The Social Impact of Brain Machine Interfaces: Structural Inequality in BMI Study and Practice

By Tim Brown and Ann Fink

Image courtesy of Pixabay

With the generous support of the MacArthur Foundation, the Center for Neurotechnology and Tech Policy Lab (both at the University of Washington) hosted a series of three online, exploratory workshops on the social impacts of brain-machine interfaces (BMIs). Existing work in this area examines the privacy and security dimensions of BMIs as well as questions of personal identity, authenticity, free will, and responsibility. Substantially less work interrogates BMI research, development, and commercialization from the perspective of social justice. These workshops were an attempt to do just that by foregrounding concerns such as human rights, civil liberties, structural inequality, representation in research, and inclusive design. These workshops were meant to place technologists and humanists in direct conversation about how current and future BMIs will impact society. Panelists and invited discussants included interdisciplinary neurotechnology researchers from the University of Washington as well as select national experts who approach neurotechnology from the perspectives of gender, sexuality, disability, and race. Our team’s goal is to produce a whitepaper on the social impacts of BMIs—inspired by the insights raised during the workshops—that we will make available to the broader community of stakeholders. 

In our second workshop, we recounted the structural inequalities found in medical–scientific practice in order to consider how these structures may take root in brain-machine interfaces. We aimed to explore the ways marginalized people have been exploited by medical research in the past and the legacies of distrust that arose as a result; the unequal distribution of cutting edge medical technologies; the barriers marginalized people face if they want to participate in clinical trials; and the underrepresentation of marginalized people as researchers and participants in neurotechnological research. Joining us for this conversation were panelists Drs. Ann Fink (of Lehigh University), Anna Wexler (of University of Pennsylvania), and Joe Stramondo (of San Diego State University). Here, we feature Dr. Ann Fink’s thoughts on a series of five discussion questions we sent panelists beforehand. In her responses, Ann discourages us from thinking of structural inequality as a problem solved through the actions of individuals locked in silos. Instead, she urges us to think relationally—within and across disciplines and communities—about how to resist and dismantle the structures of inequality that are set to creep into work on BMIs. 

1. What does it mean for inequalities to be structural? What inequalities are built into medical-scientific research and practice?  

Structural inequalities are a feature of the system in question—whether thinking about a culture or specific institutions within it (e.g. academic, hospital or clinic). While they may be manifested in individual behaviors, not resolved by individual or incremental interventions. As such, they are not solved by individual representation (which runs the risk of tokenism). Bigger than individual acts. 

Systems of access and inaccessibility, violence overt or covert, maintain the accumulation of power and resources within a limited class of people. These could be: wealth (generally speaking), access to health, “the good things in life,” reproduction, reproductive choice and family. 

Image courtesy of Pixabay

I took a good look at Sara Ahmed’s On Being Included, which exposes the machinations of diversity work, this often works to reinforce structural inequality and inequities. The myth of individualized solutions to structural problems (e.g. racism) the cynicism of institutional responses to diversity work. It is worth staying with Ahmed’s discussions of resistances and currents experienced by those who do diversity work. 

There are many medical-scientific manifestations of inequities / inequalities. Who is doing science and medicine? Race is, quite violently, built into science and medicine through biological race as a factor in eGFR testing for kidney function, spirometers, the Tuskeegee syphilis experiments, and J. Marion Sims’ experiments on enslaved Black women, Buck v. Bell and sterilization, sexist/racist/ableist theories of IQ and social world. Policing of gender, sex, and sexuality is also built in—coercive enforcement of gender norms is common, and there’s a need for not only competent but affirming care for LGBTQ+ folks (…trans folks in particular). Travesties in care systems for people living with chronic illness and disability are also all too common.
constructions of racial categories—e.g., 

2. How should clinicians, researchers, engineers, and ethicists understand the inequities within the medical practice? How should each of these stakeholders understand the role they play in alleviating or exacerbating structural inequalities? 

People who have been marginalized do understand—this should be clear up front (though varying dimensions of privilege). 

How should they understand...? There is a lot to this question, and I’m not sure what it is asking. They should understand. By definition, these are structural problems. It is worthwhile to discuss individual behaviors and advocacy, activism, but I would avoid the siren call of individual solutions. Education and ethics programs that broadly reach across research, clinical, and engineering contexts are probably one attainable small step. 

