Medical Application: Social & Cultural

There are several key issues that arise when considering the social and cultural implications of neurotechnologies and the conditions on which they intervene. First, it is important to consider these interventions in the context of the social stigma that is experienced by people with disabilities and mental health conditions. The social pressures toward an approximation of species-typical functioning (“healthy” or “normal” functioning) may create an expectation for intervention, regardless of individual desire. Users may feel less choice in rejecting these technologies, given social and political discrimination, cultural bias, and inaccessibility. The availability of these technologies, and their proliferation in the public imagination, may lead to further marginalization of people with disabilities and neurological conditions that choose not to use them (see Sadowski, 2014 for a similar argument re: exoskeletons). With this stigma, intervention may become an expectation rather than an individual choice. Additionally, there may be stigma associated with the neurotechnologies themselves, particularly if they result in visually apparent physical outcomes such as scarring, head-shaving, or visually-obvious implantation that may impact the desirability of interventions, regardless of their efficacy. Understanding how these stigmas impact decisions to pursue neurotechnologies is crucial for ensuring autonomous decision-making and to mitigate systemic injustices.

Attending to differences within a given social context is also necessary. For example, the relative differences in tech literacy between older and younger populations must be taken into consideration when thinking through the implications of informed consent. Differences across race, gender, age, ability, citizenship status, educational attainment, and class could all correspond to different ethical risks. Therefore, a society can not be interpreted as homogenous when evaluating a technology in a given context.

Socially, there are also issues of perceived trust to attend to. In a given context, what group or organization is responsible for ensuring health and safety in the context of neurotechnologies? For
funding research related to neurotechnologies? For carrying that research out? For ensuring access to life-saving or life-affirming care? How trustworthy do individual potential users consider those parties? Is there a deliberative process for ensuring public agreement on research directions? How are these technologies or regulatory bodies framed in a media context (e.g., Racine, Waldman, Rosenberg and Illes, 2010; Gilbert and Ovadia, 2011)? How and through what channels do experts communicate with the public? While these questions are not unique to neurotechnologies, these perceptions will impact the viability and desirability of neurotechnologies.

Culture generally refers to systems of values, beliefs, attitudes, practices, meanings or knowledge shared by a group of people. Cultures evolve and individuals in a culture will also vary in their beliefs etc., but culture is a shared system that they are drawing from.

There is cultural variation in perspectives and meanings given to specific ethical issues, such as what it means for a person to have autonomy in a situation. The weight given to particular ethical values, such as whether individual autonomy is prioritized over family preferences, may also differ according to culture. There is a growing awareness of the need for those involved in the development and implementation of neurotechnology to incorporate awareness and sensitivity to cultural differences in the design process. Cultural considerations are key in design to ensure usability and desirability among potential users across the globe. Further, the ethical and moral frameworks that undergirds neurotechnological decisions (Salles, Herrera-Ferra, and Cabrera, 2018).

In the context of neurotechnologies, specific consideration must be given to cultural beliefs about the brain, disability, and interventions. Regarding perceptions of the brain and the sense of self, in some places, like South Korea, research has shown that the sense of identity among people with Parkinson’s is not limited to the self, but includes familial and community relationships (IEEE Brain and IBI, 2021). More broadly, accounting for differences in perceptions of the self across communitarian and individualistic cultures is necessary when considering neurotechnologies that may impact identity. Further, understanding cultural differences regarding perceptions of the conditions intervened on by neurotechnologies is also critical, including perceived differences between neuromuscular, psychiatric, and cognitive disabilities. For example, sociocultural beliefs about the biological basis for mental illness would impact the perceived acceptability or desirability of neurotechnologies addressing mental health (Herrera-Ferra et al. 2020). Attendance to the social stigma associated with disability, particularly psychiatric conditions, across cultural contexts should also be reflected in both research and commercial applications. Differing perspectives on interventions include considerations such as the acceptability of invasive technology.

Further, it is necessary to grapple with intra-cultural tensions between privileged and marginalized communities. For example, while the majority Hearing population in the United States interprets cochlear implants as vital medical interventions for a person with a biological impairment, some aligning with Deaf culture view them as a threat to cultural and linguistic practices in the Deaf community. Similar tensions are found between communities adopting a disability pride or neurodivergent standpoint and the majority nondisabled population. Including patient representatives in the research process can address this issue and align research more closely with actual need.

Finally, important consideration must be given to inter-cultural tensions, particularly with the importation of Western biomedical perspectives alongside biomedical technologies into non-Western contexts. For true global humanitarian benefit, and to avoid imperialism, international and cross-cultural collaborations are required for the development of algorithms and machine learning.

Example Socio-Cultural Questions for Consideration:

● What are the key social perceptions related to this technology? How might those perceptions impact research or clinical use?
● How are neurotechnologies being framed in the mass media? Is there misinformation? Can it be addressed through research or clinical practice?

● Is this technology designed with cultural context in mind? How can it be?
● Are there cultural beliefs that pose challenges to the implementation of this technology? Can they be meaningfully addressed in design, research, or clinical practice?