Proactive Ethical Design for Neuroengineering, Assistive and Rehabilitation Technologies: the Cybathlon Lesson
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Proactive Ethical Design for Neuroengineering, Assistive and Rehabilitation Technologies: the Cybathlon Lesson Marcello Ienca1,6* , Reto W. Kressig2,3, Fabrice Jotterand1,4 and Bernice Elger1,5
Abstract Background: Rapid advancements in rehabilitation science and the widespread application of engineering techniques are opening the prospect of a new phase of clinical and commercial maturity for Neuroengineering, Assistive and Rehabilitation Technologies (NARTs). As the field enters this new phase, there is an urgent need to address and anticipate the ethical implications associated with novel technological opportunities, clinical solutions, and social applications. Main idea: In this paper we review possible approaches to the ethics of NART, and propose a framework for ethical design and development, which we call the Proactive Ethical Design (PED) framework. Conclusion: A viable ethical framework for neuroengineering, assistive and rehabilitation technology should be characterized by the convergence of user-centered and value-sensitive approaches to product design through a proactive mode of ethical evaluation. We propose four basic normative requirements for the realization of this framework: minimization of power imbalances, compliance with biomedical ethics, translationality and social awareness. The aims and values of the CYBATHLON competition provide an operative model of this ethical framework and could drive an ethical shift in neuroengineering and rehabilitation. Keywords: Ethics of assistive technology, Proactive ethical design, User-centered, Value sensitive design, Neuroethics, Cybathlon
Background With rapid advancements in rehabilitation science and the widespread application of engineering techniques for the restoration, compensation, assistance and enhancement of human neural systems, the field of neuroengineering is entering a new phase of clinical and commercial maturity. The first pioneering research prototypes of the 1980s and 90s have evolved into an increasingly mature technological spectrum with direct clinical applications and corroborated efficacy. Over the past two decades, assistive and rehabilitation technologies * Correspondence: [email protected] 1 Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Bernoullistrasse 28, -4056 Basel, CH, Switzerland 6 Health Ethics & Policy Lab, Department of Health Sciences & Technology, ETH Zürich, Zürich, Switzerland Full list of author information is available at the end of the article
have increased in number and variety. Concurrently, many invasive and non-invasive neurotechnologies have become available for assistive and rehabilitation aims. This expanded technological domain might be regarded as Neuroengineering, Assistive and Rehabilitation Technology (NART). NARTs have been developed with the main purpose of mitigating several morbidities associated with diseases and traumatic injuries to the human nervous system. Today, this evolving spectrum encompasses five major technological families: d
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