Ethics of the Electrified Mind: Defining Issues and Perspectives on the Principled Use of Brain Stimulation in Medical Research and Clinical Care

Abstract

In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation (DBS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice.

Transcranial direct current stimulation in psychiatric disorders

“…Topics particularly relevant are: the "cosmetic use" of tDCS as a cognitive-enhancement procedure (i.e., for non-research or non-therapeutic objectives), the hypothetical long-term effects of tDCS on other mental faculties of its recipients, and the inappropriate assemblage and use of tDCS devices by nonmedical population, in nonclinical settings [7,138,139] . There are several medical interventions (both pharmacological and non-pharmacological) aimed at improving cognitive faculties in some neuropsychiatric disorders.…”

“…The same phenomenon could occur with tDCS. Consequentially, an intervention initially devised to treat pathological conditions, such as major depressive disorder, and lead to recovery of secondary cognitive deficits, might mistakenly be used for cosmetic cognitive enhancement [138] . The major concern about the indiscriminate use of tDCS, especially for cosmetic purposes, is that since it is a relatively novel method, and in many ways still in phases of research, its long-term side effects are not completely known.…”

“…Finally, it is important to recognize that while the equipment necessary to perform other neuromodulatory techniques is expensive and not portable (rTMS, for instance), naturally limiting their use in nonclinical settings, the device used in tDCS is lightweight, portable and can be assembled inexpensively [138] . Moreover, it can be used at home, and in fact, there are websites and open discussion groups aimed at instructing nonmedical population on how to independently apply tDCS on oneself.…”

Changing the Brain, Changing the Society: Clinical and Ethical Implications of Neuromodulation Techniques in Neurology and Psychiatry

“…Some technologies with this potential for interventions are already widely available, including invasive methods such as transcranial or intracranial stimulation (Schlaepfer and Bewernick 2014;Cabrera et al 2014), but also novel use of non-invasive imaging methods (such as functional magnetic resonance imaging or electroencephalography) for real-time control of brain activity and neurofeedback (Birbaumer et al 2014;Gevensleben et al 2014). In addition, progress at the molecular and genetic levels has induced (and will further promote) the development of new drugs that can change brain functions and possibly alter its synaptic architecture in a long-lasting (perhaps permanent) manner (Fins and Shapiro 2014).…”

“…However, the global overview offered by these authors clearly makes the case that the future will bring powerful intervention methods that will not only concern motor control in Parkinson's disease, stroke, or tetraplegia (Birbaumer et al 2014;Cabrera et al 2014), but also increasingly target higher-level mental functions such as mood and anxiety regulation (Schlaepfer and Bewernick 2014), as well as memory, attention, impulsivity (Gevensleben et al 2014), or even social behavior and morality (Baertschi 2014). In virtually each of these domains, neural intervention techniques are currently being explored through various approaches including deep brain stimulation, TMS, neurofeedback, pharmacology, and even innovative neuroprosthetics devices.…”