title: The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems.
abstract: Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability. We advocate the development of a comprehensive ethical and legal framework to address the challenges of emerging closed-loop neurotechnologies like BCIs and stress the centrality of informed consent and refusal as a means to foster accountability. We propose the creation of an international neuroethics task force with members from medical neuroscience, neuroengineering, computer science, medical law, and medical ethics, as well as representatives of patient advocacy groups and the public.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kellmeyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Cochrane
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.forename: Christine
authors.initials: C
authors.lastname: Mitchell
authors.forename: Tonio
authors.initials: T
authors.lastname: Ball
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fins
authors.forename: Nikola
authors.initials: N
authors.lastname: Biller-Andorno
mesh_terms: D062207:Brain-Computer Interfaces / Q000941:ethics* / Q000639:trends; D003657:Decision Making; D004992:Ethics, Medical; D006801:Humans; D007258:Informed Consent; D009014:Morals; D010243:Paralysis; D026684:Personal Autonomy; D035842:Research Subjects
keywords: accountability; autonomy; brain-computer interfaces; neuroethics; neurotechnology