An Ethical Evaluation of Brain-Computer Interfaces

A Comprehensive Review Discussing the Various Applications of the Technology

Oscar Petrov
27 min readJul 20, 2021

The history of the Brain-Computer Interfaces dates back to 1976 when UCLA Professor and computer scientist, Jacques J. Vidal, proved that a visual evoked potential [A visual evoked potential describes how certain visual stimuli can cause spikes in the brain activity of a user.] (VEP) could be directly relayed from the brain to the computer. By recording the EEG (electroencephalography) signals emanating from the visual cortex of the brain, Vidal discovered that it could be determined where a user was trying to move a mouse cursor, ultimately marking the “first successful attempt to include brain signals into human-computer interaction” (Vidal 4). It was then that Vidal coined the term “brain-computer interface” (BCI) for the first time. Since then, neurophysiologists and scientists alike have devised many unique definitions for a BCI, but as Vidal emphasizes in his 1973 paper, Toward Direct Brain-Computer Communication, at its core, a brain-computer interface is an interface that consists of some form of neural-based information transfer between a human and a machine (“Toward Direct Brain-Computer Communication”).

For the purposes of this argument, it is necessary to understand the various types of BCI devices and how those devices impact their users. In essence, there are two main types of BCIs which are classified based on where they are placed on the head. These include, non-invasive BCI and invasive BCI. Non-invasive BCIs are typically attached via an electrode cap directly on the head. Invasive BCIs, however, require neurosurgical intervention, as these devices are either placed on the surface of the brain, or directly inside the brain where it can read brainwave signals better due to its close proximity. As one might expect, however, there are medical complications that arise, and risks that come into play for these devices, which are vital to the ethical debate. For a deeper overview on the types of BCIs and their benefits and drawbacks, see Appendix A.

Fig. 1. Depicts the three recording methodologies of BCIs, primarily distinguished by their location and the advantages and limitations of these devices (Kotchetkov, Ivan S., and Brian Y. Hwang 2)
Fig. 2. A non-invasive electrode cap which rests directly atop a user’s cranium to record signals (Nailat).

Today, BCIs have been known for their many impacts in society. From being used to diagnose and alleviate clinical conditions such as Alzheimer’s disease or Parkinson’s disease to being used to measure the attentive states of elementary school children during classroom settings (See Appendix B), modern-day BCIs are well known for their potential to drastically influence the status quo of a particular field or methodology. While the current state of BCI technology is far from being able to dramatically societal norms, behaviors, and decision-making processes, there still remain many legal and ethical concerns that ought to be considered and harshly evaluated.

Proponents of BCI technology will generally point towards some of the many transformative benefits of BCIs, such as increased autonomy, enhanced capabilities, and improved satisfaction, whereas opponents will express overall disdain regarding where the technology is heading and how safe it really is. As such, there exists an urgent need to understand and address the arguments on both sides, namely regarding the question of what ethical experimentation and implementation actually entails. Moreover, it is important that we as a society can collectively agree upon where boundaries should be enforced regarding BCI technology as there are many cases that prove to be extremely unethical, like in the case of neuromarketing and advertising.

There exists a deep controversy regarding the ethical implications of BCI technology with regards to various medical and clinical applications. While it is generally considered that the use of both non-invasive and invasive BCI devices is ethical when used for purposes such as restoration, rehabilitation, diagnosis and prediction, and treatment of clinical conditions, such applications begin to digress from the scope of being ethical either when the effects are not substantially beneficial for a given party or when these applications lack statistically significant research to be considered safe.

