The Ethical Implications of Neural Implants

The Ethical Implications of Neural Implants
June 22, 2020 No Comments Brave New World Apara Sharma

Thinking Out Loud: The Ethical Implications of Neural Implants

By Adaora Dadson

 Image by Gerd Altmann from Pixabay

This paper focuses on neural implants and how they could affect us as we encounter more advanced technology and medical procedures in a brave new world. Neural implants create electrical stimulation for the brain to counteract certain neurodegenerative diseases such as Parkinson’s and epilepsy. With the creation of these implants, we have to consider the ethical implications behind their development. While alleviating symptoms of disease, these devices can allow for increased autonomy of a patient and can provide more fairness for the disabled community. Even though the benefits are life changing, we also have to consider the possible negative ethical issues that could arise. Do neural implants have the capability to change who we are? Could neural implants infringe on our privacy? Can neural implants keep our data secured?  Prior to these questions being resolved, we should contemplate these main ethical considerations of neural implants and whether the benefits outweigh the negative consequences to society through the perspective of consequentialism. In this paper, I will argue that neural implants can provide patients with certain disabilities such as Parkinson’s, epilepsy, paralyzed limbs etc. with a more immediate, long lasting solution that promotes more autonomy and fairness for the disabled community. I will also elaborate more on my opinion on the topic and suggestions I would propose for implementation if I was in the position to do so.


Table of Contents


Abstract

Neural implants, also known as brain implants, are technological systems that can stimulate certain parts of the brain and the nervous system. Besides the creation of Deep Brain Stimulation in the 1980s, which I believe could be thought of as the first prototype of neural implants, these complex implants had been nothing but wishful thinking to scientists in the 20th century. A small, completely implantable chip that could have the ability to regulate irregular brain processes or connect the brain to a computer was thought of as something that would only be available in the far future. On the contrary, I believe that my research indicates that we could have neural implants available to the public within the next few decades (Corbyn). These implants could restore damaged brain tissue and neurons, decode the language of the brain to understand how we think, and decrease the severity of the side effects from different neurodegenerative diseases.

The purpose of this paper is to consider the possible ethical implications that can emerge from neural implants; how these implants could impact different aspects of our society and how they can revolutionize the medical world while providing factual information on what these devices can do.  I will argue that neural implants can provide patients with certain disabilities such as Parkinson’s, epilepsy, paralyzed limbs etc. with a more immediate, long lasting solution for their disease therefore creating more autonomy and fairness for the disabled community. The main conflicts I will discuss are issues of privacy through the implant’s access to brain activity, the possible changes in one’s identity that can come from the use of these implants, and of course the safety implications that could arise with using these devices in the advancement of medicine.


The Story of HB

In 2008, doctors diagnosed HB, a patient whose real name is unknown, with locked in syndrome which completely paralyzed her body while her brain remained perfectly intact. One of the effects of the disease was that she couldn’t breathe on her own and therefore couldn’t communicate with other people. She was trapped inside her own body. HB then had the opportunity to be implanted with a small, wireless electrode underneath the skull which was able to record her brain waves. By analyzing her brain activity, the device in her head allowed her to select letters on a computer screen as a form of communication. The recording of her brain waves allowed the scientists to observe whenever she thought about moving her fingers because her brain waves in her motor cortex would act differently than normal. She also had a control device implanted in her chest which was able to communicate to a computer via a radio transmitter.

Image by Unbox Science from Pixabay

This was a huge achievement because it enabled HB to communicate easily for the first time in many years. Aside from being able to converse, she was able to transition smoothly to using an implant and quickly learned how to control it. She was trained to control a cursor of a video game with her neural implant just two days after surgery. This device allowed for an improved quality of life for HB

 “The ability to communicate has given her more freedom and made her more independent”

-Erick Aarnoutse, a neuroscientist who helped with the technical aspects of the device (article by Fields)

HB would likely have never had the chance to communicate again without the help of neural implants (Fields). In addition to giving disabled people the option to address severe disabilities, neural implants could also provide able bodied people with the ability to enhance their minds and push the envelope on the definition of what it means to be human. Although there are real risks that have to be considered and controlled, I believe neural implants will become an integral part in the future of our brave new world because the benefits are compelling.


What are Neural Implants?

Neural implants are technological systems that have the ability to stimulate different parts of the brain and nervous system. Through access to nerve cells, these implants are able to record and regulate brain activity.  The implant processes information, analyses it, and then sends it out as a signal to a different part of the brain. This is beneficial because with certain diseases such as Alzheimer’s that results in damaged brain tissue, neural implants can help restore tissue function. Similar to how Morse code has a different sequence for every letter or phrase, the implants can fire a series of impulses in order to communicate with other neurons. The implants can also use these impulses to override the regular function of one’s neurons to force them to interact in a different way; this can reactivate nerve cells that have been damaged or dormant in order to aid in restoring their function (Neural Implants).

