1. Background
Several centuries ago, technology is not regarded as a problematic approach since it provides a significantly higher efficiency in machine manufacturing and speeds up the development of human. However, as the society moves to dig deep in the field of neuroscience, in which scientists attempt to know the inner nature of mankind and try to elicit expected behaviors by changing or stimulating the brain areas, challenges start to emerge, especially in bioethical viewpoints. Whether people should have the direct access to one’s mind is a controversial topic.
To narrow down, the following will focus on one commonly used neurotechnology: brain computer interfaces(BCI), which allows the interaction between human and computer. Several ethical issues regarding this technology is posed in figure1.
Particularly, the paper will first provide basic working process of BCI technology and focus on discussing BCI’s ethical concerns related to justice and equity. Eventually, the paper will offer solutions to mitigate inequity and future direction to the usage of BCI.
2. BCI Technology
2.1 Introduction of BCI
Severely disabled and paralyzed people need the help of neurotechnology to communicate the signals in brain to the outside world. Brain computer interfaces(BCI) and electroencephalogram(EEG) are the most popular technologies that provides the interaction between human and computer and the control of firing neurons needed to treat certain disease.
The basic BCI system functions as described in figure 2, with sensors installed at specific part of the brain(figure3) to acquire brain signals such as firing rates and numbers and amplitudes of action potentials. The signals attained are presented through EEG and then transferred to be processed, reducing the noise and eventually reconstruct the original brain activity (figure 4). Using several translation algorithm, BCI is able to transform brain signal to device commands.[3,4]
2.2 BCI usage in rehabilitation and human augmentation
The ability for BCI to transfer, interpret, and control brain signals leads to its usage in neural rehabilitation and human augmentation.
For instance, in the field of Parkinson’s disease, BCI is used with deep brain stimulation, implanting electrode to inhibit Spatial Transformer Network(STN). Parkinson’s disease is caused by the decline in dopaminergic neurons, contributing to a decrease of firing in cortex and less control to muscles. With BCI and deep brain stimulation, the indirect pathway and direct pathway in basal ganglia both excite the thalamus, resulting in an increased excitation in cortex and a mitigation of Parkinson’s disease paralyzing symptoms.[5]
On the ground of human augmentation, BCI can also compensate for sensory losses by providing feedback information through electrode stimulation.
Apart from treating blind or deaf people with BCI technology and enhancement of senses, there is also potential usage in augmenting senses and cognitive ability of normal people. Bavelier also suggests the possibility of BCI human augmentation, vision and cognitive augmentation, being deployed for warfighter.[6,7] However, introducing BCI technology to augment normal people contains many ethical issues, especially equity challenges.
3. Definitions of Inequity
3.1 Sources of inequity
According to Barbara Starfield, inequity stands as the social, economic,and geographical differences among population groups that are usually remediable. It can also be categorized into two types, the horizontal inequity and vertical inequity, which respectively encapsulate the situation where people with the same needs fail to get the same resources and people with different degrees of needs get unmatched level of resources. [8]
With this classification, sources of inequity can also be divided into two parts:
For patients needing the same BCI treatments, wealth distribution and scientific development among different regions contribute to the discrepancy and inequity of BCI treatment people received.[1] As figure 6 and 7 describe, the USA, Australia, countries in Europe and China are more financially and scientifically more developed compared to other countries.
Additionally, FDA in USA has approved the use of Neuralink BCI while other countries have not, resulting in the inequity of treatment people with same need receive as well.
As a result, as BCI is a relatively costly treatment and a high-demanding technology[1,10], it is more likely for wealthier and scientifically more developed areas to attain better treatment, causing the inequity between affluent and impoverished regions.
In terms of vertical inequity, among patients that have access to the same level of BCI treatment, patients differ from each other due to their diseases degree and type. If both severe and middle phase depression patients receive same level of treatment, middle phase ones have higher possibility of mitigating depression condition compared to their severe counterparts. This may also occur between normal human wanting to be ‘upgraded’ as superhuman and patients really need BCI for life saving purpose.[1,9]
3.2 Forms of inequity
These sources of inequity described above lead to many forms of influences to the society.
