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Extending Our View on Using BCIs for Locked-in Syndrome

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Abstract

Locked-in syndrome (LIS) is a severe neurological condition that typically leaves a patient unable to move, talk and, in many cases, initiate communication. Brain Computer Interfaces (or BCIs) promise to enable individuals with conditions like LIS to re-engage with their physical and social worlds. In this paper we will use extended mind theory to offer a way of seeing the potential of BCIs when attached to, or implanted in, individuals with LIS. In particular, we will contend that functionally integrated BCIs extend the minds of individuals with LIS beyond their bodies, allowing them greater autonomy than they can typically hope for in living with their condition. This raises important philosophical questions about the implications of BCI technology, particularly the potential to change selves, and ethical questions about whether society has a responsibility to aid these individuals in re-engaging with their physical and social worlds. It also raises some important questions about when these interventions should be offered to individuals with LIS and respecting the rights of these individuals to refuse intervention. By aiding willing individuals in re-engaging with their physical and social worlds, BCIs open up avenues of opportunity taken for granted by able individuals and introduce new ways in which these individuals can be harmed. These latter considerations serve to highlight our emergent social responsibilities to those individuals who will be suitable for, and receive, BCIs.

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Notes

  1. Available at: http://www.cyberkineticsinc.com/content/index.jsp. Accessed on 19 Dec 2007.

  2. See [3].

  3. See, for example, [4].

  4. These caveats should not be taken as concessions to Neo-Cartesian theories of mind. The assumption of Neo-Cartesians that mental states are essentially private is not required to make our point. Due to the anomalous circumstance of interacting with a largely or totally unresponsive individual, the evidence, including context of action, ordinarily used to justify cognitive vocabulary in explaining intentional behavior is unavailable. We can expect that this will sometimes place severe constraints on what can be reasonably ascribed to a patient with classic or total LIS. See [11, 12].

  5. Note that there are other technologies being examined for use as BCIs (e.g., magnetoencephalography and functional magnetic resonance imaging), but their utility and practicality for patients with LIS is unknown.

  6. “Neurotrophic electrode is a tiny device implanted onto a target area on outer layer of brain to detect neural activity there.” http://www.neuralsignals.com/movementrestoration.htm. Accessed 21 Dec 2007.

  7. See [50].

  8. Arguably, extended mind theory falls under the broad rubric of functionalism, where mental state terms are functional terms and any given mental state is identified, and individuated, by its respective functional roles in ordering an individual’s behavior or interacting with other mental states [52]. Extended mind theory contends that the physical substrate over which human mentality supervenes is not limited to either the central nervous system or the organic body. This will come as a surprise to brain centrists (e.g., mind-brain identity theorists) and dualists, but perhaps not to many functionalists.

  9. There are, for instance, attendant worries about the boundaries of the extended mind that emerge out of accounts like this one. Put succinctly, where does the material substrate of the extended mind stop? We suspect that any answer to such a question must be contextualized to the particular instance of cognition we are discussing. This allows for, or places no a priori conditions on, a change in physical substrates (e.g., a PDA instead of paper and pencil) over which an individual’s cognitive processes supervene as she cognitively engages with her environment. Substantive, a priori means of setting the boundary of an extended mind are limited to such conditions as have already been mentioned (e.g., functional integration). Rather than rehearse emerging discussions in the literature responding to this, and other, kinds of worries or criticisms, we direct interested readers to Neil Levy’s helpful discussion. See [54].

  10. Here we follow the work of such feminists as Sue Sherwin in using various theories or frameworks as lenses through which to re-see a certain domain of action or discourse. See [55]. Instead of becoming embroiled in metaphysical debates about the nature, or extention, of mind that might threaten to undo any possible philosophical advance arising from a re-seeing of mind as extended, we use extended mind theory heuristically.

  11. Bauby, editor-in-chief of Elle magazine, suffered a brain stem stroke at the age of 43 in 1995. He had classic LIS, retaining the ability to blink his left eye, through which he communicated with others

  12. Our thanks to Jocelyn Downie for this analysis of autonomy.

  13. This is not intended as a claim that rules out other ways of seeing functionally integrated BCIs as self-changing. What an extended mind theory makes clear is that changes in the body, including changes in what counts as the boundary of the body, have ontic, rather than merely psychological or subjective, implications for self-identity.

  14. Our thanks to Chris Kaposy for this point.

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Acknowledgement

The research for this paper was funded in part by a grant from the Canadian Institutes of Health Research. Sincere thanks are owed to members of the Novel Tech Ethics research team for helpful comments on earlier drafts of this paper. Thanks also to an anonymous reviewer for the journal Neuroethics.

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  1. Novel Tech Ethics, Department of Bioethics, Dalhousie University, Halifax, Canada

    Andrew Fenton & Sheri Alpert

  2. Novel Tech Ethics, Intellectual Commons, Dalhousie University, 1234 Le Marchant Street, Halifax, NS, B3H 3P7, Canada

    Andrew Fenton & Sheri Alpert

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Correspondence to Andrew Fenton.

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Fenton, A., Alpert, S. Extending Our View on Using BCIs for Locked-in Syndrome. Neuroethics 1, 119–132 (2008). https://doi.org/10.1007/s12152-008-9014-8

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