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The Promises and Perils of Neurotechnology

image of light beams refracting from model brain

In late May, a groundbreaking study published in Nature outlined how new developments in neurotechnology have allowed a man to walk again after being paralyzed for the better part of a decade. The patient in question – Gert-Jam Oskam – sustained a spinal cord injury in a cycling accident ten years prior, leaving him entirely unable to walk. This injury – like most spinal injuries – essentially meant that Oskam had suffered an interruption in the communication between his brain and certain parts of his body. In the revolutionary new procedure, Oskam received a brain-spine interface (BSI) that essentially created a “digital bridge” between the brain and spinal cord. The treatment was highly effective, with Oskam recovering the ability to stimulate leg muscles mere minutes after implantation. Within a year, Oskam was once again able to stand, walk, climb stairs, and navigate complex terrain.

The rapid development of neurotechnology will provide a raft of new medical interventions; from restoring spinal injuries such as Oskam’s, to allowing the control of prosthetic limbs. It also creates promising opportunities for the treatment of dementia and Parkinson’s disease, as well as more common mental health issues such as depression, insomnia, anxiety, depression, and addiction. Given this battery of potential medical applications, it would seem that neurotechnology is clearly a force for good. But is this really the case?

On a consequentialist analysis, we must not only consider the benefits of new scientific developments, but also their potential costs. What concerns, then, might arise in the context of neurotechnology?

Given its highly invasive nature, neurotechnology’s greatest threats involve potential breaches to both our (1) privacy, and (2) autonomy. Consider, first, privacy. Neurotechnology literally creates a digital connection to our minds – the very thing that makes us us. In doing so, it holds the capacity to gain intimate knowledge of our (previously) most private psychological states. There are very real concerns, then, about what neurotechnology might do with this information. Many of us know the surprise, frustration, and – perhaps –  indignation that comes when we are targeted by a commercial tailored specifically to our internet browsing history. Imagine, then, what would happen if such marketing was based on neurotechnology’s knowledge of our innermost thoughts. Consider the audacity of receiving an advert for the latest SUV just moments after thinking “I really need to buy a new car.”

Of course, this threat to privacy already exists thanks to the ubiquity of technology in our daily lives. While not nearly as invasive, digital technology currently enjoys unprecedented access to our lives via our phones and myriad other smart devices (all, of course, in communication with each other and with unfettered access to our social media, digital communications, and financial transactions). In this way, then, neurotechnology might only represent a difference in the degree of our loss of privacy, rather than an entirely novel intrusion in our lives.

Consider, then, how neurotechnology might instead threaten our autonomy. A vital component of autonomy is retaining complete control over our thoughts and actions. The inclusion, via neurotechnology, of any kind of “digital bridge” necessarily compromises this control – creating a vulnerability that might compromise our autonomy. If there is a digital “middleman” between my psychological desire to lift a glass of water, and my hand’s physical performance of this task, then there is the opportunity for my autonomy to be threatened. What if my BSI refuses to perform the action I desire? What if the BSI is hacked, and I am forced to perform an action that I do not desire? In this sense, neurotechnology poses a threat that prior technological advancements – like phones and smart devices – have not yet created. While social media implements algorithms to monopolize our attention, and advertisers might use every trick in the book to manipulate us into purchasing their products, they have not (yet) been able to wrest control of our physical bodies. With the advent of neurotechnology, however, this may become a possibility.

In addition to concerns relating to our privacy and autonomy, there is the larger concern that neurotechnology might threaten our very humanity. There is, of course, much debate in philosophy about what it means to be “human” – or whether there is any such thing as “human nature” in the first place. However, in Enough: Staying Human in an Engineered Age, author Bill McKibben argues that human life would be meaningless if every challenge we faced could be easily overcome. By this reasoning, then, neurotechnology might threaten to strip meaning from our life by allowing us to strive over adversity without hard work and the development of important skills and character traits.

Of course, this doesn’t imply that the use of all neurotechnology is wrong. We routinely implement medical technology to make people’s lives better, and certain applications of neurotechnology – like the BSI that allowed Gert-Jam Oskam to walk again – are really no different to this. The novelty of neurotechnology, however, is in its capacity to go beyond therapy and provide enhancement – to take us beyond our traditional nature and, in doing so, threaten our very nature. This concern – coupled with those regarding the threats it raises to privacy and autonomy – mean we should practice caution in its development and implementation. What stands to be seen however, is whether such fears are merely the techno-paranoia of Luddites, or reasonable concerns about the wholesale exploitation of technology to threaten our privacy, autonomy, and humanity.

“It Wasn’t ‘Me'”: Neurological Causation and Punishment

photograph of dark empty cell with small slit of sunshine

The more we understand about how the world works the more fraught the questions of our place in the causal network of the world may seem. In particular, the progress made in understanding how the mechanisms of our brain influence the outward behavior of our minds consistently raises questions about how we should interpret the control we have over our behavior. If we can understand the neurological processes in a causal network that explain the way we act, in what sense can we preserve an understanding of our behavior as ‘up to us’?

