• Ethics

This month’s issue of Journal of Medical Ethics features a symposium on ‘neuro rights’ and the ‘right to mental integrity’. Medical ethics and the law have long recognised bodily rights—motivating requirements that patients give informed consent before medical interventions are performed on them or before research is conducted on them.

Rapid advancements in neuroscience and neurotechnology are raising new questions about the boundaries of bodily rights, whether they extend to the mind or the brain, or whether we need new concepts and rights to apply to the mental sphere.

As Farahany1 writes in her recent (2023) book, ‘The Battle for Your Brain’, the global market for consumer neurotechnology is growing rapidly, expecting to reach US$21 billion by 2026. A growing number of people are using personal neurotechnology that allows them to visualise and track their emotions, levels of alertness and concentration, as well as their actual brain waves (p. 3). Neurotechnological devices are also used in the medical realm to diagnose a concussion immediately after it occurs and to track changes in the brain over time—changes that might signal Alzheimer’s disease or schizophrenia. They are also used as assist devices, for example, the company Neuralink has recently enrolled their second patient in their PRIME study. The Neuralink implant, ‘Link’, allows persons with quadriplegia to control a computer cursor with their thoughts, allowing them to play video games or code.2 Artificially intelligent ‘brain decoders’ read the thoughts of patients who cannot speak and verbalise them through a computer-animated avatar via a brain–computer interface.3

Who owns the thoughts and other forms of mental data that are uncovered through these new technologies? Do we need patient consent to use this information and to ‘read off’ or influence people’s mental lives in any way, shape or form? What are the boundaries of such rights and permissions given that ordinary life involves interpreting and influencing each other’s mental lives? How do new technologies change that? Do we need new rights such as the right to mental integrity or are concerning cases covered by existing legal and ethical norms and rights such as the right to privacy and bodily autonomy?

Farahany1 has argued that we need a new right, which she calls ‘the right to cognitive liberty’, that becomes part of the Universal Declaration of Human Rights (p. 111). This right is a bundle of rights that protects freedom of thought, mental privacy and self-determination over our brains and mental experiences (p. 11). This is to combat a world that she thinks we are rapidly heading towards, ‘…a world of brain transparency, in which scientists, doctors, governments and companies may peer into our minds at will’ (p. 4). Brain and mental activity get to the heart of selfhood and identity, so ensuring we have the correct legal and ethical frameworks to protect them is of central importance.

It is in response to this central concern that this special symposium occurs. The articles in the symposium section of this month’s issue take on fundamental questions about one of the most frequently proposed kind of neuro rights—the right to mental integrity. While there is some variation in its conceptualisation and terminology, the basic idea of a right to mental integrity is that people have a right to not have their minds or mental states non-consensually interfered with.

An article by myself and Ubel cautions that the right to mental integrity is overly broad and superfluous in that existing concepts and rights in medical ethics and law can cover most cases of concern—we ought to avoid rights (violation) inflation.4 An article by Zuk offers an attempt to carve out a conception of the right to mental integrity that is not overly broad and he argues that it protects several types of fundamental interests—affective, epistemic and agential.5 An article by Tesink et al examines the intersection between the extended mind thesis and the right to mental integrity.6 They argue that on a philosophical account of the extended mind, some neurotechnologies would become part of the mind (and as such protected) and many others would no longer pose a special threat since so much would be covered by the right to mental integrity (eg, environmental influences infringe on the mind just as much as a neurodevice). In short, metaphysics has a central role to play in our thinking about the scope and boundaries of neuro rights like the right to mental integrity. Finally, an article by Wajnerman-Paz et al argues that if we do embrace something like a right to mental integrity, it ought to involve positive rights as well—namely, the idea that individuals have a right to interventions that restore and sustain mental and neural function.7

We hope that this special symposium highlights one of the core commitments of the Journal of Medical Ethics—the idea that philosophical analysis is important for medical ethics. As new areas of technology develop and raise new (and old) ethical questions, normative and conceptual analysis has an important role to play in shaping those questions and discourse—which, ultimately shapes law, policy and practice. Advances in neurotechnology and the accompanying development in thinking about neuro rights such as the right to mental integrity is but one example.