Brain Recording, Mind-Reading, and Neurotechnology: Ethical Issues from Consumer Devices to Brain-Based Speech Decoding.

Brain reading technologies are rapidly being developed in a number of neuroscience fields. These technologies can record, process, and decode neural signals. This has been described as 'mind reading technology' in some instances, especially in popular media. Should the public at large, be concerned about this kind of technology? Can it really read minds? Concerns about mind-reading might include the thought that, in having one's mind open to view, the possibility for free deliberation, and for self-conception, are eroded where one isn't at liberty to privately mull things over. Themes including privacy, cognitive liberty, and self-conception and expression appear to be areas of vital ethical concern. Overall, this article explores whether brain reading technologies are really mind reading technologies. If they are, ethical ways to deal with them must be developed. If they are not, researchers and technology developers need to find ways to describe them more accurately, in order to dispel unwarranted concerns and address appropriately those that are warranted.

[The contribution of an ethical concertation group in nephrology validated by a research protocol]. / L'apport d'une unité de concertation éthique pour la pratique professionnelle en néphrologie validé par un protocole de recherche.

For more than 10 years, nephrologists in the Grenoble-region have sought advice from the Ethical Concertation Unit in Nephrology with regards to whether to stop or continue dialysis for patients under palliative care. This process deserves a multidisciplinary debate between health professionals and qualified non-health professionals. Thus, we organized a qualitative research protocol in three parts (medical, philosophical, judicial) to explore this issue. Our study aimed to assess the impact of Ethical Concertation Unit in Nephrology's discussions regarding perception, knowledge, and judicial and ethical considerations. The practical repercussions of decision-making within medical practice, its impacts on the patient and his/her family, as well as associated-health professionals, was assessed. To achieve this, two questionnaires and an interview were organized by three Ethical Concertation Unit in Nephrology-leaders to review the viewpoints of the 22 permanent Ethical Concertation Unit in Nephrology members that had participated in 10 Ethical Concertation Unit in Nephrology sessions between 2015 and 2016 to discuss 21 case-reports. Only 13 persons (4 physicians, 6 nurses, 3 non-health professionals) agreed to respond to the questionnaires, and six physicians agreed to participate in an interview. Overall, it was found that most affected patients' physicians agreed with the multidisciplinary discussion, which included judicial and ethical perspectives, and felt reassured with regards to Ethical Concertation Unit in Nephrology's final decision. However, our study showed that Ethical Concertation Unit in Nephrology's functioning could be improved by promoting its existence more widely, by making these decisions earlier within clinical situations, to make Ethical Concertation Unit in Nephrology more accessible to health workers, to make reports easier to understand, to re-examine a posteriori some clinical situations, and to broaden the scope of multidisciplinary skills.

Neuroprosthetic Speech: The Ethical Significance of Accuracy, Control and Pragmatics.

Neuroprosthetic speech devices are an emerging technology that can offer the possibility of communication to those who are unable to speak. Patients with 'locked in syndrome,' aphasia, or other such pathologies can use covert speech-vividly imagining saying something without actual vocalization-to trigger neural controlled systems capable of synthesizing the speech they would have spoken, but for their impairment.We provide an analysis of the mechanisms and outputs involved in speech mediated by neuroprosthetic devices. This analysis provides a framework for accounting for the ethical significance of accuracy, control, and pragmatic dimensions of prosthesis-mediated speech. We first examine what it means for the output of the device to be accurate, drawing a distinction between technical accuracy on the one hand and semantic accuracy on the other. These are conceptual notions of accuracy.Both technical and semantic accuracy of the device will be necessary (but not yet sufficient) for the user to have sufficient control over the device. Sufficient control is an ethical consideration: we place high value on being able to express ourselves when we want and how we want. Sufficient control of a neural speech prosthesis requires that a speaker can reliably use their speech apparatus as they want to, and can expect their speech to authentically represent them. We draw a distinction between two relevant features which bear on the question of whether the user has sufficient control: voluntariness of the speech and the authenticity of the speech. These can come apart: the user might involuntarily produce an authentic output (perhaps revealing private thoughts) or might voluntarily produce an inauthentic output (e.g., when the output is not semantically accurate). Finally, we consider the role of the interlocutor in interpreting the content and purpose of the communication.These three ethical dimensions raise philosophical questions about the nature of speech, the level of control required for communicative accuracy, and the nature of 'accuracy' with respect to both natural and prosthesis-mediated speech.

Breaking Bad News about Cancer to Adolescents and Young Adults: The French Experience.

The announcement of a serious illness, like cancer, can be very stressful for adolescents and young adults, as well as for their parents. In view of this difficulty, the protection of patients' dignity and autonomy is a central concern of medical ethics. It was with this goal in mind that a French Announcement protocol was developed following the First French Convention for Cancer Patients (1998) and reaffirmed, in 2010, by the First French Convention for Child Cancer Patients and Their Families. Because the ethics literature on this subject is underdeveloped, an empirical study was conducted from 2012 to 2016 to explore patients' and parents' experience. This study concerns adolescents, young adults, their parents and their health care professionals. The objective of this article is to present the outcomes of the study, summarising the experience of patients, parents and professionals and outlining current practices in France.