'The trauma of losing your own identity again': the Ethics of Explantation of Brain-Computer Interfaces

One of the most discussed topics about the ethics of implantable Brain-Computer Interfaces is whether the intrusion of experimental technologies in the central nervous system impacts the personality, identity, agency, autonomy, authenticity and/or self (PIAAAS). Despite the numerous ethical discussions devoted to the putative effects of neural device implantation on PIAAAS, next to nothing has been explored on how explantation impacts the PIAAAS of trial participants. In this chapter we will address this gap in the literature by using data gathered from interviews conducted with patients implanted with Brain-Computer Interfaces. The chapter will be built as follows. Firstly, we will explain what explantation is and the reasons for doing it on research participants who have been implanted with a neural device for research purposes. Secondly, we will consider the perspective of a trial participant whose neural device will be explanted and how it could lead to troubling PIAAAS related changes, describing it as the "the trauma of losing your own identity again" and leading some participants to refuse explantation. Thirdly, we will discuss how serious PIAAAS changes are widely appreciated as important moral considerations of whether to proceed with neural device implantation. We argue that such reasoning should also extend to neural device explantation, given that such interventions can also make participants vulnerable to troubling PIAAAS-related changes. Finally, we argue that clinicians and researchers have responsibilities towards their patients or research participants to avoid or mitigate the serious negative effects of explantation, including any concerning PIAAAS-related changes. This includes recognizing that explantation can be experienced as a traumatic event and major disruption of their sense of self and the ethical imperative to provide support - like developing exclusion criteria for explantation and providing counseling to explantees - in response to it.