published: 19 February 2018
Frontiers in Neuroscience | www.frontiersin.org 1February 2018 | Volume 12 | Article 82
Duke University, United States
Jose Luis Contreras-Vidal,
University of Houston, United States
Federico Gustavo Pizzetti,
Università degli Studi di Milano, Italy
Sameer A. Sheth,
Baylor College of Medicine,
Gabriel José Corrêa Mograbi,
Universidade Federal de Mato
This article was submitted to
a section of the journal
Frontiers in Neuroscience
Received: 15 September 2017
Accepted: 01 February 2018
Published: 19 February 2018
Lavazza A (2018) Freedom of Thought
and Mental Integrity: The Moral
Requirements for Any Neural
Prosthesis. Front. Neurosci. 12:82.
Freedom of Thought and Mental
Integrity: The Moral Requirements for
Any Neural Prosthesis
Neuroethics, Centro Universitario Internazionale, Arezzo, Italy
There are many kinds of neural prostheses available or being researched today. In most
cases they are intended to cure or improve the condition of patients affected by some
cerebral deﬁciency. In other cases, their goal is to provide new means to maintain
or improve an individual’s normal performance. In all these circumstances, one of the
possible risks is that of violating the privacy of brain contents (which partly coincide with
mental contents) or of depriving individuals of full control over their thoughts (mental
states), as the latter are at least partly detectable by new prosthetic technologies. Given
the (ethical) premise that the absolute privacy and integrity of the most relevant part of
one’s brain data is (one of) the most valuable and inviolable human right(s), I argue that
a (technical) principle should guide the design and regulation of new neural prostheses.
The premise is justiﬁed by the fact that whatever the coercion, the threat or the violence
undergone, the person can generally preserve a “private repository” of thought in which
to defend her convictions and identity, her dignity, and autonomy. Without it, the person
may end up in a state of complete subjection to other individuals. The following functional
principle is that neural prostheses should be technically designed and built so as to
prevent such outcomes. They should: (a) incorporate systems that can ﬁnd and signal
the unauthorized detection, alteration, and diffusion of brain data and brain functioning;
(b) be able to stop any unauthorized detection, alteration, and diffusion of brain data.
This should not only regard individual devices, but act as a general (technical) operating
principle shared by all interconnected systems that deal with decoding brain activity and
Keywords: neural prosthesis, freedom of thought, mental privacy, thought control, brain datasets
This is Germany. The Nazi party is in power. Hladík, a Jewish citizen and writer, is arrested and
sentenced to death. The thought of being killed terriﬁes him, but what scares him the most is the
idea of not being able to ﬁnish what would have been his most important play: The Enemies.
“He had asked God for an entire year in which to ﬁnish his work: His omnipotence had granted him the
time. For his sake, God projected a secret miracle: German lead would kill him, at the determined hour,
but in his mind a year would elapse between the command to ﬁre and its execution (...) He disposed of
no document but his own memory; the mastering of each hexameter as he added it, had imposed upon
him a kind of fortunate discipline not imagined by those amateurs who forget their vague, ephemeral,
Lavazza Freedom of Thought, Mental Integrity
paragraphs. He did not work for posterity, nor even for God, of
whose literary preferences he possessed scant knowledge. (...) He
brought his drama to a conclusion: he lacked only a single epithet.
He found it: the drop of water slid down his cheek. He began a
wild cry, moved his face aside. A quadruple blast brought him
down. Jaromir Hladik died on March 29, at 9:02 in the morning”
(Borges, The Secret Miracle).
Thus wrote Jorge Luis Borges in a famous short story, showing
the relevance of our mental life even in the face of the extreme
threat—that of the end of life. Borges wrote ﬁction, introducing
references to miracles that are little pertinent here. However, a
valid point could still be made: if Nazi criminals, like other evil
people in the history of humanity, had come to realize that their
victims could ﬁnd great comfort in thoughts concealed within
their minds, they would have tried to stop this by all means. Well,
today we might be living in an age where this is possible.
