Contributors.

It is well known that we are beholden to Norbert Weiner for coining the modern use of the term “cybernetics” to denote a field of study in technological control mechanisms. In recognition of the fact that the blurring between technology and life is becoming increasing apparent, perhaps the title of this Special Section should have been “The Cyborgs among Us.” Using a definition of “cyborg” (i.e., “cybernetic organism”) as persons in which the organic and the technical have fused, more than 10% of the American population already qualify, for example, people with artificial organs, limbs, joints, or electronic pacemakers, drug implant systems, or implanted corneal lenses. Of course, such a definition is quite broad and purposefully provocative, but it remains insightful. Technology is already “under our skin” (both figuratively and literally) and the future only promises more interface at the micro-, nano-, and cellular levels.

Healthcare depends increasingly on advanced medical technology. In addition, other forms of technology contribute to determine how our lives are influenced by disease and disability. The extent to which persons with impaired bodily functions are forced to live their lives differently than other people depends to a large part on a variety of technologies, from wheelchairs to computer interfaces, from hearing aids to garage doors. This wide-ranging influence of technology has important ethical aspects, but has seldom been discussed in bioethics, the ethics of technology, or other branches of applied ethics.

Mechanical devices implanted in the body present implications for broad themes in religious thought and experience, including the nature and destiny of the human person, the significance of a person's embodied experience, including the experiences of pain and suffering, the person's relationship to ultimate reality, the divine or the sacred, and the vocation of medicine. Community-constituting convictions and narratives inform the method and content of reasoning about such conceptual questions as whether a moral line should be drawn between therapeutic or enhancement interventions and/or between somatic and neural/cognitive interventions. By attending to these broader community-forming concepts, it is possible to identify three general orienting themes in religious perspectives on incorporated mechanical devices, which we shall designate as perspectives of “appropriation,” “ambivalence,” and “resistance.”

After decades of specialization within the sciences, the development and application of implantable microchips and biosensors are now being made possible by a growing convergence among seemingly disparate scientific disciplines including, among others, biology, informatics, chemistry, and engineering. This convergence of diverse scientific disciplines is the basis for the creation of new technologies that will have significant medical potential. As of today, implantable microchips and biosensors are being used as mental prostheses to compensate for a loss of normal function, to remotely monitor patients' vital signs, to control the delivery of medications, and to communicate with geographically distant healthcare professionals and the outside environment.

Revolutions in semiconductor device miniaturization, bioelectronics, and applied neural control technologies are enabling scientists to create machine-assisted minds, science fiction's “cyborgs.” In a paper published in 1999, we sought to draw attention to the advances in prosthetic devices, to the myriad of artificial implants, and to the early developments of this technology in cochlear and retinal implants. Our concern, then and now, was to draw attention to the ethical issues arising from these innovations. Since that time, breakthroughs have occurred at a breathtaking pace. Scientists, researchers, and engineers using differing methodologies are pursuing the possibilities of direct interfaces between brains and machines. Technological innovations as such are neither good nor evil; it is the uses devised for them that create moral implications. As there can be ethical problems inherent in the proper human uses of technologies and because brain chips are a very likely future technology, it is prudent to formulate policies and regulations that will mitigate their ill effects before the technologies are widespread. Unlike genetic technologies, which have received widespread scrutiny within the scientific community, national governments, and international forums, brain–machine interfaces have received little social or ethical scrutiny. However, the potential of this technology to change and significantly affect humans is potentially far greater than that of genetic enhancements, because genetic enhancements are inherently limited by biology and the single location of an individual, whereas hybrids of human and machine are not so restricted. Today, intense interest is focused on the development of drugs to enhance memory; yet, these drugs merely promise an improvement of normal memory, not the encyclopedic recall of a computer-enhanced mind combined with the ability to share information at a distance. The potential of brain chips for transforming humanity are astounding. This paper describes advances in hybrid brain–machine interfaces, offers some likely hypotheses concerning future developments, reflects on the implications of combining cloning and transplanted brain chips, and suggests some potential methods of regulating these technologies.We are grateful to Prof. Michah D. Hester for helpful comments on this article.

