An ethical assessment of powered exoskeletons: Implications from clinical use to industry and military contexts.

Exoskeletons are technologies that can help to increase or improve mobility, dexterity, and strength. They can be used as assistive devices, to restore lost affordances, or for rehabilitation. While mechanical exoskeletons are passive and rely on the body's power for movement, powered exoskeletons are active mechanical systems that can assist or enhance a user's capacity, including in strength and performance. They also offer scope to augment or enhance beyond simple medical support, with potential in the future for superhuman power and strength. While these technologies present promising clinical opportunities, including for those who want to regain walking capacity, they also bring ethical questions, such as about data privacy and accessibility. In addition, the physical features of the technology can prove mentally, physically, and financially demanding, and may be deployed in contexts where user choice and autonomy is constrained. In this article, we discuss these issues, and raise some pertinent ethical questions, not all of which can be easily answered. We touch upon medical and therapeutic uses, for industrial and workplace settings, and in military contexts specially, given these are contexts where such technology may be required or even imposed. We argue that reasonable optimism for such technologies needs to be tempered by sufficient ethical assessment to identify and address barriers to research, development, and use. As well as managing any impacts and expectations for the health and wellbeing of users, the potential impact on autonomy and the risk of coercion, we have to consider what kind of data may be recorded or used, and the risk that these technologies could exacerbate existing inequalities or harms.

An Anticipatory Approach to Ethico-Legal Implications of Future Neurotechnology.

This paper provides a justificatory rationale for recommending the inclusion of imagined future use cases in neurotechnology development processes, specifically for legal and policy ends. Including detailed imaginative engagement with future applications of neurotechnology can serve to connect ethical, legal, and policy issues potentially arising from the translation of brain stimulation research to the public consumer domain. Futurist scholars have for some time recommended approaches that merge creative arts with scientific development in order to theorise possible futures toward which current trends in technology development might be steered. Taking a creative, imaginative approach like this in the neurotechnology context can help move development processes beyond considerations of device functioning, safety, and compliance with existing regulation, and into an active engagement with potential future dynamics brought about by the emergence of the neurotechnology itself. Imagined scenarios can engage with potential consumer uses of devices that might come to challenge legal or policy contexts. An anticipatory, creative approach can imagine what such uses might consist in, and what they might imply. Justifying this approach also prompts a co-responsibility perspective for policymaking in technology contexts. Overall, this furnishes a mode of neurotechnology's emergence that can avoid crises of confidence in terms of ethico-legal issues, and promote policy responses balanced between knowledge, values, protected innovation potential, and regulatory safeguards.

Rights and Wrongs in Talk of Mind-Reading Technology.

This article examines the idea of mind-reading technology by focusing on an interesting case of applying a large language model (LLM) to brain data. On the face of it, experimental results appear to show that it is possible to reconstruct mental contents directly from brain data by processing via a chatGPT-like LLM. However, the author argues that this apparent conclusion is not warranted. Through examining how LLMs work, it is shown that they are importantly different from natural language. The former operates on the basis of nonrational data transformations based on a large textual corpus. The latter has a rational dimension, being based on reasons. Using this as a basis, it is argued that brain data does not directly reveal mental content, but can be processed to ground predictions indirectly about mental content. The author concludes that this is impressive but different in principle from technology-mediated mind reading. The applications of LLM-based brain data processing are nevertheless promising for speech rehabilitation or novel communication methods.

Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'.

The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.

Speaker Responsibility for Synthetic Speech Derived from Neural Activity.

This article provides analysis of the mechanisms and outputs involved in language-use mediated by a neuroprosthetic device. It is motivated by the thought that users of speech neuroprostheses require sufficient control over what their devices externalize as synthetic speech if they are to be thought of as responsible for it, but that the nature of this control, and so the status of their responsibility, is not clear.

Brain-State Transitions, Responsibility, and Personal Identity.

This article examines the emerging possibility of "brain-state transitioning," in which one brain state is prompted through manipulating the dynamics of the active brain. The technique, still in its infancy, is intended to provide the basis for novel treatments for brain-based disorders. Although a detailed literature exists covering topics around brain-machine interfaces, where targets of brain-based activity include artificial limbs, hardware, and software, there is less concentration on the brain itself as a target for instrumental intervention. This article examines some of the science behind brain-state transitioning, before extending beyond current possibilities in order to explore philosophical and ethical questions about how transitions could be seen to impact on assessment of responsibility and personal identity. It concludes with some thoughts on how best to pursue this nascent approach while accounting for the philosophical and ethical issues.

