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Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Stimulating the Brain : Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Machine Interfaces Johansson, Veronica 2013 Link to publication Citation for published version (APA): Johansson, V. (2013). Stimulating the Brain : Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Machine Interfaces. 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LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00 Stimulating the Brain Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Machine Interfaces Veronica Johansson DOCTORAL DISSERTATION by due permission of the Faculties of Humanities and Theology, Lund University, Sweden. To be defended at Medicon Village Hörsalen, Scheelevägen 2, Lund January 17, 10.15 Faculty opponent Jens Clausen Organization Document name LUND UNIVERSITY DOCTORAL DISSERTATION CTR, Ethics Date of issue: 18-12-13 Author: Veronica Johansson Sponsoring organization Title and subtitle: Stimulating the Brain - Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Machine Interfaces Abstract This thesis addresses some of the ethical concerns raised by connecting man and machine through so called Brain-Machine Interfaces, BMIs, elaborate brain implants that may both further our knowledge of the brain and alleviate neurological dysfunction and impairments. The primary foci have been to address urgent and prominent concerns elicited by BMIs; to critically evaluate arguments relevant to an ethical analysis of Deep Brain Stimulation, DBS; and to address and develop ignored or underrepresented perspectives of importance in an ethical analysis of DBS. The main method used in the analysis is ‘embedded ethics’. This method was developed during the doctoral project, to answer the specific research questions examined in paper I-IV, and builds on methodology such as empirical ethics and casuistry. The purpose of ‘embedded ethics’ is not to derive final conclusions or action guidance regarding a technology as such, but to identify, critically assess and problematize central ethical concerns elicited by new and emerging technologies, and to detect and address the lacunas in the current debate. Some key contributions of this thesis to the fields of nanoethics, neuroethics and bioethics are: to introduce the distinction between inherent and noninherent ethical concerns to elaborate on upcoming and future ethical concerns elicited by DBS; to identify biases, for instance as regards technology, time, speculative scenarios, and authenticity, that may distort an ethical analysis of DBS; to argue for the duty of ethicists analysing bioethical concerns to acknowledge the necessity of acquiring sufficient knowledge of the scientific/biological subject matter of analysis, knowledge either achievable by being an ‘embedded ethicist’ or through a firm dedication to understanding the particulars and contextual impact factors specific to the subject of analysis. Key words Brain-Machine Interfaces, BMI, Deep Brain Stimulation, DBS, Neuroethics, Nanoethics, Embedded Ethics, Biases, Authenticity, Inherent Ethical Concerns, Noninherent Ethical Concerns Classification system and/or index terms (if any) Supplementary bibliographical information Language ISSN and key title ISBN 978-91-7473-819-3 Recipient´s notes Number of pages Price 166 Security classification Signature Date December 8, 2013 Stimulating the Brain Ethical Perspectives on Deep Brain Stimulation & Nano Scaled Brain Machine Interfaces Veronica Johansson Copyright © Veronica Johansson 2013 Centre for Theology and Religious Studies Department of Ethics ISBN 978-91-7473-819-3 Printed in Sweden by Media-Tryck, Lund University Lund 2013 CONTENTS ORIGINAL PAPERS 7 ABBREVIATIONS 8 WHAT IS THE HYPE? 9 PROJECT BACKGROUND 15 Neuronano Research Center 18 BRAIN MACHINE INTERFACES 21 Terminology and Scope 21 Stimulating the Brain – A Historical Exposé 24 Deep Brain Stimulation – A Pacemaker for the Brain 31 PHILOSOPHICAL CONTEXTS 41 Terminology and Scope 42 The First Discussions on Ethics and DBS 44 Personality Changes and DBS 48 AIM AND METHOD 60 The Process of Formulating Specific Research Questions 61 Methodological Concerns 66 Embedded Ethics 70 PAPER I-IV: SUMMARY AND MAIN CONCLUSIONS 74 Paper I: Brain-Machine Interfaces and Nanoethics 74 Paper II: DBS for Treatment