Studies have shown that some covertly conscious brain-injured patients, who are behaviorally unresponsive, can reply to simple questions via neuronal responses. Given the possibility of such neuronal responses, Andrew Peterson et al. have argued that there is warrant for some covertly conscious patients being included in low-stakes medical decisions using neuronal responses, which could protect and enhance their autonomy. The justification for giving credence to alleged neuronal responses must be analyzed from various perspectives, including neurology, bioethics, law, and as we suggest, philosophy of mind. In this article, we analyze the warrant for giving credence to neuronal responses from two different views in philosophy of mind. We consider how nonreductive physicalism’s causal exclusion problem elicits doubt about interpreting neural activity as indicating a conscious response. By contrast, such an interpretation is supported by the mind-body powers model of neural correlates of consciousness inspired by hylomorphism.

This article presents a comprehensive neuroethical framework that seeks to deepen our understanding of human consciousness and free will, particularly in the context of psychiatric and neurological disorders. By integrating insights from neuroscience with philosophical reflections on freedom and personal identity, the paper examines how various states of consciousness from interoception to self-awareness influence an individual’s autonomy and decision-making capabilities. The discussion utilizes a multidimensional, bottom-up approach to explore how neurobiological processes underlie different levels of conscious experience and their corresponding types of freedom, such as “intero-freedom” related to internal bodily states and “self-freedom” associated with higher self-awareness. This stratification reveals the profound impact of neurological conditions on patients’ freedom of choice and the ethical implications therein. The insights gained from this analysis aim to inform more tailored and effective treatments for psychiatric patients, emphasizing the restoration of autonomy and respect for their inherent dignity. This work underscores the essential unity of the human person through the lens of neuroethics, advocating for healthcare policies that recognize and enhance the personal freedom of those with mental health challenges.

Brain–computer interfaces (BCIs) exemplify a dual-use neurotechnology with significant potential in both civilian and military contexts. While BCIs hold promise for treating neurological conditions such as spinal cord injuries and amyotrophic lateral sclerosis in the future, military decisionmakers in countries such as the United States and China also see their potential to enhance combat capabilities. Some predict that U.S. Special Operations Forces (SOF) will be early adopters of BCI enhancements. This article argues for a shift in focus: the U.S. Special Operations Command (SOCOM) should pursue translational research of medical BCIs for treating severely injured or ill SOF personnel. After two decades of continuous military engagement and on-going high-risk operations, SOF personnel face unique injury patterns, both physical and psychological, which BCI technology could help address. The article identifies six key medical applications of BCIs that could benefit wounded SOF members and discusses the ethical implications of involving SOF personnel in translational research related to these applications. Ultimately, the article challenges the traditional civilian-military divide in neurotechnology, arguing that by collaborating more closely with military stakeholders, scientists can not only help individuals with medical needs, including servicemembers, but also play a role in shaping the future military applications of BCI technology.

This article, titled “A Unified Understanding of the Human Mind - A Neuroethical Perspective,” examines the evolution of the concept of the human mind in Western thought and its integration with neuroscience, psychology, psychiatry, and relational dimensions. The author explores how the understanding of the mind has changed over time, influenced by shifts in philosophical paradigms, scientific advancements, and societal perspectives. The article traces the historical development of the mind’s concept, starting from ancient Greece, through influential thinkers like Plato and René Descartes, and progressing to contemporary perspectives. It highlights various philosophical and scientific approaches, including structuralism, functionalism, empiricism, and associationism, which have shaped our understanding of the mind. The article also delves into contemporary integration, where advancements in neuroimaging and the rise of holistic approaches offer a more nuanced understanding of the human mind. The author emphasizes the importance of the relational dimension and the interconnectedness of mental processes, the brain, and the external environment. This integrated perspective can benefit psychiatric treatment and psychological assessments by fostering a holistic approach to mental health. In conclusion, the article advocates for a multidimensional perspective that bridges subjective and objective aspects of human experience, offering promise for theoretical knowledge and practical applications in psychology, psychiatry, and neuroscience.

Portable MRI (pMRI) technology, which promises to transform brain imaging research by facilitating scanning in new geographic areas and the participation of new, diverse populations, raises many ethical, legal, and societal issues (ELSI). To understand this emerging pMRI ELSI landscape, we surveyed expert stakeholder views on ELSI challenges and solutions associated with pMRI research.

The paucity of existing baseline data for understanding neurologic health and the effects of injury on people from Indigenous populations is causally related to the limited representation of communities in neuroimaging research to date. In this paper, we explore ways to change this trend in the context of portable MRI, where portability has opened up imaging to communities that have been neglected or inaccessible in the past. We discuss pathways to engage local leadership, foster the participation of communities for this unprecedented opportunity, and empower field-based researchers to bring the holistic worldview embraced by Indigenous communities to neuroimaging research.

Advances in brain–brain interface technologies raise the possibility that two or more individuals could directly link their minds, sharing thoughts, emotions, and sensory experiences. This paper explores conceptual and ethical issues posed by such mind-merging technologies in the context of clinical neuroethics. Using hypothetical examples along a spectrum from loosely connected pairs to fully merged minds, the authors sketch out a range of factors relevant to identifying the degree of a merger. They then consider potential new harms like loss of identity, psychological domination, loss of mental privacy, and challenges for notions of autonomy and patient benefit when applied to merged minds. While radical technologies may seem to necessitate new ethical paradigms, the authors suggest the individual-focus underpinning clinical ethics can largely accommodate varying degrees of mind mergers so long as individual patient interests remain identifiable. However, advanced decisionmaking and directives may have limitations in addressing the dilemmas posed. Overall, mind-merging possibilities amplify existing challenges around loss of identity, relating to others, autonomy, privacy, and the delineation of patient interests. This paper lays the groundwork for developing resources to address the novel issues raised, while suggesting the technologies reveal continuity with current healthcare ethics tensions.