Return to Status Quo Ante: The Need for Robust and Reversible Pandemic Emergency Measures.

This paper presents a normative analysis of restrictive measures in response to a pandemic emergency. It applies to the context presented by the Corona virus disease 2019 (COVID-19) global outbreak of 2019, as well as to future pandemics. First, a Millian-liberal argument justifies lockdown measures in order to protect liberty under pandemic conditions, consistent with commonly accepted principles of public health ethics. Second, a wider argument contextualizes specific issues that attend acting on the justified lockdown for western liberal democratic states, as modeled on discourse and accounted for by Jürgen Habermas. The authors argue that a range of norms are constructed in societies that, justifiably, need to be curtailed for the pandemic. The state has to take on the unusual role of sole guardian of norms under emergency pandemic conditions. Consistently with both the Millian-liberal justification and elements of Habermasian discourse ethics, they argue that that role can only be justified where it includes strategy for how to return political decisionmaking to the status quo ante. This is because emergency conditions are only justified as a means to protecting prepandemic norms. To this end, the authors propose that an emergency power committee is necessary to guarantee that state action during pandemic is aimed at re-establishing the conditions of legitimacy of government action that ecological factors (a virus) have temporarily curtailed.

Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence.

The incorporation of neural-based technologies into psychiatry offers novel means to use neural data in patient assessment and clinical diagnosis. However, an over-optimistic technologisation of neuroscientifically-informed psychiatry risks the conflation of technological and psychological norms. Neurotechnologies promise fast, efficient, broad psychiatric insights not readily available through conventional observation of patients. Recording and processing brain signals provides information from 'beneath the skull' that can be interpreted as an account of neural processing and that can provide a basis to evaluate general behaviour and functioning. But it ought not to be forgotten that the use of such technologies is part of a human practice of neuroscience informed psychiatry. This paper notes some challenges in the integration of neural technologies into psychiatry and suggests vigilance particularly in respect to normative challenges. In this way, psychiatry can avoid a drift toward reductive technological approaches, while nonetheless benefitting from promising advances in neuroscience and technology.

Brain Recording, Mind-Reading, and Neurotechnology: Ethical Issues from Consumer Devices to Brain-Based Speech Decoding.

Brain reading technologies are rapidly being developed in a number of neuroscience fields. These technologies can record, process, and decode neural signals. This has been described as 'mind reading technology' in some instances, especially in popular media. Should the public at large, be concerned about this kind of technology? Can it really read minds? Concerns about mind-reading might include the thought that, in having one's mind open to view, the possibility for free deliberation, and for self-conception, are eroded where one isn't at liberty to privately mull things over. Themes including privacy, cognitive liberty, and self-conception and expression appear to be areas of vital ethical concern. Overall, this article explores whether brain reading technologies are really mind reading technologies. If they are, ethical ways to deal with them must be developed. If they are not, researchers and technology developers need to find ways to describe them more accurately, in order to dispel unwarranted concerns and address appropriately those that are warranted.

Neuroprosthetic Speech: The Ethical Significance of Accuracy, Control and Pragmatics.

Neuroprosthetic speech devices are an emerging technology that can offer the possibility of communication to those who are unable to speak. Patients with 'locked in syndrome,' aphasia, or other such pathologies can use covert speech-vividly imagining saying something without actual vocalization-to trigger neural controlled systems capable of synthesizing the speech they would have spoken, but for their impairment.We provide an analysis of the mechanisms and outputs involved in speech mediated by neuroprosthetic devices. This analysis provides a framework for accounting for the ethical significance of accuracy, control, and pragmatic dimensions of prosthesis-mediated speech. We first examine what it means for the output of the device to be accurate, drawing a distinction between technical accuracy on the one hand and semantic accuracy on the other. These are conceptual notions of accuracy.Both technical and semantic accuracy of the device will be necessary (but not yet sufficient) for the user to have sufficient control over the device. Sufficient control is an ethical consideration: we place high value on being able to express ourselves when we want and how we want. Sufficient control of a neural speech prosthesis requires that a speaker can reliably use their speech apparatus as they want to, and can expect their speech to authentically represent them. We draw a distinction between two relevant features which bear on the question of whether the user has sufficient control: voluntariness of the speech and the authenticity of the speech. These can come apart: the user might involuntarily produce an authentic output (perhaps revealing private thoughts) or might voluntarily produce an inauthentic output (e.g., when the output is not semantically accurate). Finally, we consider the role of the interlocutor in interpreting the content and purpose of the communication.These three ethical dimensions raise philosophical questions about the nature of speech, the level of control required for communicative accuracy, and the nature of 'accuracy' with respect to both natural and prosthesis-mediated speech.