As legal researcher and neuroscientist, Caesar Augusto Fontanillo Lopez, points out in his comprehensive review, non-invasive BCIs are predominantly used in the medical sector for either predictive, diagnostic, or therapeutic purposes. Lopez recounts EEG’s [Electroencephalography, or EEG, is one of the most common non-invasive techniques for measuring brain activity. It consists of placing electrodes directly on the scalp to measure changes in voltage of a cortical region of the brain that emerges with excitations of the neurons within that region] usefulness in generating “risk prediction models” [Risk-prediction models are frameworks that are created to analyze the probability that a patient will develop “certain diseases, events, or complications” after a procedure, based on the patient’s personal “demographics, test results, or disease characteristics” (Lopez 4).] as particularly significant in predicting outcomes given patterns of behavior in patients. By having more information to create better judgement, health professionals may be able start treatment before a patient’s condition worsens (“Why Early Diagnosis of Dementia is Important”). There are also placebo effects. As neurologist and ALS [Amyotrophic lateral sclerosis (ALS)] researcher, Benjamin R. Brooks, points out, early diagnosis “may lead to a perception of improved” well-being and “survival in young ALS patients,” thus strongly justifying its usage and overall ethicalness (Brooks 1). Besides, it has been shown that EEG technology is able to diagnose certain neurodegenerative disorders with significant accuracy. According to Lopez, “a growing body of evidence supports [EEG’s] application for early detection of Alzheimer’s disease, Parkinson’s disease” as well as many other “dementia subtypes” (Lopez 5). Known for their cost-effectiveness, EEG-based technologies are a great resource for those who are in need of cheaper diagnosis tools, or if they simply cannot afford some of the more expensive procedures. [Likewise, EEG is able to alleviate financial burdens on the user’s family due to its cost-effectiveness. A recent analysis conducted by Time Magazine showed that the average cost of getting an MRI — one of the most detailed body-imaging techniques available — was a little over two-and-a-half thousand dollars. Contrastingly, the average cost of an EEG ranges as low as $200 (Vrocher III, Diamond, and Mark J. Lowell). While some opponents may claim that healthcare can just as well alleviate some of these burdens, a New York Times survey proves otherwise, showing that over “40 percent” of patients deferred going to the doctor “when they thought they needed to” due to the overwhelming costs attached (Abelson). What’s more, people have been using similar technology for a while now. For example, Apple Watches use biometric capabilities for authentication purposes, checking user’s heart rate, and measuring blood oxygen levels. On a fundamental level, non-invasive BCIs really aren’t so different in this regard.] From the preceding, it is evident that non-invasive BCI devices are vastly impactful in their capabilities for prediction and diagnosis of various clinical conditions, as well for providing financial alternatives to those who need it, thus justifying their ethicalness.

Invasive BCIs are slightly different from their non-invasive counterparts in that they measure neuronal activity via a thin chip [Specifically, it is a cortical microelectrode array, which is essentially a small chip wired with electronic circuitry that is able to funnel neural signals to/from neural pathways.] that is surgically implanted within the cerebral cortex (Fig. 1.). Invasive devices are well known for their high precision and performance, however, there are many drawbacks to the technology (Kotchetkov et al. 2). Not only do ethical concerns emerge regarding the various extreme uses of the technology — for example, using invasive BCI to manipulate someone’s inner thoughts and decision-making processes on a biological level is unethical as that manipulates their very human autonomy — but, overall, neural implants generally “carry more associated risks such as … infection[] and glial scarring” and bodily rejection of electrodes [The scarring that results from surgical implantation could cause brain signals to weaken. This could lead to a chance that the body ends up “reject[ing] [the] implanted electrodes,” which may cause the device to malfunction and promote harm (Abdulkader et al. 1).] (Steinert, et al. 478; North Carolina State University 1).

In the case of invasive BCIs, it is evaluated that using such devices for medical applications, including restorative or rehabilitative — a biomedical discipline often known as neuroprosthesis — is largely ethical due to the mainly beneficial transformative impacts on patients. Moreover, the necessity of patient consent regarding these medical procedures puts an especial emphasis on its ethicalness, as it implies that patients are aware of the risks involved. These devices digress further from the scope of being ethical when it involves applications that infringe on neural privacy, manipulate the biological origins of users’ decision-making processes, or there is simply an overall lack of research and justification for these applications. Brain-to-brain communication (BTBI), for example, is one field that has been experimented with fairly minutely in past years. Because of its brief exploration by scientists, it is argued that it is unethical to allow users to engage in BTBI communication as it has not yet been fully explored and the risk is wholly unknown.