Of course, it is probably fair to say that the research done
in universities, corporations, hospitals, and other institutions is
geared toward beneﬁcial or neutral purposes, where any abuse is
attributable to single malicious individuals or to non-democratic
regimes. Nevertheless, the development of the latest devices has
increased the possibility that mental/brain privacy and integrity
be put at risk in an unprecedented way (cf. Rose, 2005; Rose and
Just to make some examples, we have gone from recording
electrical activity by means of EEG in strictly clinical settings
to neurofeedback with portable instruments that monitor and
modulate the individual’s attention to speciﬁc tasks (Thibault
et al., 2016). We can predict intentions and choices that will be
made within a few seconds by means of fMRI (Haynes et al., 2007;
Soon et al., 2008, 2013). We can interpret the neural activity of an
individual by means of fMRI scans and understand whether he is
thinking about, say, a motorcycle or a knife (Kay et al., 2008). We
are able to identify forms of awareness thanks to brain activation
in subjects that are in an apparent vegetative state (Monti et al.,
2010), and we can understand the neural signature of political
orientation (Schreiber et al., 2013). Neuromarketing makes it
possible to know and/or manipulate someone’s taste with various
direct or indirect techniques that capture hidden preferences
(McClure et al., 2004). In the legal ﬁeld it seems possible to
understand with diﬀerent methods if subjects are lying (Wolpe
et al., 2005; Monaro et al., 2017) and to evaluate the possibility of
recidivism by observing the brain proﬁles of individuals released
from prison on parole (Aharoni et al., 2013). There have been
fairly successful attempts at obtaining speech from brain waves
(Herﬀ et al., 2015; Mirkovic et al., 2015), and we have just
opened the door to optogenetics, which has made it possible—
in non-human animals—to radically change behaviors or modify
memories, implanting new ones (Kim et al., 2013; Redondo et al.,
2014; Berndt et al., 2016; Ferenczi et al., 2016). And new micro
brain implants for reading or controlling neural activity and
new kinds of brain-computer interfaces could be made real by
advancements in miniaturizing devices. For example, recently
antennas for wireless communication 100 times smaller than
their current sizes have been ﬁgured out (Nan et al., 2017). In
2017, Darpa launched the Neural Engineering System Design
project, aimed to achieve a “wireless human brain device that can
monitor brain activity using 1 million electrodes simultaneously
and selectively stimulate up to 100,000 neurons” (Yuste et al.,
It therefore seems reasonable to try to avoid potential abuses
not only by establishing rights and laws, but also by incorporating
in the devices themselves the possibility of preventing these
abuses according to a precisely deﬁned technical principle.
There are already juridical and deontological tools available, of
course, such as the Declaration of Helsinki, the Belmont Report
for the United States and the Oviedo Convention for Europe.
However, in May 2017a team of leading scholars in the ﬁelds of
neurotechnologies (including neural prostheses) and AI, called
the Morningside Group, gathered at Columbia University in New
York to discuss the ethics of neurotechnologies and machine
intelligence. They stated that “the existing ethics guidelines are
insuﬃcient for this realm” (Yuste et al., 2017). In their view,
“as neurotechnologies develop and corporations, governments
and others start striving to endow people with new capabilities,
individual identity (our bodily and mental integrity), and agency
(our ability to choose our actions) must be protected as basic
human rights” (ib.). Expressing a certain worry about the use
of new enhancement techniques, they urged “that guidelines are
established at both international and national levels to set limits
on the augmenting neurotechnologies that can be implemented,
and to deﬁne the contexts in which they can be used—as is
happening for gene editing in humans” (ib.).
So, ﬁrst I will argue for the protection of mental/cerebral
privacy and integrity; then I will establish a principle that may
be valid for all devices that have the ability to detect, spread, and
alter (certain) brain data and brain functioning. Some objections
may arise about the absolute conception of the right to mental
integrity and therefore also to the application of the technical
principle of device control. I shall therefore discuss some of these
A famous text by Henry David Thoreau dated 1849 illustrates the
importance of the various aspects of human action that, at the
time, fell under the inﬂuence of the state.
“I have paid no poll-tax for 6 years. I was put into a jail once on
this account, for one night; and, as I stood considering the walls
of solid stone, two or three feet thick, the door of wood and iron,
a foot thick, and the iron grating which strained the light, I could
not help being struck with the foolishness of that institution which
treated me as if I were mere ﬂesh and blood and bones, to be
locked up. I wondered that it should have concluded at length that
this was the best use it could put me to, and had never thought to
avail itself of my services in some way. I saw that, if there was
a wall of stone between me and my townsmen, there was a still
more diﬃcult one to climb or break through before they could get
to be as free as I was. I did not for a moment feel conﬁned, and the
walls seemed a great waste of stone and mortar. I felt as if I alone
of all my townsmen had paid my tax.
They plainly did not know how to treat me, but behaved
like persons who are underbred. In every threat and in every
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Lavazza Freedom of Thought, Mental Integrity
compliment there was a blunder; for they thought that my chief
desire was to stand the other side of that stone wall. I could
not but smile to see how industriously they locked the door on
my meditations, which followed them out again without let or
hindrance, and they were really all that was dangerous. As they
could not reach me, they had resolved to punish my body; just
as boys, if they cannot come at some person against whom they
have a spite, will abuse his dog. I saw that the State was half-
witted, that it was timid as a lone woman with her silver spoons,
and that it did not know its friends from its foes, and I lost all
my remaining respect for it, and pitied it. Thus the State never
intentionally confronts a man’s sense, intellectual or moral, but
only his body, his senses. It is not armed with superior wit or
honesty, but with superior physical strength” (Thoreau, Resistance
to Civil Government).
In the situation described by Thoreau, the state’s repressive
apparatus could not do much against the ideas that supported
civil disobedience. But today the scenario is changing. In what
has been termed an era of neuroscientiﬁc and neurotechnological
imperialism and pervasiveness (Frazzetto, and Anker, 2009;
Fumagalli, 2018), it seems much easier to violate the privacy and
integrity of our brain and minds.
