Ethical Concerns about The vOICe

Ideally it would be the well-informed personal decision of each blind individual whether or not to embark upon learning to see with sound, while being aware of the various unknowns and possible risks. On the other hand, brain plasticity is most likely much higher in young children, making that they have the best chances of mastering seeing with sound to the maximum extent possible. Is it ethical to expose children to a new and largely unexplored technology for which final outcomes and benefits are still unknown? On the other hand, is it ethical to withhold this option in view of the risk that there are critical ages beyond which a blind child may no longer be able to fully master seeing with sound? Some sort of early intervention program involving vision substitution for blind children may also aid in building good spatial awareness and help improve their spatial understanding and their understanding about vision in general.

Acquiring or restoring vision does not necessarily contribute to happiness. In fact, there have been reports about blind people who got their natural eyesight restored through surgery, and whose lives got disrupted through this change. It is conceivable that synthetic vision can have similar negative effects, such as depression, depending on a variety of psychological factors, including personal attitude towards change.

It is unknown if there are long-term negative side effects in using The vOICe, other than the possible risk of hearing damage if the soundscapes are played at a too high loudness for prolonged periods of time. Still, one can never be certain if there are no detrimental side effects due to the relatively large-scale brain reorganization involved in learning to see with sound. So far, no such side effects are anticipated or reported. Theoretically, one could think of maladaptive side effects of neural plasticity even with purposeful changes in afferent input, but so far the potential benefit seems to outweigh any known risks. The risks of pathological consequences of manipulating and exploiting brain plasticity might become higher once sensory training is combined with enhancement or modulation of neural plasticity through rTMS treatment (e.g., LTP enhancement found with 15 Hz rTMS, and treatment of depression, amblyopia and tinnitus) or drugs (pharmacological treatment, generally envisioned also in neurorehabilitation contexts for optimized recovery from stroke or other neurological disorders; examples of substances that are known to affect cortical plasticity and brain reorganization include amphetamine, icotine, rolipram and piracetam, as well as the histone deacetylases such as trichostatin), while the PirB protein reportedly limits neural plasticity in the adult brain. Note that blindness itself may also influence neural plasticity, for instance through a decrease in GABA levels or GABA transmission (GABA, or γ-aminobutyric acid, is the brain's main inhibitory neurotransmitter). Substances like bilobalide and pentylenetetrazol also affect GABA levels or block GABA receptors, but high doses bring a high risk of seizures. Other research indicates that visual cortical excitability can become elevated through ecstasy use, possibly due to massive serotonin release followed by serotonin depletion. In any case, any use of therapeutic drugs in combination with sensory training lies beyond the current scope of using The vOICe technology, and may only be considered in academic and clinical research settings that are carefully overlooked by ethical committees while adhering to the applicable research regulations and regulations imposed by government bodies such as the American FDA (US Food and Drug Administration) or its non-US equivalents. The new field of neuroethics seeks to answer questions about cases where neuroscience research raises social and ethical issues.

Without proper training by orientation and mobility experts, truly mobile outdoor usage of The vOICe could prove highly dangerous to the blind user. Interpretation of soundscapes is very difficult to master, while some degree of auditory masking (e.g., of traffic sounds) remains inevitable - just as in wearing a walkman or portable radio. Involvement of the community of orientation and mobility instructors is needed to arrive at procedures to balance opportunities for independence against risks, much like is done in teaching the use of long cane or guide dog. Little is known about any increase or decrease in the incidence of injury or mortality among blind users of electronic travel aids (ETAs) and synthetic vision devices.

The unique human capabilities obtained after mastering seeing with suond or adaptation to other special brain-machine interfaces might have military and intelligence applications, for better or for worse (e.g., "mind control"). Military interest is illustrated by initiatives such as the US DARPA Brain-Machine Interfaces Program and earlier rumours from Russia about a "computerized acoustic device allegedly capable of implanting thoughts".

Independent access to vision through dependence on a certain technology can be a source of concern if continued availability of this technology is not guaranteed. However, the core image to sound mappings used by The vOICe are well-documented and published in the open literature, such that the (unrefined) technology could be easily revived in case the current source disappears. Much will depend on whether there is a sufficiently large user base to warrant the cost of (re)development and user support: the blind community only makes for a fairly small market in which it is very hard to sustain an advanced assistive technology on a commercial (profitable) basis without some form of government support. Furthermore one can observe that people in general are already dependent on technology for food supply, transportation, healthcare, and so on.

The vOICe provides auditory access to any graphical material, including image files downloaded from the web, thus including the adult content of sexually explicit photographs exposing nudity, sex, porn, etcetera. A separate issue is how people would (learn to) experience soundscapes of adult material, but there is no fundamental reason why this would be any different from how the sighted experience and have fantasies about the widespread adult visual content. The skin color filter (Shift Alt s) further highlights exposed skin area, be it faces, hands - or much more. This could be considered a downside of striving for full and uncensored access to any raw visual material. However, would one for this reason advocate total blindness?

Would blindness agencies and institutions that do not manage to catch up with the latest high-tech options risk becoming the dinosaurs of the twenty-first century? Hard to tell, but if The vOICe synthetic vision technology would prove successful, it would imply a need for revolutionary changes in the way blind people are to be trained, educated and supported in and about vision. In turn, their teachers and trainers would need to acquire many new skills for which they have not previously been trained and certified, and for which training programs are still lacking. A lack of interest, conservatism or even opposition to change could result from a perceived lack of personal benefit for those currently involved in teaching blind people about orientation and mobility. There can be a temporary divergence between the interests of blind people and the interests of those who are currently supposed to represent the interests of blind people.