Operationalizing Agency in Brain Computer Interface (BCI) Research

As researchers involved in examining ethical issues related to neurotechnologies, we see potential utility in tools like the Qualitative Agentive Competency Tool (Q-ACT) designed to help clinicians, researchers, users, and caregivers evaluate impacts of neural devices on users’ agency. Sch€ onau et al. (Sch€ onau Andreas et al. 2021) introduce the Q-ACT to help assess changes in agency when a person uses a neural device, arguing that agency sits at the intersection of ethical issues rarely explored together in the neuroethics literature. Based on our team’s previous conceptual and empirical work (Mu~ noz et al. 2020; Zuk and L azaroMu~ noz 2019; Zuk, McGuire, and L azaro-Mu~ noz 2018; Zuk et al. 2020), we offer three suggestions to help guide further development of the Q-ACT. First, the Q-ACT is the kind of tool whose development we have advocated for in the past (Zuk and L azaro-Mu~ noz 2019), particularly given its incorporation of elements highlighted by experiential and relational conceptions of autonomy. Such a tool will help operationalize and measure the impacts that neurotechnologies can have on the lives of patients and their families, including impacts on personality, identity, agency, authenticity, autonomy, and self (PIAAAS) (Gilbert, Via~ na, and Ineichen 2018). However, actualization of this kind of tool has been limited by the sometimes dramatically different ways of talking about key constructs of interest and how they overlap. Through the Q-ACT, Sch€ onau et al. position agency as a key aspect of the experience of living with a neural device and implicate autonomy as a unifying concept for holistically understanding impacts on PIAAAS-related factors, particularly responsibility, privacy, authenticity, and trust. We have argued (Zuk and L azaro-Mu~ noz 2019) that three conceptions of autonomy appear in the neuroethics literature: the experiential and relational conceptions already mentioned, as well as a more traditional conception of autonomous agency as solely consisting in a set of basic capacities. This traditional, capacity-based conception of autonomy refers to an individual’s capacity to act intentionally, with understanding, and without internal or external controlling influences (Beauchamp and Childress 2001). This conception typically informs clinical understandings of autonomy used to assess an individual’s capacity to consent to medical interventions in ways that are informed by and congruent with their attitudes, desires and preferences. In the context of neural devices, a person may experience compromised autonomy in the traditional sense if they (1) feel no viable treatment options exist apart from acceptance of the neural device, 92) if they suffer from a psychiatric condition or some form of cognitive impairment that potentially affects their ability to choose a treatment option with sufficient understanding or appreciation, or (3) if the effects of the neurotechnology itself alter an individual’s mental state in a way that impacts their ability to effectively consent or withdraw consent (Cabrera, Evans, and Hamilton 2014). To these basic capacities, experiential conceptions of autonomy add a focus on agentive experience (Bayne 2008), that is, the experience of intentional and deliberate causation as well as a sense of initiation and control over ones thoughts and actions (related in important ways to Sch€ onau et al.’s dimensions of responsibility, trust, and authenticity). These conceptions of autonomy in turn differ from relational autonomy, which include as part of an individual’s autonomous agency the