Image by Gerd Altmann from Pixabay

Modern implants have an exterior soft cover and an interior that contains a processor similar to a computer chip. The inside of the implant usually contains metals, carbon nanotubes and conductive polymers. Currently, the external parts of the implants are often made from silicone and/or polymers but researchers continue to experiment with other materials. Silicone is soft and malleable but can be harder to implant. On the other hand, polymers are flexible without being elastic. However if the polymers move around a lot, it could damage the brain or nervous system. Both materials have their benefits and deficits: the malleability of silicone is desirable because it causes less scarring but polymers are easier to implant (Volpicelli). Researchers continue to experiment with both materials to see which one would be best for the exterior of a neural implant.

History of Neural Implants

Even though the idea of using electricity to manipulate human brains seems very modern and futuristic, experimentation actually started as far back as in the 18th century. The first prototype of a neural implant was created after Luigi Galvani’s discovery of how all living things were “electrical” in 1780.

In 1870, two German scientists Edward Hitzig and Gustav Frisch demonstrated that the movement of living things (emphasis on “living things”- human testing had not been done yet) could be manipulated through electrical brain stimulation. The first human testing occurred in 1874 by an American scientist Roberts Bartholow.

A patient by the name of Mary Rafferty had an ulcer on her head which created a gap in her skull. With her consent, he used electrodes on her brain and saw that different limbs reacted to the stimulation. Unfortunately, the electrical currents were too extreme and she didn’t survive. Even though she died, Bartholow showed that human brains could definitely be manipulated by electrical stimulation (Fitchett). This history set the foundation for continued experimentation with electricity and the key role it plays in the proper function of the human brain. In more modern times, scientists have continued to use this knowledge to develop neural implants that could alleviate deafness (cochlear implants)(1961), blindness (Argus I) (2002), help with symptoms of neurodegenerative diseases, and better improve neural prosthetics.

How Neural Implants Function

The job of a neural implant is to gather information from brain activity and have the ability to send it out to other parts of the brain or external sources. The reason that implants need to get information is so that they can closely monitor the activity to detect any irregular patterns that could negatively affect the patient’s health. From monitoring the brain’s signals, the implant can identify which neurons are firing from what part of the brain and what action those neurons create.

In the cases where the neural implants is exporting brain activity to external sources such as to a doctor, the doctor can use the information to understand how the brain and the neural implant work together and if any adjustments have to be made.

Within most neural implants is a micro-electrocorticography machine that can monitor brain activity and feed it into the implant. The micro-electrocorticography (micro-ECoG) machine is easily implantable and allows for less chance of infection and foreign body response which would cause the brain to attack the implant, thinking that it is an infection. This type of listening device is always recording activity with a high spatial and temporal resolution to ensure that the neural implants will have clear and specific information from micro-ECoG signals which is better for scientists to analyze. These signals can also be split so that instead of going to another part of the brain, that activity can immediately be collected and exported for research. In terms of who or what can get access to these brain transmissions, it can either be shared from neuron to neuron or from the brain to an external source. Signals can be communicated to work with other parts of the body.

Neural implants can be connected with prosthetics to help to better control the prosthetic and to make them feel more like a real limb. Additionally, these implants can communicate with other paralyzed body parts to encourage its neurons to reactivate. Neural implants could allow specific portions of the brain activity to be exported for further analysis by neurologists and researchers for example. With data from the brain being exported to external parties, privacy issues could arise therefore this data should be covered by patient-doctor confidentiality, and in addition, there should be controls to determine who can have access to a patient’s brain activity.

When neural implants send information to other parts of the brain, they aid or act as neurotransmitters in the brain. Neurotransmitters assist nerve cells by sending messages to other cells in our muscles and other nerves. This function allows for neurotransmitters to regulate many critical processes in the body such as muscle movement, breathing, and heart rate. A neurotransmitter that is more commonly known is dopamine which is responsible for giving us pleasure while also assisting with learning, memory, and coordination. A disease like Parkinson’s creates a dopamine deficiency because it makes neurons in the substantia nigra part of our brain degenerate (Triarhou).

This inevitably decreases dopamine flow because the neurons in the substantia nigra are needed in order to communicate with basal ganglia neurons to create dopamine. With the aid of neural implants, the creation of dopamine for Parkinson’s patients would be regulated. 

