Ethical concerns with evolving brain technologies

In the most recent issue of Nature, Jens Clausen, from the Institute of Ethics and History in Medicine at the University of Tübingen, has written a commentary on the evolving science of brain-implantable devices. Machines that are implanted in the brain aren’t entirely new, notes Clausen, having already been used for enhancing hearing through cochlear implants, for pre-surgical diagnosis and monitoring of patients with epilepsy and for control of devastating motor control symptoms of end-stage Parkinson’s through a technique called Deep Brain Stimulation.

Here’s the story: Man, machine and in between

Clausen’s main point in this commentary is that while some of these new and evolving technologies are unfamiliar, pose high risks and have unknown long term effects, the ethical concerns with brain-implantable devices aren’t new ones per se. The issues — risk and vulnerability — are the same kinds of concerns that arise in other kinds of high-risk medical research with unknown outcomes.

Who would these kinds of devices be tested on? Normally, new drugs and devices undergo trials on healthy subjects as a first step in testing. However, with the significant risk of known side effects from implanting a device into a healthy person’s brain (operative risk, bleeding, swelling, infection, etc.), testing on healthy individuals seems questionable, even inappropriate. Testing on those who already have neurological issues seems even more problematic, as they not only have an increased vulnerability due to the fact that they may be seriously ill but also their brains’ functioning and reactions may be more unpredictable, when faced with an implanted device. Long term effects of implanting a device in our most complex organ, are, at this point, completely unknown. While the risk is high, as Clausen notes, it is even higher due to the degree of unknown short and long term risks.

He does, however, note some ethical concerns with the use of brain-implantable devices that, arguably, are unique to this technology and are, really, important philosophical and value-based concerns about how we define normal, abnormal and deficient in terms of human functioning. There is a danger that with the development of this kind of science, we may be driving the problematic concept of what is considered to be “normal” even further. Cochlear implants, for example, are surrounded by controversy. Many activists in the deaf community take an opposing stand towards the supposed “normalization” of children with deafness by the use of these implants, as the implication clearly is that deafness is an aberrance and to not be able to hear is to not be able to lead a full and rewarding life. As the science of engineering and controlling brain functions through the use of implantable devices progresses, there are some who would certainly warn against the drive to use this kind of technology to further define those with “deficiencies” and push them towards a dangerous and narrow standard of what is considered to be “normal”.

If, instead, we look not at fixing what might be defined as “deficiencies” but at the very real possibility of enhancing “normal” functioning by, for example, using brain-implants to help professionals track athletes run faster, musicians to hear greater ranges of tones or allow mathematicians to calculate faster, this raises other kinds of ethical questions. Who would set limits on the technology in this case? Who would pay for it? How would we allocate resources — towards those who are paralyzed and could use devices to walk or move limbs or towards those who could have more than optimal, maybe even super-human functioning? The Six Million Dollar Man and the Bionic Woman might not be that far off.

This isn’t to say that we shouldn’t pursue this exciting and potentially very beneficial technology. But the ethical controversies are in fact, not the same as they’ve ever been in other areas of health research. Before we can plunge headfirst into thinking about the practicalities of conducting research using brain-implantable devices, we need to have much more discussion and contemplation on fundamental questions about how and why the technology might be used and subsequent implications for a diverse society.

~ by Nancy Walton on March 1, 2009.

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