Skip to main content
    • Aa
    • Aa

The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems


Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability. We advocate the development of a comprehensive ethical and legal framework to address the challenges of emerging closed-loop neurotechnologies like BCIs and stress the centrality of informed consent and refusal as a means to foster accountability. We propose the creation of an international neuroethics task force with members from medical neuroscience, neuroengineering, computer science, medical law, and medical ethics, as well as representatives of patient advocacy groups and the public.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

S. A Fairclough closed-loop perspective on symbiotic human-computer interaction. In: B Blankertz , G Jacucci , L Gamberini , A Spagnolli , J Freeman , eds. Symbiotic Interaction. Berlin, Germany: Springer International; 2015:5767.

G Baranauskas . What limits the performance of current invasive brain machine interfaces? Frontiers in Systems Neuroscience 2014;8:68.

V Nagaraj , ST Lee , E Krook-Magnuson , I Soltesz , P Benquet , PP Irazoqui , et al. Future of seizure prediction and intervention: Closing the loop. Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society 2015;32:194206.

NP Holmes , HJ Snijders , C Spence . Reaching with alien limbs: Visual exposure to prosthetic hands in a mirror biases proprioception without accompanying illusions of ownership. Perception & Psychophysics 2006;68:685701.

RR Murphy , DD Woods . Beyond Asimov: The three laws of responsible robotics. IEEE Intelligent Systems 2009;24:1420.

JJ Fins . Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness. Cambridge: Cambridge University Press; 2015.

J Habermas . Three normative models of democracy. Constellations 1994;1:110.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 37
Total number of PDF views: 158 *
Loading metrics...

Abstract views

Total abstract views: 906 *
Loading metrics...

* Views captured on Cambridge Core between 16th September 2016 - 24th August 2017. This data will be updated every 24 hours.