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A JOB Neuroscience
ISSN: 2150-7740 (Print) 2150-7759 (Online) Journal homepage: https://www.tandfonline.com/loi/uabn20
Selected Abstracts From the 2018 International
Neuroethics Society Annual Meeting
To cite this article: (2018) Selected Abstracts From the 2018 International Neuroethics Society
Annual Meeting, AJOB Neuroscience, 9:4, W1-W21
To link to this article: https://doi.org/10.1080/21507740.2018.1553906
Published online: 25 Feb 2019.
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Abstracts
Selected Abstracts From the 2018
International Neuroethics Society
Annual Meeting
The editorial team of AJOB Neuroscience blind-reviewed all abstracts from the INS meeting for merit, based on nov-
elty, relevance, and contribution to the field of neuroethics. The scores were tallied and the top abstracts appear in
random order.
What Justifies the Prioritization of Health Care
Resources to Patients With Severe Brain Injury?
A. Peterson
1
, S. Aas
2
, and D. Wasserman
3
1. George Mason University
2. Georgetown University
3. National Insitutes of Health
Severe brain injury is a leading cause of death and
disability. Improvements in intensive care have increased
survival rates following severe brain injury, but outcome
is highly variable. Following a period of coma, some
patients make a good recovery, while others progress into
a vegetative or minimally consciousness state. Diagnosis is
difficult and errors in diagnosis occur often. Discordance
between standardized behavioral diagnosis and consensus
diagnosis could be as high as 40%, and this can negatively
impact quality of care (Seel et al. 2010). Recent
advancements in neuroimaging might provide a solution.
Neuroimaging and electrophysiological measures can
detect preserved consciousness in some patients who
appear to be in the vegetative state (Kondziella et al.
2016). This information might improve the accuracy of
diagnosis and distinguish positive from poor outcomes.
Despite this potential benefit, neuroimaging and
electrophysiological measures are resource intensive, and
it might be unclear what justifies the prioritization of
resources for patients with severe brain injury over
competing uses of these resources. In this presentation, we
outline an argument for the prioritization of health care
resources to detect preserved consciousness in patients
with severe brain injury. We argue that the prioritization
of health care resources likely turns on the moral status of
patients, and that moral status is associated with
consciousness. This, however, creates a puzzle, as the
consciousness of patients with severe brain injury might
be indeterminate prior to assessing them with expensive
neuroimaging or electrophysiological measures. To
address this issue, we argue that prioritization can be
evaluated by identifying the prospective benefit of health
care resources. We define prospective benefit as a
probabilistic function of (inter alia) the likelihood that
treatment-warranting consciousness is preserved in a
patient. We consider whether a cost-effectiveness
calculation, the QALY framework, can be adapted for this
purpose (Sassi 2006). We identify three potential caveats
to cost-effectiveness calculations in this probabilistic
context. First, if the QALY framework is used, then the
utility valueor quality of lifeof possible health states
before and after neuroimaging or electrophysiological
assessment must be determined. Quality-of-life metrics,
however, are difficult to apply in this population and are
predominately informed by surveys of health
professionals or the general population, of whom fewif
anywill have experienced a severe brain injury (Graham
et al. 2015). Second, one convention of the QALY
framework is to assume that there is no worse health
outcome than death. Nevertheless, some argue that the
vegetative state is worse than death (Kahane and
Savulescu 2009). This suggests that the baseline utility
value of a QALY calculation could be a negative value, or
that we should revise the QALY scale such that death
does not equal the utility value, 0. Both options raise
technical puzzles for cost-effectiveness calculations in this
population. Finally, when considering the prospective
benefits of investment in diagnostics for severe brain
injury, it will be important to consider whether non-
health-related improvements in quality of life can be
factored into cost-effectiveness calculations. This may
challenge the QALY frameworks emphasis on health-
related changes in quality of life.
REFERENCES
Graham, M., C. Weijer, D. Cruse, et al. 2015. An ethics of
welfare for patients diagnosed as vegetative with covert
awareness. AJOB-Neuroscience 6(2): 3141. [InsertedFromOnline]
Kahane, G., and J. Savulescu. 2009. Brain damage and the moral
significance of consciousness. Journal of Medicine and Philosophy
34(1): 626.
ajob Neuroscience W1
AJOB Neuroscience, 9(4): W1W21, 2018
#2018 Taylor and Francis Group, LLC
ISSN: 2150-7740 print / 2150-7759 online
DOI: 10.1080/21507740.2018.1553906
Kondziella, D., C. K. Friberg, V. G. Frokjaer, M. Fabricius, and
K. Møller. 2016. Preserved consciousness in vegetative and
minimal conscious states: Systematic review and meta-analysis.
Journal of Neurology, Neurosurgery & Psychiatry 87(5): 485492.
doi:10.1136/jnnp-2015-310958
Sassi, F. 2006. Calculating QALYs, comparing QALY and DALY
calculations. Health Policy and Planning 21(5): 402408.
Seel, R. T., Sherer, M., J. Whyte, et al. 2010. Assessment scales
for disorders of consciousness: Evidence-based recommendations
for clinical practice and research. Archives of Physical Medicine and
Rehabilitation 91(12): 17951813. doi:10.1016/j.apmr.2010.07.218
BrainComputer Interfaces and Brain Death: How
Neural Implants Provide Problems and Solutions for
Modern Medicines Legal Fiction
Z. Suskin
1
, and R. Evans
2
1. Harvard Medical School Center for Bioethics,
Georgetown University School of Medicine, and
Pellegrino Center for Clinial Bioethics
2. Harvard Medical School Center for Bioethics, and
Barts and The London School of Medicine
and Dentistry
In the 50 years since the Harvard brain death criteria
were established, the Congressionally termed Decade of
the Brain(1990s) and Decade of Pain Research(2000s)
augmented immense progress in brain research and
neurotechnology. In particular, braincomputer interfaces
(BCIs) have furthered our ability to image/measure and
manipulate/stimulate the brain with devices, particularly
deep brain stimulation (DBS), currently implanted in over
100,000 patients (Medtronic 2015) and continuously being
developed for novel purposes. However, as BCIs continue
to become more prevalent and advanced, they may have
significant technical and ethical implications for the
definition, determination, and continued use of brain
death clinically and legally. We examine the issues that
may arise when a patient with an implanted BCI is (or
would otherwise be) classified as brain-dead, how these
illustrate wider issues with defining and determining
brain death, and ways in which implantable BCIs may
resolve these issues and further augment understanding
of brain death. Brain death is defined as the irreversible
loss of all functions of the brain (Uniform Determination
of Death Act 1980). BCIs may complicate the diagnosis of
brain death in several ways. First, already-implanted
neural implants may migrate or continue to fire/function,
interfering with clinical determination and possibly
precluding confirmatory neuroimaging. Second, BCIs may
confound identification of a clear etiology of brain death, a
necessary factor for clinical determination. Third, recent
advances in BCIs complicate issues of consciousness and
brain death. Finally, recent neuroscience research
regarding the neurobiological processes of brain death
coupled (Dreier et al. 2018) with the therapeutic
possibilities of some BCIs may complicate existing notions
of the irreversibility of brain death (Bioquark 2018; Joffe
et al. 2009). By the same token, the aforementioned
research and BCI capabilities suggest potential for
implanting devices in order to suspend the brain death
process, as well as to use DBS to jump-startthe brain
even after deathhas been determined. In addition, BCIs
may help resolve several other issues surrounding brain
death. For example, it may be possible to use strategically
placed BCIs to identify micro-level brain functioning,
appraise function of undetermined significance, and
assess brain function directly from the source (rather than
afferent pathways that may be interrupted and obfuscate
necessary clinical examinations). Should BCIs be used for
such purposes, they may develop as a more accurate
method than existing, notoriously poor clinical methods
for diagnosing brain death. Similarly, BCIs may advance
neurobiological research by examining neurobiomarkers
and other relevant findings in real time, rather than
commencing research once the brain death process has
commenced. The issues stemming from and solutions
provided by BCIs in brain death raise important ethical
considerations. Most notably, we must ask questions
related to (1) the value of brain death as a legal fiction
given such issues and increased potential for harm; (2)
anticipated consent issues for explantation and
implantation of BCIs; and (3) whether further BCI
advances and their uses as described may impede other
clinical endeavors (e.g., organ donation) reliant on existing
notions of brain death. We discuss these implications and
their tentative solutions.
REFERENCES
Bioquark. 2018. Bioquark. Accessed June 21, 2018. http://www.
bioquark.com/
Dreier, J. P., S. Major, B. Foreman, et al. 2018. Terminal
spreading depolarization and electrical silence in death of
human cerebral cortex. Annals of Neurology 83(2): 295310. doi:
10.1002/ana.25147.
Joffe, A. R., K. Hanna, D. Jonathan, and R. dCaen Allan. 2009. A
10-month-old infant with reversible findings of brain death.
Pediatric Neurology 41 (5):378382. doi:10.1016/j.pediatrneurol.
2009.05.007.
Medtronic 2015. Medtronic DBS: Taking Healthcare Further,
Together. Accessed June 21, 2018. https://www.movementdisorders.
org/MDS-Files1/About/PDFs/EarlyStimulus6.pdf
Unif. Determination of Death Act 1980. §1 12A U.L.A. 781
(2008)
Sentencing Intoxicated Offenders: Does Alcoholism
Excuse Drunkenness? Anonymous Stipend Award
N. Sinclair-House
1
, J. J. Child
2
, and H. S. Crombag
3
1. University of Sussex
2. University of Birmingham and University of Sussex
3. University of Sussex
Criminal responsibility is founded on the volitional
control of action, yet many offenses are committed while
intoxicated. Alcohol is a widely used intoxicant known to
impair behavioral control and memory, opening the door
AJOB Neuroscience
W2 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
to claims of partial or absent responsibility. Criminal law
rules have developed to resist such claims. In particular,
findings of criminal responsibility in intoxicated offenders
frequently call on prior faultlogic: The intoxicated
offender may claim to have been irrational, but culpability
can be imported from their earlier, rational choice to
consume intoxicants (Robinson 1985). That drunkenness
does not excuse derives from an unforced choice to
become drunk. Yet this raises questions over the extent to
which an alcoholics choice to drink is unforced. Current
neurobiological models of addiction stress compulsion as
a primary component, bringing into question the
volitional nature of continued consumption (Dalley et al.
2011; Volkow and Fowler 2000). At the same time, some
legal scholars have noted that the potentially fatal nature
of alcoholic withdrawal could likewise undermine
suggestion that consumption is voluntary, drawing
analogy to a defense of duress where actions have been
forced under the threat of death (Husak 1999; Yaffe 2013).
We asked 290 UK magistrates to consider a criminal
sentencing scenario in which evidence of a defendants
state of intoxication at the time of the offense was
presented in tandem with information that they were
either teetotal, a casual drinker, or an alcoholic. We found
that intoxication reduced blameworthiness for criminal
acts if the offender had no previous experience with
alcohol, while, in direct contrast, intoxication served to
aggravate offending if the defendant was an alcoholic. The
likelihood of our defendant receiving a reduced sentence
was more than 10 times greater in the event that, though
intoxicated, they were not also an alcoholic. Leniency was
blocked by alcoholism despite magistratesqualitative
responses suggesting understanding it as a generally
mitigating factor, revealing a disconnect between
expressed opinion and sentencing behavior in practice.
Our results indicate that, far from excusing drunkenness,
the state of being an alcoholic is more frequently deemed
to aggravate offending, being associated with harsher
sentencing even where the offense in question was
committed while sober.
REFERENCES
Dalley, J. W., B. J. Everitt, and T. W. Robbins. 2011. Impulsivity,
compulsivity, and top-down cognitive control. Neuron 69(4):
680694.
Husak, D. 1999. Addiction and criminal liability. Law and
Philosophy 18: 655684. doi:10.2307/3505096
Robinson, P. H. 1985. Causing the conditions of ones own
defense: A study in the limits of theory in criminal law
doctrine. Virginia Law Review 71(1): 163. doi:10.2307/1072934
Volkow, N. D., and J. S. Fowler. 2000. Addiction, a disease of
compulsion and drive: Involvement of the orbitofrontal cortex.
Cerebral Cortex (New York, N.Y. : 1991) 10(3): 318325.
Yaffe, G. 2013. Are addicts akratic?: Interpreting the
neuroscience of reward. In Addiction and self-control: Perspectives
from philosophy, psychology, and neuroscience, ed. N. Levy,
190213. New York: Oxford University Press.
Big Data and the Brain: Assessing the Impact of Large-
Scale Data Analysis in Clinical Neuroscience
Marcello Ienca, Swiss Federal Institute of Technology
(ETH Zurich)
Advances in ubiquitous computing, medical informatics,
and data science are enabling the large-scale collection,
sharing, aggregation, and analysis of unprecedented
volumes and varieties of data, a phenomenon commonly
known as big data (Ienca et al. 2018). The application of big
data approaches to clinical neuroscience, in parallel with the
development of artificial intelligence (AI) techniques for
multimodal and multiscalar data analysis, can create new
promising opportunities for brain and mental health. These
include unlocking the pathological conundrum of poorly
understood brain disorders (e.g., Alzheimersdisease)and
enabling more precise diagnostic and therapeutic solutions
for patients. Big data approaches to the mind and brain
sciences rely on the acquisition of data from
heterogeneous sources (including genetic, neuroimaging,
and mobile health data, as well as data from consumer-
grade neurodevices) at various scales (from the molecular
to the individual and population scale). While these big
brain data (Kellmeyer 2018; Landhuis 2017) trends hold
diagnostic and therapeutic promise, their deployment is
still hindered by technical, methodological, and regulatory
challenges (Fr
egnac 2017). Furthermore, they raise ethical
controversy (Ienca et al. 2018; Monteith and Glenn 2016)
In this contribution, we use scoping methodology to
review the existing scientific literature on big data and AI
approaches to brain and mental health. Our content
analysis suggests that large-scale data analysis hold
promise for improving current preventive and predictive
models in clinical neuroscience, revealing insights on
disease etiology, enabling earlier diagnosis, optimizing
resource allocation, and delivering more tailored
treatments to patients with specific disease trajectories. At
the same time, our results show that ethical and
methodological challenges arise primarily in relation to
five thematic families: (I) data privacy and security, (II)
data ownership and control, (III) risk of algorithmic bias
and discrimination, (IV) ethical guidelines for big data
research, and (V) cognitive enhancement. This
contribution provides an overview and normative
assessment of the challenges just described and charts the
route ahead for neuroscience, neuroethics, and policy.