In fact, the consideration and respect for the autonomy and
self-determination of the individual have gradually increased in
contemporary culture, also in the wake of Kant’s deontological
reﬂection and Mill’s liberal utilitarianism, making it harder to
justify generically paternalistic positions. A clear example can
be found in the ﬁeld of bioethics, where the patient’s informed
choices have prevalence over medical judgment and community
rules. From an epistemological point of view, the premise is
that knowledge concerning the facts and dynamics of human
relationships is widespread, nobody knows everything or can
decide for everyone in the best way.
Privacy is one of the conditions for the exercise of personal
freedom and autonomy. The concept of privacy generally regards
the protection of a space of non-interference, based on a principle
of “inviolate personality” which—as Brandeis and Warren (1890)
famously stated—is a part of the person’s general right of
immunity. Indeed, privacy limits the intrusion into a person’s
seclusion or solitude or into her private aﬀairs. The right to
privacy seems to prevent the public disclosure of embarrassing
facts as well as actions that would publicly put one in a bad light.
One can argue that, if others can enter your own sphere, even just
to see it, this potentially aﬀects your freedom of action, because
being “observed” implies giving others an advantage over us,
thus creating an asymmetry between us and them, and generally
binding and limiting ourselves. The right to privacy thus seems
an essential correlate of autonomy, which, as we have noted, is
the preferred framework of liberal societies.
Distinguishing, like Berlin (1969), between negative freedom
and positive freedom makes it easier to appreciate the value of
freedom and the justiﬁcations that can be oﬀered for it. Negative
freedom has to do with the absence of external obstacles to the
agent: we are free if nobody prevents us from doing what we
want to do. It is political freedom, in favor of which millions
of people have sacriﬁced themselves throughout the twentieth
century. Positive freedom is characterized instead by the control
exercised by the agent: one is free if one is self-determined, if one
inﬂuences one’s destiny according to one’s own interests. But what
is the area in which one should leave the subject to do or be what
he is capable of doing or being? What is the source of control or
interference that can cause someone to do or be something rather
than something else?
According to a radical interpretation of positive freedom, it
can be said that in many cases (of divided self, of incompatible
desires, of neurological diagnoses of true, or presumed diseases,
of activations in the average or above-normal range of a cerebral
area), a self can be considered superior to another, or an
activation to another, and one can therefore think that one self
should take precedence over another. The aim will then be to ﬁnd
the true self of the individual in question. Individuals that are
more rational or have more knowledge (or better means) could
then act to make the true self and the right neuronal activation
prevail in everyone (even simply through a preventive control).
Anything could be done in the name of the true self or the right
neuronal activation, in the presumed certainty—says Berlin—
that everything that represents the ultimate purpose of man
(happiness, the fulﬁllment of duty, wisdom, a just society, self-
realization) must be the choice of this “true” self, even if hidden
or unexpressed. This is the essence of paternalism at its fullest,
which is the antithesis of freedom. And this kind of paternalism
has often proven in history to be cruel and ineﬀective, being
unable to increase overall happiness. The freedom and autonomy
of the individual, also guaranteed by her mental integrity, are
instead the conditions for several other goals in addition to being
an objective in itself, as written today in the Constitutions of
many democratic countries.
Here it is worth clarifying the diﬀerent elements that are at
stake and the way in which they are involved. Any individual
is primarily concerned with the mental states he is conscious
of. Borges’s playwright, for instance, wants to compose his work
without anyone knowing about it; Thoreau wants to maintain
his view that the state has no right to demand tax and wants
to transmit his ideas to other people. Now, today’s devices and
new neural prostheses are able to detect brain data in the form
of connection patterns and activation of nerve cells (cf. Peña-
Gómez et al., 2017). Such patterns are probably the neuronal
correlates of the thoughts (mental states) that the individual has
at any point in time. The relationship between neural activation
patterns and thoughts is being actively researched and, even
though many aspects are still to be clariﬁed, research is making
a lot of advancements. It has been recently made it possible to
decode what the brain is neurally representing by using artiﬁcial
intelligence to interpret fMRI scans of subjects watching videos.
Researchers used convolutional neural networks, a form of deep-
learning (Wen et al., 2017). Their ﬁndings make it necessary to
consider the ethical implications of this kind of “mind-reading”:
such a device should be used for shared purposes and not to
threaten individual privacy and freedom.
However, even brain data that do not match individual states
and mental contents may be relevant to the individual, who
may very well want to avoid both their diﬀusion and alteration
(Mitchell et al., 2008). These elements, in fact, make it possible
to predict behavior based not so much on conscious desires
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Lavazza Freedom of Thought, Mental Integrity
and intentions, but on “automatic” behavioral reaction patterns,
such as what we call impulsivity or poor empathy. In addition,
other techniques make it possible to identify the individual’s
unconscious tendencies manifested in the form of fast brain
activation in front of a stimulus (such as for example, the so-
called unconscious racism or other judgments we suppress in
favor of responses that are more appropriate to the given social
context). All this intuitively constitutes the individual’s “private
repository” of his convictions and identity, his dignity, and
autonomy. Without it, the person may end up in a state of
complete subjection to other individuals.
