Should we be concerned about preserving agency and personal identity in patients with Adaptive Deep Brain Stimulation systems?
Should we be concerned about preserving agency and personal identity in patients with Adaptive Deep Brain Stimulation systems?
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DOI：
10.1080/21507740.2017.1320337
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发表时间：
2017-01-01
影响因子：
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通讯作者：
Goodman, Wayne K
中科院分区：
文献类型：
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作者：
Lazaro-Munoz, Gabriel;McGuire, Amy L;Goodman, Wayne K
大量关于脑深部电刺激（DBS）的理论神经伦理学文献集中在DBS如何影响代理和个人身份。使用刺激特定大脑区域和修改人类输出的设备是对“自我”进行哲学检查的肥沃土壤，包括这些设备如何改变我们对代理和个人身份的理解。这些都是重要而有趣的问题，特别是考虑到下一代神经设备的当前发展，例如自适应DBS（aDBS）系统，这是一种“智能”脑机接口，可以根据个人的神经活动自动调整刺激，以调节情绪和运动和行为输出。Goering及其同事（2017）认为，aDBS系统“有可能影响我们的身份，也许支持我们，使我们成为我们想成为的人，但也许也会以我们不希望的方式改变我们，甚至挑战我们的身份和/或代理”（67）。我们认为，（1）aDBS相关的代理和个人身份的变化本质上并不是负面的结果，其影响可能在很大程度上取决于患者的前aDBS病理状态;（2）aDBS对代理和个人身份的影响需要与aDBS患者和其他利益相关者进行实证研究，以产生和测试充分知情的假设;以及（3）当评估aDBS系统作为一种医疗干预措施的发展时，从伦理角度来看，目标不应仅仅是最大限度地保护机构或个人身份，而是要了解风险和收益（包括对机构或个人身份的积极和消极影响），以及aDBS的权衡，并使其利益最大化，危害最小化。
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.