: privacy and consent; agency and identity; augmentation; and bias. Different nations and people of varying re...

There is ample evidence that patient mistrust toward the American medical system is to some extent associated with communal and individual experiences of racism. For groups who have faced exploitation and discrimination at the hands of physicians, the medical profession, and medical institutions, trust is a tall order and, in many cases, would be naive. Nevertheless, trust is often regarded as a central feature of the physician‐patient relationship. In this article, I draw on empirical research, ethical theory, and clinical cases to propose one way that providers might address and, ideally, resolve mistrust when it arises in an immediate case. I describe how medical mistrust has been characterized empirically within medical and bioethics scholarship, and I provide an overview of theories of trust, arguing that they may be unable to account for the risks that providers must take in seeking to establish trust within many American medical institutions. Common assumptions in medical and bioethical scholarship on trust notwithstanding, caring and competence are not always enough to establish a trusting relationship between physician and patient. I suggest that, in an atmosphere of mistrust, comprehension of the existence and source of suspicion is essential to effective signaling of trustworthiness.

Advancements in novel neurotechnologies, such as brain computer interfaces (BCI) and neuromodulatory devices such as deep brain stimulators (DBS), will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose (1) democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, (2) new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, (3) new methods of identifying and preventing bias, and (4) the adoption of public guidelines for safe and equitable distribution of neurotechnological devices.

Purpose: This study presents survey responses of pediatric physical therapists' use and alteration of standardized assessments of motor function in children aged 2 to 10 years. Methods: Electronic and paper surveys were distributed to practicing physical therapists through the APTA Academy of Pediatric Physical Therapy electronic newsletter and 2 national conferences. Data were analyzed by response frequencies, qualitative responses, and χ2analyses for demographic characteristics. Results: A total of 497 pediatric physical therapists responded. Most (93%) reported using standardized assessments, with the majority (84%) reporting the normative scores. Almost all respondents (94%) also reported that they at least occasionally modify assessments. Conclusion: Standardized assessments are used by most therapists, but the high use of modifications during testing is concerning. Survey reports from therapists indicate a disconnect between standardized assessments and the needs of the child, leaving clinicians working to report required scores while maintaining validity of testing procedures.