Ethical brain stimulation – neuroethics of deep brain stimulation in research and clinical practice

Abstract

Deep brain stimulation (DBS) is a clinically established procedure for treating severe motor symptoms in patients suffering from end-stage Parkinson's disease, dystonia and essential tremor. Currently, it is tested for further indications including psychiatric disorders like major depression and a variety of other diseases. However, ethical issues of DBS demand continuing discussion. Analysing neuroethical and clinical literature, five major topics concerning the ethics of DBS in clinical practice were identified: thorough examination and weighing of risks and benefits; selecting patients fairly; protecting the health of children in paediatric DBS; special issues concerning patients' autonomy; and the normative impact of quality of life measurements. In exploring DBS for further applications, additionally, issues of research ethics have to be considered. Of special importance in this context are questions such as what additional value is generated by the research, how to realise scientific validity, which patients should be included, and how to achieve an acceptable risk-benefit ratio. Patients' benefit is central for ethical evaluation. This criterion can outweigh very serious side-effects, and can make DBS appropriate even in paediatrics. Because standard test procedures evade central aspects of patients' benefits, measuring quality of life should be supplemented by open in-depth interviews to provide a more adequate picture of patients' post-surgical situation. To examine its entire therapeutic potential, further research in DBS is needed. Studies should be based on solid scientific hypotheses and proceed cautiously to benefit severely suffering patients without putting them to undue risks.

Rethinking segregation and integration: contributions of whole-brain modelling

“…Using direct causal brain interference methods such as TMS also provides a promising approach to causally interfere with brain networks. However, there are significant ethical problems associated with causally interfering with the human brain 5,6 . Here, we argue that whole-brain computational modelling based on and constrained by neuroimaging data can help to gain new insights into segregation and integration.…”

Ethical Focal Points in the International Practice of Deep Brain Stimulation

“…The first dimension involves information of patients, the referral practice, exclusion criteria, decision-making, the intervention, and the follow up (Clausen 2010;Kubu and Ford 2012;Lipsman et al 2012). The infrastructure-related dimension captures aspects of the development of the DBS infrastructure that are decisive for high-quality interventions.…”

Some Recent Trends and Further Promising Directions in Functional Neurosurgery

“…As the frontiers for neuromodulation expand to include conditions where patient autonomy and competence may be impaired, treating physicians and research scientists must consider certain ethical principles and follow basic established guidelines to protect individual patients involved in clinical experiments [ 6,7,50 ] . Many of the conditions discussed in this article render patients vulnerable by causing physical, cognitive, and emotional disabilities, some to the extent that they are not able to provide valid informed consent.…”