If the levels of dopamine become too low in the brain, the neural implant can send electrical pulses to the neurons to make them release the normal amount. This feature is beneficial because the implant would be in charge of the regulation of many different neurotransmitters and the patient wouldn’t have to do anything to enact the implant’s pulses. Similar functions can be attained with dopamine releaser medications such as Prozac and Ritalin. However with medication, it is entirely up to the patient to remember to take it in order for effects of the disease to subside so there is more room for error with medication. Additionally, medicine gives patients more of a generalized dose that usually works for most people. Meanwhile, neural implants can be more personalized to the patient’s needs right down to their neurons because the location and intensity of the stimulation can be changed at any time based on the brain’s reactions. Along with aiding neurotransmitters, neural implants make the generation of new neurons more efficient, thus contributing to neuroplasticity

What is Neuroplasticity? Neuroplasticity is the process in which your brain’s neural synapses and pathways are altered as an effect of environmental, behavioral, and neural changes. Neuroplasticity changes over the course of your life because people learn more as they get older.

In fact, it works together with synaptic pruning, which is responsible for deleting neural connections that are no longer useful to the brain in order to put more energy into strengthening other connections that we use more often. Neuroplasticity is also utilized when someone suffers from a brain injury because it allows for the reallocation of functions to new areas of the brain previously used for other tasks. For example, if the left hemisphere of the brain, which controls speech, gets damaged, the right hemisphere of the brain can reorganize different neuron connections and obtain some of those speech skills to compensate (Shiel).

Neural implants can help facilitate more motor control recovery by encouraging neuroplasticity through neural implant based neurofeedback, a technique where the receiver of the implant learns to change their brain activity.

Neurofeedback works together with action observation and motor imagery in order to create the best chance at rehabilitation for the patient. Both action observation and motor imagery work as treatments for improving motor skills. Action observation allows patients to watch other people perform simple actions and then they mirror that action, creating new neural structures in the patient’s brain from what they see (Buccino). Motor imagery involves having a patient imagine that they are completing a task without physically doing it which can activate certain parts of the brain that are associated with that action (Mulder).

Treatment of Diseases

Neural implants were originally created with the purpose of attempting to better relieve symptoms of patients with neurodegenerative diseases or illnesses, compared to traditional methods of treatment. The most prevalent disease that neural implants have affected is Parkinson’s disease. As stated earlier, Parkinson’s is a neurodegenerative disease which affects the amount of dopamine released in the brain. This disease causes a wide range of side effects but some of the main ones are limited movement abilities and extreme tremors.

Today, there is already a solution to help improve the effects of Parkinson’s: a form of neural implant called Deep Brain Stimulation (DBS).

DBS has two components: one part is connected to the patient’s head which monitors brain activity and the second part is lower on the body by the shoulder and it acts like a battery pack in order to generate the electrical impulses. The battery pack and the headpiece are connected by a wire that travels throughout the body. DBS has helped numerous patients manage their Parkinson’s and relieve their symptoms. However, it doesn’t work for every patient and its stimulation levels are not as adjustable as newer versions of neural implants. In fact, some people have even experienced a deterioration after using Deep Brain Stimulation. Also, DBS has only been used in treating Parkinson’s and hasn’t had much success in treating other diseases. Neural implants have the potential to treat a diverse range of diseases, not just one. Some of these neurological diseases include clinical depression and epilepsy. 

According to ScienceNews, one-third of the 16.2 million U.S. adults with severe depression don’t respond to conventional treatments. This means that for over five million people, their brain function and symptoms don’t adequately improve with the use of antidepressants.

With the help of neural implants, researchers have learned more about depression and which brain networks are involved in the regulation of our emotions. Trials for treating depression with DBS have occurred but have shown mixed results (Sanders).

A neural implant’s microscopic size and wide range of signal can provide specificity in the areas where there are different brain waves related to emotions. Even with this groundbreaking discovery, there is still a lot of research to be done on depression and how neural implants could help in its treatment in the future.

For epilepsy, neural implants have made great strides in reducing the severity of its symptoms. A neural implant can regulate neurotransmitters in the brain that are connected to epilepsy to combat a seizure before it even starts. Once the beginning of a seizure is detected in the brain, the neural implant sends out neurotransmitters to the seizure site which can counteract the spread of electrical disturbance in the nervous system. This theory was tested on implanted rats to see whether the neural implant could actually prevent a seizure. In the experiment, the implant was designed to send out precautionary neurotransmitters to the rats’ brains. Then, chemicals that induce seizures were injected and the rats successfully avoided a seizure (Proctor).

Neural implants have also contributed to neural prosthetics. As mentioned earlier, neural implants can be connected to prosthetics in order to make them feel more like a natural limb. Much research and testing for this idea has been conducted by the Defense Advanced Research Projects Agency. Their vision is to make prosthetics smarter by using them with neural implants which can allow patients with artificial limbs to recover sensation. And it has worked.

A paralyzed man named Nathan Copeland had a neural implant made of microelectrode arrays implanted into his primary somatosensory cortex. After this procedure, he was able to sense when pressure was applied to different fingers on his robotic arm with about 80% accuracy.

