Abstract
As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and Martha Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions.
Similar content being viewed by others
References
Rommelfanger KS, Pustilink A and Salles A. Mind the gap: Lessons learned from Neurorights. Science and Diplomacy. Feb 28, 2022. Accessed on 21 June 2022 at: https://www.sciencediplomacy.org/article/2022/mind-gap-lessons-learned-neurorights
Yuste, R., S. Goering, B.A.Y. Arcas, G. Bi, J.M. Carmena, A. Carter, J.J. Fins, P. Friesen, J. Gallant, J.E. Huggins, J. Illes, P. Kellmeyer, E. Klein, A. Marblestone, C. Mitchell, E. Parens, M. Pham, A. Rubel, N. Sadato, L.S. Sullivan, M. Teicher, D. Wasserman, A. Wexler, M. Whittaker, and J. Wolpaw. 2017. Four ethical principles for neurotechnologies and artificial intelligence. Nature. 551 (7679): 159–163. https://doi.org/10.1038/551159a3 (https://www.nature.com/news/four-ethical-priorities-for-neurotechnologies-and-ai-1.22960).
Goering, S., E. Klein, L.S. Sullivan, A. Wexler, B. AguerayArcas, G. Bi, J.M. Carmena, A. Carter, J.J. Fins, P. Friesen, J. Gallant, J.E. Huggins, J. Illes, P. Kellmeyer, A. Marbleston, C. Mitchell, E. Parens, M. Pham, A.L. Ruberl, N. Sadato, M. Teicher, D. Wasserman, M. Whittaker, J. Wolpaw, R. Yuste, (Neurotechnology Ethics Taskforce [NET]). 2021. Guidelines for responsible development and application of neurotechnologies. Neuroethics 14: 365–386. https://doi.org/10.1007/s12152-021-09468-6.
Ienca, M., J.J. Fins, R.J. Jox, F. Jotterand, S. Vöneky, R. Andorno, T. Ball, C. Castelluccia, R.C. Lozano, H. Chneiweiss, A. Ferretti, O. Friedrich, H. Greely, S. Hurst, G. Merkel, F. Molnar-Gabor, J. Scheibner, E. Vayena, R. Yuste, and P. Kellmeyer. 2022. A Global governance framework for brain data. Neuroethics 15: 20. https://doi.org/10.1007/s12152-022-09498-8 (Published online 3 June 2022.).
McCay A. Neurorights: the Chilean constitutional change. AI & Society. Published on line 02 March 2022. https://doi.org/10.1007/s00146-022-0196-0.
Proyecto de reforma constitucional, iniciado en moción de los Honorables Senadores señor Girardi, señora Goic, y señores Chahuán, Coloma y De Urresti, que modifica el artículo 19, número 1°, de la Carta Fundamental, para proteger la integridad y la indemnidad mental con relación al avance de las neurotecnologías. Boletín N° 13.827–19. Sesion Ordinaria Numero 101. Celebrada el 07 de octubre de 2020, Legislatura numero 368. Accessed on 17 June 2022 at: https://www.bcn.cl/laborparlamentaria/wsgi/consulta/verParticipacion.py?idParticipacion=2216335
Bublitz, J.C. 2022. Novel neurorights: From nonsense to substance. Neuroethics 15: 7.
Schiff, N.D., J.T. Giacino, K. Kalmar, J.D. Victor, K. Baker, M. Gerber, B. Fritz, B. Eisenberg, J. O’Connor, E.J. Kobylarz, S. Farris, A. Machado, C. McCagg, F. Plum, J.J. Fins, and A.R. Rezai. 2007. Behavioral improvements with thalamic stimulation after severe traumatic brain injury. Nature 448 (7153): 600–603.
Giacino, J.T., S. Ashwal, N. Childs, R. Cranford, B. Jennett, D.I. Katz, J.P. Kelly, J.H. Rosenberg, J. Whyte, R.D. Zafonte, and N.D. Zasler. 2002. The minimally conscious state: Definition and diagnostic criteria. Neurology 58 (3): 349–353.
Fins, J.J. 2015. Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness. New York: Cambridge University Press.