REFERENCES
Fr
egnac, Y. 2017. Big data and the industrialization of
neuroscience: A safe roadmap for understanding the brain?
Science 358(6362): 470477. doi:10.1126/science.aan8866
Ienca, M., E. Vayena, and A. Blasimme. 2018. Big data and
dementia: Charting the route ahead for research, Ethics, and
policy. Frontiers in Medicine 5: 13. doi:10.3389/fmed.2018.00013.
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W3
Kellmeyer, P. 2018. Big brain data: On the responsible use of brain
data from clinical and consumer-directed neurotechnological
devices. Neuroethics.116.
Landhuis, E. 2017. Neuroscience: Big brain, big data. Nature
541(7638): 559561. doi:10.1038/541559a.
Monteith, S., and T. Glenn. 2016. Automated decision-making
and big data: Concerns for people with mental illness. Curr
Psychiatry Rep 18(12): 112.
Ethical Deliberation and Autism Research Ethics
M. A. Cascio
1
, J. Weiss
2
, and E. Racine
3
1. Institut de recherches cliniques de Montr
eal and
McGill University
2. York University
3. Institut de recherches cliniques de Montr
eal, McGill
University, and Universit
e de Montr
eal
Autism spectrum conditions represent a growing area
of research in both the clinical and social sciences.
Attention to research ethics is necessary to ensure that
participants on the spectrum are included in research
safely and meaningfully. This project aims to develop best
practices that researchers can use when designing such
studies, following a pragmatic ethics approach involving
ethical deliberation with people affected by autism
personally and professionally. Pragmatic ethics aims to
understand ethical issues by focusing on ethical agents in
broader sociocultural context and centering the
experiences of people directly affected by these ethical
issues. An integrative pragmatist approach (Racine 2016)
seeks informed responses to ethical situations based on
reflection and experience. A key component of this
approach is ethical deliberation, or reflective discussion on
an issue, which involves many actors who participate in a
creative effort to generate action scenarios with a focus on
the analysis of key ethical principles. In this project, the
actors are researchers, professionals, autism advocates,
autistic people, and parents of people with autism; the key
ethical principles are the five guideposts of person-
oriented research ethics. Person-oriented research ethics is
a model we developed to capture experiential and
relational aspects of research ethics, moving beyond a
regulatory framework. The model is characterized by five
guideposts: (1) respect for holistic personhood; (2)
acknowledgment of lived world; (3) individualization; (4)
focus on researcherparticipant relationships; and (5)
empowerment in decision-making (Cascio and Racine
2018). Through a process of deliberation, we aim to
collaboratively coauthor a report on best practices for
autism research ethics. Researchers can use this report
when designing and executing studies involving
participants on the autism spectrum. Developing these
best practices is based on three sources of experience. The
first is a critical-interpretive literature review (McDougall
2015) on autism research ethics issues, including
approximately 400 articles with both explicit and
hidden(Dubois et al. 2008) ethics data. The second is a
process of community engagement, where members of the
general public and concerned groups are able to provide
feedback on the project through our website at
autismresearchethics.net. The third is the process of Task
Force deliberation, in which various stakeholders both
discuss the other sources of experience and creatively
reflect on autism research ethics issues. The Task Force
met for a workshop in December 2017. Strategies to
increase accessibility included sending information in
advance; providing read-along copies for presentations;
discussing guidelines for engagement and conversation;
allowing multiple ways to engage; and providing a quiet
room during the workshop. After the event, we worked
collaboratively in a flexible format including both e-mail
and a Web-based office suite and both open-ended and
closed-ended modes of participation. Deliberating in this
way allows us to identify what aspects of research ethics
are salient for researchers and potential research
participants. It recognizes the role of people affected by
neurodevelopmental conditions such as autism not only
as potential research participants, but also as stakeholders
with important contributions to the development of
research ethics and ethics theory.
REFERENCES
Cascio, M. A., and E. Racine. 2018. Person-Oriented research
ethics: Integrating relational and everyday ethics in research.
Accountability in Research 25(3): 170197.
Dubois, J. M., R. L. Volpe, and E. K. Rangel. 2008. Hidden
empirical research ethics: A review of three health journals from
2005 through 2006. Journal of Empirical Research on Human
Research Ethics 3(3): 718. doi:10.1525/jer.2008.3.3.7.
McDougall, R. 2015. Reviewing literature in bioethics research:
Increasing rigour in non-systematic reviews. Bioethics 29(7):
523528.
Racine, E. 2016. Can moral problems of everyday clinical
practice ever be resolved? A proposal for integrative pragmatist
approaches. In Ethics in child health: Principles and cases in
neurodisability, ed. Peter L. Rosenbaum, Gabriel M. Ronen,
Bernard Dan, Jennifer Johannesen and Eric Racine, 3348.
London: Mac Keith Press.
Analysis of Moral Judgments in Frontal-Lobe Pathology
Utilizing the ADC Model
M. Ferguson
1
, and V. Dubljevic
2
1. North Carolina State University
2. North Carolina State University
The findings of neuroethics have led to new
understandings of how we think through moral
quandaries. Models that have been constructed to
understand moral judgment have typically focused on
normal populations and how they process judgments.
Patients with frontal-lobe pathology, such as fronto-
temporal dementia (FTD), frontal-lobe damage, and
psychopathy, have been shown to have profound deficits
with sociomoral judgment and decision making even
though they retain cognitive function (Koenigs et al. 2012;
AJOB Neuroscience
W4 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
Mendez 2009). The question is then about where their
moral judgement goes awry. The explanation of this
behavior, in regard to the models, has been inconclusive,
so new models that work for both populations, normal
and with frontal-lobe pathology, are needed. One such
model that has been finding success recently is the
agentdeedconsequence (ADC) model (Dubljevi
c and
Racine 2014), which has found empirical backing and can
predict key component parts of moral judgment (Bialek
et al. 2014; Dubljevi
c et al. 2018). This model postulates
three factors for steering ones moral judgment: the
intuitive evaluation of the agent (A), the deed (D), and the
consequence (C). The agent factor revolves around the
character of the person performing the action. The deed
relates to the action the agent is performing, and the
consequence is the direct result of the action being
performed. The central idea of this model is that each of
these processes is a subconscious heuristic and they are
integrated to create a judgment of moral acceptability or
unacceptability (Dubljevi
c and Racine 2014; Dubljevi
c
et al. 2018). Utilizing this model, we plan to survey 20
patients with fronto-temporal dementia and 20 patients
with frontal-lobe damage by utilizing low- and high-stake
vignettes designed specifically to test the model and
administering the Preferences for Precepts Implied in
Moral Theories (PPIMT) (Dubljevi
cetal.2018) scale for
testing conscious preference for virtue ethics and
deontological and consequentialist judgment, while the
control group will consist of 500 people recruited via
Amazon Mechanical Turk. This group will rate vignettes,
the PPIMT, and an established measure of psychopathy
(PPI-R) to distinguish between healthy controls and an
additional sample of people with psychopathic tendencies.
This experiment will test the hypothesis that those with
psychopathic tendencies lack deontological intuitions as
shown by the analysis of influence in moral acceptability
ratings by the D factor, the hypothesis that frontal-lobe
damage patients lack the integration function to consider
A, D, and C components with multi-attribute decision-
making capacities, and the hypothesis that deontological
intuitions are selectively diminished in low-intensity
moral dilemmas in frontotemporal dementia patients. This
project will determine the clinical viability of the ADC
model, which if viable will give a route to examining
moral judgements in clinical settings. It will elucidate the
specific sociomoral deficits of individuals with frontal-lobe
pathology, which can potentially have an impact in legal
proceedings.
REFERENCES
Bialek, M., S. Terbeck, and S. Handley. 2014. Cognitive
psychological support for the ADC model of moral judgment.
AJOB Neuroscience 5(4): 2123. doi:10.1080/21507740.2014.951790
Dubljevi
c, V., and E. Racine. 2014. The ADC of moral judgment:
Opening the black box of moral intuitions with heuristics about
agents, deeds and consequences. AJOBNeuroscience 5(4): 320.
doi:10.1080/21507740.2014.939381
Dubljevi
c, V., S. Sattler, and E. Racine. 2018. Deciphering moral
intuition: How agents, deeds and consequences influence moral
judgment. PLOS One 13(10): e0204631.
Koenigs, M., M. Kruepke, J. Zeier, and J. Newman. 2012.
Utilitarian moral judgment in psychopathy. Social Cognitive and
Affective Neuroscience 7(6): 708714. doi:10.1093/scan/nsr048
Mendez, M. F. 2009. The neurobiology of moral behavior:
Review and neuropsychiatric implications. CNS Spectrums
14(11): 608620. doi:10.1017/S1092852900023853
InvestigatorsPerspectives on Recruitment and Consent
Procedures for Human Intracranial
Electrophysiology Studies
Joncarmen Mergenthaler
1
, Winston Chiong
2
, Daniel
Dohan
3
, Philip Starr
4
, Josh Feler
5
, Cailin Lechner
6
, and
Jalayne Arias
7
1. University of California San Francisco
2. University of California San Francisco
3. University of California San Francisco
4. University of California San Francisco
5. Yale School of Medicine
6. University of California San Francisco
7. University of California San Francisco
Purpose: Invasive intracranial techniques, such as
electrophysiological recordings and electrical stimulation
of cerebral cortex and deep structures, are essential for
progress in human cognitive neuroscience and hold
promise for advancing treatment in neuropsychiatric
illness. Such invasive studies in humans can only be
carried out in a neurosurgical context, and as such are
performed in patients who already have an indication for
neurosurgical treatment (e.g., epilepsy, brain tumor, or
Parkinsons disease). This setting poses ethical concerns,
including conflict of interest and therapeutic
misconception. Yet there are few guidelines and little
consensus on how recruitment and consent should be
conducted. This study will examine existing recruitment
and consent practices for electrophysiology studies and
aims to provide guidance to researchers and regulators.
Methodology: Investigators identified National Institutes
of Health (NIH)-funded invasive electrophysiology
studies through NIH RePORT using standardized search
terms. We included active NIH-funded studies that
require entry to the human skull for the purposes of
recording or stimulation (51 studies that met criteria). We
sent e-mails to the principal investigator of record for each
study and invited each to participate; we also asked them
to identify study team members familiar with the consent
process. Additionally, we recruited through in-person
communication during relevant conferences (ASSFN June
2018; Atlanta DBS Think-tank May 2018). We conducted
semistructured interviews to collect investigators
perspectives on study recruitment and consent
procedures. Results: We conducted interviews with 26
intracranial electrophysiology investigators (8 female/18
male, 15 PIs/11 other investigator). Preliminary results
include: Design of recruitment and consent: Interviewees
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W5
reported that the design of recruitment and consent
procedures was shaped by three factors: practical and
logistic factors, need for expert advice regarding the
surgical or research procedures, and avoiding possible
coercion. Despite similar study methods, we found
heterogeneity in recruitment and consent procedures.
Consent procedures: Interviewees reported that the
neurosurgeon who performs the investigational surgical
procedure is present for the informed consent process, but
formal consent is requested by a study coordinator or
other investigator. However, other participants reported
dissimilar consent procedures and varied rationales for
their approaches, including institutional review board
(IRB) requirements for technical expertise and mitigating
conflict of interest. Consent for continuing participation:
Among interviewees conducting nontreatment studies,
four reported formalized time points after the initial
consent to verbally seek an agreement to proceed with the
procedure (i.e., prior to and between intraoperative tasks),
while the remaining three reported no formalized
procedure for continuing consent. Some interviewees
reported a belief that research subjects understand
continued participation to be voluntary. Study subject
vulnerability and study risks: Interviewees identified
concerns that enrolling intracranial electrophysiology
research subjects is complex due to presurgery stress that
may cause a feeling of obligation. Several interviewees
expressed a need for an examination of recruitment and
consent procedures in invasive neurophysiology studies
to address ethical concerns and inconsistencies of
regulatory requirements. Outcomes: This study identifies
patterns in recruitment and consent procedures in
invasive intracranial research. This study aims to promote
research practices that emphasize human subject
protections, while recognizing the importance of
intracranial electrophysiological research for reducing the
future burden of neuropsychiatric illness.
Psychiatric and Degenerative Cognition: Normative
Referents for Neurotechnology Intervention?
Denis Larrivee
1
, and Elizabeth Mezzacappa
2
1. Loyola University Chicago and University
of Navarra
2. Catholic University America
Cochlear implants, pacemakers, and vagal stimulators
comprise just several of a broad group of neural devices
now used therapeutically for restoring nerve function in
peripheral and sensory nerve tissue (Cong 2016). Building
on these successes, a new generation of neural implants is
proposed for use in the brain, including, among those
likely to be deployed, braincomputer interfaces, magnetic
nanoparticles, and sono- and optogenetic technologies
(Rivnay et al. 2017). Implanting such technologies in the
brain, however, could pose significant ethical challenges
due to their potential to modify uniquely human
attributes that are underpinned by neural operation.
