Do Criminal Offenders Have a Right to Neurorehabilitation?

Soon it may be possible to promote the rehabilitation of criminal offenders through neurointerventions (interventions which exert direct physical, chemical or biological effects on the brain). Some jurisdictions already utilise neurointerventions to diminish the risk of sexual or drug-related reoffending. And investigation is underway into several other neurointerventions that might also have rehabilitative applications within criminal justice-for example, pharmacotherapy to reduce aggression or impulsivity. Ethical debate on the use of neurointerventions to facilitate rehabilitation-henceforth 'neurorehabilitation'-has proceeded on two assumptions: that we have instrumental reasons for employing neurorehabilitation (e.g. because it helps protect the public from crime); and that its permissibility depends upon whether its use unjustifiably infringes offenders' rights. This paper defends a different, hitherto neglected thought. I argue we have rights-based reasons to offer neurorehabilitation to offenders-in other words, that offenders have a moral right to neurorehabilitation. I identify three considerations which support a moral right to conventional rehabilitative interventions-(1) as a countermeasure to the debilitating side-effects of punishment; (2) as a derivative right of the right to hope for renewed liberty; and (3) as compensation for structural injustice. I argue these considerations extend to support a moral right to neurorehabilitation in the following instance: when neurorehabilitation would be part of the most effective package for facilitating rehabilitation, and can be carried out at reasonable cost. I then defend my argument against potential objections, including the objection that neurorehabilitation is a bad option for offenders to have and the charge of over-medicalisation.

The various faces of vulnerability: offering neurointerventions to criminal offenders.

In recent years, we have witnessed considerable progress in neurotechnologies that visualize or alter a person's brain and mental features. In the near future, some of these technologies could possibly be used to change neural parameters of high-risk behavior in criminal offenders, often referred to as neurointerventions. The idea of delivering neurointerventions to criminal justice populations has raised fundamental normative concerns, but some authors have argued that offering neurointerventions to convicted offenders could be permissible. However, such offers raise normative concerns too. One prominent worry that is often emphasized in the literature, relates to the vulnerability of convicted offenders in prison and forensic patients in mental health facilities. In this paper, we aim to show that as far as vulnerability is considered relevant within the context of offering medical interventions to offenders, it could contribute to arguments against as well as in favor of these offers.

'If we don't have consent, we need to have beneficence': Requiring beneficence in nonconsensual neurocorrection.

Neurointerventions-interventions that cause direct physical, chemical or biological effects on the brain-are sometimes administered to criminal offenders for the purpose of reducing their recidivism risk and promoting their rehabilitation more generally. Ethical debate on this practice (henceforth called 'neurocorrection') has focused on the issue of consent, with some authors defending a consent requirement in neurocorrection and others rejecting this. In this paper, I align with the view that consent might not always be necessary for permissible neurocorrective use, but introduce a qualification I argue ought to inform our ethical and legal analysis of neurocorrection if we are to administer neurocorrectives nonconsensually. I maintain our use of nonconsensual neurocorrection should be constrained by a beneficence requirement-that it should be limited to neurocorrectives that can be expected to benefit those required to undergo them; and my argument is that a beneficence requirement is necessary in order to safeguard against offender abuse. I highlight how we afford a heightened protective role to beneficence in other instances of biomedical intervention where consent is absent or in doubt; and I argue a beneficence requirement is also necessary in the correctional context because alternative candidate protections would provide insufficiently strong safeguards on their own. I then consider whether requiring beneficence in nonconsensual neurocorrection would (a) be incompatible with penal theory, (b) be objectionably paternalistic, or (c) foreclose many fruitful avenues of crime control. I argue in each case that it would not.

A Framework for ExacTrac Dynamic Commissioning for Stereotactic Radiosurgery and Stereotactic Ablative Radiotherapy.

This paper aims to provide guidance and a framework for commissioning tests and tolerances for the ExacTrac Dynamic image-guided and surface-guided radiotherapy (SGRT) system. ExacTrac Dynamic includes a stereoscopic X-ray system, a structured light projector, stereoscopic cameras, thermal camera for SGRT, and has the capability to track breath holds and internal markers. The system provides fast and accurate image guidance and intrafraction guidance for stereotactic radiosurgery and stereotactic ablative radiotherapy. ExacTrac Dynamic was commissioned on a recently installed Elekta Versa HD. Commissioning tests are described including safety, isocenter calibration, dosimetry, image quality, data transfer, SGRT stability, SGRT localization, gating, fusion, implanted markers, breath hold, and end-to-end testing. Custom phantom designs have been implemented for assessment of the deep inspiration breath-hold workflow, the implanted markers workflow, and for gating tests where remote-controlled movement of a phantom is required. Commissioning tests were all found to be in tolerance, with maximum translational and rotational deviations in SGRT of 0.3 mm and 0.4°, respectively, and X-ray image fusion reproducibility standard deviation of 0.08 mm. Tolerances were based on published documents and upon the performance characteristics of the system as specified by the vendor. The unique configuration of ExacTrac Dynamic requires the end user to design commissioning tests that validate the system for use in the clinical implementation adopted in the department. As there are multiple customizable workflows available, tests should be designed around these workflows, and can be ongoing as workflows are progressively introduced into departmental procedures.