ETHICS & MEDICS NOVEMBER 2019 VOLUME 44, NUMBER 11 A Commentary of The National Catholic Bioethics Center on Health Care and the Life Sciences enable a person to generate text or speech with only his or BRAINS, MACHINES, AND her thoughts by decoding signals in the brain regions that control speech-related muscles in the mouth and larynx. THE PERSONS IN BETWEEN This could be especially helpful for persons with facial paralysis. In 2019, researchers were able to achieve this in real time with 61 percent accuracy using electrocorticogra- Christopher M. Reilly phy technology.5 Even more impressive is the capability of algorithms to identify which questions are asked (out of a predetermined set) and then anticipate the responses with 75 percent accuracy. Facebook hopes to replicate such suc- cesses with a noninvasive headset rather than direct contact o 6 he ethical implications of brain–machine interface with the brain. (BMI) are mind-boggling. Connecting a person’s A new electronic system called BrainNet enables people Tbrain to a computer or other machine and success- to communicate with each other through mental activity.7 fully transmitt ing thoughts and instructions bidirection- The participants direct signals by looking at LED lights, ally has enormous potential for therapeutic applications and the system records the frequency of the relevant brain in health care; but great harm can come from meddling activity and sends those data to the brain of a third person with fragile human brains, succumbing to the tempta- in a diff erent room. Not only have three persons used the tions of cognitive enhancement, and exposing vulnerable system to collaboratively solve problems in a game, but the individuals to the power relations formed among owners, person receiving the data was able to distinguish the cor- generators, users, and sellers of what was once considered rect information sent by other participants—which would the private realm of human thoughts. help them win the game—from false commands sent by the Therapeutic Opportunities researchers. Neuralink, a company owned by the prolifi c entrepreneur Elon Musk, has built on technology available person who has lost control of one or more limbs, as since 2006 that will enable individuals to control digital A with a spinal cord injury, will fi nd it a great blessing devices and computers with their thoughts. Human trials to operate a robot that restores lost functions; responds to are expected to begin in 2020 if approval is secured from that person’s thoughts with fl uid, accurate movement; and the US Food and Drug Administration (FDA).8 transmits sensory data back to the brain. While the basic Much of the current research into BMI is heralded as technological capability has existed since 2005, researchers a great leap forward in human civilization but oriented announced in 2019 the invention of a robotic arm (located toward clearly frivolous consumer products. For-profi t enti- away from the patient’s body) that a person controls using ties like Foc.us and Neurable are brashly developing BMI to 1 an electroencephalogram cap. enhance the speed and creative possibilities of digital game Other researchers have created a robotic prosthetic play. Facebook takes a more poetic approach to its head- arm that is connected to the peripheral nerves through set, which will enable consumers to control virtual reality one hundred 1.5 mm long microneedles.2 That arm has the scenarios, play music, and engage in similar recreational advanced capability of relaying complex sensory informa- activities: “You could spend quality time with the people tion to the patient. who matt er most in your life, whenever you want, no mat- The company Mindmaze is helping paralyzed persons ter where in the world you happen to be. And where you to experience the world in more detail through a system could connect with others in a meaningful way, regardless that captures motion and relays it back in a virtual real- of external distractions, geographic constraints, and even 9 ity format.3 Neuropace is trying to predict and stop the physical disabilities and limitations.” neuronal signals that cause epileptic seizures.4 Facebook, Other potential applications of BMI can have therapeutic the Defense Advanced Research Project Agency (DARPA), benefi ts yet seemingly are being developed for maximum and others are racing to develop new technology that will profi t driven by broad consumer desires. Kernel is working on recording individuals’ memories and already can capture Christopher M. Reilly, MPIA, resides in the Washington, DC, basic recollections with 80 percent accuracy.10 The company region and studies theology and bioethics at Holy Apostles hopes the technology will improve memory retention and College and Seminary. recall and will integrate the memory data with the internet DEFENDING THE DIGNITY OF THE HUMAN PERSON IN HEALTH CARE AND THE LIFE SCIENCES SINCE 1972 ETHICS & MEDICS NOVEMBER 2019 and digital cloud. Such technology holds great potential for shield their devices and applications. The rise of deceptive persons with impaired