The main instances in which BCI users have adopted neural implants for restorative purposes are in the case of motor or sensory impairments, such as in the case of visual, auditory, and communicative implants. These applications have been demonstrated to have provided patients with increased mobility and overall general satisfaction in their lives. One example of demonstrated impact in this broad field of neuroprosthetics lies in its application in being used to treat tetraplegic (also called quadriplegic) [Quadriplegia, also called tetraplegia, is the paralysis of the body in all four limbs. This is due to severe “damage to the spinal cord which prevents” communication via the nervous system from the brain to the “rest of the body” (“What You Should Know About Quadriplegia”).] members and their spinal cord injury (SCI).

Neuroscientist Gregoire Courtine and his colleagues at Courtine Labs in Lausanne, Switzerland, is one of the teams that have been working whole-heartedly to help injured people regain motor and sensory function in their bodies (Sandoiu). A recent venture of his involved quadriplegic research participant, Bill Kochevar, who was the first patient in the world to test a SCI neuroprosthetic device (Fig. 3.). In a YouTube video published by Case Western Reserve University in 2017, Bill recounts his experience with the technology: “It was amazing,” he says, “because I thought about moving my arm and it did” (Case Western Reserve University). While Kochevar’s functionality is limited in the sense that he has to make a series of up-to-down and left-to-right movements in order to accomplish his desired task, this technology is nevertheless a life-changer for people like him. One of the lead neuroengineers and co-facilitators of many of the experiments at Courtine Labs, Silvestro Micera, believes that the “technology could one day significantly improve the quality of life of people confronted with” functional problems, especially as they relate to “neurological disorders” (Sandoiu). As the aforementioned impacts alluded towards, benefits such as increased autonomy and overall satisfaction are among the many reasons that using invasive BCIs as a neuroprosthesis is ethical and defensible.

Fig. 3. Quadriplegic research participant, Bill Kochevar, uses an invasive brain-computer interface to miraculously move his arm. (Orenstein).

Similar to how neuroprosthetics have been used to restore mobile function in users, they have also had applications in restoring effective communication in users when it wouldn’t otherwise be possible. Many recent studies have illustrated the usefulness of BCIs when they relate to enabling locked-in patients [Locked-in syndrome (pseudocoma) is a condition in which patients are fully conscious and awake, but are deafferented. This state describes a complete paralysis of “nearly all voluntary muscles in the body except for vertical eye movements and blinking,” and results in an inability to communicate verbally (Duffy 295).] to communicate again via a BCI speller [A BCI Speller is a non-invasive BCI device that utilizes visual evoked potentials (VEPs) to stimulate “source-induced EEG signal[s]” within the user’s brain (Lin, Zhimin, et al.). By analyzing the frequencies of these stimuli, a computer is able to decipher what the user is trying to communicate.] (Fig. 4.) (Chen; Rezeika et. al). With BCI spellers, locked-in patients — patients who are otherwise unable to communicate due to a full body paralysis (with the exception of blinking) — gain the opportunity to communicate with their loved ones again. However, as the novelty of any new system precedes itself with challenges, there are many drawbacks that critics will call to attention. For example, current applications of these communicative devices “have been severely limited by low communication speed,” questioning its overall usefulness for patients in need (Chen 1). Moreover, these devices have the potential to impose many burdens on users and their families [Some authors, like Burwell, even suggest that with certain BCI devices, there comes a heightened sense of stress at the potentiality of device failure. For example, “a BCI wheelchair failing as its user is crossing a street” could ultimately have fatal “consequences,” thus putting greater tension and stress on users (Burwell 4). While these are all admissible concerns for critics to point out, no drastic consequences have occurred as a result of device failures to this date.]. This is evident by “the need for regular and challenging training sessions” to get users familiarized with the novel technologies, which could be burdensome on a “physical, emotional, and financial level” (Burwell 4). Despite these burdens, the potential for extraordinarily positive impact that these technologies generate as well as the necessity of the willingness of the user to use these technologies in the first place justifies its usage and overall ethicalness.

