On January 29th (Monday), 2024, Neuralink, Elon Musk's brain-computer interface company, achieved a significant milestone with its inaugural successful human implantation. Elon Musk announced, "Neuralink has conducted its first surgical test of a brain implant." The device, comparable in size to a coin, features "threads" that interface with the brain. According to Neuralink, the implant boasts "1024 electrodes distributed across 64 threads." Additionally, the company states on its website, "The implant is powered by a small battery charged wirelessly from the outside via a compact, inductive charger that enables easy use from anywhere." While specific details regarding the patient and the precise purpose of the implant remain confidential, we can offer some insights gathered from various sources.

The Initial Trial. The billionaire entrepreneur announced that the initial surgery proceeded smoothly and the patient was recuperating well. "Initial results show promising neuron spike detection," his post indicated. Neuron spikes signify activity by neurons, which are cells that utilise electrical and chemical signals to transmit information throughout the brain and body. Musk and Neuralink have not disclosed further details regarding the recipient of the implant or its functionality. The number of participants in the trials remains unclear, but the Neuralink website indicates that recruitment for the first-in-human clinical trials is open.

Background. Last year, the US Food and Drug Administration (FDA) granted clearance to the company to conduct its inaugural trial testing its implant on humans, expressing its intention to enrol individuals aged 22 and above who are living with quadriplegia due to a spinal cord injury or amyotrophic lateral sclerosis (ALS), a disease that deprives individuals of the ability to control their bodies. In September, Neuralink announced that it had received approval to recruit participants for the human trial. Experts suggest that even if the brain-computer interface (BCI) device proves safe for human use, obtaining commercial clearance from regulatory bodies could take over a decade for the start-up.

What is Neuralink, and what does it do? Neuralink is a brain-chip start-up founded by Musk in 2016. The company implants a device, approximately the size of a coin, into the skull, with ultra-thin wires extending into the brain to establish a BCI. The disk records brain activity and transmits it to a device like a smartphone via a standard Bluetooth connection.

"Telepathy", the first product, would enable individuals to control their phones or computers, subsequently, nearly any device "simply by thinking," Musk stated. By implanting the chip in the brain region responsible for motor function, individuals could potentially overcome neurological disorders, according to the company's claims. Musk mentioned that initial users would be those who have lost the use of their limbs. "Imagine if Stephen Hawking could communicate faster than a speed typist or auctioneer. That is the goal," he emphasised.

PRIME. Months after commencing recruitment for its clinical trial, Neuralink's PRIME trial, short for Precise Robotically Implanted Brain-Computer Interface, utilises a robotic procedure to surgically implant wires into a brain region linked to movement. The device interprets neural activity, enabling computer or smartphone operation through thought alone, eliminating the need for physical movement. Neuralink's implant procedure employs custom-made microscopic needles, allowing for minimal cortex damage. The PRIME trial aims to implant a small, discreet device in the brain's movement planning region, aligning with Neuralink's mission to develop a generalised brain interface for unmet medical needs and human potential enhancement. In essence, the company seeks to enable thought-driven control of computer cursors or keyboards.

Neuralink has been Controversial. Neuralink has been embroiled in controversy over allegations regarding its testing procedures involving monkeys and pigs, as well as Elon Musk's depiction of this work. The company showcased several monkeys engaging in basic video games or manipulating a cursor on a screen via their Neuralink implants. While Neuralink asserts that no monkeys died due to their implants, reports surfaced in 2022 and 2023, alleging that the company's practices led to debilitating effects such as paralysis, seizures, and brain swelling in monkeys and other test animals. There were even claims suggesting that up to 12 monkeys were euthanised as part of the research. In response to these allegations, Musk stated last September, "No monkey has died as a result of a Neuralink implant," and explained that in initial tests, "to minimise risk to healthy monkeys, we chose terminal monkeys (close to death already)." Following these controversies, members of Congress have urged the Securities and Exchange Commission to investigate how Musk represented Neuralink's use of animals in testing its implants, specifically questioning whether he may have exaggerated the marketability of the implants.

