Page - 63 - in Cyborg Mind - What Brain–Computer and Mind–Cyberspace Interfaces Mean for Cyberneuroethics

Neuronal Interface Systems • 63 However, with DBS, there is always a risk of damaging blood vessels in the brain or disturbing previously healthy regions as the electrodes are inserted. This means that the procedure can only be used in patients with severe symptoms that cannot be controlled by pharmaceutical treatments.53 DBS electrodes can also be connected via a subcutaneous extension wire to battery-driven stimulus generators that may be implanted subcutaneously so that the system is located entirely within the patient’s body.54 But it is important to note that even though DBS is an intervention that may increase the patient’s quality of life, which is otherwise restricted by his or her illness, it is neither life-saving nor curative.55 From a more research-based perspective, DBS offers the ability to study specific and important brain functions and cognitive abilities while consid- ering them in real time. For instance, it is possible to examine the effects of DBS on agency and decision-making because the procedure can directly change a person’s mood and behaviour by modifying the biological neuronal basis of unconscious and conscious mental states. This can be done either intentionally, if the individual was affected by a major psychiatric indication such as a serious depressive disorder, or as an unintended consequence of the procedure that was undertaken for another reason.56 On this account, the European Parliament’s 2009 Science and Technology Options Assessment’s report entitled Human Enhancement Study indicated: [A] presupposition underlying much of the debates on the societal and ethical implications of technologies such as DBS is that they manifest that medicine has come to grips with something that was until recently considered to be out of reach of direct medical intervention: the mind . . . The capacity of turning on and off emotions, moods, motor control . . ., simply by switching on or off one’s DBS, appears to powerfully illustrate this enlarged power of science and technology.57 In this regard, the fact that DBS may have a direct, unconscious effect on a patient may give rise to questions about his or her ability to make free will decisions, since it in unclear whether it is the patient or the DBS device that is actually in control of his or her different moods and their consequences. For example, if the depressive symptoms of certain patients can only be addressed by DBS, then they may be uncertain whether they are, in fact, in complete control of their behaviour and thoughts. However, control is very likely to be a matter of degrees depending on the manner in which DBS may affect different persons.58 It is also possible to examine the way in which patients’ experience with DBS can affect their concepts of identity and how it alters their sense of who they are, whether or not they are even aware that this change has occurred. Indeed, the influence of DBS on identity is unique in that:59 This open access edition has been made available under a CC-BY-NC-ND 4.0 license thanks to the support of Knowledge Unlatched. Not for resale.