Mapping the Dimensions of Agency

Figures & data

Table 1. Four ethical dimensions in neurotechnology research.

Dimensions	Agency Concerns	Quotes
Responsibility	Did I do that? Am I responsible?	“I guess I didn’t concentrate hard enough. But it also may be that the measuring is not optimal.” (Kögel, Jox, and Friedrich 2020) “I’ve begun to wonder what’s me and what’s the depression, and what’s the stimulator. I mean, for example, I can be fine, and then all of a sudden … I’ll say something that is insensitive or just misread a person entirely, say something that either makes me look like a fool, or hurts them, or, something along that line. I can’t really tell the difference. There are three things—there’s me, as I was, or think I was; and there’s the depression, and then there’s depression, and the device and … it blurs to the point where I’m not sure, frankly, who I am” (Klein et al. 2016).
Privacy	Who has access to information about me? How can I limit that access or extend it to the people I choose?	“I wouldn’t want anyone to know my feeling when I see my husband, or go to bed with my husband, … see my doctor, or any of those things” (unpublished, DBS user at MGH).
Authenticity	Is this me? Is this who I want to be?	“I did not like that at all…No, that clearly didn’t fit with who I am…it was really too much; that really wasn’t me, you know; I really felt as if there was someone [else] standing next to me…” (Haan 2017).
Trust	Did that really just happen? Can I trust myself to know if it did? Do my sensations feel ‘natural’?	“Both subjects reported that the sensations elicited by electrical stimulation of the SI cortex felt ‘unnatural’ and unlike anything they had ever felt before” (Collins et al. 2017).

Each ethical dimension (responsibility, privacy, authenticity, trust) is aligned with sample core questions most strongly associated with the respective dimension and relevant quotes from individual end users.

Figure 1. The Agency Map shows how different dimensions of agency are integrated in a single user of neurotechnology: (1) authenticity as reflecting upon the past self and creating a future self that has continuity over time; (2) privacy as a function of negotiating other people’s access to private data, thoughts, body, and so on; (3) trust as the ability to discern and make use of sensory feedback received from or through the device; and (4) responsibility as the capacity to exercise control over an intentional action.

Table 2. Qualitative Agentive Competency Tool (Q-ACT).

Dimension	Agential Competency	Agency Inquiry Prompts
	Exercising Control	1. Do you feel that the (device mediated) movements you perform are under your intentional control? 2. Do you sometimes feel that you share control with the AI/device? 3. To what extent do you feel responsible for those movements?
	Negotiating Access	1. Would you say that information about your behaviors, thoughts, or attitudes is becoming more or less private? Do you feel that you are active in determining who has access? 2. Do you feel that having the device alters your privacy with respect to decision making in your life? 3. Do you feel that others know more about the state of your physical body due to the presence of the device? Are you comfortable with that access?
	Integrating Self	1. Has living with the device changed your perception of yourself? Have others noticed changes in you? 2. Do you feel comfortable with these changes? 3. Do you feel able to adequately shape the person you are now and want to be?
	Fostering Self-Trust	1. Do you think the device works reliably and records/stimulates correctly? 2. Does the feedback from the device feel natural/trustworthy? 3. Do you trust yourself when you are using the device? 4. Do you think that others trust you when you are using the device?

Each dimension (responsibility, privacy, authenticity, trust) is aligned with a competency agents make use of and a series of prompts researchers and clinicians can use to ascertain how neurotechnologies impact these competencies.

Kögel, J., R. J. Jox, and O. Friedrich. 2020. What Is It like to Use a BCI? - insights from an interview study with brain-computer interface users. BMC Medical Ethics 21 (1):2. doi:10.1186/s12910-019-0442-2.

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Klein, E., S. Goering, J. Gagne, C. V. Shea, R. Franklin, S. Zorowitz, D. D. Dougherty, and A. S. Widge. 2016. Brain-Computer Interface-Based Control of Closed-Loop Brain Stimulation: Attitudes and Ethical Considerations. Brain-Computer Interfaces 3 (3):140–48. doi:10.1080/2326263X.2016.1207497.

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Haan, S. D. 2017. Becoming More Oneself? Changes in Personality Following DBS Treatment for Psychiatric Disorders: Experiences of OCD Patients and General Considerations. PLOS One. 12 (4):e0175748. Edited by Christian Schmahl. doi:10.1371/journal.pone.0175748..

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Collins, K. L., A. Guterstam, J. Cronin, J. D. Olson, H. Henrik Ehrsson, and J. G. Ojemann. 2017. Ownership of an Artificial Limb Induced by Electrical Brain Stimulation. Proceedings of the National Academy of Sciences of the United States of America 114 (1):166–71. doi:10.1073/pnas.1616305114.

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