Closed-loop devices that modify neurotransmitter levels
without conscious awareness, for instance, could result in
the infringement of autonomous behavior. Assessing the
effects of implants currently entails perceptual criteria,
like the sense of self-identity, that are both arbitrary and
subjective. Hence, there is a current and significant need
for objective estimates of cognitive function when such
devices are introduced, analogous to those of
neuroimaging technologies now used to assist with
conciousness diagnosis (Giacino et al. 2014). Determining
the neural correlates modified by intervention, if possible,
would afford a pragmatic way to ground normative
frameworks in a physical standard useful for discerning
whether intervention is ethically licit. Although the brains
great complexity has limited the identification of such
correlates to date, it is increasingly apparent that the
neural substrate for faculties such as personal identity are
derived from organismal properties, that is, properties
that are good for the whole individual, and that are
physically instantiated by global brain activity. In the case
of autonomy, for example, it has been shown that
cognitive tasks that impose greater workloads on
executive circuits are parceled over larger modular
domains, revealing a top-down effect that synchronizes
neural activity for executing goal directed behavior
(Vatansever et al. 2015). Significantly, findings from
degenerative cognitive diseases like Alzheimers dementia
and psychiatric diseases like schizophrenia appear to
modify such global dynamical states (Alexander-Bloch
et al. 2012). These findings suggest that neural correlates
impaired in these diseases could function as objective
biomarkers for human faculties that are altered by the
disease state; hence they can be expected to serve as an
upper bound on the extent to which a neurotechnological
intervention may be regarded as normatively licit. This
poster discusses current evidence of global brain states,
their relation to human faculties impaired in cognitive
diseases, and how their assessment might be incorporated
into an ethical framework for guiding neurotechnology
intervention.
REFERENCES
Alexander-Bloch, A., R. Lambiotte, B. Roberts, J. Giedd, N.
Gogtay, and E. Bullmore. 2012. The discovery of population
differences in network community structure; new methods and
applications to brain functional networks in schizophrenia.
NeuroImage 59(4): 38893900.
Cong, P. 2016. Neural interfaces for implantable medical
devices: Circuit design considerations for sensing stimulation,
and safety. IEEE Solid States Circuits Magazine Fall 8: 4856.
Giacino, J. T., J. J. Fins, S. Laureys, and N. D. Schiff. 2014.
Disorders of consciousness after acquired brain injury: The state
of the science. Nature Reviews Neurology 10(2): 99114. doi:
10.1038/nrneurol.2013.279
Rivnay, J., H. Wang, L. Fenno, K. Deisseroth, and G. G.
Malliaras. 2017. Next-generation probes, particles, and proteins
for neural interfacing. Science Advances 3(6): e1601649e1601669.
AJOB Neuroscience
W6 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
Vatansever, D., D. K. Menon, A. E. Manktelow, B. J. Sahakian,
and E. A. Stamatakis. 2015. Default mode network connectivity
during task execution. NeuroImage 122: 96104.
Is It Me or the Machine? BrainComputer Interfaces,
Control, and Vulnerabilities
F. Gilbert, University of Tasmania and University
of Washington
Many experimental trials are currently testing in
paralyzed and amputee patients novel medical
braincomputer interfaces (BCIs) operated by artificial
intelligence (AI) (Bouton et al. 2016; Flesher et al. 2016;
Marasco et al. 2018). While these new generations of
implantable AI-controlled BCIs move rapidly ahead,
ethical concerns about their potential effects on patients
sense of agency and control is growing. AI-operated
implants offer great control at the level of neural circuits,
but the extent to which this grasp on neuronal function
affects the patients sense of control and agency at the
psychological level is still uncharted territory (Gilbert
et al. 2017). What happens to a persons sense of control
when the person voluntarily initiates an action, but a
computer then steps in to complete the action? What
about if an intelligent BCI bypasses an agent intention?
Who should be held responsible for a BCIs autonomous
behaviors? A pressing ethical concern to explore is how
BCIs may introduce unprecedented vulnerabilities in
implanted individuals. We examine these phenomena and
discuss their ethical implications by using some data we
obtained from a first-in-human clinical trial involving AI-
BCIs (Bouton et al. 2016). Our presentation shows that, on
the one hand, artificially intelligent brain BCIs can
positively increase a sense of the self and control. On the
other hand, they can introduce unprecedented
vulnerabilities, for example, by inducing radical distress,
feelings of loss of control, and a rupture of
patient identity.
REFERENCES
Bouton, C. E., A. Shaikhouni, N. V. Annetta, et al. 2016.
Restoring cortical control of functional movement in a human
with quadriplegia. Nature 533(7602): 247250. doi:10.1038/
nature17435
Flesher, S. N., J. L. Collinger, S. T. Foldes, et al. 2016.
Intracortical microstimulation of human somatosensory cortex.
Science Translational Medicine 8: 361ra141361ra141. doi:10.1126/
scitranslmed.aaf8083.
Gilbert, F., M. Cook, T. OBrien, and J. Illes. 2017. Embodiment
and estrangement: Results from a first-in-Human Intelligent
BCItrial. Science and Engineering Ethics. doi:10.1007/s11948-017-
0001-5.
Marasco, P. F., J. S. Hebert, J. W. Sensinger et al. 2018. Illusory
movement perception improves motor control for prosthetic
hands. Science Translational Medicine 10: eaao6990. doi:10.1126/
scitranslmed.aao6990.
Neuroethics in Dementia Prevention: Ethical Issues
in Early Intervention for Better Lifelong Brain
HealthFindings from the ROADMAP Project
A. McKeown, University of Oxford
The growing impact of Alzheimers disease (AD) is
driving its reconfiguration as a public health prevention issue,
away from one of standard remedial clinical medicine. This
raises important ethical issues relating to the goals of
medicine, and the demographic impact of extending healthy
longevity through improvements in lifelong brain health.
Here we analyze a selection arising within ROADMAP, a
European Union consortium project aiming to improve
outcomes in AD and realize better predictive and
preventative interventions by building a research platform
applying a big data predictive analytic approach to real-
world data sets, cohort studies, clinical trials, and electronic
health records. First, in AD the aim is to develop means by
which healthy individuals can (a) make lifestyle choices
for risk reduction and (b) take biomarker/genetic tests for
risk disclosure. This poses ethical questionsfor example,
when we should intervene. We might assume it is better
to know ones risk as early as possible so preventative
action can be taken. However, this risks medicalizing
aging, tacitly redefining health as (presymptomatic)
illness. While AD is considered a disease of older age,
predictive tools will focus on younger adults. Political will
endorses early intervention, and younger people will face
difficult choices regarding risk disclosure and potentially
distressing information of variable accuracy about their
future. Second, reconfiguring AD in public health terms
shifts its management squarely toward one of prevention,
and arguably toward one of enhancement. Many public
health successes enhancefor example, vaccination, sewer
engineering, and water purification. Each has delivered
improved health norms across entire populations, to
healthy as well as ill people. Once the constraint of normal
health remediation in standard clinical medicine no longer
applies, it is not obvious what our upper goals should be
with regard to treatment or prevention. The population
goals we should aim for in combating cognitive decline
once the threshold of remediation is removed require
scrutiny. Evaluating this is important for determining the
long-term goals of better brain health. Our methodology
here is neuroethical analysis at the intersection of clinical
medicine and public health. We develop normative
conclusions to frame future neuroethics research in
dementia prevention by drawing on findings from
ROADMAP, including those from systematic literature
reviews on patient and health professional perspectives on
AD and health economic modeling of the impact of the
disease; and from stakeholder surveys carried out with
patients, carers, clinicians, health economists, ethicists, and
others. ROADMAP Phase 1 is from November 2016 to
November 2018 as a proof of concept for the research
platform and its analytic strategy. Phase 1 has yielded
numerous peer-reviewed publications on its findings with
more forthcoming, while preparations for ROADMAP
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W7
Phase 2 were being made. Research being done by
ROADMAP is important in view of the rising economic
and demographic challenge of AD, the mitigation of
which requires better predictive and preventative
interventions. The neuroethical implications of this
necessary response are significant for the general public,
patients, their caregivers, clinicians, regulators,
policymakers, the pharmaceutical industry, and others,
given the population-wide impact of dementia.
REFERENCES
Karagiannidou, M., R. Wittenberg, F. I. T. Landeiro, et al. 2018.
Systematic literature review of methodologies and data sources
of existing economic models across the full spectrum of
alzheimers disease and dementia from apparently healthy
through disease progression to end of life care: A systematic
review protocol. BMJ Open 8(6): e020638. doi:10.1136/bmjopen-
2017-020638
Landeiro, F., H. Wace, I. Ghinai, et al. 2018a. Resource
utilisation and costs in predementia and dementia: A systematic
review protocol. BMJ Open 8(1): e019060.
Landeiro, F., K. Walsh, I. Ghinai, et al. 2018b. Measuring quality of
life of people with predementia and dementia and their caregivers:
A systematic review protocol. BMJ Open 8(3): e019082.
Winblad, B., P. Amouyel, S. Andrieu, et al. 2016. Defeating
alzheimers disease and other dementias: A priority for
european science and society. The Lancet Neurology 15(5):
455532. doi:10.1016/S1474-4422(16)00062-4
World Health Organization. 2012. Dementia: A public health
priority. Geneva: World Health Organization.
Beyond the Dualistic Model of Moral Judgement. The
Idea of Respect in Kantian Philosophy as a Normative
Foundation in Neuroethics
F. Lozano, Universidad Polit
ecnica de Valencia. Ingenio
Institute (CSICUPV)
Based on Haidts seminal work (Haidt 2001),
numerous empirical neuroethics studies have established
a dichotomy between intuitionism and rationalism
responses in moral decision making (Crockett 2013;
Crockett 2016; Kahane et al. 2015; Wiech et al. 2013).
Assuming this dichotomy, some authors have attempted
to identify the neural correlates of two cognitive ways of
reaching a conclusion over good or bad in moral
dilemmas (Casebeer 2003; Funk and Gazzaniga 2009;
Greene 2009; Koenigs et al. 2008). Even though some
authors (Dubljevi
c 2017; Dubljevic and Racine 2014) call
for this dualistic model to be overcome, it is still present in
the literature and is used as a basic assumption for
empirical research on ethical decision making and ethical
leadership development (Egorov et al. 2018). This basic
conceptual mistake has led to mistaken conclusions in
empirical neuroethics research. We consider this dual
process of moral judgment that generally identifies
intuitionism with deontology and rationalism with
utilitarianism to be inaccurate and dangerous. It is
inaccurate because Kantian moral philosophy is
essentially rational (and only secondarily emotional); and
it is dangerousfrom our point of viewbecause it
denigrates the use of reason and leads to spontaneity and
Denkenlosigkeit (lack of reflection). Our aim in this paper
is twofold: First, we would like to criticize the assumption
that Kants moral philosophy is intuitive or blind to the
agents character or the consequences. Second, inspired by
Dubljevic and Racine (2014), we would like to present the
Kantian concept of respect as a key normative concept for
the ADC model of moral judgement. This normative
concept could be the philosophical foundation for
prioritizing principles and intuitions. According to Kant
(1785), respect is a feeling that emerges spontaneously
from reason and manifests itself in a willingness to
comply with practical law: The immediate determination
of will by law and awareness of the same is called
respect(Kant, 1785, p. BA17). Respect is an attitude with
a cognitive, affective, conative, and evaluative dimension
(Dillon 2014). Respect is guided but not limited by reason
and deliberation, nor is it abstract to reality. We would
like to start by clarifying and demonstrating the weakness
of the two dominant approaches to moral judgment in
neuroethics: rationalism and intuitionism. Second, we
briefly present the Kantian formula of Humanity as
justification for respect and a source of concrete duties
(Sensen 2011). Finally, we attempt to justify why the
Kantian idea of Respect Owed to Otherscould be a
normative foundation for the ADC model presented by
Dubljevic and Racine (2014).
REFERENCES
Crockett, M. J. 2016. How formal models can illuminate
mechanisms of moral judgment and decision making. Current
Directions in Psychological Science 25(2): 8590. doi:10.1177/
0963721415624012
Dubljevic, V., and E. Racine. 2014. The ADC of moral judgment:
Opening the black box of moral intuitions with heuristics about
agents, Deeds, and consequences. AJOB Neuroscience 5(4): 320.
doi:10.1080/21507740.2014.939381
Haidt, J. 2001. The emotional dog and its rational tail: A social
intuitionist approach to moral judgment. Psychological Review
108(4): 814. doi:10.1037//0033-295X.
Kant, I. 1785. Grundlegung zur metaphysik der sitten. Frankfurt am
Main: Shurkamp.
Sensen, O. 2011. Kant on human dignity.G
ottingen: Walter de
Gruyter.
