Brain–machine interfaces for communication in complete paralysis: Ethical implications and challenges

Abstract

Recent advances in computational capacities and sensor technologies allow online translation of electric, magnetic, or metabolic brain activity into control signals of computers or external devices. These brain-machine or braincomputer interfaces (BMI/BCI) allow individuals with complete paralysis to sustain communication, for example, enabling them to answer simple “yes-no” questions or to select letters in order to spell out whole words and phrases. The possibility to sustain communication through BMI/BCI systems in paralysis raises many critical neuroethical questions addressed in this chapter. After an introduction and overview of the available BMI/BCI systems used for communication, ethical implications of this novel technology are drafted and discussed in direct reference to results and new insights from several clinical studies. These suggest, for example, that quality of life in locked-in syndrome (LIS), a state in which an individual is unable to move or speak, is not as limited and poor as generally believed, so that “patient wills” or “advanced directives” that were signed long before the locked-in state are questionable and might be used to avoid financial and social burdens by shortening what is anticipated to be long periods of care. After discussing limitations and challenges of the current BMI/BCI technology, the chapter closes with a future outlook and perspectives.