Wright, M.S., and J.J. Fins. 2016. Rehabilitation, Education, and the integration of individuals with severe brain injury into civil society: Towards an expanded rights agenda in response to new insights from translational neuroethics and neuroscience. Yale Journal of Health Policy, Law, and Ethics 16 (2): 233–288.
Wright, M.S., M.R. Ulrich, and J.J. Fins. 2017. Guardianship and Clinical Research Participation: The Case of Wards with Disorders of Consciousness. Kennedy Institute of Ethics Journal 27 (1): 43–70.
Fins, J.J., and M.S. Wright. 2018. Rights Language and Disorders of Consciousness: A Call for Advocacy. Brain Injury 32 (5): 670–674.
Wright, M.S., N. Varsava, J. Ramirez, K. Edwards, N. Guevremont, T. Ezer, and J.J. Fins. 2018. Justice and Severe Brain Injury: Legal Remedies for a Marginalized Population. Florida State University Law Review 45: 313–382.
Fins, J.J., M.S. Wright, and S.R. Bagenstos. 2020. Disorders of Consciousness and Disability Law. Mayo Clinic Proceedings 95 (8): 1732–1739.
Shapiro, Z.E., D. Chaarushena, C. Lawrence, J. Wilner, A. Rabkin Golden, J. Wilner, A. Durkin, Z.M. Adams, W. Zhao, K. James, A. Pan, M.S. Wright, and J.J. Fins. (2021). Olmstead Enforcements for Moderate to Severe Brain Injury: The Pursuit of Civil Rights through the Application of Law, Neuroscience, and Ethics. Tulane Law Review. 95 (3): 525–600.
Shapiro ZE, Rabkin Golden A, Antill GE, Deb C, Fang K, Clarke E, Kallen A, Shulman K, Qureshi HM, Lawrence CV, Hoffman LC, Wright MS and Fins JJ. Designing an Americans with Abilities Act: Consciousness, capabilites, and civil Rights. Boston College Law Review. (Accepted for 2022).
Ezer, T., M.S. Wright, and J.J. Fins. 2020. The neglect of persons with severe brain injury: An international human rights analysis. Health and Human Rights Journal 22 (1): 265–278.
Sen, A. 1999. Commodities and Capabililties. New York: Oxford University Press.
Nussbaum, M. 2011. Creating Capabilities: The Human Development Approach. Cambridge: The Belknap Press of Harvard University Press.
Americans with Disabilities Act of 1990, Pub. L. No. 101–336, 104 Stat. 328 (1990)
UN General Assembly, Convention on the Rights of Persons with Disabilities : resolution / adopted by the General Assembly, 24 January 2007, A/RES/61/106. Accesed on 21 June 2022 at: https://www.refworld.org/docid/45f973632.html [accessed 21 June 2022]
Braslow, J.T., and J.T. Marder. 2019. History of psychopharmacology. Annual Review of Clinical Psychology 15: 25–50.
DeLong, M.R., and A.L. Benabid. 2014. Discovery of high-frequency deep brain stimulation of Parkinson disease: 2014 Lasker Award. JAMA 312 (11): 1093–1094.
BRAIN 2025 A Scientific Vision. Bargmann C and Newsome W, co-chairs. National Institutes of Health. June 5, 2014. Accessed on 21 June 2022 at: https://braininitiative.nih.gov/sites/default/files/pdfs/brain2025_508c.pdf
Monti, M.M., A. Vanhaudenhuyse, M.R. Coleman, M. Boly, J.D. Pickard, L. Tshibanda, A.M. Owen, and S. Laureys. 2010. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 362 (7): 579–589.
Hirsch, J., M.I. Ruge, K.H. Kim, D.D. Correa, J.D. Victor, N.R. Relkin, D.R. Labar, G. Krol, M.H. Bilsky, M.M. Souweidane, L.M. DeAngelis, and P.H. Gutin. 2000. An integrated functional magnetic resonance imaging procedure for preoperative mapping of cortical areas associated with tactile, motor, language, and visual functions. Neurosurgery 47 (3): 711–721.