Mind Reading or Misleading? Assessing Direct-to-
Consumer Electroencephalography (EEG) Devices
Marketed for Wellness and Their Ethical and Regulatory
Implications International Neuroethics Society
Stipend Award
A. Wexler
1
, and R. Thibault
2
1. University of Pennsylvania
2. McGill University and Chapman University
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W8 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
Background: The market for direct-to-consumer brain
health productsincluding brain-training games,
neurostimulation devices, and consumer
electroencephalography (EEG) devicesis expected to top
$3 billion by 2020 (SharpBrains 2018). While many direct-
to-consumer neurotechnology products have come under
scrutiny from scientists and regulators, one set of
productsconsumer EEG deviceshave largely escaped
scholarly and regulatory critique. While consumer EEG
products do not present overt safety risks, by claiming to
provide individuals with snapshotsof their own mental
states they present a subtle, and arguably more complex,
set of neuroethical issues. This paper presents an initial
critique of consumer EEG, focusing only on devices that
are marketed directly to consumers for improving their
well-being. We categorize the behavioral and wellness-
related marketing claims made by consumer EEG
companies, analyze the evidence base for such claims, and
argue that the ethical and legal issues wrought by these
devices deserve greater attention. Methods: We identified
companies marketing consumer EEG devices based on
specific keyword searches. Companies were included in
the study if (a) they were marketing EEG devices to
individual consumers for personal use; (b) their device
was immediately available for purchase on the companys
website as of January 2018; or (c) they had received funding
from individuals via a crowdfunding campaign. Two coders
independently coded companiesclaims. Results: Eighteen
companies met the inclusion criteria. The greatest number
of claims made by consumer EEG companies were related
to improving concentration, relaxation, meditation, and
sleep. Beyond claims regarding well-being, five companies
claimed their device could allow individuals to control
virtual or real-world objects via brainwaves and four
claimed to promote lucid dreaming. Discussion:
Although the marketing approaches taken by consumer
EEG companies differed in tone, they all relied on the
assumption that observing ones own brainwaves can
improve well-being. However, for consumer EEG to
improve well-being beyond the benefits derived from
placebo effects, three assumptions would need to hold
true. First, the device would need to validly and reliably
record the brain signals that companies claim to measure.
Second, the measured brain signal would need to
accurately reflect a given behavior or mental state. Third,
providing individuals with their brainwave data would
need to help them alter a behavior or mental state. After
reviewing the evidence for these assumptions, we find
little data to support the marketing claims of consumer
EEG companies. Conclusion: Consumer EEG devices may
raise more ethically troublesome issues than other direct-
to-consumer neurotechnologies, as their promoters make
claims not only of behavioral improvement but also of a
kind of diagnosticof ones mental state. Claiming to
provide individuals with information about their mental
states is not without consequence, as it may affect their
behavior in unexpected ways. In light of our findings, we
recommend that companies marketing consumer EEG
devices substantiate their claims with adequate evidence.
We further recommend that the authorities that regulate
advertising take note of the unsubstantiated claims that
continue to pervade the rapidly expanding consumer
EEG market.
REFERENCE
SharpBrains. 2018. Market Report on Pervasive Neurotechnology:
a Groundbreaking Analysis of 10,000þPatent Filings Transforming
Medicine, Health, Entertainment and Business,https://
sharpbrains.com/pervasive-neurotechnology/.
Data Sharing and Privacy Heat Map: An Interactive Tool
for Data-Driven Risk Assessments of Neurotechnologies
 Institut de Recherches Cliniques de Montr
eal
Stipend Award
K. Kallmes
1
, and K. Ramos
2
1. Duke University Law School
2. National Institute of Neurological Disorders and
Stroke, National Institutes of Health
Background and purpose: Advances in neurofunctional
imaging and neuromodulation have allowed researchers to
gather novel and profound data on human brain function.
New abilities elicit new ethical questions, including
implications of potential misinterpretation, privacy breach, or
inadequate consideration of patient autonomy. Therefore,
diverse stakeholdersresearchers, funding agencies, the
public, and patient populationswould benefit from
empirically grounded ethics-related risk assessments (Illes
2007; National Institutes of Health 2017]. However, there is a
critical lack of reproducible methods for compiling evidence
for neuroethics-related risk assessments, limiting the ability
to base neuroscience research and funding decisions on
consistent application of normative frameworks to novel
neurotechnologies. The purpose of the Heat Map project was
to develop a consistent paradigm of data collection and
analysis for empirical risk assessments related to autonomy,
privacy, potential harmful uses, and data management
practices in neuroscience research. It may be of use in the
National Insitutes of Health (NIH) proactive strategy to
anticipate neuroethical considerations related to BRAIN-
funded research. Methods: The Heat Map adopted the
normative framework of the NIH Brain Research through
Advancing Innovative NeurotechnologiesV
R(BRAIN)
Initiatives Guiding Principles (NIH BRAIN Initiative
Multi-Council Working Group Neuroethics Division
forthcoming), which identify ethical points to consider in
BRAIN-funded research. We included technologies based
on their relevance to BRAIN-funded projects. To
operationalize the Guiding Principles as they apply to
data sharing and privacy, in consultation with ethicists
and neuroscientists at NIH, we designed a
neurotechnology-based Heat Map and identified research
questions related to these principles for which a literature
review may provide insight into existing practices and
possible future risks. Our replicable methodology of
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W9
creating empirical risk assessments used a metric decision
tree that directed the type of metric based on the nature of
the question and available evidence. The hierarchy of
evidence was (1) randomized literature review; (2)
scientific evidence of technological characteristic; (3)
survey of ethics-related publications; (4) descriptive
synthesis of existing sources; (5) no sources available.
Each risk metric queried existing characteristics of each
technology as a proxy for predictive assessment. All
sources were amalgamated in a centralized database,
which, along with methodological descriptions, is directly
accessible from the Heat Map. All methods and metrics
are editable to allow the map to be applied to new
research questions and neurotechnologies. Results: The
Heat Map includes 14 research questions (e.g., whether
data were gathered during private activities or concerning
psychiatric characteristics, possible data reuse, and social
implications of incorrect interpretation) and 10
neurotechnologies, including deep brain stimulation,
functional magneetic resonance imaging (fMRI), and
electroencephalography. Our research demonstrated areas
of privacy and data management that are
underresearched, especially the opinions of patients with
relevant conditions and data collection standardization
methods. The Heat Map demonstrated proof of concept
for empirical research compilations to provide targeted,
context-independent data to assist with normative
discussions. Conclusions: The Heat Map project
amalgamated a vast pool of neurotechnological evidence
and expert opinions in an interactive, editable, visual tool
with source- and methods-linked risk assessments. As a
paradigm for presenting research in an accessible manner,
this tool offers a comprehensive overview of ethical
concerns related to specific neurotechnologies and,
critically, can identify areas in need of further
neuroethics research.
REFERENCES
Illes, J. 2007. Empirical neuroethics: Can brain imaging visualize
human thought? Why is neuroethics interested in such a
possibility?. EMBO Reports 8: S57S60. 1: doi:10.1038/
sj.embor.7401007.
National Institutes of Health. 2017. BRAIN initiative: Research
on the ethical implications of advancements in neurotechnology
and brain science (R01). Accessed June 25, 2018. https://grants.
nih.gov/grants/guide/rfa-files/RFA-MH-18-500.html.
NIH BRAIN Initiative Multi-Council Working Group
Neuroethics Division. Forthcoming. Neuroethics guiding
principles for the NIH BRAIN initiative. Manuscript in
Production.
Device Removal Following Brain Implant Research
Demetrio Sierra-Mercado
1
, Peter Zuk
2
, Amy L. McGuire
3
,
and Gabriel L
azaro-Mu~
noz
4
1. University of Puerto Rico School of Medicine and
Baylor College of Medicine
2. Baylor College of Medicine and Rice University
3. Baylor College of Medicine
4. Baylor College of Medicine
Brain implant research promises to help people living
with treatment-resistant forms of movement and mental
health disorders, such as essential tremor, Tourettes
syndrome, and obsessive-compulsive disorder. However,
at this stage of research, the prospect of direct benefit to
individual participants is limited. For those who do not
receive direct benefit, what should happen with the
implanted device at the end of the study? Our review of
seven research protocols and communications with
researchers suggests that device removal is typically
offered at the end of the trial, but studies often do not
offer to cover the cost. If the participant would like the
device removed, then that persons insurance must cover
it. If the participant does not have insurance or it will not
cover the cost, then it is up to the participant to pay for
removal (approximately $13,000). Since the device is still
at an experimental phase, health insurance programs are
usually not contractually or legally obliged to cover these
costs. We examine whether there is a legal or ethical
obligation to cover the cost of removing a neural device at
the end of brain implant research. From a legal
standpoint, we were not able to identify an obligation to
cover the cost of removing the device. Most federally
funded research in the United States has to comply with
the Common Rule (45 CFR 46). The Common Rule does
not specifically address the obligation of researchers to
remove experimental devices after a trial ends. The
institutional review board (IRB), which is tasked with
evaluating the risks and benefits of the research, could
decide that device removal is ethically required, but our
review of research protocols suggests that this is generally
not the case. If the device is not removed at the end of the
study and the participant suffers harm (e.g., psychological
distress) because of that, then he or she could sue the
researchers for negligence. However, the participant
would have to prove that the current standard of practice
is to pay for device removal, which it clearly is not, and
no legal cases have addressed the issue of whether
payment for removing the device should be included as
part of the research as a matter of standard practice. Thus,
we conclude that there is currently no legal obligation to
cover these costs in the United States. Is there nevertheless
an ethical obligation to cover the cost of device removal?
In this presentation, we first identify and weigh the
potential harms and benefits of device removal against
those of keeping the device in place but deactivated at the
end of the study. We also use the Partial-Entrustment
Model (Richardson and Belsky 2004) to evaluate the
obligations that may emerge between researchers and
participants in this context. We combine these two
analytical approaches to argue that researchers do, in fact,
have an ethical obligation to pay for the removal of
implanted devices at the end of studies, under some
circumstances. We use this analysis to propose an
AJOB Neuroscience
W10 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
ethically justified management plan for investigators
conducting brain implant research.
REFERENCES
45 CFR 46. 2009. Protection of Human Subjects Common
Rule.
Richardson, H. S., and L. Belsky. 2004. The ancillary-care
responsibilities of medical researchers: An ethical framework for
thinking about the clinical care that researchers owe their
subjects. Hastings Cent. Rep 34(1): 2533. doi:10.2307/3528248
Ethics of Invasive Neuromodulation in Pediatric
Populations
Gabriel L
azaro-Mu~
noz
1
, Laura Torgerson
2
, Peter Zuk
3
,
and Eric A. Storch
4
1. Baylor College of Medicine
2. Baylor College of Medicine
3. Baylor College of Medicine and Rice Univeristy
4. Baylor College of Medicine
Increasing investment in the development of invasive
neuromodulation technologies (e.g., adaptive deep brain
stimulation [aDBS] and conventional DBS) promises to
help numerous adults and children with intractable
movement and psychiatric disorders. DBS is already Food
and Drug Administration (FDA)-approved for adults with
intractable Parkinsons disease, offered under FDA-
humanitarian device exemptions (HDE) for adults with
intractable dystonia and obsessive-compulsive disorder
(OCD), and is under investigation for numerous other
conditions. The use of DBS in children (younger than
18 years) has received much less attention, but usage is
increasing due to advances in DBS research and the
number of children who suffer from severe and intractable
movement or psychiatric disorders that could benefit from
these technologies. In fact, DBS is already offered under
an FDA HDE for children (starting at 7 years of age)
suffering from intractable dystonia (FDA 2017) and there
is no age restriction in Europe (Marks et al. 2017). We
have identified numerous clinics and research studies
conducting DBS in children with anorexia nervosa,
Tourettes syndrome, dystonia, parkinsonism, and other
movement disorders (Isaias et al. 2011; Smeets et al. 2018).
Furthermore, our collaborators conducting DBS/aDBS
research often receive calls from parents asking whether
their children may be eligible for invasive
neuromodulation studies. Some of us have already raised
the concern that the use of invasive neuromodulation in
pediatric populations is in need of more thorough clinical
and ethical analysis (Johnco and Storch 2016). As
neuromodulation technologies advance, it is foreseeable
that their use in children with intractable conditions will
increase significantly in much the same way that drugs
are often FDA approved for use in adults and then used
off label in pediatric patients. Invasive neuromodulation
in children raises numerous potential ethical concerns
(e.g., unknown impact of DBS on personal identity in
developing children, responsible surrogate decision
making regarding DBS implantation, determining the best
interest of the child in this context, and the role of children
in decision making). However, very few theoretical papers
have addressed the ethics of invasive neuromodulation in
pediatric populations and, to our knowledge, there are no
empirical studies on this. Neuroethics research, both
theoretical and empirical, is necessary to develop
management plans to prevent ethical missteps and
misuses of these technologies in children. In this
presentation, we identify and analyze pressing
neuroethics issues in this area. We weigh the potential
benefits and harms associated with different management
plans for addressing the identified neuroethics issues. The
long-term goal of our research is to develop ethically
justified and empirically informed management plans for
the neuroethics challenges raised by the use of invasive
neuromodulation technologies in children. This research is
critical for maximizing the benefits and minimizing the
harms to minors that are currently receiving surgery for
invasive neuromodulation devices in clinical and research
settings, and the many more that will do so in the future.
REFERENCES
Food and Drug Administration Pediatric Advisory Committee. 2017.
Medtronic activa neurostimulator for dystonia treatment. Available at:
https://www.fda.gov/downloads/AdvisoryCommittees/Committees
MeetingMaterials/PediatricAdvisoryCommittee/UCM543856.pdf
(accessed June 24, 2018).
Isaias, I. U., J. Volkmann, A. Kupsch, et al. 2011. Factors
predicting protracted improvement after pallidal DBS for
primary dystonia: The role of age and disease duration. Journal
of Neurology 258(8): 14691476.
Johnco, C., and E. A. Storch. 2016. Evaluating risks and benefit
of deep brain stimulation for Treatment-Refractory tourette
syndrome. Neurosurgery 78(5): 762764.
Marks, W., L. Bailey, and T. D. Sanger. 2017. PEDiDBS: The
pediatric international deep brain stimulation registry project.