This has been a concern for those of us with mental illness and neurological disorders for some time: having scientific accounts of depression, anxiety, mania, and dementia can help target treatment and provide us with tools to navigate relationships with people that don’t always behave like ‘themselves’. In serious cases, it can inform how we engage with people who have violated the law: there is a rising trend to use “behavioral genetics and other neuroscience research, including the analysis of tumors and chemical imbalances, to explain why criminals break the law.”

In a current case, Anthony Blas Yepez is using his diagnosis with a rare genetic abnormality linked to sudden violent outbursts to explain his beating an elderly man to death in Santa Fe, New Mexico, six years ago in a fit of rage. His condition explains how he wasn’t “fully in control of himself when he committed the crime.”

Putting aside our increasing ability to explain the psychological underpinnings of our behavior more causally or scientifically, our criminal justice system has always acknowledged a distinction between violent crimes committed in states of heightened emotionality and those performed out of more reasoned judgments, finding the latter to be more egregious. If someone assaults another immediately after finding out they cheated with a significant other, the legal system punishes this behavior less stringently than if the assault takes place after a “cooling off period”. This may be reflective of a kind of acknowledgement that our behavior does sometimes “speak” less for us, or is sometimes less in our control. Yepez’s case is one of a more systematic sort where he is subject to more dramatic emotionality than the standard distinction draws.

Psychological appeals for lesser sentences like Yepez’s are successful in about 20% of cases. Our legal system still hasn’t quite worked out how to interpret scientific-causal influences on behaviors, when they are not complete explanations. Having a condition like Yepez’s, or other psychological conditions we are gaining more understandings of every year, still manifest in complex ways in interaction with environmental conditions that make the explanations fall short of having a claim to fully determining behavior.

It does seem that there is something relevantly different in these cases; the causal explanations appear distinct. As courts attempt to determine the implications of that difference, we can consider the effect of determination-factors in how we understand behavior.

John Locke highlights the interplay between what we may identify as the working of our will and more external factors with a now-famous thought experiment. Imagine a person in a locked room. There seems to be an intuitive difference between such a person who wishes to leave the room but cannot – their will is constrained and they cannot act freely in this respect. On the other hand, something seems importantly different if the person were in the locked room and didn’t know the door was locked – say they were in rapt conversation with a fascinating partner and had no desire to leave. The world may be “set up” so that this state of affairs is the only one the person could be in at that moment, but it isn’t clear that their will is not free; the constraints seem less relevant.

We can frame the question of the significance of the determination of our wills in another way. While not all of our actions are a result of conscious deliberation, consider those that are. When you question what to eat for lunch, what route to take to get to your destination, which option to take at the mechanics, etc., what would result from your certainty that your ultimate decision is determined by the causal network of the world? If, from the perspective of making a decision, we consider ourselves not to be a source of our own behavior, we would fail to act. We would be rendered observers to our own behavior, yet in a perspective of wondering what to do.

Note an interesting tension here, however: after we decide what to do (to have a taco, take the scenic route, replace the transmission) and perform the relevant action, we can look back at our deliberative behavior and wonder at the influences that factored into the performance. It often feels like we are in control of our behavior at the time – say, when we consider tacos versus hamburgers and remember how delicious, fresh and cheap the fish tacos are at a stand nearby, it seems that these factors lead to seeking out the tacos in a paradigmatic instance of choice.

But what if you had seen a commercial for tacos that day? Or someone had mentioned a delicious fish meal recently? Or how bad burgers are for your health or the environment? What if you were raised eating fish tacos and they have a strong nostalgic pull? What if you have some sort of chemical in your brain or digestive system that predisposes you to prefer fish tacos? If any of these factors were the case, does this undermine the control you had over your behavior, the relevant freedom of your action? How do such factors relate to the case that Locke presents us with – are they more or less like deciding to stay in a locked room you didn’t know was locked?

These questions could be worrying enough when it comes to everyday actions, but they carry import when the behaviors in question significantly impact others. If there is a causal explanation underpinning even the behaviors we take to be up to our conscious deliberation, would this alter the ways we hold one another responsible? In legal cases, having a causal explanation that doesn’t apply to typical behaviors does lessen the punishment that seems appropriate. Not everyone has a condition that correlates to violent outbursts, which may make this condition a relevant external factor.

Consent to Dying: The Case of Julianne Snow

Recently, a 5-year-old child named Julianne Snow passed away from from a neurological disease known as Charcot-Marie-Tooth, causing nerves in the brain to degenerate and loss in the muscles related to chewing, swallowing, and eventually breathing. Although Charcot-Marie-Tooth disease is one of the world’s most commonly inherited neurological disorders, this story made national headlines due to Julianne’s independent decision to refuse treatment.

Continue reading “Consent to Dying: The Case of Julianne Snow”