Refractory Depression 77 Paper III: Authenticity, Depression and DBS 79 Paper IV: Thinking Ahead on DBS 81 THINKING AHEAD 84 ACKNOWLEDGMENTS 90 BIBLIOGRAPHY 92 ORIGINAL PAPERS The thesis is based on the following papers, which will be referred to by their Roman numerals: I. Johansson, V., 2009, “Do Brain Machine Interfaces on Nano Scale Pose New Ethical Challenges?”, Ach, J. & Weidemann, C. (eds.) in Size Matters: Ethical, Legal and Social Aspects of Nanobio- technology and Nano-Medicine, LIT Verlag: 75-100 II. Johansson, V., Garwicz, M., Kanje, M., Röcklinsberg, H., Schouenborg, J., Tingström, A. & Görman, U., 2011, “Beyond Blind Optimism and Unfounded Fears: Deep Brain Stimulation for Treatment Resistant Depression.”, Neuroethics, DOI 10.1007/s12152-011-9112-x III. Johansson, V., Garwicz, M., Kanje, M., Schouenborg, J., Tingström, A. & Görman, U., 2011, “Authenticity, depression, and deep brain stimulation.” Frontiers in Integrative Neuroscience, DOI 10.3389/fnint.2011.00021 IV. Johansson, V., Garwicz, M., Kanje, M.†, Halldenius, L.* & Schouenborg, J.*, “Thinking Ahead on Deep Brain Stimulation: An analysis of the ethical implications of a developing technology.”, American Journal of Bioethics – Neuroscience, (Forthcoming Jan 2014) * Equal contributions The papers have been reprinted with kind permission from the following publishers: LIT Verlag; Springer Science and Business Media; Frontiers Media SA; and the Taylor & Francis Group. 7 ABBREVIATIONS BCI: Brain Computer Interface BMI: Brain Machine Interface DBS: Deep Brain Stimulation EEG: Electroencephalography IEC: Inherent Ethical Concern MDD: Major Depressive Disorder N-IEC: Noninherent Ethical Concern NRC: Neuronano Research Center PD: Parkinson’s Disease TRD: Treatment Refractory Depression 8 WHAT IS THE HYPE? Then the eyes of the blind shall be opened, and the ears of the deaf shall be unstopped. Then shall the lame man leap as an hart, and the tongue of the dumb sing Isaiah 35: 5-6 Can the blind regain their vision, the deaf begin to hear, a paraplegic person walk, or the silent start communicating? For someone not up to date with the frontiers of science, these scenarios likely sound incredible and for those with a Christian inclination such suggestions may even have a prophetic ring to them. Nonetheless, Isaiah’s vision is now slowly becoming realized by intricate brain implants connecting man and machine, known as Brain Machine Interfaces (BMIs). These BMIs create a direct interface between an electronic device and the central nervous system, allowing them to interact and communicate. Invasive BMIs require a surgical procedure where the device is inserted either into the brain or the spinal cord. Once implanted, the BMI is supposed to remain in the body and is then used for listening to or stimulating the adjacent cells, thus generating the actual brain-machine interaction. There are also non-invasive BMIs, devices that do not require surgery, where the BMI is placed on the scalp. 9 Some BMIs are acknowledged and well-used in clinical practice, but most applications are still experimental. The first commercialized BMI, the cochlear implant, is an electronic hearing device designed to produce useful hearing sensations for persons with severe to profound neural deafness. Today more than 324 200 people worldwide have received cochlear implants1, and over 100 000 people2 use a device, best described as a pacemaker for the brain, known as Deep Brain Stimulation (DBS). At the experimental stage there are BMIs such as retina implants that will provide the blind with rudimentary visual orientation skills, electronic devices designed to improve memory function, and advanced prostheses manoeuvred by neural control, just to mention a few examples. Although it is easy to marvel at the progress already made, research on BMIs is still very much in its cradle, considering some of the expectations of what BMIs can come to make possible. Does it sound like science fiction? The association would not be surprising considering that BMIs are a recurring theme within the genre. Elaborate fusions of man and machine surface in blockbusters like The Matrix and Robocop; as do brain implants used for mind control, as for example in the remake of The Manchurian Candidate. Conversely, what if we, like the X-Man Jean
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