LAUSR

The article “Staying in the Loop: Relational Agency and Identity in Next-Generation DBS for Psychiatry” by Goering and colleagues (2017) brings forward a discussion about the ethical aspects of closed-loop technologies, in particular closed-loop psychiatric deep brain stimulation (DBS) (Goering et al. 2017). Not disregarding the potential benefits of this specific technology, since patients could gain from interventions that do not require user involvement, they voice concerns related to agency and identity. Such issues are likely to surface in different contexts since closed-loop devices stand to grow in the future in neuroscience and beyond (Bergmann et al. 2016; Shah et al. 2014). However, we bring attention to the need for greater clarity about the nature of concepts of agency and identity, notably their relational aspects, since the authors borrow indiscriminately from different accounts of these concepts that attribute more or less significance to the role of the brain therein. This confusion leads the authors to conclude that nonneural closed-loop devices do not pose significant issues for identity and agency. However, we suggest that a truly relational account of agency and identity, and emerging evidence about the artificial pancreas (common name for a set of closed-loop systems for insulin monitoring and delivery), show the contrary.