Wren Boehlen’s research while affiliated with Montreal Clinical Research Institute and other places

The work of public safety personnel (PSP; e.g. firefighters, police officers, and paramedics, among others) is essential to society but is practically and ethically complex, especially with the increased challenges posed by the COVID-19 pandemic. The strain on mental health in this population of workers and volunteers has been the focus of recent research. New programs and strategies are being developed and implemented in order to address the causes and implications of mental health problems at the individual and organizational levels in Canada and elsewhere. Yet, the properly ethical aspects of the work and work conditions of PSP have largely fallen outside the scope of public health research. There are few empirical studies on moral distress and moral injury of Canadian PSP, and the rich and complex moral life of these workers is often obfuscated by a pervasive, stoic, militaristic moral model that generally aligns with narrow biomedical treatment approaches. We argue that the lack of attention to the public, social, and ethical aspects of the moral distress and moral injuries experienced by PSP in Canada warrants greater public and academic awareness, more research on experiences of moral distress and moral injury in PSP, and evidence-informed training and support programs for individuals and organizations.

As brain-computer interfaces are promoted as assistive devices, some researchers worry that this promise to "restore" individuals worsens stigma toward disabled people and fosters unrealistic expectations. In three web-based survey experiments with vignettes, we tested how refusing a brain-computer interface in the context of disability affects cognitive (blame), emotional (anger), and behavioral (coercion) stigmatizing attitudes (Experiment 1, N = 222) and whether the effect of a refusal is affected by the level of brain-computer interface functioning (Experiment 2, N = 620) or the risk of malfunctioning (Experiment 3, N = 620). We found that refusing a brain-computer interface increased blame and anger, while brain-computer interface functioning did change the effect of a refusal. Higher risks of device malfunctioning partially reduced stigmatizing attitudes and moderated the effect of refusal. This suggests that information about disabled people who refuse a technology can increase stigma toward them. This finding has serious implications for brain-computer interface regulation, media coverage, and the prevention of ableism.

Over the last two decades, researchers have promised “neuroprosthetics” for use in physical rehabilitation and to treat patients with paralysis. Fulfilling this promise is not merely a technical challenge but is accompanied by consequential practical, ethical, and social implications that warrant sociological investigation and careful deliberation. In response, this paper explores how rehabilitation professionals evaluate the development and application of BCIs. It thereby also asks how the BCIs come to be seen as desirable or not, and implicitly, what types of persons, rights, and responsibilities are assumed in this discourse. To this end, we conducted a web-based survey (N=135) and follow-up interviews (N=15) with Canadian professionals in physical therapy, occupational therapy, and speech-language pathology. We find that rehabilitation professionals, like other publics, express hope and enthusiasm regarding the use of BCIs for assistive purposes. They envision BCI devices as powerful means to reintegrate patients and disabled people into social life but also express practical and ethical reservations about the technology, positioning themselves as uniquely qualified to inform responsible BCI design and implementation. These results further illustrate the nascent “co-production” of neural technologies and social order. More immediately, they also pose a serious challenge for implementing frameworks of responsible innovation; merely prescribing more inclusive technology development may not counteract technocratic processes and widely held ableist views about the need to augment certain bodies using technology.

Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement.

Forms of Artificial Intelligence (AI), like deep learning algorithms and neural networks, are being intensely explored for novel healthcare applications in areas such as imaging and diagnoses, risk analysis, lifestyle management and monitoring, health information management, and virtual health assistance. Expected benefits in these areas are wide-ranging and include increased speed in imaging, greater insight into predictive screening, and decreased healthcare costs and inefficiency. However, AI-based clinical tools also create a host of situations wherein commonly-held values and ethical principles may be challenged. In this short column, we highlight three potentially problematic aspects of AI use in healthcare: (1) dynamic information and consent, (2) transparency and ownership, and (3) privacy and discrimination. We discuss their impact on patient/client, clinician, and health institution values and suggest ways to tackle this impact. We propose that AI-related ethical challenges may represent an opportunity for growth in organizations.

Purpose: It has been proposed that rehabilitation practice expand its aims beyond recovery to “ultrabilitation,” but only if certain biological, technological, and psychosocial conditions are met. There is thus an opportunity to connect ultrabilitation, as a concept, to adjacent literature on assistive technology and sociotechnical systems. Method: We draw on insights from sociology of technology and responsible innovation, as well as concrete examples of neural devices and the culture of rehabilitation practice, to further refine our understanding of the conditions of possibility for ultrabilitation. Results: “Assistive” technologies can indeed be re-imagined as “ultrabilitative,” but this shift is both psychosocial and technological in nature, such that rehabilitation professionals will likely play a key role in this shift. There is not, however, sufficient evidence to suggest whether they will support or hinder ultrabilitative uses of technology. Conclusion: Advancing the idea and project of ultrabilitation must be grounded in a nuanced understanding of actual rehabilitation practice and the norms of broader society, which can be gained from engaging with adjacent literatures and by conducting further research on technology use in rehabilitation contexts. • Implications for rehabilitation • “Assistive” technologies can be conceptually re-imagined as “ultrabilitative” technologies, expanding their utility from recovery to enhancement and flourishing. • Actual development and use of ultrabilitative technology is both a technical and psychosocial challenge, and its success depends on the cultural context in which technology is situated. • Further empirical research is needed on the ways in which rehabilitation culture and the norms of broader society might impact or even inhibit the use of ultrabilitative technology.