Ethical empowerment? Ethical aspects of the design, development and deployment of implantable artificial muscles

Abstract Advances in soft and wearable robotics, surgery, biomaterials and biomimetics suggest that implantable artificial muscles are becoming a reality. If successful, these implants promise to help alleviate muscular conditions, like sarcopenia, by complementing natural muscles. Artificial muscles therefore promise to empower and benefit their recipients—but they also risk them (and others) being disempowered or otherwise harmed. We adopted a future-focused, anticipatory ethics approach to explore the ethical dimensions of the design, development and deployment of artificial muscles. A narrative review of pertinent literature was conducted to explore ethical questions associated with the overarching obligations to respect autonomy, balance benefits and burdens, and serve the public interest. Our analysis suggests that careful consideration should be given to: the selection of materials and methods; participants and patients; ensuring that recipients provide voluntary and informed consent; mechanisms of review and redress; arrangements for sharing and protecting data; managing access and distribution; and ensuring the inclusion of, and engagement with, diverse stakeholders. We conclude that further such engagement is now needed, including in the co-production of standards—such as an ethical framework—to guide developments going forward.