European Journal of Paediatric Neurology 21(1): 218222. doi:
10.1016/j.ejpn.2016.06.002
Smeets, A. Y. J. M., A. A. Duits, D. Horstk
otter, et al. 2018.
Ethics of deep brain stimulation in adolescent patients with
refractory tourette syndrome: A systematic review and two case
discussions. Neuroethics 11(2): 143155. doi:10.1007/s12152-018-
9359-6
Owning Ethical Innovation: Claims About Commercial
Brain Wearable Technologies Neuroethics Canada
Stipend Award
I. Coates McCall, C. Lau, N. Minielly, and J. Illes,
1University of British Columbia
Technological advances in neurosciences in the last
75 years have exceeded those of the thousands of years
that preceded them. With each advance in the
understanding of brain health and disease, new ethical
questions related to human values and dignity arise.
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W11
Today, for example, technologies for monitoring and
boosting brain functions are pervasive in Western society.
Once the instrument of physicians for diagnosing and
treating brain disorders, in this new environment,
wearable technologies that record and upload brain
activity to smartphones or stimulate the brain with small
amounts of electrical current can be purchased on the
open, unregulated marketplace. They are purported to
optimize brain fitness and improve cognitive functions
such as memory and attention, and they can be purchased
and used by anyoneyoung and old. This represents a
substantial market: Wearable technologies are a $20B
industry and brain wearables specifically will be a $12.22B
industry by 2021 (Markets and Markets 2017). The claims
that producers make about brain wearables and strategies
for communicating them are of central interest to
neuroethics as they touch upon core issues of justice,
fairness, transparency, rights, and responsibility.
Empirically driven knowledge about these realities of the
market, however, is limited. To address this gap, we are:
1. Developing and classifying a comprehensive set
of neurotechnology products available for
purchase in the open marketplace. We define
neurotechnology as any device that exerts its
function either directly or indirectly through
neural activity and are sourcing the products
both from both aisles of stores and the Internet.
2. Analyzing marketing claims according to five
key variables: (1) target consumers (healthy;
neurologic or psychiatric conditions); (2) explicit
applications; (3) implicit applications; (4)
declared benefit; (5) declared risk.
3. Categorizing the techniques used to convey
claims (Illes et al. 2004).
Findings to date reveal a focus on healthy populations
and on applications that span emotional control,
attentional processing, and creativity. Many claims are
unsubstantiated statements about benefit, backstopped by
minimal to no empirical evidence. For example, one
electroencephalography (EEG) product claims to treat
children with attention-deficit hyperactivity disorder
(ADHD) by improving confidence, calmness, and self-
control. This device is not approved by the FDA for any
clinical indication, and there are no supporting data for
efficacy provided. Detail about safety precautions and
responsible use is also absent. We are in an information
society today that is more than ever technologically
enabled. Questions about the challenges of the right to
access technologies and the responsibility to minimize
harms are key phenomena in this revolution. The
utilization of these technologies has direct implications for
human health, and acutely so when brain health for self-
improvement for younger populations and self-
preservation for older populations are at stake. The results
of this work will inform responsible citizenship in the
neurotechnological revolution by promoting a paradigm
of evidence-based, informed expectations, and deliver
pragmatically situated recommendations for good practice
that motivate industry to own the ethics of its innovation.
REFERENCES
Illes, J., D. Kann, K. Karetsky, et al. 2004. Advertising. Patient
decision-making, and self-referral for computed tomographic
and magnetic resonance imaging. Archives of Internal Medicine
164(22):24062408.
Markets and Markets. 2017. Brain Monitoring Market by Product
(MRI, CT, PET, EEG, EMG, MEG, TCD, ICP, Electrodes, Sensors,
Gels, Cables), Procedure (Invasive, Non-Invasive), Disease (TBI,
Stroke, Dementia, Epilepsy) & End User (Hospital, Clinic, ASC,
Ambulance) Forecasts to 2021. Available at: https://www.
marketsandmarkets.com/Market-Reports/brain-monitoring-devices-
market-909.html?gclid¼EAIaIQobChMIiPqg1e7l2wIVBGt-Ch1jYQew
EAAYASAAEgLf6_D_BwE
Weisberg, D. S., F. C. Keil, J. Goodstein, E. Rawson, and J. R.
Gray. 2008. The seductive allure of neuroscience explanations.
Journal of Cognitive Neuroscience 20(3): 470477. doi:10.1162/
jocn.2008.20040.
Neuroscientific Evidence in English Criminal Trials:
Looking Back and Looking Forward
L. Claydon
1
, and P. Catley
2
1. The Open University
2. The Open University
Adopting the methodology of Farahany (2015), the
poster will visually summarize the analysis of the case law
of England and Wales that found that neuroscientific
evidence was used by those accused of criminal offenses
to appeal against conviction, to appeal against sentence, to
resist extradition, and to resist prosecution appeals against
allegedly unduly lenient sentences. The poster will
examine the extent to which it was used for these different
purposes, the range of criminal offenses charged in the
cases under consideration, and the success rates of those
appealing against conviction and against sentence of those
relying on neuroscientific evidence. In addition, the poster
will take the previous research forward by looking at the
new rules on the admissibility of expert evidence in
criminal trials to explore how these changes might impact
on the admission of neuroscientific evidence in the future.
It will also provide the opportunity to consider the
possible impact of the Law Commission for England and
Waless proposed new defense of not criminally
responsible by reason of a recognized medical condition,
which if introduced would replace the defense of insanity
and reduce the scope of the automatism defense.
REFERENCES
Farahany, N. A. 2015. Neuroscience and behavioral genetics in
US criminal law: An empirical analysis. Journal of Law and the
Biosciences 2(3): 485509. https://doi.org/10.1093/jlb/lsv059
Law Commission. 2013. Criminal liability: Insanity and
automatism a discussion paper. https://s3-eu-west-2.
AJOB Neuroscience
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amazonaws.com/lawcom-prod-storage-11jsxou24uy7q/uploads/
2015/06/insanity_discussion.pdf
Lisa, C., and C. Paul. 2016. Abolishing the insanity verdict in
England and Wales: A better balance between legal rules and
scientific understanding? In Legal insanity and the brain: Science,
law and European courts, ed. Sofia Moratti and Dennis Patterson,
207237. Oxford: Hart Publishing.
Paul, C., and C. Lisa. 2015. The use of neuroscientific evidence
in the courtroom by those accused of criminal offenses in
England and Wales. Journal of Law and the Biosciences 2(3):
510549. https://doi.org/10.1093/jlb/lsv025
Preventing a Lifetime of Trauma: Is It Ever Acceptable
to Alter Memories in Children?
T. Moses, 1Wayne State University
Memory alteration seems straight from science fiction,
but the idea has gained more scientific traction over the
past decade. One area where this has been prominently
discussed is the use of medications to block or dampen
memory consolidation in the aftermath of trauma (Parens
2010); however, there have been a myriad of associated
ethical concerns. One primary concern is the risk that
editing memory results in a lack of authenticity (Erler
2011). In isolation, the concerns of authenticity hold merit;
however, when one considers the malleability of memory
in general and our understanding that many of our
memories may not be based in fact (Loftus and Greenspan
2017), this concern becomes less relevant. If we partially
define authenticity by our ability to remember occurrences
accurately, we must accept that most of us already live
inauthentic lives. As such, we must consider that memory
manipulation may occasionally be warranted and ethical.
The use of pharmacologic agents to reduce posttraumatic
stress disorder (PTSD) risk in adults has seen the most
discussion; however, since trauma in childhood may have
the longest impact, it is important to consider whether
there is a situation where this therapy could be
appropriate in children. For many, the initial response
would be robustly negative. I argue that this gut response
is not consistent with behavior. Parents regularly say or
do things that alter their childs memory of situations,
often in innocuous and subconscious ways (e.g., the last
time you tried peas you really liked them). While
sometimes these are born from forgetfulness, others are
active attempts to make the child remember something
different (such as liking peas)agood-faith
manipulation. The point to recognize is that we are
frequently responsible for altering memories, including
childrens. These examples are innocuous, but there are
many instances of young children experiencing trauma
and parents refusing to talk about or mention these events
in the hopes that the child will forgeta once medically
sanctioned approach. If we accept that this behavior is
commonplace and currently not seen as inherently
unethical, we can question whether there is ever a
situation in which to use a pharmacological agent for
memory blocking in childhood trauma. The effects of
childhood trauma often cause lifelong negative impacts, in
many ways binding the child to a certain type of future
and removing many future possibilities. By preventing the
development of PTSD, we provide the child access to
more opportunities. Arguably, both options remove
autonomy from the child: the loss of the choice to
remember an experience, or the loss of the ability to
experience childhood free from the long-term
psychological and physical impacts of trauma. We accept
that there are many instances where a child cannot make
autonomous choices about his or her own future, and we
trust parents and physicians to decide what is best for
children. It merits consideration that blocking
consolidation of traumatic memories may sometimes be
the right choice.
REFERENCES
Erler, A. 2011. Does memory modification threaten our
authenticity? Neuroethics 4(3): 235249. doi:10.1007/s12152-010-
9090-4.
Loftus, E. F., and R. L. Greenspan. 2017. If Im certain, Is it
true? Accuracy and confidence in eyewitness memory.
Psychological Science in the Public Interest 18(1): 12. doi:10.1177/
1529100617699241.
Parens, E. 2010. The ethics of memory blunting: Some initial
thoughts. Frontiers in Behavioral Neuroscience 4: 190. (December
20, doi:10.3389/fnbeh.2010.00190.
Some Neglected Practical Concerns About
Memory Editing
A. Erler, The Chinese University of Hong Kong
Referred to as memory editing,prospective
biomedical interventions that would allow one either to
selectively erase painful memories or to blunt their
emotional impact have been generating a growing
literature in neuroethics in recent years (e.g., Elsey and
Kindt 2016; Erler 2011; Gligorov 2016; Parens 2010; Vukov
2017). Various ethical concerns have been raised in
relation to such interventionsparticularly about
potential nontherapeutic uses that would target
unpleasant yet nontraumatic memories. Such concerns
include the risk that memory editing might interfere with
emotional growth or might lead users to live an
inauthenticlife. I argue that this ethical debate has, in
the process of focusing on such questions, tended to
neglect some more practical concerns that are nevertheless
highly relevant to both the prudential desirability and
ethics of memory editing. One such concern has to do
with the possibility that nontherapeutic memory editing
might fail to achieve its goal of alleviating mental
suffering. This could, for instance, happen in the case of
memory blunting, if the negative emotional valence of a
declarative memory were at least partly the result of the
interaction between the factual content of that memory
with a persons values and general emotional dispositions,
which would make it resistant to change by biomedical
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W13
means (at least in the absence of a more general blunting
of those dispositions); or in the case of memory erasure, if
the persons imagination were to fill the gap left by the
erased memory in a way that again aroused negative
affect. Another such concern, specific to memory erasure
and related to the previous one, bears on the strong
vulnerability (e.g., to manipulation by others) that the
users of such a procedure might open themselves to,
especially if erasing memories became a common practice.
I argue that while such practical issues do not show all the
familiar ethical concerns about memory editing to be
unfounded, they nonetheless deserve greater attention,
partly for their own sake and partly because they can help
refine our ethical analysis of memory editing procedures.
REFERENCES
Elsey, J., and M. Kindt. 2016. Manipulating human memory
through reconsolidation: Ethical implications of a new
therapeutic approach. AJOB Neuroscience 7(4): 225236. doi:
10.1080/21507740.2016.1218377
Erler, A. 2011. Does memory modification threaten our
Authenticity? Neuroethics 4(3): 235249.
Gligorov, N. 2016. Neuroethics and the scientific revision of common
sense. Dordrecht: Springer.
Parens, E. 2010. The ethics of memory blunting and the
narcissism of small differences. Neuroethics 3(2): 99107. doi:
10.1007/s12152-010-9070-8
Vukov, J. 2017. Enduring questions and the ethics of memory
blunting. Journal of the American Philosophical Association 3(02):
227246. doi:10.1017/apa.2017.23
Scientific and Moral Reasoning in an Arts-Based Course
on the Neurobiology of Stress, Traumatic Memory, and
Social Identity International Neuroethics Society
Stipend Award
A. E. Fink
1
, and S. M. Quintana
2
1. Lehigh University
2. University of WisconsinMadison
Teaching the neurobiology of memory, emotion, and
stress provides opportunities to foster a critical
understanding of mental health and illness and to
emphasize social influences on the mind and body. This
subject also challenges students and instructors to engage
responsibly with neurobiological theories of identity and
mental illness. Such theories carry the potential to
stigmatize populations deemed vulnerable to mental
illness (Rusch et al. 2010) but can also be used beneficially
to counter stigma, to enhance studentsagency in
learning, and to illuminate new modes of coping and
recovery. A neuroethics perspective in the classroom
enriches biological understanding by raising these
questions. Neuroscientific knowledge, in turn, can
constructively inform pedagogical strategy and ethics. The
classroom environment impacts studentslearning
outcomes and well-being, with downstream effects on
social stratification within clinical and research
communities. Thus, quality of learning, and deployment
of power in these classrooms, are important issues that
carry significant potential for benefit and harm at
individual and social levels. The first author taught an
interdisciplinary course at the University of
WisconsinMadison titled Gender, Neurobiology and
Traumatic Memory across two academic years (previously
described; Fink 2017). Predicated on the notion that a lack
of social context in teaching this material might cause
harm through negligence, the course incorporates
neurobiological models of stress, traumatic memory and
health within a critical feminist analysis of social power
and identity. The course is designed to interrogate
definitions of mental health and illness, and to invite
participation of historically marginalized students in
biology. This is crucial, given that these students may also
be disproportionately represented in experiencing trauma
(Berger and Sarnyai 2015). The classroom environment is
itself informed by the effects of stress and trauma on well-
being and learning, the protective effects of enriching
environments (Davidson and McEwen 2012), and
evidence that the social environment is a major
determinant of health outcomes (Hackman et al. 2010).