This was the first time that he had been able to feel anything for years. Even though he wasn’t able to feel whether objects were hot or cold, this experiment was still deemed a success and a step in the right direction for the future of patients with paralyzed limbs (Dvorsky).

Neural Implants vs. Traditional Methods

As I’ve mentioned briefly in the paper, there are already different non-neural-implant treatments that we use today to help people with their diseases. So what makes neural implants different or better than the traditional methods such as Deep Brain Stimulation and physical therapy?

Before explaining how neural implants stand out from the rest, it must be noted that since neural implants are currently still in the testing stages, they will most likely be used together with one of these traditional methods. But as the abilities of neural implants become more definite, they will likely become treatment on their own. 

Deep Brain Stimulation and modern neural implants are actually very similar. DBS is thought of as the first prototype of neural implants; the original version of a brain implant. From being in use since the 1980s, it has provided scientists with a good base for the research of modern neural implants, and without its advances in medicine, we wouldn’t have any recent knowledge of how we could safely use electrical impulses on the brain. However, the structure of DBS is slightly different from modern neural implants. Since DBS uses a wire to connect the brain piece to the battery back, it can create many complications as the wire runs through the body. The wire can easily become infected and is prone to breakage which leads to a complicated surgery to fix it.

Modern neural implants would be a brain piece with no battery pack. All of the components needed for it to work would be compact inside the tiny neural implant which decreases the chances of having complications for the patient

Although DBS was one of the first types of machines to examine brain processes, modern neural implants can expand beyond DBS’s capabilities since they provide fewer complications and greater impacts on a wider range of diseases. 

The second traditional method, physical therapy, has been the most common solution for patients suffering from paralysis or brain injury. It is very traditional in the sense that it generally doesn’t use any electronics but it focuses on repeated use of the injured body part to enact neuroplasticity. One benefit of physical therapy is that it is a very reliable therapeutic method because it has been utilized for many years and it is very effective. However, physical therapy usually takes weeks or even months for the progress to take hold, meanwhile the effects of neural implants can change a patient instantly. A neural implant can be a more efficient solution because once it is turned on and adjusted, patients can have positive results within minutes.

Neural implants can also decrease the amount of human error that could possibly come from doing physical therapy. With physical therapy, it is usually up to the patient to keep up with the appointments and not lose progress.

If a person has a neural implant, they don’t have to remember to do anything because it still works whether the patient remembers or not. In addition, an experiment was conducted with four patients who were paralyzed and unable to walk or stand. They all did the same amount of physical therapy for many weeks but this alone was unsuccessful in allowing them to stand. An electrode array was then implanted in the spine of each patient while they also continued physical therapy, and this combination allowed them to walk with a walker and stand. As soon as the implant was disabled, they lost their abilities (Emery). Even though this isn’t a neural implant (because it was implanted in the back and not the brain), it still demonstrates that an electrode array implanted in the body can drastically improve the life of a patient and allow them to walk again. From this experiment, it is expected that these results might generalize to other applications of neural implants.


The Status of Neural Implants Today

Within recent years, there have been tremendous strides made in the innovation of neural implants and the possibilities of what they could do. Different companies have started to take interest in neural implants and have started to make some of their own. Elon Musk has created a company called Neuralink which is focused on neurotechnology. In the future, he not only wants to help treat brain diseases with these machines but he also wants to create them for the purpose of human enhancement. Musk is inspired by the transhumanism movement which pushes to improve human conditions by having these new technologies increase human intellect. He has already conducted successful tests on monkeys and is planning on proceeding with human testing as soon as the end of the year. Other companies such as Synchron and Facebook have followed in Neuralink’s footsteps, creating their own version of neural implants.

 However, these companies are less focused on helping to treat diseases and more focused on making the overall population more advanced. Synchron and Facebook want to focus on connecting the brain to the computer to allow humans to “type” without actually having to type. As I mentioned before, DARPA has also started testing neural implants with prosthetics and they also have done research in creating prosthetic memory. The Restoring Active Memory program was started with the goal of creating implants that help extend memory through electrical impulses, specifically focusing on helping short term memory. This device could greatly benefit military personnel who have suffered from brain injuries and can allow them to retain information faster and for longer.

Millions of dollars have been used to create neural implants which are now being used by thousands of people.

The total number of people that have neural implants is unknown, but it is known that over 30,000 people have been implanted for the treatment of Parkinson’s disease. Additionally, as of 2012, about 324,200 people had been implanted with cochlear implants worldwide (Cochlear Implants).

So with additional applications, the amount of neural implants in use could increase towards a million in the near future.