Proyecto de reforma constitucional, iniciado en moción de los Honorables Senadores señor Girardi, señora Goic, y señores Chahuán, Coloma y De Urresti, que modifica el artículo 19, número 1°, de la Carta Fundamental, para proteger la integridad y la indemnidad mental con relación al avance de las neurotecnologías. Boletín N° 13.827–19. Sesion Ordinaria Numero 101. Celebrada el 07 de octubre de 2020, Legislatura numero 368. Accessed on 17 June 2022 at: https://www.bcn.cl/laborparlamentaria/wsgi/consulta/verParticipacion.py?idParticipacion=2216335
Fins JJ, Wright MS, Henderson JM and Schiff ND. Subject and family perspectives from the central thalamic deep brain stimulation for traumatic brain injury study, Part I. Cambridge Quarterly of Healthcare Ethics - Clinical Neuroethics. In Press.
Fins JJ. "Cognitive Restoration: Neuroethics and Disability Rights" as part of a panel entitled "Towards the Responsible Research and Innovation of Novel Neurotechnologies across Domains: Considerations of Agency, Responsibility and Access." Co-panelists included: Laura Y. Cabrera, Rachel Wurtzman, Jacob Robinson, Sara Goering and Gabriel Lazaro Munoz." 8th Annual BRAIN Initiative Meeting. June 21, 2022.
Fins, J.J., M.D. Bacchetta, and F.G. Miller. 1997. Clinical Pragmatism: A method of moral problem solving. Kennedy Institute of Ethics Journal 7 (2): 129–145.
Fins, J.J., F.G. Miller, and M.D. Bacchetta. 1998. Clinical Pragmatism: Bridging theory and practice. Kennedy Institute of Ethics Journal 8 (1): 39–44.
Fins, J.J., G.S. Dorfman, and J.J. Pancrazio. 2012. Challenges to deep brain stimulation: A pragmatic response to ethical, fiscal and regulatory Concerns. Annals of the New York Academy of Sciences 1265: 80–90. https://doi.org/10.1111/j.1749-6632.2012.06598.x.
Fins, J.J., and J. Illes. 2018. Pragmatic convergence and the epistemology of an adolescent neuroethics. Introduction to a collection entitled, Competing Identities of Neuroethics. Cambridge Quarterly of Healthcare Ethics. 27 (4): 554–557.
Miller FG and Fins JJ. Protecting human subjects in brain research: A pragmatic perspective. In, Neuroethics: Defining the Issues in Theory, Practice and Policy. Illes, J. editor. New York: Oxford University Press, 2005.
Fins, J.J. 2015. Neuroethics and disorders of consciousness: A pragmatic approach to Neuro-palliative Care. In The Neurology of Consciousness, Cognitive Neuroscience and Neuropathology, 2nd ed., ed. S. Laureys, O. Osseries, and G. Tononi, 241–255. Amsterdam: Elsevier.
Fins, J.J. 2017. Towards a pragmatic neuroethics in theory and practice. In The Debate about Neuroethics: Perspectives on the Field’s Development, Focus, and Future, ed. E. Racine and J. Aspler, 45–65. Berlin: Springer.
Fins, J.J. 2019. Disorders of consciousness in clinical practice: Ethical, legal and policy considerations. In Plum and Posner’s Diagnosis of Stupor and Coma, 5th ed., ed. J.P. Posner, C.B. Saper, J. Claussen, and N.D. Schiff, 449–477. New York: Oxford University Press.
Lammi, M.H., V.H. Smith, R.L. Tate, and C.M. Taylor. 2005. The minimally conscious state and recovery potential: A follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehanil 86 (4): 746–754.
Estraneo, A., A. Magliacano, S. Fiorenza, R. Formisano, A. Grippo, E. Angelakis, H. Cassol, A. Thibaut, O. Gosseries, G. Lamberti, E. Noé, S. Bagnato, B.L. Edlow, C. Chatelle, N. Lejeune, V. Veeramuthu, M. Bartolo, D. Mattia, J. Toppi, N. Zasler, C. Schnakers, and L. Trojano. 2022. Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study. European J Neurology 29 (2): 390–399.