Human brain organoids (HBOs) are three-dimensional biological entities grown in the laboratory in order to recapitulate the structure and functions of the adult human brain. They can be taken to be novel living entities for their specific features and uses. As a contribution to the ongoing discussion on the use of HBOs, the authors identify three sets of reasons for moral concern. The first set of reasons regards the potential emergence of sentience/consciousness in HBOs that would endow them with a moral status whose perimeter should be established. The second set of moral concerns has to do with an analogy with artificial womb technology. The technical realization of processes that are typically connected to the physiology of the human body can create a manipulatory and instrumental attitude that can undermine the protection of what is human. The third set concerns the new frontiers of biocomputing and the creation of chimeras. As far as the new frontier of organoid intelligence is concerned, it is the close relationship of humans with new interfaces having biological components capable of mimicking memory and cognition that raises ethical issues. As far as chimeras are concerned, it is the humanization of nonhuman animals that is worthy of close moral scrutiny. A detailed description of these ethical issues is provided to contribute to the construction of a regulative framework that can guide decisions when considering research in the field of HBOs.

Rapid advances in neurotechnology and neurosurgery are positioned to revolutionize care for patients suffering from debilitating neurological and psychiatric disease. Enthusiasm for the adoption of these technologies is tempered by ethical dilemmas regarding resource allocation, provision of care, communication with patients and other providers, and other potential pitfalls. In the present work, we discuss bioethical implications of novel neurotechnologies for medical practice. In particular, we examine the implications of neurotechnological advancement through the lens of professional communication. Emerging challenges within this domain are presented in the context of physician interactions with four key partners: (i) patients; (ii) other physicians; (iii) industry; and (iv) society-at-large. Anticipated issues as well as mitigation strategies are discussed as they relate to communication with these stakeholders.

Despite increased efforts of government and non-government organisations to intervene via harm reduction and education initiatives, the opioid crisis has continued to worsen and has been exacerbated by the COVID-19 pandemic. In British Columbia, Canada, opioid overdose deaths in 2021 are the highest ever recorded. Neuromodulation procedures such as deep brain stimulation and repetitive transcranial magnetic stimulation have gained traction as treatments for opioid use disorder in various countries such as Germany, the Netherlands, the United States and China. However, these treatment options have been met with apprehension from both clinicians and patients, likely owing to fear, stigma and reluctance to label addiction as a brain disorder. Further complicating this landscape are socio-demographic factors, as marginalised communities are disproportionately burdened by addiction, while having poor access to care and a history of distrust in the health system. This multifactorial challenge involving many sociocultural factors requires culturally sensitive, interdisciplinary approaches to ensure direct-to-brain innovations are implemented ethically and equitably. This review summarises the state of the science for using neuromodulation to treat opioid use disorder, as well as the available ethical discourse surrounding the expansion of clinical trials and eventual widespread clinical implementation. Additional ethics discussions highlight opportunities for the engineering and clinical evolution of neuromodulation for opioid use disorder trials.

Geographic, social, political, and economic factors shape access to advanced neurotechnologies, yet little previous research has explored the barriers, enablers, and areas of opportunity for equitable and meaningful access for diverse patient communities across Canada. We applied a mixed-mode approach involving semi-structured interviews and rating scale questions to consult with 24 medical experts who are involved in the care of patients who undergo functional neurosurgery targeting the brain. Seven major themes emerged from the qualitative analysis: Health care system, Neurotechnology features, Patient demographics, Target condition features, Ethics, Upstream barriers and enablers, and Areas of opportunity. Descriptive statistics of the Likert-scale responses suggest that interviewees perceive a disparity between the imperative of access to advanced neurotechnologies for people living in rural and remote areas and the likelihood of achieving such access. The results depict a complex picture of access to functional neurosurgery in Canada with pockets of excellence and a motivation to improve the availability of care for vulnerable populations through the expansion of distributed care models, improved health care system efficiencies, increasing funding and support for patient travel, and increasing awareness about and advocacy for advanced neurotechnologies.

The neurotechnology sector is likely to develop under pressure towards commercialized, nonmedical products and may also undergo market consolidation. This possibility raises ethical, social, and policy concerns about the future responsibility of neurotechnology innovators and companies for high-consequence design decisions. Present-day internet technology firms furnish an instructive example of the problems that arise when providers of communicative technologies become too big for accountability. As a guardrail against the emergence of similar problems, concerned neurotechnologists may wish to draw inspiration from antitrust law and direct efforts, where appropriate, against undue consolidation in the commercial neurotechnology market.

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023.

One health suggests that human and animal health are comparable, but in practice, the concept aligns with the principles of public health ethics. One health ethics, as such, appears to eschew connotations of equality for the natural world. A theory of agency revises that anthropocentric assumption. This article begins with a critique of environmental dualism: the idea that human culture and nature are separate social realms, thus justifying public health as a (unifying) purpose. In response, this article argues that, first, a neuroethics of one health might equally regard humans and (some) animals, which have comparable mental states, as rational agents. Second, rational agency should ground our moral connections to nature in terms of the egalitarian interests we have (as coinhabitants) in the health of the planet. While this article makes a moderate case for interspecific rights (as the first argument asserts), neuroscience is unlikely for now to change how most public institutions regard nonhuman animals in practice. However, the second argument asserts that rational agency is also grounds for philosophical environmentalism. One health ethics, therefore, is a theory of equality and connects culture to nature, and, as such, is a separate, but coextensive approach to that of public health.

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.