Society has already seen multiple potential futures of neurotechnologies through the multifaceted lens of science fiction. We do not know which of those futures we will come to live, but the strong force in society's evolutionary process will likely continue to be the insight and oversight developed by the bioethics community, pushing and being pushed by the advances of technology, improvements in medical care, and market competitiveness.The author thanks the “Ethical Dimensions in Neuroscience” Program of the Stanford University BioX Interdisciplinary Initiative and the Stanford Center for Biomedical Ethics for supporting this work.

As neural implants transition from engineering design and testing into human subjects research, careful consideration must be paid to the ethical elements in developing research protocols. Although these ethical aspects may be framed by the design choices of the engineering, a number of challenging choices arise. In spite of many ethical considerations for neural implant technologies being shared with generic research ethics questions, there are subsets needing special attention. Even in considerations requiring increased attention, substantial overlap can be found with research ethics questions for general medical implants and for psychiatric pharmaceuticals. The special attention to specific ethical questions in neural implants exists because of the value placed on preserving cognition and control as well as our continued memory of significant past research abuses in neurosurgery. This paper focuses on three issues of particular saliency to neural implant testing: inclusion/exclusion of subjects with psychiatric conditions, consent withdrawal of research subjects, and enhancement as a goal.

The application of neurostimulation techniques such as deep brain stimulation (DBS)—often called a brain pacemaker for neurological conditions like Parkinson's disease (PD)—has generated “currents of hope.” Building on this hope, there is significant interest in applying neurostimulation to psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). These emerging neurosurgical practices raise a number of important ethical and social questions in matters of resource allocation, informed consent for vulnerable populations, and commercialization of research.The authors acknowledge the help of Dr. Jarrett Rosenberg, Ofek Bar-Ilan, Stacey Kallem, Allyson Mackey, and Cynthia Forlini. This study was supported by the Institut de recherches cliniques de Montréal (E.R.), SSHRC (E.R.), and NIH/NINDS R01 #NS045831 (J.I.)

Once a neural implant has shown some efficacy during initial research trials, it begins to enter the world of clinical application. This culminates when the implant becomes approved for a particular indication. However, the ethical challenges continue as the technology is adopted as a standard of practice. Patient eligibility criteria, as documented by inclusion and exclusion criteria with any new treatment, are not always clearly quantified and defined. These vagaries can result in considerable debate regarding who should or should not proceed with surgery. There is often considerable room for clinical judgment that can result in extension of the treatment to a wider range of patients. The ethical questions that arise in clinical decisionmaking differ significantly from those inherent in engineering design and research development.

These CQ Sources were compiled by Bette Anton.

“Health and Human Rights,” edited by Doris Schroeder, welcomes contributions on all areas outlined below. Submitted papers are peer-reviewed (short discussion papers will be reviewed by at least one, full papers by at least two reviewers). To submit a paper or to discuss suitable topics, please e-mail Doris Schroeder at [email protected].

In 2003, the United Kingdom's Human Fertilisation and Embryology Authority (HFEA) published a report entitled Sex Selection: Options for Regulation. The report outlined the findings of a 2-year review of available sex selection techniques and recommended that the United Kingdom ought not to permit any regulated technique to be used other than for medical reasons (i.e., other than for the avoidance of serious sex-linked genetic conditions). In so doing, it reflected the widespread opinion—repeatedly expressed in the public consultations that formed the cornerstone of the HFEA's review—that there is something ethically unacceptable, or at least ethically suspect, about sex selection for nonmedical, or “social,” reasons.I thank Dr. Doris Schroeder for her incisive and extremely useful comments on an earlier draft of this paper.

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].

Developments in the last several years have sparked renewed interest in the ethics of research involving humans. Issues relating to the global extent of research and its guiding principles are of particular importance to researchers, health officials, and individual ethics committees who want a deeper and more encompassing inquiry regarding the foundation and evolution of human research. This department of CQ launches a long overdue effort to explore these wider issues. Readers are invited to submit papers to Charles MacKay, 5011 Worthington Drive, Bethesda, MD, 20816, USA. E-mail: [email protected].

There is no greater paradox in bioethics than its tendency to constantly rediscover, in every conceivable venue, that the only way to honor and preserve the dignity and freedom of huddled, exploited masses is to trim away their decisional authority and appoint panels of well-educated, rational thinkers (such as bioethicists) to lay down the reasonable options for them. Bioethics cannot claim to be the first field to impugn the rationality of the oppressed as a means of upholding their dignity. But it certainly has claims on bringing this process toward its ultimate perfection.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.