For sake of completeness, it should be speciﬁed that, from a
philosophical standpoint, there is another aspect of mental life
that, by deﬁnition, is inaccessible to external decoding, namely
that of ﬁrst-person sensations: what philosophy of mind calls
“what it is like.” I am referring to things like perceiving a certain
color nuance, enjoying a given wine, but also feeling loved or
ﬁnding the solution to a mathematical problem (Nagel, 1974).
Yet, from a scientiﬁc standpoint, the fact that one cannot feel
the same ﬁrst-person pleasure as another does not imply that
we cannot decodify it. In fact, knowledge of the link between
a stimulus (e.g., drinking a certain wine) and the activation
of speciﬁc brain areas can make us validly infer that the
subject is having, say, a reaction of disgust, even if she tries to
hide it. In this sense, although we cannot access the subject’s
ﬁrst person phenomenology, we can still decode her subjective
cerebral/mental states and this makes the decoding of brain states
relevant to the present discussion. That being said, there are many
examples of situations where mental/brain integrity is at risk.
The term “mental integrity” seems to be the most suitable way to
account for the concept I want to express here. In the normative
sense, the following deﬁnition might be adopted:
Def1: Mental Integrity is the individual’s mastery of his mental
states and his brain data so that, without his consent, no one can
read, spread, or alter such states and data in order to condition the
individual in any way.
This deﬁnition broadens the one oﬀered by Ienca and Andorno
(2017), by which the right to mental integrity “should provide
a speciﬁc normative protection from potential neurotechnology-
enabled interventions involving the unauthorized alteration of a
person’s neural computation and potentially resulting in direct
harm to the victim.” The deﬁnition I propose addresses both the
issue of privacy and that of cognitive freedom, which Bublitz
deﬁned as “the right to alter one’s mental states with the help
of neurotools as well as to refuse to do so” (Bublitz, 2013). My
point is that privacy, understood as the secrecy of one’s brain
data and mental contents, is key to a free conduct, because
autonomy is exercised not only in public but also in private. Being
spied on through mind-reading reduces the subject’s autonomy
in the Kantian sense, that is, the subject can be limited in self-
imposing her own norm of conduct, free of external pressures
and conditioning (which are only avoided by keeping one’s
thoughts private). What follows is an inappropriate imposition
over the individual, even in the absence of direct harm.
The deﬁnition I propose also grasps another aspect: as
previously noted, even brain data apparently unrelated to
conscious contents or cognitive processes (mental states) can
help predict one’s behavior. This is of particular importance in
the light of the fact that recent interpretations of brain activity
are emphasizing its predictive character. In particular, it has been
argued that our brains are similar to prediction machines, capable
of anticipating the incoming streams of sensory stimulation
before they arrive (Hohwy, 2013; Clark, 2016). If the brain is more
than a response machine and if actions are more than stimulus
responses, but are a way of selecting the next input, then knowing
the present state of the brain (understood as prediction machine)
can say a lot about an individual and her future behavior—much
more than one would have thought within a diﬀerent paradigm
of brain functioning. However, one may wonder why mental
(cerebral) integrity should be granted special value compared to
other individual aspects, and whether the right to integrity is
relative or absolute. I will reply to the ﬁrst question in this section,
while the second will be tackled in the following one.
Mental integrity is the basis for freedom of thought as it
was classically conceived, before the era of neuro-technological
pervasiveness (Shen, 2013). It is the ﬁrst and fundamental
freedom that the individual must be granted in order to have
all the other freedoms considered relevant. In the long Western
tradition from Socrates to Augustine of Hippo, the inner life—the
one that no one can see and with which no one can interfere—
has always been considered the most precious and intangible
resource of the human being. Personal autonomy seems to
directly follow from freedom of thought. Human ﬂourishing
in many of its declinations—albeit not all of those proposed
in diﬀerent human cultures—feeds on freedom of thought
understood as a “private repository” where nothing and no one
can go without the person’s consent. In fact, it has been claimed
that “the right and freedom to control one’s own consciousness
and electrochemical thought processes is the necessary substrate
for just about every other freedom” (Sententia, 2004). In this
sense, cognitive freedom is a new form of freedom of thought that
“takes into account the power we now have, and increasingly we
will have, to monitor and manipulate cognitive function” (Ib.).
Faced with the potential new threats to mental integrity due to
neuroscientiﬁc techniques, attempts have been made to introduce
new human rights, speciﬁcally aimed at safeguarding the right
to cognitive freedom, the right to mental privacy, the right to
mental integrity, and the right to psychological continuity (Ienca
and Andorno, 2017). As said, it is also important to protect brain
data that can give access to the (more or less precise) prediction
of the person’s behavioral patterns through her neural connection
and activation patterns. In fact, such information can be used for
forms of prevention/discrimination (cf. Raine, 2013) based on the
subject’s hypothetical attitudes, or even to implement forms of
forced re-education or compulsory moral bio-enhancement (cf.
Persson and Savulescu, 2012; Douglas, 2014; cf. also Bublitz and
In this vein, examples of mental integrity violations are
related to brain-hacking. Ienca and Haselager (2016) deﬁne
brain-hacking as “illicit access to and manipulation of neural
information and computation.” Given that neural computation
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underlies cognition, behavior and our self-determination, any
unauthorized access, as said, may have signiﬁcant consequences.