"A Steadying Hand": Ascribing Speech Acts to Users of Predictive Speech Assistive Technologies.

Neuroprosthetic speech technologies are in development for patients suffering profound paralysis, such as can result from amyotrophic lateral sclerosis. These patients would be unable to speak without intervention, but with neurotechnology can be offered the chance to communicate. The nature of the technology introduces a neuroprosthesis that mediates neural activity to generate synthesised speech. How word prediction coheres with speaker intentions requires scrutiny. Some future forms of prostheses, using statistical language models to predict word patterns, could be thought of as participating with communicative intent - not merely channelling it. Concepts relating to vicarious liability, may serve to clarify these issues. This column shows how technology might interact with speaker intent in cases of delegated action, and how it should be seen as participating in the implementation of user "instructions".

A gap between reasons for skilled use of BCI speech devices and reasons for utterances, with implications for speech ownership.

The skilled use of a speech BCI device will draw upon practical experience gained through the use of that very device. The reasons a user may have for using a device in a particular way, reflecting that skill gained via familiarity with the device, may differ significantly from the reasons that a speaker might have for their utterances. The potential divergence between reasons constituting skilled use and BCI-mediated speech output may serve to make clear an instrumental relationship between speaker and BCI speech device. This will affect the way in which the device and the speech it produces for the user can be thought of as being "reasons responsive", hence the way in which the user can be said to be in control of their device. Ultimately, this divergence will come down to how ownership of produced speech can be considered. The upshot will be that skillful use of a synthetic speech device might include practices that diverge from standard speech in significant ways. This might further indicate that synthetic speech devices ought to be considered as different from, not continuous with, standard speech.

Control and Ownership of Neuroprosthetic Speech.

Implantable brain-computer interfaces (BCIs) are being developed to restore speech capacity for those who are unable to speak. Patients with locked-in syndrome or amyotrophic lateral sclerosis could be able to use covert speech - vividly imagining saying something without actual vocalisation - to trigger neural controlled systems capable of synthesising speech. User control has been identified as particularly pressing for this type of BCI. The incorporation of machine learning and statistical language models into the decoding process introduces a contribution to (or 'shaping of') the output that is beyond the user's control. Whilst this type of 'shared control' of BCI action is not unique to speech BCIs, the automated shaping of what a user 'says' has a particularly acute ethical dimension, which may differ from parallel concerns surrounding automation in movement BCIs. This paper provides an analysis of the control afforded to the user of a speech BCI of the sort under development, as well as the relationships between accuracy, control, and the user's ownership of the speech produced. Through comparing speech BCIs with BCIs for movement, we argue that, whilst goal selection is the more significant locus of control for the user of a movement BCI, control over process will be more significant for the user of the speech BCI. The design of the speech BCI may therefore have to trade off some possible efficiency gains afforded by automation in order to preserve sufficient guidance control necessary for users to express themselves in ways they prefer. We consider the implications for the speech BCI user's responsibility for produced outputs and their ownership of token outputs. We argue that these are distinct assessments. Ownership of synthetic speech concerns whether the content of the output sufficiently represents the user, rather than their morally relevant, causal role in producing that output.

Automating autism assessment: What AI can bring to the diagnostic process.

This paper examines the use of artificial intelligence (AI) for the diagnosis of autism spectrum disorder (ASD, hereafter autism). In so doing we examine some problems in existing diagnostic processes and criteria, including issues of bias and interpretation, and on concepts like the 'double empathy problem'. We then consider how novel applications of AI might contribute to these contexts. We're focussed specifically on adult diagnostic procedures as childhood diagnosis is already well covered in the literature.

The Post-Normal Challenges of COVID-19: Constructing Effective and Legitimate Responses.

