{"title":"Non-voluntary BCI explantation: assessing possible neurorights violations in light of contrasting mental ontologies.","authors":"Guido Cassinadri, Marcello Ienca","doi":"10.1136/jme-2023-109830","DOIUrl":null,"url":null,"abstract":"<p><p>In research involving patients with implantable brain-computer interfaces (BCIs), there is a regulatory gap concerning post-trial responsibilities and duties of sponsors and investigators towards implanted patients. In this article, we analyse the case of patient R, who underwent non-voluntary explantation of an implanted BCI, causing a discontinuation in her sense of agency and self. To clarify the post-trial duties and responsibilities involved in this case, we first define the ontological status of the BCI using both externalist (EXT) and internalist (INT) theories of cognition. We then give particular focus to the theories of extended and embedded cognition, hence considering the BCI either as a constitutive component of the patient's mind or as a causal supporter of her brain-based cognitive capacities. We argue that patient R can legitimately be considered both as an embedded and extended cognitive agent. Then, we analyse whether the non-voluntary explantation violated patient R's (neuro)rights to cognitive liberty, mental integrity, psychological continuity and mental privacy. We analyse whether and how different mental ontologies may imply morally relevant differences in interpreting these prima facie neurorights violations and the correlational duties of sponsors and investigators. We conclude that both mental ontologies support the identification of emerging neurorights of the patient and give rise to post-trial obligations of sponsors and investigators to provide for continuous technical maintenance of implanted BCIs that play a significant role in patients' agency and sense of self. However, we suggest that externalist mental ontologies better capture patient R's self-conception and support the identification of a more granular form of mental harm and associated neurorights violation, thus eliciting stricter post-trial obligations.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Ethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1136/jme-2023-109830","RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0
Abstract
In research involving patients with implantable brain-computer interfaces (BCIs), there is a regulatory gap concerning post-trial responsibilities and duties of sponsors and investigators towards implanted patients. In this article, we analyse the case of patient R, who underwent non-voluntary explantation of an implanted BCI, causing a discontinuation in her sense of agency and self. To clarify the post-trial duties and responsibilities involved in this case, we first define the ontological status of the BCI using both externalist (EXT) and internalist (INT) theories of cognition. We then give particular focus to the theories of extended and embedded cognition, hence considering the BCI either as a constitutive component of the patient's mind or as a causal supporter of her brain-based cognitive capacities. We argue that patient R can legitimately be considered both as an embedded and extended cognitive agent. Then, we analyse whether the non-voluntary explantation violated patient R's (neuro)rights to cognitive liberty, mental integrity, psychological continuity and mental privacy. We analyse whether and how different mental ontologies may imply morally relevant differences in interpreting these prima facie neurorights violations and the correlational duties of sponsors and investigators. We conclude that both mental ontologies support the identification of emerging neurorights of the patient and give rise to post-trial obligations of sponsors and investigators to provide for continuous technical maintenance of implanted BCIs that play a significant role in patients' agency and sense of self. However, we suggest that externalist mental ontologies better capture patient R's self-conception and support the identification of a more granular form of mental harm and associated neurorights violation, thus eliciting stricter post-trial obligations.
在涉及植入式脑机接口(BCI)患者的研究中,赞助商和研究人员在试验后对植入患者的责任和义务方面存在监管空白。在本文中,我们分析了患者 R 的案例,她在非自愿的情况下拆除了植入的 BCI,导致其代理感和自我意识中断。为了澄清该案例中涉及的审判后义务和责任,我们首先使用外部主义(EXT)和内部主义(INT)认知理论定义了 BCI 的本体论地位。然后,我们特别关注扩展认知理论和嵌入认知理论,从而将 BCI 视为患者心智的构成部分或其大脑认知能力的因果支持者。我们认为,患者 R 既可以被视为嵌入式认知主体,也可以被视为扩展认知主体。然后,我们分析了非自愿切除是否侵犯了患者 R 的(神经)认知自由权、精神完整性、心理连续性和精神隐私权。我们分析了不同的精神本体论在解释这些表面上侵犯神经权利的行为以及赞助者和研究者的相关责任时,是否以及如何意味着道德上的相关差异。我们的结论是,这两种精神本体论都支持对患者新出现的神经权利的识别,并使赞助商和研究人员承担试验后义务,为植入式生物识别装置提供持续的技术维护,因为这些装置在患者的代理和自我意识中发挥着重要作用。然而,我们认为外部主义精神本体论能更好地捕捉患者 R 的自我感知,并支持识别更细化的精神伤害形式和相关的神经权利侵犯,从而引起更严格的试验后义务。
期刊介绍:
Journal of Medical Ethics is a leading international journal that reflects the whole field of medical ethics. The journal seeks to promote ethical reflection and conduct in scientific research and medical practice. It features articles on various ethical aspects of health care relevant to health care professionals, members of clinical ethics committees, medical ethics professionals, researchers and bioscientists, policy makers and patients.
Subscribers to the Journal of Medical Ethics also receive Medical Humanities journal at no extra cost.
JME is the official journal of the Institute of Medical Ethics.