Think, for example, of people who have public responsibilities
and who have to resort to devices to stabilize or (in the future)
improve their brain functionality. They would certainly have
to disclose the use of such prostheses (Garasic and Lavazza,
2016), but access to incoming and outgoing data could be a very
serious violation of mental integrity for the implanted subjects.
Indeed, one could use these data to infer—arbitrarily and without
scientiﬁc certainty—tendencies or behavioral predispositions of
the subject, both innate and due to incipient pathological states.
And the disclosure of these news could seriously harm the subject
with regard to his or her public role.
THE TECHNICAL PRINCIPLE OF
PROTECTION OF MENTAL INTEGRITY
If the premise on the importance of mental integrity obtains, a
(technical) principle for the protection of mental integrity may
Def2: The technical principle for the protection of mental
integrity is a functional limitation that should be incorporated
into any devices capable of interfering with mental integrity (as
deﬁned in Def1). Speciﬁcally, new neural prostheses should (a)
incorporate systems that can ﬁnd and signal the unauthorized
detection, alteration, and diﬀusion of brain data; (b) be able
to stop any unauthorized detection, alteration, and diﬀusion of
brain data. This should not only concern individual devices,
but act as a general (technical) operating principle shared by all
interconnected systems that deal with decoding brain activity.
As for devices already in use, they could, for example, incorporate
a device emitting a signal with a certain wavelength through
a mind-reading device detector that would be readily available
to the public. This should respond to the need to prevent
people from being secretly subjected to or deceived about the
use of devices capable of threatening the right to mental/brain
integrity (Ienca and Haselager, 2016). For example, think of
neural prostheses for cognitive enhancement, especially for those
who in the future might be obliged to use them because of their
profession (airplane pilots, surgeons, etc.) and might want to
avoid privacy violation or brain manipulation (Santoni de Sio
et al., 2014). In addition, brain-altering devices could be equipped
with various usage thresholds, each activated only with diﬀerent
access keys, related to the professional proﬁles of users: laboratory
technicians, doctors, medical investigators. . . In this way, the
most invasive practices would be only available to a few people
that would have been selected over time for their professional
skills and ethical integrity, as a safeguard against possible abuse.
As for new neural devices and prostheses (Lebedev et al.,
2011)—such as tools for the treatment of consciousness
disorders, direct brain-to-brain communication, networks
composed of many brains, artiﬁcial parts of the brain replacing
damaged circuitry and improving the existing one, and even the
transfer of brain content and functions to an artiﬁcial carrier—it
should be made possible to extract brain data only by means of
special access keys managed exclusively by the subjects under
treatment or by their legal representatives. Some of these devices
could be speciﬁcally aimed at brain alteration for rehabilitation
or other medical purposes, and likewise they should only be
made accessible to professionals in charge of their correct use,
which should be able to be monitored by a speciﬁc authority
upon the subject’s request. Think, for example, of new portable
devices such as fNIRS instrument for mobile NIRS-based
neuroimaging, neuroergonomics, and BCI/BMI applications
(von Lühmann et al., 2015).
As for the military or anti-terrorism use of such devices,
it would be desirable to stipulate an international treaty on
the model of those that have been signed by many countries
concerning antipersonnel mines, cluster bombs, or even chemical
weapons. These treaties establish the dismantling and non-
production of such weapons in peacetime. In fact, if such
weapons were readily available during a war, countries would
likely be tempted to use them. If the production of those weapons,
however, had been interrupted long before, it would be much
more diﬃcult to resort to them. Similarly, if mind-reading
or brain-altering devices were available without mechanisms
preventing their improper use, some would likely want to use
them for military purposes. This would be very tempting, because
the point would not be to threaten anyone’s safety, but only to
temporarily violate their mental privacy and/or integrity in order
to defend the community—say, from a terror attack. However,
if unregulated mind-reading devices (that is, without the limits
imposed by the technical principle proposed in Def2) were not
available, it would be much more diﬃcult to resort to them.
Notwithstanding all this, in some medical, legal, and military
cases the right to mental integrity may seem to be competing with
other rights, so that the principle of protection of mental integrity
may be occasionally bypassed. Therefore, it must be established
whether the right to mental integrity is absolute or relative. To
assert that the right to mental integrity is absolute requires a
strong justiﬁcation covering every possible case—a goal that is
hard to reach and is unlikely to have many supporters. On the
other hand, setting the right to mental integrity as relative risks
weakening it, making it less important than it is and making
it much easier to violate thanks to neurotechnological progress.
Consider the positive purposes for which neural prostheses were
built in the ﬁrst place: they might be partly hindered by the
technical principle of the protection of mental integrity. For
example, prostheses able to signal and/or prevent epileptic crises
might also be able to do the same for violent outbursts. But these
positive goals should only be pursued if the subject in question
has expressed full informed consent on the matter.
Even in this case, however, it might be argued that the
individual’s freedom, autonomy, and intrinsic value are only
expressed when the subject enacts positive behaviors himself,
without being constrained by an automated device. In other
words, if a person suﬀering from epilepsy may give her informed
consent to treatment, being fully aware of its pros and cons, the
issue seems a lot more complex when it comes to a violent subject.