Ethical Implications of Neural Implants

Before I start to examine the different ethical issues, I want to present a real life case with a patient using a neural implant and how the implant affected him. Mr. B  (who’s name was unknown for privacy reasons) had DBS implanted for his OCD. Before he got the DBS treatment, he didn’t like music but afterwards he had a specific love for Johnny Cash’s music. As soon as the device was turned off, he didn’t like Johnny Cash anymore (Cabrera and Carter-Johnson). His implant didn’t give him the choice to decide whether he liked Johnny Cash’s music, it just conditioned his brain to do so. Even though in this example the DBS didn’t cause a change in Mr. B’s external appearance, it affected his identity because his music taste changed. This is just one example but in the future could DBS or other types of implants affect our identities in a more drastic way?

In analysing the possible ethical issues that could arise from the concept and implementation of neural implants, I chose to think through the perspective of consequentialism.

According to the Stanford Encyclopedia of Philosophy, consequentialism is an ethical theory that judges whether or not something is morally right by what its consequences are (Sinnott-Armstrong).

With neural implants, there are several good and also several bad consequences that could arise from their creation. If the good outweighs the bad, then from the perspective on consequentialism, it is morally right to continue to develop neural implants.

It is important to consider the values of equity and justice when analyzing the ethics of  neural implants. The cost of these implants could create a socioeconomic divide between people who can afford neural implants and people who can’t. Right now, a singular implant could cost thousands of dollars, plus additional costs for maintenance and doctors’ appointments. Although currently neural implants are not available on the open market, in a few decades they could become available and could create a prominent divide in society. As an example, a wealthy family could give their children neural implants to enhance their performance versus a poorer family who would not be able to and therefore would be further disadvantaged in society. 

Another negative consequence that could arise from neural implants being widely available is that regulators may review them more from the perspective of the broader population than from the perspective of the disabled population. Some researchers have argued that neural implants shouldn’t be created at all because of potential negative impacts on the general population such as worsening income inequality (McKissen). Even though worries about negative impacts on the broader population are valid, these have to be weighed against the potential significant benefits neural implants could have for the disabled community. Referring back to the story of Nathan Copeland, he was interviewed on his experience with having an implant and was asked what his motivation was to sign up to use this device. 

 “To help push the technology so it is commonplace enough to really help people out, so they don’t go through the things that I went through. The depression and the feeling that you can’t do anything anymore and can’t contribute to society—it’s just despair. Joining this study has given me a sense of purpose”

-Nathan Copeland, participant of neural implant testing (article by Regalado)

With the help of neural implants, he was able to feel like a part of society again and he was grateful to have the ability to aid his injuries from his accident. The implant helped him not only by restoring some of his movement functions but also by allowing him to feel useful. Positive experiences like this show that neural implants can be beneficial to some disabled people and therefore should not be disregarded. An important point to highlight is that some people with a disability may not want a neural implant because they are comfortable with their disability and don’t consider it as something that needs to be fixed. Nevertheless, it still makes sense to develop neural implants because it gives all disabled people the option to use or not use them and therefore the positive benefits to the people who choose to use them (such as Mr. Copeland) should not go unnoticed.

If we were to focus only on how able bodied people could possibly abuse neural implants, that would prioritize their needs of the general population over that of the disabled population. The disabled population makes up about 1/7 of the world’s population, and disadvantaging them just because researchers are concerned about potential abuses for the broader population is unjust. Therefore, as neural implants continue to progress and regulations are developed to control them, it should be kept in mind that this machine could greatly benefit the disabled community and could completely change their lives.

Ethical Consideration: Autonomy

The implementation of neural implants highlights important questions regarding the autonomy of the patient. Autonomy is having the ability to self-govern (Christman). One positive benefit is that neural implants can allow disabled people to further express their autonomy. For example, one of the common side effects of Parkinson’s is tremors which can make it hard for patients to eat, drink, walk, or bathe themselves without shaking. Using an implant that subdues tremors could allow a person to more easily pick up a utensil and eat by themselves.Without disease or without most side effects of disease, patients with paralysis or other debilitating symptoms wouldn’t have to rely on anyone else to do day to day tasks, therefore promoting their own independence.  

However, there is a risk that neural implants could actually decrease autonomy. How much of a patient’s decisions is based on conscious thinking and how much is due to the neural implant completing actions for the patient? And how does this affect the patient’s competency? When Mr. B got DBS, it seemed like he didn’t make the decision to like Johnny Cash, the neural implant just made him like it. In some ways, his autonomy was compromised because he didn’t make the choice; the implant had authority over his brain (Woolf). Neural implants can create new personality changes such as a gambling addiction which was a side effect seen in a patient using DBS who started to spend all of their family’s money without understanding why it was a bad decision (Extraordinary Personality Changes).

If a person is unable to understand the consequences of their behavior and why it’s bad, then they cannot take full responsibility for doing that action therefore they are not fully competent as moral agents. It is a possibility that our autonomy and the “autonomy” of the implant could clash over control of the human brain.

