Neuroethics and neurotechnology: confronting just distribution

The University of Michigan is developing a minimally-invasive low-power brain implant, termed “BioBolt”, that transmits neural signals to a computer control station, and may someday be used to reactivate paralyzed limbs.


While the BioBolt carries enormous potential, the issues of intellectual property and market partnership raise a number of neuroethical questions. In our current era of fast-emerging innovative neurotechnology, we must critically confront the practical questions of how such technologies will be provided to those who need them. In our modern society, commutative justice theories establish the disproportionate provision of goods based upon relative (and unequal) need. Their fundamental assumption is that all patients who need such interventions would be provided access and means to acquire them. Implicit to this assumption are notions of neoclassical economics based upon Adam Smith’s construct of rational actors and unlimited resources (Smith, 1776). However, even a cursory analysis of the contemporary atmosphere of healthcare provision reveals such Smithian assumptions to be vastly unrealistic. In fact, resources are limited, and their provision is based upon a multidimensional calculus that determines the relative distribution of medical goods and services. Put simply, not everybody gets what they need, and this is particularly the case for high-tech medical interventions that are often only partially covered, and in some cases, not covered at all by the majority of health insurance plans. Moreover, some 57 million Americans are currently without health insurance (Wolf, 2010).


Now more than ever, we face the pragmatic charge of access: who will receive state-of-the-art neurotechnological interventions, such as the BioBolt? Will these approaches become part of a new ‘boutique neurology,’ or will there be active assertion and effort(s) to increase the utility and use of these interventions, so as to make them more affordable and more widely accessible within the general population of those patients who might require them? Will some newly developed medical criteria accommodate these decisions and actions, or, as is more likely, will the tipping points be governed by healthcare insurance provisions? How can and/or should healthcare reform(s) be adjusted and adjudicated in order to accommodate rapidly advancing science and the potential benefit(s) it might confer? While certain provisions of the new federal healthcare plan might support such directions, real availability and access will only be sustainable through a real shift toward a more demand-side health economics, which would constitute something of a sea change in our overall economic infrastructure. But rarely does such change occur all at once. Instead, it may be more viable to dedicate efforts to developing realistic designs for more equitable allocation of neurotechnologies. Such efforts, if appropriately subsidized and sustained, could be important droplets towards the sea change that may be necessary.


For further reference, see:

Giordano, J. (2010). Neuroethical Issues in Neurogenetic and Neuro-Implantation Technology: The Need for Pragmatism and Preparedness in Practice and Policy. Studies in Ethics, Law, and Technology. Vol. 4 (3): Article 4.

Giordano, J., Benedikter, R., and Boswell, M. V. (2010). Pain Medicine, Biotechnology and Market Effects: Tools, Tekne and Moral Responsibility. Ethics in Biology, Engineering, and Medicine. Vol. 1 (2): 135-42.