For example, he may ﬁnd himself forced to choose between
staying in prison or accepting a neural prosthesis controlling
his violent drives; but it must be considered that violence may
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sometimes be needed to defend oneself or others from a threat, so
that having the drive controlled at a neural level might be highly
dysfunctional and damaging to the individual himself.
Other cases may involve diﬀerent levels of consensus and
collective security. For example, access to the EEG data of a
vehicle driver could allow for a built-in tool to detect a neuronal
activation pattern that would lead to decreased attention while
driving (Biondi and Skrypchuk, 2017). The purpose of avoiding
serious accidents could be considered superior to the driver’s
right not to undergo the constant monitoring of his brain states.
Following the same line of thought, protecting the population
from terror attacks could result in introducing compulsory
“neural” control in order to ﬁnd potential terrorists. In this case,
the right to mental integrity would be violated for a number of
people, most of whom would be unrelated to any malicious plans.
Generally speaking, it might be argued that the best solution
would be to let judges decide on a case by case basis whether to
authorize the violation of the right to integrity.
Finally, one may wonder how the need to protect the
fundamental right to mental integrity may coexist with the need
to violate the following technical principle. Well, in this case, the
increasingly sophisticated neurotechnological techniques might
help. In fact, producing all neural prostheses from the start
according to the technical principle for the protection of mental
integrity would make it more complicated to use them in
violation of this fundamental right, even if for a goal that is
considered socially positive. For example, if the secret codes
to control neural prostheses were available to an independent
authority, this would make potential breaches more rare. Also,
the process of authorization of “improper” but “necessary” use
of such prostheses—in cases related to collective security—would
be more diﬃcult and rigorous. One can also support a more rigid
position, so as to further limit the possibility of mental integrity
violations. For example, one can argue that, once implanted,
these devices should belong to, and only be “controlled” by,
the subject, even in case of maintenance and reprogramming.
However, the subject will always need physicians and experts
to implant the prosthesis, make it work and introduce potential
changes. The problem therefore does not seem to have an easy
THE CASE OF CLOSED-LOOP DBS
A new type of deep brain stimulation (DBS) may be a good
illustration of the issues addressed so far as well as of other ethical
quandaries associated with them. DBS, consisting of an external
neurostimulator that sends electrical impulses to brain nuclei
(according to the pathology to be treated) through electrodes
implanted permanently, is used to reduce the symptoms of
Parkinson’s disease, dystonia, chronic pain, major depression,
and obsessive–compulsive disorder. The results, especially for
the treatment of neuropsychiatric conditions, such as Tourette’s
syndrome, are mixed (Greenberg et al., 2010; Dougherty et al.,
2015). The ﬁrst generation of BDS is called “open loop,” as the
devices provide a given level of brain stimulation, which can be
modiﬁed over time to try to improve the therapeutic eﬀect, but
feedback is linked to the patient’s subjective assessment. Also,
in the presence of side eﬀects, the stimulator can be turned oﬀ,
thereby making the DBS a reversible stimulation technique.
The new generation of DBS devices is instead called “closed-
loop,” as electrodes can stimulate the areas in which they are
placed and record their electrical activity. The idea is that
sensors can detect brain activity patterns that are related to the
symptoms to be cured, using these data at a neural level to adjust
the stimulation accordingly. This makes feedback much faster:
indeed, it should hopefully be simultaneous to, if not preventive
of, the emergence or deterioration of the neuropsychiatric
symptoms to be treated. In addition, the patient and physicians
allegedly don’t have to do anything, as happens with diabetic
patients who use automated insulin pumps (Wheeler et al., 2015).
The new tools are inspired by brain-computer interfacing,
where algorithms are used to decode brain activity and identify
impaired patients’ intentions to control prostheses or other
devices (Widge et al., 2014). Once the electrical activity is
registered, the aim is to classify it as either a “healthy” or a
“symptomatic” state, and to modify the location and intensity of
the stimulation accordingly. The ﬁrst results were achieved with
epilepsy and tremor control (Malekmohammadi et al., 2016).
These devices or prostheses raise new ethical questions
(Kellmeyer et al., 2016; Goering et al., 2017) and several orders
of issues. The ﬁrst order of questions concerns the personal
condition of the implanted subject, with respect to her identity,
agency, and autonomy. The second, closely linked to the former,
concerns the protection of mental integrity and freedom of
thought. The third concerns the liability for violations and
malfunctions that may have consequences on the subject and on
Let’s start with the ﬁrst issues: namely, the identity, agency,
and autonomy of the implanted subject. First-generation DBS
already triggered a wide debate on the possible modiﬁcation
of the subject’s identity. For example, Schechtman (2009)
has made interesting remarks on the deep brain stimulation
used for Parkinson’s. Neurosurgery can cause changes in the
patient’s character and inclinations. Schechtman believes that
DBS can threaten personal identity because it can change—
partly or fully—the subject’s personality traits, aims, and interests.