The use of arts-based teaching methods allows for creative
intervention into these issues. In this presentation, we
describe preliminary findings from a collaborative
qualitative study into student experiences from the course.
We obtained consent from former students to complete a
short survey and allow their completed assignments to be
analyzed to assess learning and attitudes toward course
material. Some questions employ Likert scales for simple
numerical ratings. Other items allow for more open-ended
answers: In your opinion what are the most important
ethical questions regarding the neurobiology of mental
health? and “… how [does] the social environment
interact with the biology of health and illness?We thus
assess self-reported learning, critical thinking about
biomedical science in social context, and studentsethical
understanding of course material. Questions about the
classroom environment, instructor, and arts-based
techniques also assess how students experience a
classroom that questions traditional power structures and
strives to balance uncomfortable topics relating to trauma
and social identity with a respectful, creative learning
environment. Finally, by analyzing individual
assignments that are rich with verbal and visual content,
we chart a course through studentsscientific and moral
reasoning and learning process.
REFERENCES
Berger, M., and Z. Sarnyai. 2015. More than skin deep: Stress
neurobiology and mental health consequences of racial
discrimination. Stress 18(1): 110. doi:10.3109/10253890.2014.
989204
Davidson, R. J., and B. S. McEwen. 2012. Social influences on
neuroplasticity: Stress and interventions to promote well-being.
Nature Neuroscience 15(5): 689695. doi:10.1038/nn.3093
AJOB Neuroscience
W14 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
Fink, A. E. 2017. Teaching the neurobiology of stress and
traumatic memory in the context of social power and identity.
International neuroethics society annual meeting abstracts.
November Washington, D.C.
Hackman, D. A., M. J. Farah, and M. J. Meaney. 2010.
Socioeconomic status and the brain: Mechanistic insights from
human and animal research. Nature Reviews Neuroscience 11(9):
651659. doi:10.1038/nrn2897
Rusch, N., A. R. Todd, G. V. Bodenhausen, and P. W. Corrigan.
2010. Biogenetic models of psychopathology, implicit guilt, and
mental illness stigma. Psychiatry Research 179(3): 328332. doi:
10.1016/j.psychres.2009.09.010
AcousticPhonetic Considerations in Development of
Hindi Speech Stimuli to Elicit Auditory Brainstem
Responses International Brain Research Organization
Stipend Award
Mohammad Shamim Ansari, Ali Yavar Jung National
Institute of Speech & Hearing Disabilities (Divyangjan)
Introduction: Speech-evoked auditory brainstem
response (spABR) helps to understand the speech processing
in the brain. The temporal and spectral characteristics of
speech sounds are faithfully represented in the subcortical
responses. These responses can be used to assess specific
auditory processing impairments in clinical population.
However, the spABR is known to be affected by the acoustic
properties of speech, language experience, and training.
Hence, the establishment of language-specific speech stimuli
is warranted for underpinning the brainstem processing
deficit in a disordered population. However, there do not
exist culturally and linguistically sensitive speech stimuli for
determining brainstem processing abilities specially in Hindi.
Objective: The objective of the study was to develop
Hindi speech stimuli for brainstem response recordings.
Methods and Material: The Hindi stop voiced and
voiceless CV combination phoneme of 40 ms was
synthesized on the basis of theorized criteria. The
behavioral identification score and discrimination ability
of the selected stimuli were obtained from children (613
years) and adults (1825 years) with normal hearing (NH)
and mild to moderate sensorineural hearing loss (HI). The
Hindi stimulus |da| was used to gain brainstem evoked
responses from norma-hearing and hearing-impaired
adults. Results: The identification and discrimination
scores of stimuli between NH and HI subjects were
calculated. Statistically significant differences in the mean
identification scores of synthesized speech stimuli were
obtained. The brainstem evoked responses to Hindi
stimulus |da| from normal hearing and hearing impaired
adults were obtained. The mean, median, standard
deviation, minimum, maximum and 95% confidence
interval values of electrophysiological responses to speech
stimulus were measured for the discrete peaks and V-A
complex for both the groups. Conclusion: The article
delineates a comprehensive approach for the development
of culturally and linguistically sensitive speech stimuli for
recording auditory brain stem responses. The acoustic
characteristic of the stimulus |da| was faithfully
represented at brainstem level in normal hearing adults
and found to be statistically different in HI individuals.
This suggests that spABR offers an opportunity to
segregate normal speech encoding from abnormal speech
processing and implies that alterations in brainstem
responses could have clinical significance for the
identification of subjects with possible speech
processing disorders.
REFERENCES
Chandrasekaran, B., and N. Kraus. 2009. The scalp-recorded
brainstem response to speech: Neural origins and plasticity.
Psychophysiology 2: 3946.
Cunningham, J., T. Nicol, S. G. Zecker, A. Bradlow, and N.
Kraus. 2001. Neurobiologic responses to speech in noise in
children with learning problems: Deficits and strategies for
improvement. Clinical Neurophysiology 112(5): 758767. doi:
10.1016/S1388-2457(01)00465-5
Hornickel, J., S. Anderson, E. Skoe, H.-G. Yi, and N. Kraus.
2012. Subcortical representation of speech fine structure relates
to reading ability. NeuroReport 23(1): 69.
Johnson, K. L., T. Nicol, S. G. Zecker, and N. Kraus. 2008.
Developmental plasticity in the human auditory brainstem. Journal
of Neuroscience 28(15): 40004007. doi:10.1523/JNEUROSCI.
0012-08.2008
Back to the Future? Pre-Hispanic Ethnopharmacology in
the Era of Neuroscience, Neurotechnology and
Neuroethics International Brain Research
Organization Award
K. Herrera-Ferr
a
1
, M. Sandoval-Balanzario
2
, and
J. Giordano
3
1. Asociaci
on Mexicana de Nuero
etica
2. Asociaci
on Mexicana de Nuero
etica
3. Georgetown University Medical Center
Utilization of pre-Hispanic ethnopharmacology (PHEP)
as treatment for insomnia, fright,”“sadness,pain, and/or
seizures is a historically noted and still common practice in
Mexico. While much of current neuroethical discussion has
centered on advanced neuroscientific techniques or
technologies, recent proposals for global/cross-cultural
neuroethics, while sensitive to cultural diversity, have not
focused on the issues fostered by the use (and/or misuse) of
traditional medicine such as PHEP. Such issues include, but
are not limited to, (1) unknown phytochemical mechanisms
and effects upon neurological and psychiatric function and
health, (2) implications of the use of ethnobotanicals for
mental health, recreational purposes, and/or enhancement,
and (3) the potential for complementary use in western
medical approaches to the treatment of certain
neurodegenerative diseases (Coe et al. 2018). Therefore, we
argue that PHEPand other types of traditional medicinal
practicesshould be explicitly defined and addressed as a
focal point of global neuroethical discourse. We posit that
this approach could be aligned with the 20142023 World
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W15
Health Organization Traditional Medicine Strategy (WHO
2013), which aims to promote scientific research in
ethnozoology and ethnobotany so as to more effectively
(and efficiently) capture the potential contributions of
traditional medicine to achieve universal (mental) health
care. We assert that neuroethical engagement within the
WHO Traditional Medicine Strategy could promote more
meaningful study of whether and under which conditions
such approaches may be most validly and valuably be
employed. Such studies could (1) follow the framework
for ethical reflection that has successfully shaped
international research projects of high-income and
developed countries (e.g., the U.S. BRAIN initiative and
European Union Human Brain Project), and (2) be
important to afford sound guidance for research and
clinical applications, especially in low- and middle-income
countries. We further argue that this neuroethical address
should (1) acknowledge specific sociocultural and medical
contexts; (2) identify sociocultural gaps in health research
and treatment; (3) recognize indigenous philosophies,
beliefs, and traditions and their influence upon on
concepts of health, disease, and the role of traditional and
nontraditional medical approaches; and (4) assess the
potential for both medical and economic benefit(s) of
ethnobotanic treatments (and their development) in
particular rural areas.
REFERENCES
Coe, S., J. Collett, D. Izadi, D. Wade, et al. 2018. A protocol for
a randomised double-blind placebo-controlled feasibility study
to determine whether the daily consumption of flavonoid-rich
pure cocoa has the potential to reduce fatigue in people with
relapsing and remitting multiple sclerosis (RRMS.). Pilot and
Feasibility Studies 4: 35. doi:10.1186/s40814-018-0230-7
World Health Organization. 2013. WHO Traditional Medicine
Strategy: 20142023. http://apps.who.int/iris/bitstream/
handle/10665/92455/9789241506090_eng.pdf?sequence ¼1
Hacking a Brain for Contemptuous Interests: Ethical
Risks of Advancing Neuroscience Techniques for Mind
Control International Brain Research Organization
Stipend Award
Ashutosh Kumar
1
, Vikas Pareek
2
, Muneeb A. Faiq
3
,
Chiman Kumari
4
, Vivek K. Sharma
5
, and Sanjib K. Ghosh
6
1. All India Institute of Medical Sciences (AIIMS) and
Etiologically Elusive Disorders Research
Network (EEDRN)
2. National Brain Research Centre (NBRC) and
Etiologically Elusive Disorders Research
Network (EEDRN)
3. New York University School of Medicine and
Etiologically Elusive Disorders Research
Network (EEDRN)
4. Postgraduate Institute of Medical Education &
Research (PGIMER) and Etiologically Elusive
Disorders Research Network (EEDRN)
5. Government Institute of Medical Sciences (GIMS)
and Etiologically Elusive Disorders Research
Network (EEDRN)
6. All India Institute of Medical Sciences (AIIMS) and
Etiologically Elusive Disorders Research
Network (EEDRN)
Recent advancements in the neuroscience techniques
for mind control impose a threat of exploitations of
healthy individuals, besides their promises in therapy for
many neurocognitive or psychiatric disorders. Evolved
versions of these mind manipulation techniques require
less operational expertise, are cheaper, and can be used
selectively to manipulate a specific mind attribute by
altering the functions of decision making and emotion
regulatory parts of the brain, which suggests their possible
unethical use. Deep brain stimulation (DBS), which
involves implanting electrodes in the brain at depths for
electrical stimulation of the neurons in targeted brain
parts, has evolved to be the least invasive technique,
allowing a large array of the tiny electrodes to be placed
on a chip implanted under the scalp and remotely
controlled. Recent introduction of magnetic nanoparticles
that can cross the bloodbrain barrier and can be
controlled with an externally applied magnetic field has
made the mind manipulation attempt even simpler (Chen
et al. 2015). Optogenetics, another potential technique for
mind manipulation, uses laser lights of specific
wavelengths to control activation of neurons that are
genetically tagged with fluorescent biomolecules.
Optogenetics has been successfully used in animal
models, and also in some human cases, for manipulation
of various mind attributes as alleviating the mood,
induction or subsidence of a specific behavior, or inserting
or erasing a memory. Although, being an invasive
method, its current application in humans is still limited,
recent uses of hair-thin optical cables mounted on an
equally thin guiding wire, which ensures a minimal
damage to the traversed brain parts, and safer methods of
introducing fluorescent biomolecules, have made this
technique appealing for the human use (Ramirez et al.
2014). Some highly efficient noninvasive methods are also
available now that can potentially be exploited for
contemptuous mind manipulations in humans.
Chemogenetics uses systemically administered Designer
Receptors Exclusively Activated by Designer Drugs
(DREADD) targeted to the specific synaptic proteins that
can cross the bloodbrain barrier (Burnett and Krashes
2016), and sonogenetics uses low-pressure ultrasound
waves to activate artificially ultrasonically sensitized
neurons (Ibsen et al. 2015). Although these methods have
not still been tested in humans, their applications in future
are definitely warranted. Another potential method of
mind manipulation is by creating a direct braincomputer
interface (BCI). The brain implantation of the computer
chips for receiving a real-time sensory feedback or
programed motor stimulus in disabled subjects has been a
success. A recent study has successfully demonstrated
AJOB Neuroscience
W16 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
human-to-human long-distance transfer of the
communication signals mediated by computers (Grau
et al. 2014). From observing the success of these discussed
methods in animal (and also a few human) studies, it may
be essential to recognize in advance the threats for their
exploitative uses in human. Although the neurocognitive
alterations made by these techniques may not be
necessarily permanent, their psychological and intellectual
cost may be tremendous for individuals, and consequently
society, if these are applied without a medical indication,
serving contemptuous interests.
REFERENCES
Burnett, C. J., and M. J. Krashes. 2016. Resolving behavioral
output via chemogenetic designer receptors exclusively
activated by designer drugs. The Journal of Neuroscience 36(36):
92689282. doi:10.1523/JNEUROSCI.1333-16.2016.
Chen, R., G. Romero, M. G. Christiansen, A. Mohr, and P.
Anikeeva. 2015. Wireless magnetothermal deep brain stimulation.
Science (New York, N.Y.) 347(6229): 14771480. doi:10.1126/
science.1261821.
Grau, C., R. Ginhoux, A. Riera, et al. 2014. Conscious brain-to-
brain communication in humans using Non-Invasive
technologies. PLoS ONE 9(8): e105225. doi:10.1371/
journal.pone.0105225.
Ibsen, S., A. Tong, C. Schutt, S. Esener, and H. C. Sreekanth.