Fig. 4. Stimulated by visual evoked potentials on the screen, a research participant uses a P300 BCI Speller to directly communicate her thoughts onto a computer (Monash University).

(Refer to Appendix D for two more case studies with positive results). While there have been many incredible impacts and success stories over the years, critics of BCIs will likely point towards case studies in which medical interventions didn’t always lead to positive results. In fact, while it was previously argued that restorative and rehabilitative technologies generally point towards increased autonomy and satisfaction, this isn’t always the case. One patient who uses a BCI to alleviate their chronic depression noted that they “can’t really tell the difference” between what they are doing and what their device is making them do. “It blurs to the point where I’m not sure, frankly, who I am,” says the patient (Goering, et al. 2017). (See Appendix E for more.) While these occurrences happen rarely, they do, nonetheless, exist, and point towards one of the drawbacks of the unpredictability of how BCIs will affect certain users.

As touched upon previously, BCI applications which are used in medical and/or clinical settings generally point towards beneficial outcomes (with few exceptions, of course). Contrastingly, BCI applications which are non-medical are much more worthy of overall apprehension and skepticism. While much research has been done to promote certain applications and usages of BCI technology, there still lacks a clear sense of how the users might be impacted in a longer time frame. What’s more, there is an overall lack of statistically significant research that supports certain applications of BCI technologies, denoting what this paper argues to be some of the less justifiable applications of the technology.

Using invasive BCIs for non-medicinal and/or non-therapeutic purposes must be deemed unethical because there has been little research and development promoted in this field and it puts the user at extraordinary risk. As addressed previously, invasive devices which require surgical implantation pose many bodily risks and complications to users, while also hampering functionality of these devices (Burwell 4). While opponents often address that users must willingly consent to these procedures and thus it wouldn’t be so unethical for these procedures to take place, the legality of the issue of informed consent [Informed consent describes the process by which healthcare professionals are legally obligated to disclose the “potential risks, benefits, and alternatives” regarding any “procedure or intervention” to their patient (Shah, et al. 1)] is a gray area that has yet to be addressed. An issue which describes the obligation for health professionals to disclose the potential risks and consequences regarding any medical intervention, informed consent by the user would indeed validate the ethicalness of these technologies; however, this is often far from the case as invasive BCI applications in the non-medical sector have not yet been fully explored and consequently, nor have the risks. This ultimately suggests that these patients will have incomplete information when trying to formulate a decision which could lead to serious, legal issues.

Similarly, the debate isn’t so black and white when evaluating the ethicalness of non-invasive devices for non-medical applications. Advocates of non-invasive BCI often point out that because the devices do not require neurosurgical intervention, they must be relatively safe; however, this does not take the entire argument into consideration. Many authors will caution that non-invasive devices could alter “the brain’s plasticity in still-developing children and even in adults” which “could bring about [many] unknown negative side-effects” (Burwell 4). Moreover, the unresearched aspect of unforeseen side effects provides for more apprehension, specifically when it relates to whether or not a user’s brains would “return to normal after [the] BCI is removed” after certain neurostimulation techniques were administered [Neurostimulation techniques include all that which fall under the category of transcranial electrical stimulation, some of which include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS). These techniques physically manipulate the electrical fields within the brain by applying non-invasive stimulation with electrodes, ultimately wielding the potential to change the structure of the brain in some instances (“Overview: Transcranial Magnetic Stimulation for Treating and Preventing Migraine”).] (Burwell 4). For these reasons, it is not safe to assume that non-invasive BCI technologies are fully risk-free, and must be dealt with vigilantly.