According to her, if, after undergoing DBS, a patient shows a very
diﬀerent behavior, it can be said that he is, in a way, “a diﬀerent
person”. What matters is how the patient has changed: not as a
result of what he has seen, learned or thought about, but through
the direct eﬀect of a passively undergone deep brain stimulation.
Schechtman sets two constraints to be respected in the light of
narrative identity. The ﬁrst is the “reality constraint,” according
to which the narrative of the self-making up a person’s identity
should be consistent with external reality. The second is the
“articulation constraint,” according to which the self-narrative
should be constructed by the subject in a way that justiﬁes
his choices and behaviors. Schechtman (2009) claims that “the
mechanism of personality change is important to its eﬀect on
forensic personhood and identity.” In fact, if a patient treated
with DBS were to show a personality change, one would “have
to acknowledge that his current passions and interests—the
things he takes as reasons—were caused by the manipulation
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Lavazza Freedom of Thought, Mental Integrity
of his brain.” As a consequence, this change would have to be
considered “disruptive to his forensic personhood and identity in
a way that natural personal development would not have been”
However, it has been claimed (Müller et al., 2017) that
Schechtman’s objection is a case of naturalistic fallacy, entailing
confusion between the property of being natural and that of
being good. Indeed, before being subjected to the BDS implant
a person may judge that improving his pathological condition
is worth the trade oﬀ with some of his personality aspects.
Subsequently, however, the person may not be able to assess
their condition, although they may be helped by relatives and
friends to understand and evaluate changes in their identity
(impulsivity, hypersexuality, gambling; cf Glannon, 2009). The
matter seems particularly complicated, and closed-loop DBS
may raise further questions in this regard. Indeed, there is a
degree of automaticity in the stimulation adjustments (resulting
in a possible accentuation of the change of personal identity)
which makes the implant even more diﬃcult to endorse by the
However, precisely because personal identity is something that
is diﬃcult to deﬁne with precision and is subject to continual
adjustments, also due to external situations outside of the
subject’s control, many scholars believe that the threats to the
agency and the autonomy of the subject are more worrying than
the ones to personal identity. For example, Baylis (2013) believes
that DBS is problematic “insofar as it is a threat to agency—
the ability to make informed and rational choices—as when a
person’s actions do not ﬂow from her intentions or beliefs but
rather are the result of direct brain manipulation.” In this sense,
closed-loop BDS can be a special threat to the subject’s agency
and autonomy, “generally understood to refer to the capacity to
be one’s own person, to live one’s life according to reasons and
motives that are taken as one’s own and not as the product of
manipulative or distorting external forces” (Christman, 2015, p.
1). Consider an extension of a real case reported by Klein et al.
(2016). A person treated for depression with closed loop DBS
could go to the funeral of a dear friend and realize that she is
not really sad for the loss and, indeed, that she has said and
done something socially and interpersonally inappropriate. Since
the device “reads” the aggravation of depression, it intervenes to
counteract it, in this case “against the will” of the subject, who
appears to other people as detached or insensitive, or in any case
not in tune with the circumstance.
As for violations of mental integrity and freedom of thought,
the closed loop BDS’s ability to record brain activity and
act in real time consequently leaves room for unauthorized
and malicious actions that can strongly aﬀect the subject’s
identity, agency, and autonomy. For this new generation of
DBS, it seems even more advisable to apply the functional
technical principle that aims to (a) incorporate systems that
can ﬁnd and signal the unauthorized detection, alteration
and diﬀusion of brain data and brain functioning; (b) and
provide means, within the same device or connected to
it, able to stop any unauthorized detection, alteration, and
diﬀusion of brain data. Speciﬁcally, implanted subjects would
ﬁnd it diﬃcult to realize that their device had been hacked,
as it would respond to changes in neuronal activity that
are only instrumentally detectable. In this way, behavioral
changes that were driven by malicious subjects able to take
control of the device could not be easily discovered, neither
by the implanted subject nor by the people around him. In
fact, brain-hacking-induced behavioral eﬀects would hardly be
distinguished from those induced by stimulation as a side eﬀect
of the cure.
This leads to the issue of liability for potential malfunctions
or misuse of devices. It is known that drug companies have
been prosecuted by family members of Parkinson’s patients who,
under the inﬂuence of dopamine agonists, have squandered
their wealth with gambling. If closed-loop DBS caused malicious
or dysfunctional behaviors that were not foreseen or reported
as potential side eﬀects, the manufacturer could be considered
responsible, in part or in full. However, it presently seems diﬃcult
to evaluate how a subject may react to stimulation, considering
the extreme variability reported in literature (Morishita et al.,
2014). Additionally, responsibility could extend to physicians
who prescribed and implanted the device, as they were
also supposed to evaluate its appropriateness and potential
All this supports the idea that regulatory bodies, speciﬁcally
those who are called upon to endorse the trade of clinical
devices, should implement strict rules for both the subject’s
safety and the protection of his mental integrity and freedom of
thought. However, the extreme importance of the issues covered
in this paper could also suggest the idea of special agencies
(including supranational ones) with the task of supervising the
development and marketing of neural prostheses. This should
not be understood as a limitation to research and to the eﬀorts to
apply new knowledge for the treatment of an increasing number
of pathologies. Rather, it should be seen as a means to protect the
patients, so that their mental integrity and freedom of thought
are kept safe.