2015. Sonogenetics is a non-invasive approach to activating
neurons in Caenorhabditis elegans.Nature Communications 6 (1):
8264. doi:10.1038/ncomms9264.
Ramirez, S., S. Tonegawa, and X. Liu. 2014. Identification and
optogenetic manipulation of memory engrams in the
hippocampus. Frontiers in Behavioral Neuroscience 7: 226. doi:
10.3389/fnbeh.2013.00226.
Enhancing the Developing Brain: Constitutional
Tension Between Parent, Child, and State INS
Stipend Award
A. Jwa, Stanford Law School
Recent advances in neuroscience offer a novel way for
parents to nurture their children: altering brain activation to
improve cognitive functions. Parental use and state regulation
of cognitive enhancement will inevitably cause constitutional
tensions between parent, child, and state. Parental use of
cognitive enhancement will generate tensions (1) between
parent and childwho should decide to use cognitive
enhancement, and how should one resolve dissagreement
between a parent and a child?and (2) between parent and
statewhen can and should the state override a parents
decision to protect a child? State regulations on cognitive
enhancement will also cause tensions between parent and
state and between child and state, both involving the issue of
the extent to which state control may restrict the rights of
parent or child (not) to use cognitive enhancement. However,
these tensions are not without precedents. The courts have
frequently struggled to set the boundary of parental
autonomy and to balance parentsrights, childrens rights,
and the states interests. The aim of this article is to shed
light on the tensions regarding cognitive enhancement by
analyzing previous U.S. court decisions on analogous
cases in the context of medical treatment, education, and
mandatory vaccination. In both medical and educational
decisions, a parent is a primary decision maker for a
minor child. However, since health care decisions involve
a minors critical constitutional liberty rights, there are
common law and statutory exceptions to parental consent,
such as mature minor doctrine. Moreover, except for
certain recommendations on mediation by physicians,
there are no applicable legal rules to address the dissent
between parent and child. The courts are generally
reluctant to uphold state interventions overruling a
parents medical or educational decision unless it
significantly impairs the well-being of a child (i.e., causes
imminent risk of death). Weighing the competing interests
at issue, the courts have held that the state can restrict a
parents or childs constitutional rights by mandating
vaccination to protect society from communicable disease,
but they tend to err on the side of parents in cases of
parentstate conflicts regarding educational decisions (i.e.,
mandatory public education laws). A minor childs
challenge to state laws mandating education was not
successful, since the courts did not acknowledge a
constitutional right to education. These legal precedents
and existing legal rules provide a valuable guide for the
potential conflicts with respect to cognitive enhancement.
They suggest that parents will have almost boundless
discretion in the use of cognitive enhancement, as long as
it does not pose significant risk to the well-being of a
child. How to resolve potential dissagreement between
parent and child is largely unexplored, but it might be
possible to carve out exceptions to parental consent, as in
cases of medical treatment, or to give children veto power
over parental use of cognitive enhancement. Moreover,
since state interests in controlling cognitive enhancement
would not be compelling enough to override the parents
constitutional right to direct the upbringing of a child,
neither mandatory cognitive enhancement nor a ban on
cognitive enhancement will likely survive
judicial scrutiny.
REFERENCES
Greely, H. T. 2008. Remarks on human biological enhancement.
Kansas Law Review 56(5): 11391157.
Hodge, J. G., and L. O. Gostin. 2001. School vaccination
requirements: Historical, social, and legal perspectives. Kentucky
Law Journal 90(4): 831890.
Olsen, C. 2009. Constitutionality of home education: How the
supreme court and American history endorse parental choice.
Brigham Young University Education and Law Journal 2009(2):
399423.
Rush, S. E. 1985. The warren and burger courts on state, parent,
and child conflict resolution: A comparative analysis and
proposed methodology. Hastings Law Journal 36(4): 461514.
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W17
Wadlington, W. 1994. Medical decision making for and by
children: Tension between parent, state, and child. University of
Illinois Law Review 1994(2): 311336.
A Meta-Analysis of the Qualitative Design and
Development of Deep Brain Stimulation Institut de
Recherches Cliniques de Montr
eal Stipend Award
Z. Suskin, Harvard Medical School Center for Bioethics,
Georgetown University School of Medicine, and
Pellegrino Center for Clinical Bioethics
Background: Deep brain stimulation (DBS) is a
neurosurgical procedure in which an electrode or
electrodes are implanted in the brain (often with lifelong
presence), measuring and modulating specific brain
activities. It is increasingly recognized that technical and
ethical design and development of DBS should be
informed by the lived experiencesof end users,
including patients, families, caregivers, and health care
professionals. Such an approach advocates individual
needs and concerns and incorporates the role of and
effect on those interacting with DBS aside from the
patient, rather than distancing patients and families by
using a one-size-fits-allideology. However, there is
wide concern that the technocratic development of DBS
has largely operated in a vacuum, overwhelmingly and
exclusively shaped by efficacy studies utilizing
standardized, quantitative data and ignoring unique,
nonscripted information regarding user experience(s).
Open-ended, qualitative research may better inform user-
centered design and subjective outcomes by
understanding how end users live with DBS. Objectives:
This meta-analysis had two goals: determine the
prevalence of qualitative research being collected on DBS
and describe the scope and content of this research.
Methods: A systematic search of PubMed Medline was
conducted for qualitative data on DBS. Inclusion criteria
comprising target studies(TS) of target participants
(TP) were any study using nonstandardized qualitative
methods, assessing end userslived experiences, or
including nonpatient subjects. Studies were analyzed
according to five data points: year of publication, study
location, patient diagnosis, and time(s) and method(s) of
qualitative assessment. Content was then analyzed
thematically. Results: An initial search returned 1273
publications, and 505 studies (S) of 22,452 participants (P)
were relevant. Of these, 86 (17%) TS of 5,179 (23%) TP met
inclusion criteria. Publications by year: last 5 years (S: 43%,
TS: 56%, P: 57%, TP: 74%), average change per year (S:
þ30%, TS: þ7%, P: þ103%, TP: þ35%). Location: 36
countriesUnited States (S: 24%, TS: 23%), Europe (S:
54%, TS: 57%), other (S: 22%, TS: 20%). Diagnosis: 31
illnessesParkinsons (S: 57%, TS: 73%), other movement
disorders (S: 28%, TS: 16%), neuropsychiatric (S: 7%, TS:
8%), pain (S: 3%, TS: 0%). Follow-up time (months): range
(pre-DBS199.2), average (S: 11.3, TS: 8.9), 12 (S: 74%,
TS: 64%), 60 (S: 3%, TS: 2%). Methods of qualitative
assessment: 1215 assessments, 215 distinct methods
standardized (91%), nonstandardized (9%); patient (95%),
caregiver (3%), health care professional (2%). Seven
themes emerged from this analysis: global perspectives,
personhood, social interactions, procedural experiences,
device effects, caregiver burden, and health care
professional evaluation. Conclusions: The composition of
qualitative data collected on DBS runs contrary to popular
concern: comprising the majority of recent studies with
increasing prevalence; performed mostly internationally
despite the productionuser physical gap; and covering a
wide array of diagnoses. However, the majority of studies
investigate user input for less than 1 year, despite DBS use
typically being lifelong. Furthermore, the qualitative
content suggests that concern may still be warranted, as
significant, widespread concerns and experiences are
unaccounted for by existing and forthcoming DBS
developments. Investigation is still underway regarding a
satisfactory threshold of types of qualitative studies and
the degree to which DBS designers incorporate such data
and/or perform research.
Distributive Justice and Neuroenhancement: Current
Technologies Point to the Importance of Protecting
Equality of Opportunity  Institut de Recherches
Cliniques de Montr
eal Stipend Award
A. R. Wang, University of Cambridge
As neuroenhancement technologies improve, we
must pose questions about how to shape policy that
governs access to these technologies. Previous statements
by leading scholars in this field have called for special
attention to be paid to issues of distributive justice
(Greely et al. 2008). The purpose of this study is to
combine the conceptual literature on enhancement with
empirical studies on the uses of current
neuroenhancement technologies in order to justify the
importance of protecting equality of opportunity in the
distribution of neuroenhancements. There are two
primary approaches to this problem of how we ought to
distribute the benefits of enhancement: One is represented
by Harris in Enhancing Evolution (2010) and the other is
represented by Buchanan, Brock, Daniels, and Wikler in
From Chance to Choice (2000). The former argues that the
potential benefits of enhancements are so great that we
should advocate aggressively for their adoption, even if
this means that only the rich will have access to them at
first. According to this view, enhancements will become
safer and cheaper over time and, as a result, more widely
adopted, thus maximizing the benefits to all in society. I
call this the inequality-tolerant (IT) view. The latter
approach argues that enhancements should be pursued,
but cautiously, and regulated heavily, in order to ensure
that new enhancement technologies do not hinder
equality of opportunity and disadvantage those who are
already the worst off. I call this the equality of
opportunity (EOO) view. I argue that the primary reason
these approaches reach different conclusions about how to
regulate enhancements is because they define and
AJOB Neuroscience
W18 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
conceptualize enhancements differently. The IT view sees
enhancements as absolute goodsgoods that allow us to
live longer, healthier, more fulfilling lives, regardless of
whether other people have access to these goods or not.
On the other hand, the EOO view sees enhancements as
positional goodsthose that are sought out in order to
improve ones position relative to other people. The
benefits of positional goods come from the competitive
advantage that they confer over others. If
neuroenhancements are more likely to fall into one
category than the other, then it will be important to shape
future policy accordingly. In this study, I survey the
empirical literature on how current pharmacological
neuroenhancements are being used by healthy individuals
and find that use of these neuroenhancements is mainly
promoted through competitive pressurethe desire to
work harder or score better than others (Judson and
Langdon 2009; Sattler et al. 2014). This indicates that
neuroenhancements are more likely to be used as
positional rather than absolute goods. Accordingly, it
seems that the EOO view is a more appropriate approach
to policy governing the distributive justice of
neuroenhancements. As policymakers grapple with how
to regulate neuroenhancements, it will be important to
ensure that the benefits of these technologies are
distributed in a way that is just. This study argues that
concern for equality of opportunity regarding the access to
neuroenhancements is justified and should be a guiding
principle of regulation.
REFERENCES
Buchanan, A., D. W. Brock, N. Daniels, and D. Wikler. 2000.
From chance to choice: Genetics and justice. Cambridge, UK:
Cambridge University Press.
Greely, H., B. Sahakian, J. Harris, et al. 2008. Towards
responsible use of cognitive-enhancing drugs by the healthy.
Nature 456(7223): 702705. doi:10.1038/456702a
Harris, J. 2010. Enhancing evolution: The ethical case for making
better people. Princeton, NJ: Princeton University Press.
Judson, R., and S. W. Langdon. 2009. Illicit use of prescription
stimulants among college students: Prescription status, motives,
theory of planned behaviour, knowledge and self-diagnostic
tendencies. Psychology, Health, and Medicine 14(1): 97104. doi:
10.1080/13548500802126723[InsertedFromOnline]
Sattler, S., G. Mehlkop, P. Graeff, and C. Sauer. 2014. Evaluating
the drivers of and obstacles to the willingness to use cognitive
enhancement drugs: The influence of drug characteristics, social
environment, and personal characteristics. Substance Abuse
Treatment, Prevention, and Policy 9(1): 8. 10.1186/1747-597X-9-8
The Microethics of Care for the Neurological Patient 
Institut de Recherches Cliniques de Montr
eal
Stipend Award
E. Siliski, Massachusetts General Hospital and Harvard
Medical School
The standard approach for teaching bioethics involves
presenting case studies posing extreme moral dilemmas
and rendering judgments by way of rules-based metrics.
In reality, the clinician often must help the patient elicit
his own values and translate them into actionable
decisions in the context of illness. These formative
moments ask the clinician to connect with the patient on a
deeply human level. To do this, the clinician engages in
communication with the patient wherein many micro
decisions will be made: whether or not to make eye
contact, what words to use to describe side effects, and
how best to respond to the natural trajectory of a
spontaneously developing conversation. Microethics seeks
to focus on these minute moral decisions, the cumulative
effect of which can result in profound reverberations for
health outcomesparticularly for that of the neurological
patient. Decisions made in the setting of neurological
illness are regarded as being uniquely different from other
instances of medical decision making. Bernat asserts that
in no other instance of medical decision making is
accurate prognostication more important than in that of
devastating neurological injury. Diagnosis of neurological
illness brings with it a changed conception of identity, of
personhood, and of capacity for meaningful human life.
There is a general inability to comprehend neurological
illness as something anyone would choose to endure,
viewed more as a tragic loss and profound disability than
as a surmountable challenge. The clinicians smallest
decisions stand to color the patients and/or familys
interpretations of this experience and materially affect the
patients clinical trajectory. Attention to microethics in
education and reflective practice will empower the
individual clinician to promote neurological patients
interests through thoughtful and meaningful interaction
and engagement, as well as to combat the cliniciansown
moral distress in caring for this uniquely challenging
patient population. Using vignettes of clinical encounters
that engage the idea of presumed dread in neurological
illness, this presentation will seek to identify and
deliberate on opportunities to promote the ethical care of
these patients on a micro level.
REFERENCES
1. Truog, R. D., S. D. Brown, D. Browning, E. M. Hundert,
E. A. Rider, S. K. Bell, and E. C. Meyer. 2015. Microethics:
The ethics of everyday clinical practice. Hastings Center
Report 45(1): 11. doi:10.1002/hast.41.
2. Bernat, J. L. 2015. Observations on ethical issues in the
Neuro-ICU. Neurocritical Care 23(1): 13. doi:10.1007/
s12028-015-0142-9.
