Should We Be Concerned About Preserving Agency and Personal Identity in Patients With Adaptive Deep Brain Stimulation Systems?

摘要

A considerable amount of theoretical neuroethics literature on deep brain stimulation (DBS) has focused on how DBS might impact agency and personal identity. The use of devices that stimulate specific brain regions and modify human outputs is fertile ground for philosophical examinations about the “self,” including how these devices may transform our understanding of agency and personal identity. These are important and fascinating issues, particularly given the current development of next-generation neural devices, such as adaptive DBS (aDBS) systems, which are “smart” brain–computer interfaces that automatically adjust stimulation in response to an individual’s neural activity to regulate emotions and motor and behavioral outputs. Goering and colleagues (2017) argue that aDBS systems “have the potential to affect our identities, perhaps supporting us so that we can be who we want to be, but perhaps also changing us in ways we wouldn’t want, even to the point of challenging our identity and/or agency” (67). We argue that (1) aDBS-related changes in agency and personal identity are not intrinsically negative outcomes and their impact will likely depend in large part on patients’ pre-aDBS pathological state; (2) the impact of aDBS on agency and personal identity needs to be empirically examined with aDBS patients and other stakeholders to generate and test well-informed hypotheses; and (3) when evaluating the development of aDBS systems as a medical intervention, the goal from an ethical perspective should not simply be to maximize the preservation of agency or personal identity, but to understand the risks and benefits (including positive and negative impacts on agency or personal identity), as well as the trade-offs of aDBS, and to maximize its benefits and minimize harms.