One prominent application of non-invasive BCIs explores its usage in the realm of neuromarketing and advertising, and for reasons such as physical biological manipulation, this usage of BCI technology is wholly unethical. According to Lopez, it is “believe[d] that by measuring consumer’s brain activity and developing effective communication techniques” people may be able to “discover the “buy button” in consumers’ brains” [In other words, by shutting the part of the brain that typically negates certain offers, corporations may be able to “learn how to better trigger consumers’ attention, which may ultimately lead to unprecedented levels of manipulation” within these users (Lopez 13).] (Lopez 13). Proponents of neuromarketing will often call attention to the fact that neuromarketing is already happening at such a mass scale, from the display and arrangement of different foods to the display of certain colors on packaging [It has been long studied that certain colors and color pairs may invoke certain emotions, as yellow does the feelings “happiness” and “warmth” for example.] (Farnsworth). However, if researchers begin to use non-invasive BCIs to take the science of neuromarketing to the next level, that would be dangerous and disastrous as the technology is fundamentally able to alter the decision pathways of humans, and correspondingly, their behaviors, as opposed to merely having an influence on those pathways (Poon). While this may seem like science fiction or some potentiality that is far off into the future, it is actually much closer than one would think; in 2015, Stanford scientists uploaded a YouTube video showing how they were able to control the decision pathways within a rat’s brain to get it to unwillingly eat food (Stanford Bio-X Team). If rats were biologically, impulsively forced to do certain tasks with the click of a button, it can only be imagined what that could look like in the context of neuromarketing for humans. As such, the line for neuromarketing in humans ought to be drawn when it involves physically influencing the biology of the brain as that is heavily despicable.

Another application of BCI technology is one that relates to multiple users and consequently, is more officially known as brain-to-brain-interface (BTBI) [BTBIs are not exclusive to non-invasive or invasive BCIs.]. As Neuroscientist, John B. Trimper, explains, “BTBIs are a novel means of [efficient] information transfer” which bypasses the typical means of transmitting/receiving information from others (Trimper 2) [Rajesh Rao, co-Director of the Center for Neurotechnology at the University of Washington (UW), and his team used two non-invasive devices — EEG to read information from one user’s brain and TMS to then send the information from the first user’s brain to the second user’s brain — with WiFi functionality to almost instantaneously transport information between multiple users (Ma; “Brain-to-Brain Interface Demonstration.”)]. While there are many proposed benefits for BTBI communication, due to a lack of research and an abundance of legal and safety concerns [More ethical concerns emerge at the unknowingness as to how much, and also what information is being transferred during BTBI communication. Additionally, there arises the “potential for a BCI device to be hacked” by evil actors, which could have drastic effects in “impeding the ascription of responsibility.” (Burwell 7).], this paper argues that the technology is unethical and is not ready to be deployed in non-medical/clinical/military settings. Supporters of BTBI technology will often call to attention BTBI’s potential for impact in educational settings, in which a mentor may be able to more quickly convey material to their students. While the justifications for linking two or more brains together, itself, may seem infallibly beneficial, especially in the consideration of its potential usages in advancing society as a whole, advocates for these devices do not take into potential second order effects. Many neuroethicists and neurotechnologists will often bring up societal concerns, like that of potential stratification effects and knowledge hierarchies emerging between the “haves” and “have-nots” of such expedient devices (“Telepathy For The Future You”). For these reasons, BTBI technology is unethical at least until more proper research is conducted and evaluated on a global scale.

There is much common ground and ethical concordance when it comes to various topics, the most prominently of which regards the notion that BCI implantation for necessary medical procedures are ethical uses of the technology. For example, as the preceding discussion indicated, non-invasive BCI devices are vastly impactful in their capabilities for prediction and diagnosis of various clinical conditions, as well for providing financial alternatives to those who need it. Similarly, invasive BCI devices in the medical sector have also enabled radical transformations, especially in its application in neuroprosthetics. On the other hand, there still exists much disagreement when it comes to certain topics, especially the controversies of what ought to be constituted as “ethical experimentation” and overall general uses of the technology. This is exemplified in the case with China’s methodology of measuring attentive states in elementary school children, among other cases as well [The following example perhaps holds much greater legal implications. One PhD student, Lawrence Farwell, the inventor of Brain Fingerprinting, is notable in the field for his incessant pushing for the usage of a P300 detector BCI to be used in courts for lie detection purposes (Farwell 6). As neuroergonomics researcher and PhD student, Marius Klug, points out, however, using a P300 detector is “not a sufficiently good method because “too many things can trigger a P300” response (Meijer 4). If a technology like Farwell’s were to go to market, especially with its weakly founded research base, it is likely that the public will not bode well to BCI innovations in the future which could be limiting and detrimental.].