The ongoing COVID-19 emergency clearly presents novel challenges, both in terms of difficulties for maintaining public health and in assuring that governmental responses are ethically sound. Centrally, responses must respect, as best as possible, fundamental human rights and human values. Conflicts among values arise in response to the crisis, and public officials have no choice but to prioritize some while sacrificing others. Utilizing the concepts of effectiveness and legitimacy within the framework of post-normal science (PNS), we investigate and recommend processes and measures to address COVID-19 that support increased public health, while upholding established rights and values. The effectiveness and legitimacy of science-led policymaking requires investigation of how that policy ought to be made (e.g. concepts of policymaking and PNS), as well as how it ought to interact with diversely-constituted publics (e.g. public inclusion in policymaking and policy communication).

When Thinking is Doing: Responsibility for BCI-Mediated Action.

Technologies controlled directly by the brain are being developed, evolving based on insights gained from neuroscience, and rehabilitative medicine. Besides neuro-controlled prosthetics aimed at restoring function lost somehow, technologies controlled via brain-computer interfaces (BCIs) may also extend a user's horizon of action, freed from the need for bodily movement. Whilst BCI-mediated action ought to be, on the whole, treated as conventional action, law and policy ought to be amended to accommodate BCI action by broadening the definition of action as "willed bodily movement". Moreover, there are some dimensions of BCI mediated action that are significantly different to conventional cases. These relate to control. Specifically, to limits in both controllability of BCIs via neural states, and in foreseeability of outcomes from such actions. In some specific type of case, BCI-mediated action may be due to different ethical evaluation from conventional action.

Is the European Data Protection Regulation sufficient to deal with emerging data concerns relating to neurotechnology?

Research-driven technology development in the fields of the neurosciences presents interesting and potentially complicated issues around data in general and brain data specifically. The data produced from brain recordings are unlike names and addresses in that it may result from the processing of largely involuntarily brain activity, it can be processed and reprocessed for different aims, and it is highly sensitive. Consenting for brain recordings of a specific type, or for a specific purpose, is complicated by these factors. Brain data collection, retention, processing, storage, and destruction are each of high ethical importance. This leads us to ask: Is the present European Data Protection Regulation sufficient to deal with emerging data concerns relating to neurotechnology? This is pressing especially in a context of rapid advancement in the fields of brain computer interfaces (BCIs), where devices that can function via recorded brain signals are expanding from research labs, through medical treatments, and beyond into consumer markets for recreational uses. One notion we develop herein is that there may be no trivial data collection when it comes to brain recording, especially where algorithmic processing is involved. This article provides analysis and discussion of some specific data protection questions related to neurotechnology, especially BCIs. In particular, whether and how brain data used in BCI-driven applications might count as personal data in a way relevant to data protection regulations. It also investigates how the nature of BCI data, as it appears in various applications, may require different interpretations of data protection concepts. Importantly, we consider brain recordings to raise questions about data sensitivity, regardless of the purpose for which they were recorded. This has data protection implications.

The role of ethics in data governance of large neuro-ICT projects.

Objective: We describe current practices of ethics-related data governance in large neuro-ICT projects, identify gaps in current practice, and put forward recommendations on how to collaborate ethically in complex regulatory and normative contexts. Methods: We undertake a survey of published principles of data governance of large neuro-ICT projects. This grounds an approach to a normative analysis of current data governance approaches. Results: Several ethical issues are well covered in the data governance policies of neuro-ICT projects, notably data protection and attribution of work. Projects use a set of similar policies to ensure users behave appropriately. However, many ethical issues are not covered at all. Implementation and enforcement of policies remain vague. Conclusions: The data governance policies we investigated indicate that the neuro-ICT research community is currently close-knit and that shared assumptions are reflected in infrastructural aspects. This explains why many ethical issues are not explicitly included in data governance policies at present. With neuro-ICT research growing in scale, scope, and international involvement, these shared assumptions should be made explicit and reflected in data governance.

Improving brain computer interface research through user involvement - The transformative potential of integrating civil society organisations in research projects.

Research on Brain Computer Interfaces (BCI) often aims to provide solutions for vulnerable populations, such as individuals with diseases, conditions or disabilities that keep them from using traditional interfaces. Such research thereby contributes to the public good. This contribution to the public good corresponds to a broader drive of research and funding policy that focuses on promoting beneficial societal impact. One way of achieving this is to engage with the public. In practical terms this can be done by integrating civil society organisations (CSOs) in research. The open question at the heart of this paper is whether and how such CSO integration can transform the research and contribute to the public good. To answer this question the paper describes five detailed qualitative case studies of research projects including CSOs. The paper finds that transformative impact of CSO integration is possible but by no means assured. It provides recommendations on how transformative impact can be promoted.