Horizontally speaking, as same patients do not obtain same treatment, disease fatality rate varies among the world, leading to people in under-developed areas suffering more.
Vertically, on the other hand, if offered with same BCI devices, normal people are prone to develop ‘superhuman’ abilities and functions, including augmented intelligence and memory as well as cognitive improvement.[9]
Therefore, BCI treatment posts challenges in equity both horizontally and vertically.
4. Possible Solutions and Future Direction
4.1 Possible solutions
In order to solve the problem of horizontal and vertical inequity, there are several practical resolutions.
First of all, government can propose policies to establish a sound health care system and organization to provide subsidy for BCI devices corporations, lower the costs of relating treatment, and set universal rules to regulate BCI usage.[1,9,10]
Also, for people who are in desperate need of BCI treatment to survive, such as patients of Parkinson’s disease, worldwide organizations should also launch emergency response protocols no matter where the patients come from. With that, equity has the opportunity to be reached.
4.2 Future direction
Regarding future potential research direction, neuroscientists and corporations can focus on developing cheaper devices available to all people with the need of the device and therefore reducing the equity challenges to a certain level.[9]
Instead of costly implanted electrode stimulation aiming to solve the stroke problem from a comprehensive view of the entire brain, scientists can find alternative non-invasive treatment, providing observable but not too drastic and uncontrollable improvement step by step.
For instance, a research by Salvatore Vita, Caterina Morra, and Angelo Rega have indicated a promising future using Virtual Reality(VR) in Emotion Regulation(ER). [11]Non-invasive devices to promote deep sleeping using vibrations transported through hand are also sold on internet. Similarly, if possible, researchers could find non-invasive substitutes, other than BCI, that gradually solve the problem by stimulating areas other than brain.
5. Conclusion
Conclusively, horizontal and vertical inequity is usually caused by the difference in wealth and science distribution and level of disease, resulting in the medical and human augmenting tensions in society. To combat the inequity and the unknown situation augmentation in human will bring, government should take efforts to regulate BCI usage and figure ways to balance scientific and economic gap. Before having relatively high level of control to BCI, researchers should think twice before implanting chips in human body and have measures to solve the problem of retracting them.
Only after a comprehensive consideration of the impact BCI technology could bring and only after people reach the consensus of preserving human dignity, privacy, and equity, can the society start to partially deploy it.
Reference
1. Coin, Allen, Megan Mulder, and Veljko Dubljević. "Ethical aspects of BCI technology: what is the state of the art?." Philosophies 5.4 (2020): 31.
2. Jawad, A. J. "Bioethics of medical devices based on brain computer interfaces (BCI)." Journal of Clinical Research & Bioethics. (2021).
3. Schalk, Gerwin, et al. "BCI2000: a general-purpose brain-computer interface (BCI) system." IEEE Transactions on biomedical engineering 51.6 (2004): 1034-1043.
4. Horlings, Robert, Dragos Datcu, and Leon JM Rothkrantz. "Emotion recognition using brain activity." Proceedings of the 9th international conference on computer systems and technologies and workshop for PhD students in computing. 2008.
5. Lecture slides from Professor Joni Wallis in University of California, Berkeley.
6. Bavelier, Daphne, et al. "Rethinking human enhancement as collective welfarism." Nature human behaviour 3.3 (2019): 204-206.
7. Raisamo, Roope, et al. "Human augmentation: Past, present and future." International Journal of Human-Computer Studies 131 (2019): 131-143.
8. Starfield, Barbara. "The hidden inequity in health care." International journal for equity in health 10.1 (2011): 1-3.
9. Burwell, Sasha, Matthew Sample, and Eric Racine. "Ethical aspects of brain computer interfaces: a scoping review." BMC medical ethics 18.1 (2017): 1-11.
10. Coin, Allen, Megan Mulder, and Veljko Dubljević. "Ethical aspects of BCI technology: what is the state of the art?." Philosophies 5.4 (2020): 31.
11. Vita, Salvatore, Caterina Morra, and Angelo Rega. "Virtual reality and emotion regulation: a systematic review." PSYCHOBIT (2021).