In fact, certain neural implants can utilize artificial intelligence to predict what the brain is going to do next. This function would be mainly used with neural implants that work with prosthetics so when the patient wants to step, the prosthetic is ready for the next move. However, if that prediction doesn’t align with what the person actually wants to do, both the human and the implants end up fighting for control. It is understandable how neural implants that use prediction would be efficient, but I believe that it can decrease the agency that humans have. A patient shouldn’t have to risk giving up the competency that they still have for extra technological features and the neural implant should work with the human mind instead of trying to control it completely. 

In addition to the risk that the neural implant could control the patient, there is another risk that could occur if external parties are able to gain access to the neural implant and control the patient. For example, if in the future a hacker was able to gain access to the neural implant that could interfere with the patient’s autonomy.

 In summary, while neural implants can increase autonomy in some ways, they can also negatively impact autonomy in other ways because the patient may not have full control over their actions.

EEthical Consideration: Fairness

When thinking about why neural implants would be an essential part of the future of medicine, it is important to consider fairness. Some diseases can be debilitating and can prevent a disabled person from being able to accomplish day to day tasks. In addition, disabled people are sometimes subject to pity from the broader population which could lead to a feeling of being marginalized.  Neural implants could promote fairness in society because they could give the disabled population the option, if they choose, to address the limitations of their disease which could improve their physical performance and their quality of life.

Ethical Consideration: Privacy

As previously mentioned, neural implants can have access to our nerve cells and brain activity. They use this accessibility to collect information about how our brains work and can constantly transmit information to other neurons or to external sources such as a doctor. However, could it become possible that our brain information could be shared with other people? Could it even be hacked? These are questions that need to be considered when thinking about neural implants and how they could possibly infringe on our privacy rights.

Image by Mohamed Hassan from Pixabay

First, we need to better understand exactly what information or activity is being monitored and how it is transmitted. As mentioned before, neural implants have the ability to observe different brain patterns and this information would later be examined by a doctor. At the moment, neural implants are designed to combat a specific condition and are located in the part of the brain to collect the information necessary for that condition. For example, with Parkinson’s, the source of the condition is in the substantia nigra, a specific region of the brain. Therefore, the implants would only show activity from that area. However in the future when we start using neural implants more recreationally for overall cognitive enhancement, I would predict that the implant would have access to all parts of the brain, covering every cognitive process. This increases the amount of brain activity information that could potentially be accessible to others. Doctors would need to be able to receive information for the implant to ensure that it is working properly. In some cases, this may require an in person office visit.

As an example, with DBS, the doctor essentially uses the “guess and check” method in the office to find the best setting to address the most symptoms for the patient because there is no set setting that works for each person (Okun and Zeilman).

However, I believe that there will be other situations where an office visit isn’t necessary and the doctor would be able to access the data remotely which increases efficiency and the doctor’s accessibility and costs less than in-person appointments. As another example, when checking pacemakers, doctors can collect information about irregular heart rate remotely, such as by phone or over the Internet. The patient could either use a transmitter given by the doctor to transmit information over the phone or the pacemaker could, with the patient’s consent, send information automatically to the doctor while the patient is asleep (Cardiac Device Monitoring). The doctor would be responsible for informing the patient of the possible risks of their information being given out to third parties so it allows them to make an educated decision about what they are about to sign up for.

The main concern with neural implants having the ability to transmit information is figuring out the extent to which the brain activity can be monitored and potentially interfered with. As mentioned before, the doctor needs access to the brain activity information so they can provide medical advice to the patient and ensure that the device is working properly. The patient can provide their consent for the doctor to be able to access that data. Contrary to these benefits, the transmission of a patient’s brain activity can be hacked although this currently seems unlikely. Based on similar technologies that are found in pacemakers, hacking seems unlikely because the hacker would have to be close to the patient and the device would have to be connected to the Internet which is not currently a requirement of neural implants. Some researchers believe that hackers wouldn’t even attempt or have the motivation to hack implants (Johnson). So far, there have been no medical devices hacked which shows that there seems to be little to no risk to hacking currently.

Based on this data, I feel that security risks have not been the first priority of implant manufacturers and they have been more focused on improving the performance of the implant in addressing the disease.

However, in my opinion, the risk of hacking could increase in the future with new advanced technology that has firsthand access to the brain therefore manufacturers should start implementing the necessary security measures to address that now.

For example, there has to be a secure means of authentication from the doctor’s side to make sure only the doctor has access to the implant in order to minimize risk of tampering with information. 

A possible function of neural implants in the future, specifically for neural implants that would be used for cognitive enhancement,  is allowing them to put the brain activity that they collect into a “cloud.” A huge risk of having a “cloud” for data collection would be that you could never have completely private thoughts; someone could also have access to it. This risk is further magnified when thinking about data breaches that could result in unauthorized access to a patient’s information.

