The implantable brain-computer interfaces (iBCIs) are cutting-edge technologies that integrate neural signal transducers like micro-electrodes into the cerebral cortex or deep brain tissue through neurosurgical procedures, establishing direct communication pathways between the brain and external devices. As a revolutionary medical advancement, iBCIs technology has been offering hope for refractory motor disorders and neurological conditions. Currently, iBCIs therapeutic strategies, such as deep brain stimulation and responsive neurostimulation, have been widely adopted in clinical practice for major brain diseases including Parkinson disease, consciousness disorders, drug-resistant epilepsy and torsion spasm, achieving significant therapeutic outcomes. However, the rapid clinical adoption of iBCIs technology has prompted urgent consideration of critical ethical issues, including patient eligibility screening, treatment goal determination, optimal intervention windows, and therapeutic targets. This review examines the current status of iBCIs applications in nationally approved clinical treatments and addresses essential ethical considerations during implementation, aiming to provide guidance for both the accelerated development and research of iBCIs technologies.