Neuralink is a Human Enhancement (HE). HE refers to any deliberate technological and/or biomedical intervention on the healthy human body or mind to improve physical and/or mental capabilities beyond the typical human level aimed at improving welfare. If Neuralink is solely utilised for therapeutic purposes, our ethical evaluation will "differ." However, when employed for non-therapeutic objectives, it inherently becomes an enhancement necessitating rigorous socio-political and ethical scrutiny.

Public Excitement and Doubts. Research in the intersection of computers and neurology has been progressing for decades, encompassing the burgeoning field of deciphering the brain's electrical activity related to words, impulses, and images. In recent years, this endeavour has extended to include the development of implantable BCIs. While a significant portion of current research endeavours to provide novel means of interaction for individuals affected by paralysis and blindness, implants have also been conceived as having the potential to "enhance" individuals who do not face such severe conditions.

Musk has previously discussed the concept of a "neural lace," which could introduce a symbiotic digital layer to the human brain, merging artificial intelligence (AI) with biological brain functions. While the current Neuralink trial may fall short of these ambitious aspirations, speculation surrounding Musk's remarks solidified around Neuralink in 2017, when he confirmed his involvement with the then-new company.

"Imagine the delight of connecting with your loved ones, surfing the web, or even playing games using only your thoughts," Neuralink stated in its video, depicting visuals of a smartphone apparently linked to a person's mind. Brain implant research has sparked numerous inquiries, including debates on whether humanity should establish boundaries for our integration with technology.

As the momentum to embrace futuristic devices continues to grow, individuals such as Tristan Harris, a former Google employee who founded the Centre for Humane Technology, have urged innovators first to scrutinise our current circumstances, including the detrimental and addictive effects our phones can exert on us. "What has led us to the current situation where our attention spans last only 40 seconds on any computer screen?" Harris queried in a 2019 interview with NPR. "We didn't arrive here by intending to shorten our attention spans. We arrived here by aiming to empower ourselves. However, we lacked sufficient self-awareness to recognise that in granting ourselves superpowers, we undermined our ability to focus."

Neuralink is Not the Only One. According to an online clinical trial database, around 40 brain-computer interface trials are currently active. Companies involved include Synchron, Precision Neuroscience, Paradromics, and Blackrock Neurotech. In July 2022, Synchron successfully implanted its device in a US patient without skull incisions. While many trials focus on medical needs, Neuralink, led by Elon Musk, aims to enable smartphone control through BCIs. Paradromics plans its first human trial soon, while Precision Neuroscience conducted its initial study in 2023. A patient implanted with Synchron's BCI tweeted from CEO Tom Oxley's account in 2021. However, Neuralink remains the most widely recognised entity in this field, owing to its high-profile owner, Elon Musk.

Ethical Concerns. Elon Musk's Neuralink brain chip, heralded for its potential advancements in medical treatment and human-computer interaction, brings myriad ethical considerations to the forefront. Here are several key points to ponder:

Safety and Well-being. (i) Brain damage: Implanting a foreign object in the brain poses inherent risks, including infection, inflammation, tissue damage, brain haemorrhage, and seizures. The long-term implications of such implants remain largely uncharted territory, with potential complications ranging from physical to cognitive and psychological domains. Thus, uncertainties persist regarding their lasting impact on individuals' overall well-being. Anticipating and mitigating potential unintended consequences or unforeseen risks is imperative. (ii) Animal testing: Neuralink has faced criticism for its animal testing practices, including allegations of high mortality rates and concerns regarding animal welfare. These issues raise questions about the applicability of animal data to humans and the ethical treatment of research animals.

Principle-Based Concerns. (i) Playing God Argument contends that such projects interfere with natural processes, which are presumed to be under the domain of God. However, other proponents might argue that there is no question of usurping God's prerogatives when interventions are undertaken to improve humanity in its fundamental capacity and propensity. (ii) Precautionary Principle. Advocates of this may argue that we should exercise caution before experimenting on humans. Opponents of the principle may criticise this perspective for overstating the hypothetical risks while giving minimal consideration to its potential benefits.