Also, one could consider the distinction between neural
prostheses used for clinical purposes and neural prostheses
used by healthy subjects for the purpose of sports or cognitive
enhancement. Devices that are less invasive than DBS are already
being tested, and closed-loop BMI systems have already been
experimented in healthy and clinical populations, especially the
real-time EEG-Based Brain Machine Interface (BMI) used for
gait rehabilitation in individuals who have problems with bipedal
locomotion (e.g., Luu et al., 2016, 2017). In addition, researchers
could construct devices able to capture a decrease in attention
thanks to neuronal activation patterns detected through EEG,
and to act immediately, without the conscious intervention of the
subject, with a stimulation via tDCS. Such tools would need the
same regulations as medical devices, but given that the subjects
in question would not have speciﬁc medical issues, perhaps
this regulation could be less strict. Still, malfunctioning and
misuse should still be prosecuted and sanctioned. Criminal law
provisions would ultimately be the main deterrent and punitive
tool for the use of neural prostheses to enhance physical and
cognitive performances and other recreational uses. However, it
should not be excluded that the spread of these not clinical uses
might be followed by a stricter protection of users.
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Lavazza Freedom of Thought, Mental Integrity
Finally, and surprisingly, a new ﬁeld in which freedom of
thought and mental privacy and integrity could be endangered
is that of neuroaesthetics and creativity. There has been growing
interest in understanding the neural basis of aesthetic perceptions
and creative abilities both of lay people and professional artists.
The risk does not come from the collection of data as such, but
from the use that could be made of it. New knowledge is the result
of studies that are conducted not only in the laboratory, but also
in “natural” environments such as museums.
For example, Kontson et al. (2015) collected aesthetic and
emotional preference data from over 400 museum visitors
using portable EEG systems. The researchers were able
“to quantify the aesthetic experience through the analysis
of brain diﬀerences that arise between participants during
è an aesthetic judgment, and through functional network
connectivity” (Kontson et al., 2015). It was thus possible to ﬁnd
quantitative diﬀerences in EEG signals across subjects; patterns
of brain activity associated with emotionally stimulating and
aesthetically pleasing pieces, and putative networks engaged
in the perception and judgments of art stimuli. Vessel et al.
(2012), combining fMRI and behavioral analysis of individual
diﬀerences in aesthetic response, identiﬁed “two distinct patterns
of neural activity exhibited by diﬀerent sub-networks. Activity
increased linearly with observers’ ratings (4-level scale) in
sensory (occipito-temporal) regions (...). In contrast, a network
of frontal regions showed a step-like increase only for the most
moving artworks (“4” ratings) and non-diﬀerential activity for all
Based on the EEG data, one might create a neural map,
showing what regions of the brain are elicited to activate by
diﬀerent features of a speciﬁc aesthetic experience. The exact
reconstruction of the cerebral maps of aesthetic perception could
allow the exploitation of this knowledge to induce aesthetic
appreciation in the visitor or in the consumer, combining
salient elements that do not “objectively” constitute a work
of art but that still arouse speciﬁc brain activations. This
would produce unwanted external control over aesthetics or
creative thought, which certainly would aﬀect people’s freedom
of thought and therefore mental integrity. Just as the diﬀusion
of certain perfumes can induce emotional states that trigger
certain behaviors to the detriment of others, so the presentation
of visual or acoustic elements that can activate speciﬁc cerebral
networks might orient people’s aesthetic judgment unbeknownst
to them. On the other hand, there will be positive eﬀects if
individuals become able to consciously increase their creativity
on the basis of the knowledge of the brain mechanisms that allow
us to appreciate and (positively or negatively) judge an artifact or
intellectual work such as a novel or a symphony.
In this paper—which has only envisioned potential problems
and solutions to be further investigated—I have tried to show
that there is a fundamental right to mental integrity that may
be threatened by the development of increasingly sophisticated
neural prostheses, able to detect and alter neural connection and
activation patterns. I have therefore argued for the introduction
of a technical principle to protect the right to mental integrity,
which would undermine any attempt to violate such fundamental
However, the right to mental integrity may not be seen
as absolute if other equally important goods or values (like
physical safety) are at high risk. In such situations, the
proposed general functional principle may still be useful in
limiting the extent of the violation of the right to integrity in
favor of other rights, goods, or values. The research on and
development of neural prostheses should therefore consider the
implications of potential violations on mental integrity, trying
to incorporate the functional technical principle to protect it.
Even if not fully implemented, this principle can still be a
reference point for the public discussion of the ethical, legal, and
social consequences of the introduction of new invasive neural
The author conﬁrms being the sole contributor of this work and
approved it for publication.
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Conﬂict of Interest Statement: The author declares that the research was
conducted in the absence of any commercial or ﬁnancial relationships that could
be construed as a potential conﬂict of interest.
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Frontiers in Neuroscience | www.frontiersin.org 10 February 2018 | Volume 12 | Article 82