As the mere presence of the varying ideologies regarding how certain systems should operate indicates, it is vitally important that we as a society can more collectively agree upon where boundaries should be enforced regarding BCI technology so that we may be able to vigilantly progress as brain technology continues to become more advanced. And while there still remains a long way to go in neuroscience and biomedical engineering before society will near states of intense stratification (to propose an extreme), it is nonetheless important that active discussion persists throughout so that we may be prepared for the shift that will inevitably come.

Looking ahead, we can see that many companies are already at the forefront of this new wave of “brainnovation.” Elon Musk’s Neuralink, for example, is one of the many that has presented zeal in creating a chip that could revolutionize the biomedical sector. According to futurist, Bryan Johnson, the question is not whether we will get “computer chips inside of our brains,” but when (Statt). His company, Kernel, is one that ambitiously hopes to make the neural code programmable. Facebook, too, finds itself on a grand venture, having recently begun a project dedicated to turning thought into text. “Brain-typing,” as it is referred, is a non-invasive typing system that aims to achieve a speed of 100 words per minute.

As the world of technology and innovation continues to unfold, and fields like artificial intelligence start to rise into ubiquity, it may be quite relevant to ponder upon the following: The more our minds synergize with artificially intelligent machines, where do our biological bodies end, and that of machines begin?” (Hu, Elise, and Rajesh Rao).


Appendix A

As brain-computer interfaces are responsible for translating the neuronal, electrical activity of the brain onto a machine-interface, the signals must be acquired with immense accuracy. Signal acquisition is the process by which neural data is acquired and it is largely affected by the recording methodology of a BCI. This causes BCIs to fall under two main classifications [Not mentioned here, though BCI devices may also be differentiated based by the dependability it has on the user (dependent BCI or independent BCI) as well as the mode by which the BCI operates (asynchronous BCI or synchronous BCI) (See Appendix C, Rashid et al. 4).]: non-invasive and invasive (this paper chooses to classify semi-invasive devices as falling under the larger umbrella of invasive BCI, slightly different than what Fig. 1. Proposes. Fig. 1. is, nonetheless, a great overview of the types of devices and their characteristics). As this paper primarily focuses on the ethicalness of BCIs, it is imperative to understand how these BCI devices affect their users on a holistic level. Breaking down the classification of BCIs further, the devices can be assessed by their main characteristics: spatial resolution (signal-to-noise ratio), cranial intrusion, and overall safety-risk. Non-invasive BCI are devices that are implanted via non-invasive means — i.e., directly atop the cranium through a cap, or headband (Fig. 2.). While non-invasive devices do not require surgical implantation and are inexpensive compared to invasive devices, they tend to have a relatively high signal-to-noise ratio (less signal clarity) and low spatial resolution due to being further away from the brain. As such, the recorded brain activity of users wearing non-invasive devices may be more elusive and thus, correspondingly, harder to decipher. Invasive (and semi-invasive [Semi-invasive devices are that which are placed on the cortical surface of the brain, as opposed to being placed within the cerebral cortex as invasive devices are. While these devices pose slightly less risk over time compared to invasive devices and do not result in cortical damage or glial scarring as they remain above the cerebral cortex, they do still require neurosurgical implantation. Due to the surgical necessity for semi-invasive devices, this paper generalizes the term semi-invasive as falling under the category of invasive BCI. This is further explicated in the diagram provided in Appendix C (Rashid et al. 4).]) devices, on the other hand, have a far greater signal clarity due to their relative proximity when recording neural activity. They do, however, require surgical intervention which increases potential risk and overall complication. While invasive BCIs are far more costly, their presence is necessitated in more serious medical conditions, such as spinal cord injury (SCI).

Appendix B

In 2019, China’s Zhejiang Province used “brainwave-reading” technology created by Harvard students which would measure the attention levels of elementary school children (Feng). When a headband noted that a student was not paying attention in class, it would light up in flashing colors to visually alert the teacher. It was later proposed by a Chinese local that there be “add[ed] a feature of electric shock, which can wake up sleepy students in class,” an alarming potentiality that must be refrained from at all costs due to a lack of consent on the student’s end.

