Neuromodulation ethics: Preparing for brain– computer interface medicine

Brain–computer interface (BCI) technology is moving from research to clinical practice. Devices that detect seizure patterns and provide preemptive neurostimulation are in clinical use, and significant advancements have been made in BCI-based control of neuroprosthetics and deep brain stimulation systems for treatment of movement disorders. The transition of BCI-based devices into regular clinical use raises ethical challenges for clinicians and patients. Clinicians have important responsibilities in the initial consent process for obtaining BCI devices and in the ongoing management or neuromodulation of patients with BCI-based devices. Rather than understanding neuromodulation as purely technical, it is argued in this chapter that neuromodulation is better thought of as assistive, and that rehabilitation medicine provides a useful framework for beginning to address the kinds of ethical challenges likely to emerge for neuromodulation in BCI medicine.