3. Komesaroff, P. A. 1995. From bioethics to microethics:
Ethical debate and clinical medicine. In Troubled bodies:
Critical perspectives on postmodernism, medical ethics, and the
body, ed. P Komesaroff, 6286. Melbourne: Melbourne
University press. doi:10.1215/9780822379782-004.
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W19
Ethics and Brain-Computer-Interfaces: A Mixed-
Methods-Study With Healthy Users Anonymous
Stipend Award
J. R. Schmid
1
, and R. J. Jox
2
1. Ludwig-Maximilians-Universit
at M
unchen
2. Ludwig-Maximilians-Universit
at M
unchen
Research on braincomputer interfaces (BCIs) has
rapidly increased in the last decades. BCIs record and use
brain activity in order to control external devices such as
personal computers or neuro-prostheses (Graimann et al.
2010). Thus, persons can act by the power of their
thoughts. Up to now, the use of BCIs has been dominated
by the fields of medicine and neuro-rehabilitation.
However, the development of BCIs for nonmedical
purposes gets more and more attention. Mark Zuckerberg
(Facebook) and Elon Musk (Neuralink) recently opened
BCI labs intensively working on applications for healthy
users. Furthermore, the amount of scientific publications
on BCIs in automobiles and planes is rising (G
ohring et al.
2013). This trend can also be seen in a growing BCI-
gaming community. Facing a new era of technology use
where a fusion of man and machine is increasingly being
realized by BCIs, widely varied questions concerning
technology use and ethics arise. What kind of expectations
and fears do BCI users have? Who is responsible for BCI-
mediated actions? What about issues of agency and
privacy? A mixed-method design was applied to answer
these questions. Based on maximum variation sampling,
24 qualitative interviews were conducted. Healthy BCI
users over a wide range, such as neurogamers, pilots,
users of consumer BCIs, and BCI developers and
researchers, were interviewed. The audiorecordings were
transcribed and analyzed using qualitative content
analysis (Mayring). Based on these findings, an online
survey with 1000 participants of the German public is
currently underway. The results indicate that BCIs as a
unique neurotechnology influence subjective perception of
humanmachine interaction in a novel way. Successful
BCI use was highly dependent on training and individual
motivation. Discomfort was mainly linked to the use of
gel and the time-consuming procedure of the
electroencephalography. Furthermore, most participants
reported to be cognitively exhausted after BCI use. Almost
all of the interviewees expressed being fascinated and
puzzled by this new technology, often using the word
weird.This ambivalence regarding BCI technology is
found in almost all users. BCI experts considered the
potential of this neurotechnology to be extremely high,
given the rapid technological progress and
individualization of mental strategies. The expert users
(researchers and developers) emphasized that the
technology is still in its early stages of development,
resulting in various performance problems. Next to signal
processing, feature extraction, and high latency, the main
hurdle is the low signal-to-noise ratio of the noninvasive
sensor arrays. Furthermore, numerous ethical issues arise.
Questions of agency and responsibility in the context of
BCIs are important topics that require further attention.
Additionally, most users report privacy issues and
increased concern about the loss of causal relations for
their actions. Above all, unrealistic expectations regarding
BCIs could easily lead to frustration. Our findings can be
the basis for a broad discussion among citizens and
policymakers trying to support a responsible and secure
future use of BCIs.
REFERENCES
Graimann, B., B. Allison, and G. Pfurtscheller. 2010. Brain-
computer interfaces: A gentle introduction. In Brain-computer
interfaces, ed. B. Graimann. Berlin: Springer.
G
ohring, D., D. Latotzky, M. Wang, and R. Rojas. 2013. Semi-
autonomous car control using brain computer interfaces. In
Intelligent autonomous systems 12. Advances in intelligent systems
and computing, ed. S. Lee, H. Cho, K. J. Yoon, J. Lee, vol.194.
Berlin: Springer.
aDBS, Automaticity, and Autonomy: In Search of a Way
Forward International Neuroethics Society
Stipend Award
Peter Zuk
1
, and Gabriel L
azaro-Mu~
noz
2
1. Baylor College of Medicine and Rice University
2. Baylor College of Medicine
In conventional deep brain stimulation (DBS), changes
in the parameters of stimulation must be made during a
clinical visit or patients may have the ability to manually
alter stimulation levels within a preestablished range.
Adaptive deep brain stimulation (aDBS), by contrast, is
characterized by the automaticity of its functioning
(L
azaro-Mu~
noz et al. 2017). In aDBS, the device adjusts
stimulation level automatically, utilizing biofeedback from
target brain regions. Some worry that the automaticity of
aDBS diminishes the subjects autonomy. In assessing and
responding to this worry, participants in the debate have
sometimes deployed quite different conceptions of
autonomy. Due to this development, those involved in the
debate now face the question of how to make further
ethical-theoretic and empirical progress regarding the
effects of aDBS on autonomy. We begin by cataloging
three major approaches to thinking about autonomy in the
context of neuromodulation: character-based approaches,
self-constitution approaches, and relational approaches.
We then consider the strengths and drawbacks of each
utilizing the ethical-theoretic method of wide reflective
equilibrium. We conclude that each offers important
insights such that, by the lights of reflective equilibrium, a
synthesis of the approaches is required. We then consider
three potential ways of accomplishing such a synthesis.
We first consider a reductionist position, inspired by the
M
uller et al. (2017) and Nyholm (2018) related debate on
DBS and personal identity. On this view, we should
reinterpret allegedly metaphysicalconcerns about
autonomy as instead amounting to conceptions of how to
live well. We question whether this position is compatible
AJOB Neuroscience
W20 ajob Neuroscience OctoberDecember, Volume 9, Number 4, 2018
with the plausible idea of autonomy as an independent
value for which the ethical significance does not derive
solely from other considerations. We next consider a
pluralist position, inspired by the Gallagher (2018) account
of personal identity. Autonomy would on this view be
multifaceted, with each of the major approaches capturing
one of these facets. We briefly assess the views resources
for responding to the de Haan et al. (2017) objection that
views like this one propose mere lists lacking in structure
and underlying theoretical unity. Finally, we consider
what we call an expansionary position. On this view, the
major approaches outlined earlier are incompatible as
views of what autonomy fundamentally consists of. But
they are compatible when recast as views of what
desirable exercises of human autonomy characteristically
involve. Regardless of which view gets the fundamental
nature of autonomy right, each identifies an aspect of
human agency that is ethically significant and importantly
related to autonomy in the context of neuromodulation,
even if not a feature of autonomy itself. The effects of
aDBS on autonomy are not solely of theoretical interest.
They are also sometimes matters of great practical
importance to prospective and current aDBS users and
their loved ones. Fully addressing the concerns of these
groups may well require explaining the effects of aDBS
not only in the terms of medical science, but also at a level
of description invoking the self, deliberation, choice, the
social backdrop against which these occur, and the net
impact of aDBS on stakeholderslives.
REFERENCES
de Haan, S., E. Rietveld, M. Stokhof, and D. Denys. 2017.
Becoming more oneself? Changes in personality following DBS
treatment for psychiatric disorders: Experiences of OCD
patients and general considerations. PLoS One 12(4): e0175748.
doi:10.1371/journal.pone.0175748.
Gallagher, S. 2018. Deep brain stimulation, self and relational
autonomy. Neuroethics. doi:10.1007/s12152-018-9355-x.
L
azaro-Mu~
noz, G., A. L. McGuire, and W. K. Goodman. 2017.
Should we be concerned about preserving agency and personal
identity in patients with adaptive deep brain stimulation
systems?. AJOB Neuroscience 8(2):7375. doi:10.1080/
21507740.2017.1320337
M
uller, S., M. Bittlinger, and H. Walter. 2017. Threats to
neurosurgical patients posed by the personal identity debate.
Neuroethics 10(2):299310. doi:10.1007/s12152-017-9304-0
Nyholm, S. 2018. Is the personal identity debate a threatto
neurosurgical patients? A reply to m
uller et al. Neuroethics 11(2):
229235. doi:10.1007/s12152-017-9337-4
Selected Abstracts From the 2018 INS Annual Meeting
OctoberDecember, Volume 9, Number 4, 2018 ajob Neuroscience W21
... Fine optical electrodes are inserted in the brain for light-induced manipulation of electrical activity in in-depth neurons and neuronal circuits. This method has revolutionized the study of animal behavior (Deisseroth 2010;Kumar et al. 2018a). Sonogenetics uses low-pressure ultrasound waves to activate the artificially ultrasonically sensitized neurons (Ibsen et al. 2015). ...
... Sonogenetics uses low-pressure ultrasound waves to activate the artificially ultrasonically sensitized neurons (Ibsen et al. 2015). Brain-computer interface (BCI) integrated with the neuro-recording methods like EEG is being used as a mode of study or manipulating a specific behavior based on the neurofeedback (Grau et al. 2014;Kumar et al. 2018a). ...
Chapter
Full-text available
The way in which an individual acts in response to a stimulus or situation is called ‘behavior’. Behavior is chiefly controlled by the central nervous system (i.e. brain and spinal cord). Behavior can be innate (present since birth) or is learned during a lifetime. Further it can be simple or complex. The simplest forms of behavior are the ‘reflexes’ which are innate in nature. For a reflexive behavior, the individuals may fail to perceive a conscious appraisal, as it primarily gets executed from the motor centers in the brainstem or spinal cord. Complex behavior, a varying motor action or response adjusted to the need of a situation, involves more than one component of the brain, and is intricately regulated. A stimulus which is received at the sensory receptors is carried by the nerves to the sensory cortex which generates perception and further sends it to the cognitive and the effectors domains of the brain where complex neural processing constructs a behavior from the substrate, in response. The comprehensive cortical processing of sensory feedback is essential for the conscious appraisal of a complex behavior. Reflex behavior is common to all the organisms, while complex behaviors are unique to the animal kingdom and denote their intellectual ability and hierarchy in the living system. Complex behaviors can be innate or learned. Innate behaviors (as feeding or sexual behavior) are genetically determined. Innate behaviors involve hypothalamus and other subcortical centers, and are associated with limited cortical processing in comparison to the learned behaviors. Emotional behaviors, which are largely innate, are regulated by limbic system which presents a unique set of cortical and subcortical centers. Learned behaviors may be driven by reward—a phenomenon called conditioning, or may not involve any reward at all—called non-associative learning. A reward pathway which connects aminergic nuclei of the brain stem to the specific nuclei group in the forebrain has been considered as the driver of any reward based behavior (Kiernan et al., 2014). Aminergic nuclei in the brain stem are known as the prime determinants of the adaptive behavior—which is largely a learned behavior helping the individuals in adapting to the environmental challenges. How brain generates behavior has been an all-time curiosity of the human which has now developed into a distinct stream of the neuroscience, called ‘Neuroethology’. In recent years, knowledge of the neural control of the behavior has got extensive research updates revolutionizing the existing understanding of neuroethology. Behavioral roles have been found for many new brain regions which were earlier either not or little known. Recent research suggest extensive role of Anterior cingulated cortex in decision making. Basal nuclei and cerebellum have been found to bear important roles in behavior, in contrast to their earlier known roles which limited to the movement control. There are also updates regarding the role of Insula (a cortical island) and Claustrum (a strip of gray matter), for which any cognitive/behavioral functions were earlier little known. Uniquely, Habenula—a subcortical set of nuclei which connects with brain stem, has been noted crucial in regulating adaptive behavior (Kumar et al., 2017). Other than the central nervous system, two other nervous system types i.e., ‘autonomic’ and ‘enteric’ are also known to bear important roles in complex behavior. The current research adds extensively into their behavioral functions. The present chapter takes a comprehensive look at the role of the three nervous system types involved in the regulation of animal behavior, and behavior-specific neural circuitries comprised of them, with a focus on humans.
Article
Full-text available
Moral evaluations occur quickly following heuristic-like intuitive processes without effortful deliberation. There are several competing explanations for this. The ADC-model predicts that moral judgment consists in concurrent evaluations of three different intuitive components: the character of a person (Agent-component, A); their actions (Deed-component, D); and the consequences brought about in the situation (Consequences-component, C). Thereby, it explains the intuitive appeal of precepts from three dominant moral theories (vir-tue ethics, deontology, and consequentialism), and flexible yet stable nature of moral judgment. Insistence on single-component explanations has led to many centuries of debate as to which moral precepts and theories best describe (or should guide) moral evaluation. This study consists of two large-scale experiments and provides a first empirical investigation of predictions yielded by the ADC model. We use vignettes describing different moral situations in which all components of the model are varied simultaneously. Experiment 1 (within-subject design) shows that positive descriptions of the AD D-, and C-components of moral intuition lead to more positive moral judgments in a situation with low-stakes. Also, interaction effects between the components were discovered. Experiment 2 further investigates these results in a between-subject design. We found that the effects of the AD D-, and C-components vary in strength in a high-stakes situation. Moreover, sex, age, education, and social status had no effects. However, preferences for precepts in certain moral theories (PPIMT) partially moderated the effects of the A-and C-component. Future research on moral intuitions should consider the simultaneous three-component constitution of moral judgment.
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Full text available at http://rdcu.be/IqxF -- Questions about the nature of self and self-consciousness are closely aligned with questions about the nature of autonomy. These concepts have deep roots in traditional philosophical discussions that concern metaphysics, epistemology and ethics. They also have direct relevance to practical considerations about informed consent in medical contexts. In this paper, with reference to understanding specific side effects of deep brain stimulation (DBS) treatment in cases of, for example, Parkinson’s Disease, Obsessive Compulsive Disorder, and Major Depressive Disorder, I’ll argue that it is best to frame discussions of informed consent in terms of relational autonomy and a pattern theory of self.
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