Mainali S, Aiyagari V, Alexander S, Bodien Y, Boerwinkle V, Boly M, Brown E, Brown J, Claassen J, Edlow BL, Fink EL, Fins JJ, Foreman B, Frontera J, Geocadin RG, Giacino J, Gilmore EJ, Gosseries O, Hammond F, Helbok R, Claude Hemphill J, Hirsch K, Kim K, Laureys S, Lewis A, Ling G, Livesay SL, McCredie V, McNett M, Menon D, Molteni E, Olson D, O'Phelan K, Park S, Polizzotto L, Javier Provencio J, Puybasset L, Venkatasubba Rao CP, Robertson C, Rohaut B, Rubin M, Sharshar T, Shutter L, Sampaio Silva G, Smith W, Stevens RD, Thibaut A, Vespa P, Wagner AK, Ziai WC, Zink E, I Suarez J; Curing Coma Campaign collaborators. Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness. Neurocritical Care 2022. doi: https://doi.org/10.1007/s12028-022-01505-3. Online ahead of print.
Zuñiga-Fajuri A, Miranda LV, Miralles DZ, Vengas RS. Neurorights in Chile: Between neuroscience and legal science. In, Regulating Neuroscience: Transnational Legal Challenges, Hevia M, editor. As part of the Developments in Neuroethics and Bioethics Book Series, Illes J, editor. Cambridge MA: Academic Press/Elsevier, 2021. Chapter 7, pp. 165–179.
Owen, A.M., M.R. Coleman, M. Boly, M.H. Davis, S. Laureys, and J.D. Pickard. 2006. Detecting awareness in the vegetative state. Science 313 (5792): 1376–1379.
Bardin, J.C., J.J. Fins, D.I. Katz, J. Hersh, L.A. Heier, K. Tabelow, J.P. Dyke, D.J. Ballon, N.D. Schiff, and H.U. Voss. 2011. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function. Brain 134 (3): 769–782.
Edlow, B.L., and J.J. Fins. 2018. Assessment of covert consciousness in the intensive care unit: Clinical and ethical considerations. The Journal of Head Trauma Rehabilitation 33 (6): 424–434.
Claassen, J., K. Doyle, A. Matory, C. Couch, K.M. Burger, A. Velazquez, J.U. Okonkwo, J.R. King, S. Park, S. Agarwal, D. Roh, M. Megjhani, A. Eliseyev, E.S. Connolly, and B. Rohaut. 2019. Detection of brain activation in unresponsive patients with acute brain injury. New England Journal of Medicine 380 (26): 2497–2505.
Schiff, N.D. 2015. Cognitive Motor Dissociation following severe brain injuries. JAMA Neurology 72 (12): 1413–1415.
Monti, M.M., A. Vanhaudenhuyse, M.R. Coleman, M. Boly, J.D. Pickard, L. Tshibanda, A.M. Owen, and S. Laureys. 2010. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 362 (7): 579–589.
Fins, J.J. 2000. A proposed ethical framework for interventional cognitive neuroscience: A consideration of deep brain stimulation in impaired consciousness. Neurological Research 22: 273–278.
Fins, J.J. 2003. Constructing an ethical stereotaxy for severe brain injury: Balancing risks, benefits and access. Nature Reviews Neuroscience 4: 323–327.
International Military Tribunal. Trials of war criminals before the Nuremberg Military Tribunals under Control Council law no. 10. Washington, D.C.: Government Printing Office, 1950.
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Department of Health, Education and Welfare. Washington D.C.: Government Printing Office, 1979.
Katz, J. 1992. The consent principle of the Nuremberg Code: Its significance then and now. In The Nazi doctors and the Nuremberg Code: Human rights in human experimentation, ed. G.J. Annas and M.A. Grodin, 227–239. New York: Oxford University Press.
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1977. Use of Psychosurgery in Practice and Research: Report and Recommendations of National Commission for the Protection of Human Subjects. Federal Register 42 (99): 26318–26332.
Childress, J.F. 1999. An introduction to NBAC’s report on research involving persons with mental disorders that may affect decisionmaking capacity. Accountability in Research 7 (2–4): 101–115.
Fins, J.J., and F.G. Miller. 1997. The call of the sirens: Navigating the ethics of medication-free research in schizophrenia. Archives of General Psychiatry 54: 415–416.
Michels, R. 1999. Are research ethics bad for our mental health? New England Journal of Medicine 340 (18): 1427–1430.