It is important to understand the history, enactment of structural inequities within each specific field and live within that field in a way that doesn’t capitulate to that enforcement of power. But also, silos are not helpful. That is, when an ethical problem arises, we cannot shrink and say “that’s an engineering problem” or “that’s up to the clinicians.” Structural problems work across fields. They are due to pernicious, underlying mechanisms of surveillance, control and enforcement of racialized, gendered and ableist hierarchies. To address them, people need to enact their roles differently, but also commit to work that is outside of their roles, that may even threaten their status within their fields. 

Also, someone is going to have to give up power. Who is going to do that? 

3. Where do BMI fit within the practices of medicine and consumer technology? Whose communities stand to benefit from BMI, and whose are rendered vulnerable by it?

Image courtesy of Pixabay

First of all, academic, clinical, or private? Protections of academic research and health information (HIPAA in the US) versus engagement with unregulated private entities, as in any of these discussions, makes such a difference [a point well-made by Anna Wexler]. Across these contexts, there are justice concerns, privacy and safety concerns, and concerns about construction of identity, disability. 

I would suggest marinating in Ruha Benjamin’s Race After Technology: the New Jim Code which asks this exact question: who is able to be empowered by tech, and able to opt in and out at their will? Who is intruded upon, surveilled, oppressed? BMI is not exempt from any of these critiques. Like any technology, wealth will allow some to reap the benefits while wealth inequality present in any system will create a hierarchy of access. On top of this, racial biases about definitions of health and illness, as well as the “deserving ill” will determine the quality of care that people get. The “legibility” of racialized bodies as sick or healthy... white people in clear focus, anybody who is not a normative white body in a weird, out of focus state. (“marshmallowy feeling” - interview from Ahmed’s book) Further, assumptions about literacy, illiteracy about science and medicine can marginalize some folks right out of consent and conversations about treatment goals. 

All biases and potential harms are built into the technology, and it is on us to challenge potentially harmful uses before, not after, developing them. 

4. Do BMI’s pose specific or unique social justice issues in the medical-scientific system? 

To the extent that they can read neural data, which many people relate to the mind, memories, “private” thoughts and feelings that aren’t supposed to be made tangible, yes. And then there is the possibility of actually controlling a person’s thoughts and behaviors. Real future possibility of forcing people to do things, think things, feel things against their will (not going down the free will rabbit hole). Different from tinkering in any other physiological system. BMIs open up some special doors to relationality, social roles and social responsibility. There is a great deal of cultural and personal variability in feelings of protectiveness over body, brain, and even mind privacy. But just look at the sci-fi literature out there: mind-reading as both this longed-for fantasy and deep fear. 

5. What steps can we take to recognize the injustices endured by marginalized communities we engage through BMI research? What strategies can the field employ to justly navigate structures of inequality as they distribute BMIs for wide-spread use? 

First: Who is “we”? Let’s ask, more importantly, why on earth do “we” not enter with any experience of injustice? Why are marginalized experiences foreign to this population of “we”? Who is “the field”? When is “the field” willing to let go of “we”? These are the real questions worth asking.

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Timothy Brown is an NIH postdoctoral research associate in the Department of Philosophy at the University of Washington and the lead architect of the Social Impacts and BMI workshop series. His work explores the role neural technologies—in particular, deep–brain stimulators and brain–computer interfaces—(will) play in our experiences of self, our interpersonal relationships, and our societies more broadly. 

Ann Fink, Ph.D., is a neuroscientist, educator and artist. She received her doctorate in Neuroscience from UCLA, and her publications on the neurobiological basis of memory, emotion and mental health have appeared in the Journal of Neuroscience, Journal of Neurophysiology, PNAS, AJOB Neuroscience, and other journals. Ann’s interdisciplinary work addresses the ethics of neuroscience in relation to topics surrounding identity, mental health, and social justice. She was a prior Wittig Fellow in Feminist Biology at the University of Wisconsin-Madison and is currently a Professor of Practice in the Department of Biological Sciences at Lehigh University. 

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Brown, T. & Fink, A. (2020). The Social Impact of Brain Machine Interfaces: Structural Inequality in BMI Study and Practice. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2020/08/the-social-impact-of-brain-machine_24.html