Appendix C

Fig. 5. “Classification of BCI systems” (Rashid et al. 4)

Appendix D

The following two case studies, Jason and Jane, respectively, dives deeper into some of the beneficially transformative impacts that BCI technology has enabled over the years.

In early 2012, Jason Esterhuizen endured a terrible car-crash that left him blind. However, after an experimental procedure was conducted by neuroscientists at UCLA Health that involved the surgical implantation of Second Sight’s ‘Orion’ device over Jason’s visual cortex, “his world suddenly grew brighter” (“Novel Brain Implant Restores Visual Perception to the Blind | UCLA Health”). “I still can’t put it into words,” Jason remarked during an interview. “From being able to see absolutely nothing — it’s pitch black — to all of the sudden being able to see little flickers of light moving around.” While Jason’s vision isn’t perfect in that his vision still lacks a sense of discreteness when it comes to identifying certain objects, he is still able to make out faint silhouettes which is nonetheless an incredible advancement. From this, the benefits of restorative BCI technologies are evident as what seemed like an incurable tragedy was quite the contrary. With his new device, Jason is now able to navigate the world around him with much greater ease, whether that involves making out the corridors of buildings or even discovering where side-walks end. In the end, it’s his visual implant which ultimately ends up making the impossible possible.

Another BCI user, Jane, has had amyotrophic lateral sclerosis, or ALS, for over a decade now. Jane suffers from what’s called locked-in syndrome, or tetraplegia, which is a rare neurological disorder that impedes on her ability to communicate in any way. Although patients with locked-in syndrome are in a state of complete paralysis, they are still conscious and able to move their eyes. While many methods of communication with patients with locked-in syndrome have been proposed throughout the years, scientists and medical professionals still lack a definitive answer as to how to effectively communicate with these members, especially in the case informed consent. Informed consent is an issue that presents great difficulty in the medical space as it’s hard to evaluate whether or not locked-in patients are conveying the message they wish to convey and are fully understanding the members around them. Moreover, the burden imposed upon them and their families may lead to overall frustration, an emotion that these patients would be able to feel and experience, but not communicate. Also, it would be hard to know whether or not patients were interested in undergoing a medical procedure to acquire an invasive Brain-Computer Interface. According to Burwell, a “BCI that enables communication also enables greater social inclusion, and could save or restore personhood in someone who is losing the ability to interact with their loved ones and community. Even non-assistive technology BCI, such as that used for entertainment, could improve social access and expressive potential in the user” (Burwell 5). On the other hand, patients might not be fully aware of the risks involved, and thus might be unintentionally putting themselves in danger. As such, it is often the case that such situations necessitate a “surrogate decision maker or legal representative” which may vary between either a “close relative” as it is in the United States and the Netherlands, or “a neutral person” as is the case in Germany (Vlek, et al. 96).

Appendix E

“I’ve begun to wonder what’s me and what’s the depression, and what’s the stimulator. I mean, for example, I can be fine, and then all of a sudden … and, and I might realize it later, I do something socially or interpersonally, just not right. I’ll say something that is insensitive or just misread a person entirely, say something that either make ME look like a fool, or, hurts them, or, something along that line. I can’t really tell the difference. There are three things — there’s me, as I was, or I think I was; and there’s the depression, and then there’s depression AND the device and, it, it blurs to the point where I’m not sure, frankly, who I am” (Goering et al. 2017)

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About the author

Hi, I’m Oscar Petrov and I’m currently working to accelerate my growth in the field of neurotechnology :-). I hope you enjoyed my article, and learned a thing or two about the implications of such an incredible piece of technology — Brain-computer interfaces. 🧠

If you found this article particularly valuable, I’d love to hear your thoughts below. Also, if there are any questions, comments, or disputes, please shoot me an email at!




Oscar Petrov

A curious manifestation of billions of exploding neurons. I like to think about brains + the universe. Also passionate about ethics, philosophy + human rights.