In the past 50 years, an ethical-legal boundary has been drawn between treatment and research. It is based on the reasoning that the two activities pursue different purposes. Treatment is aimed at achieving optimal therapeutic benefits for the individual patient, whereas the goal of scientific research is to increase knowledge, in the public interest. From this viewpoint, the patient’s experience should be clearly distinguished from that of a participant in a clinical trial. On this premise, two parallel and mutually exclusive (...) regimes have been established. Yet in the case of deep brain stimulation (DBS), this presentation is a poor fit, for both the patient’s lived experience and medical practice and research. The frictions may be explained by the specificities of the treatment (including surgery and medical devices) and of the pathologies concerned (chronic and evolutive), and by the characteristics of the medical team implementing the treatment. These particularities challenge the dominant frame of reference in medical bioethics and cause difficulties for the current legal framework in fulfilling its dual role: to protect patients while supporting the development of innovative treatments. The dominant model is still the clinical trial for medication safety and legal requirements of drug market regulation. However, DBS forces us to reflect on a medical device that is permanently implanted in the brain by highly specialized multi-disciplinary neurosurgical teams, for the treatment of chronic evolutive diseases. These devices demand fine-tuning on a case-by-case basis and there is still a lot to discover about why DBS is effective (or not). As a result, the wall between treatment and research is osmotic: many discoveries are made incidentally, in the course of treatment. The following study begins with these observations, and suggests that we review legal provisions (especially in French and United States law) so that they are better adapted to the first-person needs and experience of the patient undergoing brain stimulation. (shrink)

After reviewing the literature on current knowledge about consciousness in humans, we present a state-of-the art discussion on consciousness and related key concepts in animals. Obviously much fewer publications are available on non-human species than on humans, most of them relating to laboratory or wild animal species, and only few to livestock species. Human consciousness is by definition subjective and private. Animal consciousness is usually assessed through behavioural performance. Behaviour involves a wide array of cognitive processes that have to be (...) assessed separately using specific experimental protocols. Accordingly, several processes indicative of the presence of consciousness are discussed: perception and cognition, awareness of the bodily-self, self-related knowledge of the environment (including social environment). When available, specific examples are given in livestock species. Next, we review the existing evidence regarding neuronal correlates of consciousness, and emphasize the difficulty of linking aspects of consciousness to specific neural structures across the phyla because high-level cognitive abilities may have evolved independently along evolution. Several mammalian brain structures (cortex and midbrain) are involved in the manifestations of consciousness, while the equivalent functional structures for birds and fishes would likely be the pallium/tectum and midbrain. Caution is required before excluding consciousness in species not having the same brain structures as the mammalian ones as different neural architectures may mediate comparable processes. Finally, specific neurophysiological mechanisms appear to be strongly linked to the emergence of consciousness, namely neural synchrony and neural feedback. Considering the limited amount of data available and the few animal species studied so far, we conclude that different manifestations of consciousness can be observed in animals but that further refinement is still needed to characterize their level and content in each species. Further research is required to clarify these issues, especially in livestock species. (shrink)

Deep brain stimulation (DBS) is an approved treatment for neurological diseases and a promising one for psychiatric conditions, which may produce spectacular results very quickly. It is also a powerful tool for brain research and exploration. Beyond an overview of the ethical and legal literature on this topic, this paper aims at showing that DBS is a compelling example for ethical-legal reflection, as it combines a highly technical surgical procedure, a complex active medical device and neuromodulation of the human brain (...) to restore lost abilities caused by a chronic and evolving disease. Some of the ethical and legal issues raised by DBS are not specific, but shed new light on medical ethics and law. Others are more DBS-specific, as they are linked to the intricacies of research and treatment, to the need to tune the device, to the patients’ control over the device and its effects and to the involvement of family caregivers. (shrink)

The techno-scientific development has no frontier, but the legal systems still take roots in local and cultural references. French Law is built on a continental model and conveys values and preferences of the French population, including an essential role given to the State and to textual requirements. Until now, French law has been modified to cope with new and emerging technologies issues with the idea that they can be taken one after the other, on the fringes of the classic legal (...) problems. Do the announcement of a convergence between Nanotechnologies, Biotechnologies, the sciences of Information and Cognition (NBIC) change the situation? According to “converging technologies” partisans, a lot of other deep perturbations may occur. Therefore, it could be pertinent to assess the legal implications of NBIC convergence. But trying to do so, a French legal scholar may first feel (and express) perplexity. What is the “convergence NBIC”? To answer, do we have to wonder which reality hides behind the expression or is it necessary to admit that the speeches are here more important to analyze than a hypothetical realization? Does it imply new legal questions? Do we need new methods to enlighten what is at stake? Is it a new challenge, stimulating the imagination of lawyers and legal scholars, or, on the contrary, is it a new illustration of the Economy of the promises, revealing big risks of vain (or inappropriate) intellectual and normative production? This article is dedicated to enlighten the important difficulties which mark out the road towards the answers to the legal questions raised by the “NBIC convergence”. (shrink)