Capron, A.M. 1999. Ethical and human-rights issues in research on mental disorders that may affect decision-making capacity. New England Journal of Medicine 340 (18): 1430–1434.
New York State Task Force on Life and the Law. Report and Recommendation for Research with Human Subjects who Lack Consent Capacity. New York State Department of Health, 2014.
Snow, C.P. 1959. The Two Cultures and the Scientific Revolution. New York: Cambridge University Press.
Fins, J.J., and Martin I. de Melo. 2010. C.P. Snow’s Two Cultures fifty years later: An enduring problem with an elusive solution. Technology in Society 32 (1): 1–4.
Fins, J.J.C.P. 2010. Snow at Wesleyan: Liberal learning and the origins of the “Third Culture.” Technology in Society 32 (1): 10–17.
The many-sided life of Sir Charles Snow. Life Magazine; April 7, 1961. p. 134–6.
Fins, J.J. 1993. PAHO’s Progress. The Hastings Center Report 23 (2): 2.
Fins JJ. Experiencia Norteamericana de la Ensenanza de la Bioetica. Serie Documentos Programa Regional de Bioetica (The North American Experience in the Teaching of Bioethics) in Seminario Taller Educacion en Bioetica. Programa Regional de Bioetica para America Latina y el Caribe. Organizacion Pan Americano de Salud/ Organizacion Mundial de Salud (PAHO/WHO). Concepcion, Chile. July 1995; pp. 31–40.
Fins, J.J. 1998. La Aproximacion y la Negociacion: El Pragmatismo Clinico y las Diferencias. Cuadernos del Programa Regional de Bioetica 6: 91–108.
"Salud y Desarrollo." Resolución REMSSAAA 19/337. Signed by Dr. Carlos Bazan Zender, Executive Secretary, Convenio Hipolito Unanue. Caracas, Venezuela, November 4, 1995.
Rodríguez del Pozo, P., and J.J. Fins. 2006. Iberian influences on Pan-American bioethics: bringing don quixote to our shores. Cambridge Quarterly of Healthcare Ethics 15 (3): 225–2383.
Rodríguez del Pozo, P., and J.J. Fins. 2009. The Many Voices of Spanish Bioethics: An Introduction. Cambridge Quarterly of Health Care Ethics 18 (3): 214–217.
O’Neil, T. 1995. All Politics is Local: And Other Rules of the Game. Avon: Adams Media Corp.
García Marco D. El proceso Constituyente de Chile es un ejemplo de esperanza para América Latina y el resto del mundo. BBC News Mundo. May 13, 2021. Accessed on 27 June 2022 at: https://www.bbc.com/mundo/noticias-america-latina-57080145
Bartlett J. Chile finalises new draft constitution to replace Pinochet-era document. The Guardian. May 16, 2022. Accessed on 27 June 2022 at: https://www.theguardian.com/world/2022/may/16/chile-constitution-new-draft-pinochet
Sengupta S. Chile writes a new constitution, confronting climate change head on. The New York Times. December 28, 2021. Accessed on 26 June 2022 at: https://www.nytimes.com/2021/12/28/climate/chile-constitution-climate-change.html?searchResultPosition=2
Ruiz-Tagle P. Chapter Eight- The most recent Chilean constitutional moment and its content. In, Five Republics and One Tradition: A History of Constitutionalism in Chile 1810–2020. Published on line by Cambridge University Press. October 8, 2021. Accessed on 26 June 2022 at: https://www.cambridge.org/core/books/abs/five-republics-and-one-tradition/most-recent-chilean-constitutional-moment-and-its-content/DC7EC023517188956B262F57853DC762
Acknowledgements
Research cited in this paper was supported in part by the National Institutes of Health BRAIN Initiative, "Cognitive Restoration: Neuroethics and Disability Rights" [1RF1MH12378-01], Fins JJ, PI.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author reports no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Fins, J.J. The Unintended Consequences of Chile’s Neurorights Constitutional Reform: Moving beyond Negative Rights to Capabilities. Neuroethics 15, 26 (2022). https://doi.org/10.1007/s12152-022-09504-z
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12152-022-09504-z