In 2019, about 32 million breeches of medical records were reported (Steger). This shows that data breaches are already a concern.

Neural implants will be able to collect information on your brain activity that is very sensitive and private information with very harmful consequences to the patient if it gets exposed. In addition to manufacturers improving the performance of  neural implants, they also have to increase security measures to make sure that a patient’s information can stay protected.

Ethical Consideration: Safety

Whenever a new product is created that is geared towards improving the health of humans, one of the first questions asked is how safe it is. In this case, we have to consider both how safe it is for a patient to use the device for their own health as well as consider the safety of the patient’s information.

While neural implants are intended to provide benefits by managing symptoms of a disease, a possible complication that could occur is triggering a foreign body response from the insertion of a foreign object into the brain.

With neural implants, the surgery has to be precise and intentional in order to minimize the chances of the body fighting against the implant and causing it to be ineffective. 

Another important way that safety is ensured for neural implants is the extensive testing that is required by the regulation process. These devices are classified as very high risk so they are required to go through diligent in vitro, in vivo, and ex vivo testing. In vitro experiments focus on the electrical and mechanical aspects of a neural implant and they get tested in different types of environments. This evaluation is done in the beginning stages of development and its results can be used during the different stages of testing. In vivo experiments determine the effectiveness and reliability of the neural implant in a preclinical evaluation. This is when animals are utilized to see how these machines function and to observe what type of animals they can benefit. Before a product can go to a proper clinical trial, it has to be tested on an animal model. Test subjects can span from mice to cats to monkeys that have a disease or injury that would later be similar to the diseases tested in the real clinical trial. The neural implant is then put to the test to see whether it can successfully combat these issues in these animals. Ex vivo experiments occur when the focus of the neural implant manufacturing process turns to human application. This includes developing surgical procedures and determining if the implant is robust enough to function in a cadaver, which gives doctors the opportunity to assess possible implant placement before the clinical trials (Shepherd). This testing process is crucial for eliminating safety concerns and it’s a necessary step before neural implants can be allowed to be put on the market. The safety of these devices is then determined by the FDA after clinical trials have been proven successful and the administration deems the product safe for the public (Welle and Krauthamer).

The safety of patient data is important with neural implants. As we get closer to integrating neural implants into our daily lives, in order to assure privacy for the patient, security measures have to be added. For example, the data from neural implants should be covered within the agreement of doctor-patient confidentiality. Another risk to patient data is the possibility of a neural implant being hacked. However, as of now there hasn’t been any immediate concern in the possibility of a neural implant getting hacked and it is believed to be relatively safe from this perspective based on data from machines with similar technology (Curley).

The safety of these implants, both from the perspective of the patient’s health and their data, are important concerns right now.

If the implant cannot assure that the patient’s safety, this would deter the development and widespread acceptance of these devices.

Ethical Consideration: Identity

With neural implants having access to our brains, not only can they control motor skills and neuron behavior, but they can also affect how we perceive ourselves and our identity. Some rare side effects of neural implants have been changes in personality such as a newly found gambling addiction or impulsive behaviors (Extraordinary Personality Changes).  In these circumstances, neural implants can impair a person’s judgement such that they are unable to comprehend why being impulsive is wrong. Such a drastic change in identity raises the question of whether a patient’s thoughts or actions are truly their own and whether they remain themselves while using a neural implant.

A report was published which showed that patients had different reactions to the changes they noticed in themselves from neural implants. For example, one patient felt that she had found her real self after having the implant take control over her condition (Extraordinary Personality Changes). She didn’t have to worry about the effects of the disease so she was able to be more sociable and active. Living with an implant became part of her identity. However, another patient had a very contrasting reaction.

 “[The device] made me feel I had no control. […] it made me feel that I was always different [from] everyone, not just in the moment of the seizure,”

Anonymous patient who used a neural implant (report by Illes

She had felt very isolated from the rest of society and it caused severe depression because she had to be so dependent on the implant. These two examples suggest that there are extremes of how different people react and that neural implants can definitely have an impact on your identity, for better or for worse.

The report by Illes and other bioethicists made me question whether a person is more likely to feel like their true self when they do not use a neural implant to improve the conditions of their disability versus when they do. According to my research, there isn’t a clear answer for this question because it appears to rely on each person’s different circumstances. I believe that the answer may depend largely on when the person was diagnosed with the onset of disease. If you were born with the disability, then you don’t know a life without it; it is a part of you and it always has been. With this once in a lifetime opportunity to relieve the symptoms of the disease, this can lead to the feeling of a new identity as it presents a new way of living that you have never experienced before.  For those who were not born with the disease, whether the use of neural implants affects your identity may depend on when in your life you were diagnosed with the disease.

Identity is mostly formed during teenage years (Identity Formation) so for people with a disease such as epilepsy that you typically get at a young age, the disease may already feel like a part of your identity, therefore, when a neural implant removes the condition you may feel a change in your identity. 

