Abstract:The world's first-in-human clinical trial using invasive intelligent brain devices-devices that predict specific neuronal events directly to the implanted person-has been completed with significant success. Predicting brain activity before specific outcomes occur brings a raft of unprecedented applications, especially when implants offer advice on how to respond to the neuronal events forecasted. Although these novel predictive and advisory implantable devices offer great potential to positively affect patient… Show more
“…Further neuroethical research is needed more than ever, especially in a context where novel generation of DBS systems including closed-loop, artificially intelligent implants, and brain-computer interfaces are being developed. [78][79][80][81][82][83][84][85] Whether or not these emerging neurotechnologies will affect PIAAAS is still uncharted territory.…”
The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention putative DBS-induced changes to patients' postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS.
“…Further neuroethical research is needed more than ever, especially in a context where novel generation of DBS systems including closed-loop, artificially intelligent implants, and brain-computer interfaces are being developed. [78][79][80][81][82][83][84][85] Whether or not these emerging neurotechnologies will affect PIAAAS is still uncharted territory.…”
The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention putative DBS-induced changes to patients' postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS.
“…This evidence justifies the claim that, generally speaking, DBS is not a threat to personal, but some patients might not experience well any form of estrangement. Patients would benefit from being informed ahead of any potential risks, prior to consenting to being implanted, as in other types of invasive brain intervention (Viaña, Vickers et al 2017;Gilbert et al 2014;Viaña, Bittlinger et al 2017;Gilbert 2015b;Bretzner et al 2011;Gilbert, Vranic, and Hurst 2013;Gilbert 2014;Vranic & Gilbert 2014;Gilbert & Cook 2015;Gilbert 2017;Gilbert & Dodds 2013;Gilbert & Focquaert 2015;Gilbert & Vranic 2015).…”
“…These physiological complications are accompanied by psychological ones including hypomania, mania, hypersexuality, and gambling 15 (in contrast to what is found with open‐loop DBS, about which there are reports of a 15‐fold increase The potential phenomenological harms of closed‐loop DBS devices may not be adequately captured by RCTs that enroll many patients with heterogenous medical and psychosocial characteristics. in the rate of suicide) 16 . Other reported phenomenological harms may happen in the patient's personality and identity after the treatment has been successful or during the treatment 17 . There is an ongoing debate in the fields of neuroethics and the neurosciences about putative postoperative DBS phenomena related to the psychology of patients.…”
Section: Closed‐loop Dbs and Potential Harmsmentioning
confidence: 99%
“…16 Other reported phenomenological harms may happen in the patient's personality and identity after the treatment has been successful or during the treatment. 17 There is an ongoing debate in the fields of neuroethics and the neurosciences about putative postoperative DBS phenomena related to the psychology of patients. For example, whether the phenomena are purely reactive responses to stimulation 18 or to the modification of drug interventions 19 and whether the phenomena reflect alleviation of symptoms, 20 lesioning of neural tissue because of devices and stimulation, 21 or the natural evolution of the disease 22 are issues of debate.…”
Section: Closed-loop Dbs and Potential Harmsmentioning
Closed‐loop deep brain stimulation (DBS) devices hold great promise for treating various neurological and psychiatric conditions. Yet while these algorithmic‐based devices provide personalized treatment to each patient, they also present uniquely individualized risks of physiological and psychological harms. These experimental devices are typically tested in randomized controlled trials, which may not be the optimum approach to identifying and assessing phenomenological harms they pose to patients. In this article, we contend that an N‐of‐1 trial design—which is being used ever more frequently to realize the goals of individualized, precision medicine—could provide beneficial phenomenological data about the potential risks of harm to properly inform the use of closed‐loop DBS devices. Data from N‐of‐1 trials may provide patients, as well as their families and other caregivers, with better information on which to base informed choices about pursuing this type of treatment option.
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