Ethical and social aspects of neural prosthetics

Neural prosthetics are devices or systems that bypass, modulate, supplement, or replace regions of the brain and its connections to the body that are damaged and dysfunctional from congenital abnormalities, brain and spinal cord injuries, limb loss, and neuropsychiatric disorders. Some prosthetics are implanted in the brain. Others consist of implants and systems outside the brain to which they are connected. Still others are completely external to the brain. But they all send inputs to and receive outputs from neural networks to modulate or improve connections between the brain and body. As artificial systems, neural prosthetics can improve but not completely restore natural sensory, motor and cognitive functions. This review examines the main ethical and social issues generated by experimental and therapeutic uses of seven types of neural prosthetics: auditory and visual prosthetics for deafness and blindness; deep brain stimulation for prolonged disorders of consciousness; brain-computer and brain-to-brain interfaces to restore movement and communication; memory prosthetics to encode and retrieve information; and optogenetics to modulate or restore neural function. The review analyzes and discusses how recipients of neural prosthetics can benefit from them in restoring autonomous agency, how they can be harmed by trying and failing to use or adapt to them, how these systems affect their identities, how to protect people with prosthetics from external interference, and how to ensure fair access to them. The review concludes by emphasizing the control these systems provide for people and a brief exploration of the future of neural prosthetics.