In contrast, for patients diagnosed with a disease such as Parkinson’s which usually affects people later in life,  because they have already lived a full life without this disease they may feel that by removing their condition the neural implant restores their identity.

As depicted in many science fiction movies, there have been characters that were half human and half robot making them a cyborg. Well, this idea might not be as fiction as we once thought. Some people implanted have seen themselves as a real-life version of cyborg because they do not feel fully human (Extraordinary Personality Changes).

The field of implant ethics gives us questions aligned with this theory: what is the definition of human and how do neural implants come into play with that definition. Implant ethics is defined as the study of ethical aspects of the lasting introduction of technological devices into the human body (Hansson 1).

Because the neural implant is working simultaneously with your brain, people may believe that neural implants would make you a mix of man and machine. Our neurological processes can be regulated which means that it can control our emotions and our thought processes. An example of this is for patients who utilize implants to help control their depression. This disease can be crippling to a person’s mental health so neural implants can help control the brain to make it feel a constant state of happiness. This can limit your range of emotion in a negative way. Another patient had used DBS to treat her depression and OCD.

 “You just wonder how much is you anymore, and you wonder: How much of it is my thought pattern? How would I deal with this if I didn’t have the stimulation system? You kind of feel artificial”

-Anonymous patient who received DBS in a focus group (report by Illes).

 Being happy all the time seems good on the surface level, but if you don’t balance it out with negative emotions, it may not feel like happiness. Part of being human is to experience being happy, sad, angry, etc. so without that range are we truly human?


Conclusion

Neural implants are the future. Its technology is destined to be an integral part of the medical field once deemed safe for human use. It has the potential to be one of the most powerful machines in neurotechnology and could better improve quality of life for patients currently suffering from Parkinson’s, epilepsy, and other different neurodegenerative diseases. It can promote autonomy for some patients and provide more justice for the disabled community. Once neural implants with the ability to provide total human cognitive enhancement become widely available on the market, this could change the way we live forever with both positive and negative implications. Although there are many benefits to neural implants, there are also some ethical issues that prevail. The values of privacy, safety, and identity can come into conflict with the different capabilities of neural implants and I discussed my findings on the many ethical questions that must be considered for the continuation of making neural implants.

All things considered, humans are always looking for new ways to be better and more advanced and the creation of neural implants would send humanity to a new level of enhancement and definitively change the definition of what it means to be human.

Obviously, there needs to be a lot more research and testing done with neural implants before they become widespread. It has to become clear what type of external devices are used to analyze information from the implants. Also, we have to conduct more experiments on human subjects. A good amount of the data that I found was based on neural implant testing on animals which leads to hypotheses on how neural implants would affect humans based on those results. This product is designed for humans so more research about how it affects us would be a better representation of the abilities of neural implants. With more tangible answers to the open ended questions of this device, this idea can become more real and can seem more legitimate.

After my extensive research in neural implants, I wanted to share my thoughts about them and possible restrictions that I would recommend if I was in a position to do so. I believe that neural implants should continue to be developed as medical devices but should have limited transmission abilities solely between the patient’s implant and their doctor/neurologist. In addition, access to the information inside a  neural implant should be tightly controlled and regulated. Doctors would need access to the information inside the implant so I suggest that neural implants should either be monitored in in-person check ups or somehow securing a private server where the information could only be seen by whoever the patient chooses.  I think that privacy and safety are the two most important considerations when it comes to possible problems with neural implants. Having a device monitoring your brain at all times puts a person in a really vulnerable position. Unauthorized access to someone’s brain in my opinion is the most invasive intrusion of privacy and therefore we must keep our brains protected. Security of data has to become more of a priority and must be ensured at all costs when using the implant. Additionally, I feel that development of neural implants for nonmedical reasons should be encouraged as well, but this should be second in priority to neural implants that could treat diseases. 

Because neural implants for nonmedical purposes can be utilized by a broader population, they can potentially be a more profitable business. Therefore I believe that companies may focus more in this area than in the development of neural implants for medical reasons or companies may have to price the medical neural implants at a higher cost as a result of the smaller percentage of people who would use it.

This leads me to the idea that one way to make neural implants more affordable and therefore accessible is to have them covered by insurance plans. I didn’t see much research on if there could be full or partial coverage, but in the future that should definitely be an option.

I think that insurance companies may be interested in this because neural implants that address a certain disease can make the patient safer overall by preventing other injuries. As an example, if a patient has a neural implant to control their epilepsy, it could make the patient safer by reducing the risk of injuries that a seizure could cause. Therefore I believe that neural implants should either be partially or fully covered by insurance companies so people who would really want it wouldn’t have to worry about the cost of the device stopping them from improving their health.



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