memory recall due to brain damage technology oft en called “deepfake” is also a cause for con- or those affl icted by traumatic memories. However, these cern, with applications that record, decode, and translate therapeutic benefi ts do not seem to be a primary concern complex data that are meant to represent accurate thoughts in the company’s marketing eff orts.11 and instructions in a person’s mind. Ethical Considerations Although DARPA and the National Institutes for Health are oft en involved in funding research, most BMI tech- he more invasive BMI technologies run the signifi cant nologies generally are being developed, distributed, and Trisks of immune reactions, infections, and damage to the licensed by commercial fi rms that are not always trustwor- tissue and blood vessels in the brain. Neuralink’s technology, thy or transparent in their use of private data. For example, for example, involves thousands of electrodes that are sewn Facebook is a leader in the BMI fi eld and was recently fi ned a into the surface of the brain by a robot, which is expected historic $5 billion for privacy violations.13 The entire market- not only to accurately identify the targeted neurons but ing profession is oriented toward understanding and infl u- also to work around blood vessels. Other technologies encing the tastes, perceptions, and decisions of individuals, use implantable computer chips or wireless transmitt ers, so there will be a great temptation among neuromarketers although eff orts are being made to scan and communicate to access individual or aggregate brain data for advertising. with neurons from outside the skull using sound, light, and The long-term dependence of users of BMI technology magnetic fi elds. on the manufacturer or developer will be high. Moreover, Any BMI technology, even when less invasive, has at they may suff er greatly from the loss of soft ware updates, least some potential to cause personality changes, addic- replacement electrodes that only last a few years, and tions, or psychological disorders. The continuously evolving dependable maintenance. Today’s developers of soft ware science on traumatic brain injury gives clear indication that and mobile phone applications oft en trap their dependent the extent and full nature of damage to the brain is very users into constantly evolving and unfavorable contracts or diffi cult to evaluate; the emotional, mood, and cognitive privacy agreements, and very many digital devices require eff ects are complex and oft en mysterious. BMI research is mandatory updates to continue functioning. The FDA has in its very early stages, focused on generating the desired recalled cardiac pacemakers for vulnerability to malicious outcomes but far from exploring the range of unintended cyberatt acks through their wireless communication fea- eff ects. More than two decades of research on a similar ture;14 cyberatt acks on consumer devices rose to nearly technology, deep brain stimulation (DBS), has found that three billion events in this year alone.15 Even with FDA patients can develop impulse-control issues, including regulations on device manufacturing and HIPAA protec- hypersexuality.12 tion for patient privacy, such oversight may not protect BMI In weighing and justifying these risks, the most com- device users when they agree to poorly understood soft ware pelling benefi ts may be those which dramatically assist in contracts or voluntarily share their thoughts in the form of communicating and participating in the human community. electronic data. Such capabilities have important eff ects on the person’s Although we would hope that Western democratic experience and expression of love, development of personal governments would be unwilling and unable to use BMI and public identities, and more active participation in their technology to influence the thoughts of users, it is not community of faith. Enhancing physical functionality can unimaginable. In China, the Cyberspace Administration is also expand a person’s opportunities for participating in the trying to promote “orthodox socialist values” and “uplift ing community and engaging in productive or creative activi- propaganda” through strict regulatory control over internet ties; this is most crucial for paraplegics, stroke victims, and content, mobile phone applications, and other digital com- other individuals with isolating disabilities. Alleviating the munications.16 When American legislators call for moder- eff ects of degenerative brain diseases and severe mental ate regulation of social media and digital content, will the illness obviously calls for taking risks, yet we might won- subsequent legislation adequately defi ne and protect BMI der if such creative ideas like MindMaze’s virtual reality applications? Shielding BMI users from management of their system for paraplegics warrant invasive BMI techniques, private thoughts will be key, yet American police depart- or whether, in truth, they are intended merely to justify the ments have already crossed digital privacy boundaries by development of profi table consumer products.