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Protecting Decision-Making in the Era of Neuromodulation John D. Medaglia 1,2,3 & Andreas Kuersten 4 & Roy H. Hamilton 3 Received: 13 November 2019 / Accepted: 17 April 2020 # Springer Nature Switzerland AG 2020

Abstract How humans make decisions is one of the primary domains of inquiry in psychology. Our ability to make decisions leads to direct consequences in our lives and defines one aspect of autonomous function. Among clinicians and researchers, the pursuit of effective cognitive enhancements and treatments that could directly or indirectly influence our decision processes has become widespread, since many of the neural circuits that we stimulate are involved in autonomous decision-making. Given rapid scientific developments, it is prudent to consider how neuromodulation could affect a person’s ability to make choices and manage trade-offs between decision outcomes. In light of this dilemma, we offer a framework based in decision neuroscience that separates brain networks into decision-making core, volitional action, and moderating systems. This framework bridges bioethics and cognitive neuroscience to provide heuristics for the neural basis of autonomous decision-making. In doing so, we provide a general call to predict and weight risks and benefits of different degrees and kinds with regard to decision-making as increasingly precise neuromodulation techniques emerge. Keywords Neural control . Autonomy . Neuromodulation . Decision-making . Neuroethics

Introduction Our ability to make decisions mediates between our environment, intentions, and actions. We are often confronted with choices among options that carry different costs and rewards near or far in time. Some decisions are less consequential yet personal, such as the choice of a latte instead of black coffee. Others are high stakes and life-changing, such as choosing a spouse, buying a home, and consenting to risky medical procedures. Understanding the basis of decisions and biases is the primary focus of decision science, which aims to predict and explain decisions in experimental and real-world contexts (Simon, 1959) and how decisions are computed in the brain (Glimcher & Fehr, 2013). * John D. Medaglia [email protected] 1

Department of Psychology, Drexel University, Philadelphia, USA

2

Department of Neurology, Drexel University, Philadelphia, USA

3

Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

4

Neuroethics Studies Program, Center for Clinical Bioethics, Georgetown University Medical Center, Washington, USA

Intentionally or not, decisions can be affected by clinical and research methods. Broadly, interventions can influence a range of biological and behavioral mechanisms and outcomes in neurological and psychiatric contexts (Ashley, 2015). Moreover, a number of techniques are increasingly applied by researchers, the public, and private entities to enhance healthy functions that directly or indirectly contribute to decision-making (Farah, 2015; Sandberg et al., 2019; Santarn