Personal responsibility in the age of user-controlled neuroprosthetics

Deep-brain stimulation systems are an accepted and clinically effective form of neuroprosthetic treatment for a variety of common and debilitating neurological movement disorders: Essential Tremor, Parkinson's, and others. Most current implementations of DBS are "open-loop:" they remain active continuously, whether or not the user is experiencing symptoms. Recent research suggests that it is possible to devise more advanced systems where stimulation is delivered on demand. Their research offers a proof-of-concept for a Brain-Computer Interface-triggered DBS (BCI-DBS) system capable of detecting either signs of tremor or the user's neural commands through an additional set of co-implanted sensors. The system then delivers stimulation to meet the user's needs or demands. These technologies, however, come with a set of moral problems - in particular, problems for personal responsibility. This paper investigates whether giving users moment-to-moment neural control over their DBS system is ethically responsible given that users can make bad choices and thus harm others. We also ask what responsibilities medical professionals have have to support users as they learn to adapt to neuroprosthetic use. We guide our exploration of these issues through a series of hypothetical scenarios that BCI-DBS users may face.