Ethical gaps in closed-loop neurotechnology: a scoping review

Abstract Closed-loop (CL) neurotechnology, which dynamically adapts to patients’ neural states, offers new opportunities for treating neurological and psychiatric disorders. However, its real-time feedback mechanisms raise critical ethical challenges. This scoping review assesses whether and how cli...

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Main Authors: Lea Haag, Georg Starke, Markus Ploner, Marcello Ienca
Format: Article
Language:English
Published: Nature Portfolio 2025-08-01
Series:npj Digital Medicine
Online Access:https://doi.org/10.1038/s41746-025-01908-4
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author Lea Haag
Georg Starke
Markus Ploner
Marcello Ienca
author_facet Lea Haag
Georg Starke
Markus Ploner
Marcello Ienca
author_sort Lea Haag
collection DOAJ
description Abstract Closed-loop (CL) neurotechnology, which dynamically adapts to patients’ neural states, offers new opportunities for treating neurological and psychiatric disorders. However, its real-time feedback mechanisms raise critical ethical challenges. This scoping review assesses whether and how clinical studies involving CL neurotechnologies address ethical concerns. We analyzed peer-reviewed research on human participants to evaluate both the presence and depth of ethical engagement. Despite the prominence of CL systems in neuroethical discourse, explicit ethical assessments remain rare. Ethical issues are typically addressed only implicitly, folded into technical or procedural discussions without structured analysis. Most notably, our findings reveal a persistent gap between regulatory compliance and meaningful ethical reflection. To address this, we propose empirically grounded, community-responsive recommendations to strengthen ethical oversight in this field. These recommendations aim to support governance frameworks that are context-sensitive, reflexive, and capable of addressing the complex ethical terrain introduced by adaptive neurotechnologies.
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spelling doaj-art-c60a927a98d04331babdedeff67a6d792025-08-20T03:43:36ZengNature Portfolionpj Digital Medicine2398-63522025-08-018111410.1038/s41746-025-01908-4Ethical gaps in closed-loop neurotechnology: a scoping reviewLea Haag0Georg Starke1Markus Ploner2Marcello Ienca3Laboratory of Ethics of AI & Neuroscience, Institute of History and Ethics in Medicine, School of Medicine and Health, Technical University of Munich (TUM)Laboratory of Ethics of AI & Neuroscience, Institute of History and Ethics in Medicine, School of Medicine and Health, Technical University of Munich (TUM)Center for Interdisciplinary Pain Medicine and Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM)Laboratory of Ethics of AI & Neuroscience, Institute of History and Ethics in Medicine, School of Medicine and Health, Technical University of Munich (TUM)Abstract Closed-loop (CL) neurotechnology, which dynamically adapts to patients’ neural states, offers new opportunities for treating neurological and psychiatric disorders. However, its real-time feedback mechanisms raise critical ethical challenges. This scoping review assesses whether and how clinical studies involving CL neurotechnologies address ethical concerns. We analyzed peer-reviewed research on human participants to evaluate both the presence and depth of ethical engagement. Despite the prominence of CL systems in neuroethical discourse, explicit ethical assessments remain rare. Ethical issues are typically addressed only implicitly, folded into technical or procedural discussions without structured analysis. Most notably, our findings reveal a persistent gap between regulatory compliance and meaningful ethical reflection. To address this, we propose empirically grounded, community-responsive recommendations to strengthen ethical oversight in this field. These recommendations aim to support governance frameworks that are context-sensitive, reflexive, and capable of addressing the complex ethical terrain introduced by adaptive neurotechnologies.https://doi.org/10.1038/s41746-025-01908-4
spellingShingle Lea Haag
Georg Starke
Markus Ploner
Marcello Ienca
Ethical gaps in closed-loop neurotechnology: a scoping review
npj Digital Medicine
title Ethical gaps in closed-loop neurotechnology: a scoping review
title_full Ethical gaps in closed-loop neurotechnology: a scoping review
title_fullStr Ethical gaps in closed-loop neurotechnology: a scoping review
title_full_unstemmed Ethical gaps in closed-loop neurotechnology: a scoping review
title_short Ethical gaps in closed-loop neurotechnology: a scoping review
title_sort ethical gaps in closed loop neurotechnology a scoping review
url https://doi.org/10.1038/s41746-025-01908-4
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