Privacy and Security. (i) Brain Data Access: Neuralink implants collect and transmit brain activity data, sparking concerns about data access, security, and the risk of misuse. The potential for malicious actors to exploit vulnerabilities, manipulate users, or access sensitive information is a pressing issue. (ii) Cognitive Privacy: Direct access to and interpretation of brain activity raises concerns regarding cognitive privacy violations. Users are more susceptible to the risks of unauthorised thought monitoring or manipulation. Limited information is available regarding users' capacity to retain control over their personal data and neural activity.

Accessibility and Equity. (i) Cost and Access: The advent of Neuralink technology is poised to introduce a new frontier of cognitive enhancement. However, its potential exorbitant cost may inadvertently spawn a digital divide, leaving only the affluent able to partake in such advancements. This socioeconomic disparity can potentially deepen existing inequalities, eliciting profound ethical inquiries about equitable access to transformative technology. (ii) Informed Consent: Securing genuine informed consent for brain chip implantation poses a formidable challenge, given the lingering uncertainties surrounding the long-term ramifications and potential hazards. Individuals may find themselves grappling with the complexities and ramifications of their decision, as the full extent of the implications remains elusive.

Existential and Philosophical Concerns. (i) Human Identity, Autonomy, and Agency: BCIs blur human-machine boundaries, prompting inquiries into consciousness, free will, and humanity. They may reshape perceptions of self, identity, and control. Safeguarding autonomy while preventing manipulation is paramount. Do these implants alter our sense of self or autonomy? (ii) Human Enhancement and Societal Impact: The tantalising prospect of cognitive enhancement through BCIs casts a stark light on the ethical landscape, evoking apprehensions about the emergence of a bifurcated society where certain individuals boast augmented capabilities. This potential stratification threatens to breed discrimination and amplify prevailing social disparities, exacerbating existing inequalities and fostering societal rifts of profound consequence. (iii) Transhuman-Posthuman Concerns. The survival instinct allows modern technology to shape us into "trans-humans" and potentially "post-humans," although assessing the state of promised post-humanity is premature. However, the central concern lies in the possibility that the current acceleration of such technology could make the transition from humans to transhumans to post-humans inevitable, raising moral apprehensions about the project of post-humanity.

The emergence of Neuralink's brain chips has raised concerns about their potential impact and ethical implications. Ethical considerations should guide the development, deployment, and regulation of these technologies to maximise their benefits while minimising adverse effects. Addressing these ethical challenges requires collaborative efforts involving scientists, ethicists, policymakers, and the public. Responsible evolution and implementation of BCI technology like Neuralink are essential for its conscientious integration and utilisation. Our critical examination of such projects highlights ethical concerns and underscores the importance of Responsible Human Enhancement. Ethical and responsible projects like Neuralink may warrant promotion if they adhere to ethical standards.

A Final Word. While we acknowledge the potential of current and future Neuralink projects, we question their necessity, moral permissibility, and desirability. We do not endorse the direct promotion of enhancements in general but advocate for social progress. However, we remain open to discussing the need and ethical acceptance of such technologies, considering cost-benefit analysis, network effects, and other ethical issues. Each enhancement necessitates a case-by-case analysis to promote an ongoing debate and evaluation from a multidisciplinary approach. Although we do not advocate for Human Enhancement in general, we support an enhanced state of life resulting from therapeutic interventions and efficient healthcare systems. We prioritise ensuring primary healthcare worldwide over pursuing technological advancements at the expense of moral and socio-cultural values, especially when vulnerable populations lack access to healthcare. As long as basic healthcare needs remain unmet, the pursuit of enhancement technologies such as Neuralink projects through state-level healthcare systems is not justifiable.

Dr Arnald Mahesh SDB, Dean of Philosophy, St Peter's Pontifical Institute, Bangalore.