Law and ethics of deep brain stimulation

Schmitz‐Luhn, Björn; Katzenmeier, Christian; Woopen, Christiane

doi:10.1016/j.ijlp.2011.12.007

Cited by 25 publications

(13 citation statements)

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“…It is of key importance to consider with patients the renewal of desperation or the disappointment, which may result from no or minimal improvement in AN symptoms after DBS (9, 44, 62–64), and to stress that DBS should not be considered as a stand-alone “miracle cure,” but rather an intervention that might facilitate response to other treatment modalities such as psychotherapies and weight restoration programs—which may not have been previously tolerated or effective. Discussion in the section “Informed Consent and Desperation in a Clinical Trial” of the therapeutic misconception draws strongly on the discussion of the uncertainties in this section and the previous one.…”

Section: Application Of the Oxford Neuroethics Framework For Dbsmentioning

confidence: 99%

Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework

et al. 2017

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Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation (DBS) (3). DBS involves electrode insertion into specific neural targets implicated in pathological behavior, which are then repeatedly stimulated at adjustable frequencies. DBS has been used for Parkinson’s disease and movement disorders since the 1960s (4–6) and over the last decade has been applied to treatment-refractory psychiatric disorders, with some evidence of benefit in obsessive–compulsive disorder (OCD), major depressive disorder, and addictions (7). Recent consensus guidelines on best practice in psychiatric neurosurgery (8) stress, however, that DBS for psychiatric disorders remains at an experimental and exploratory stage. The ethics of DBS—in particular for psychiatric conditions—is debated (1, 8–10). Much of this discourse surrounds the philosophical implications of competence, authenticity, personality, or identity change following neurosurgical interventions, but there is a paucity of applied guidance on neuroethical best practice in psychiatric DBS, and health-care professionals have expressed that they require more (11). This paper aims to redress this balance by providing a practical, applied neuroethical gold standard framework to guide research ethics committees, researchers, and institutional sponsors. We will describe this as applied to our protocol for a particular research trial of DBS in severe and enduring anorexia nervosa (SE-AN) (, unique identifier NCT01924598), but believe it may have wider application to DBS in other psychiatric disorders.

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Section: Application Of the Oxford Neuroethics Framework For Dbsmentioning

confidence: 99%

Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework

et al. 2017

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“…This further underscores the need to establish, on an individual basis, whether persons are capable of providing appropriate consent. Extending this notion further, an assessment of the ethical implications of these techniques must also take into consideration whether the cognitive and behavioral effects of stimulation themselves alter the ability of individuals to provide or withdraw consent (Heinrichs 2012; Schmitz-Luhn et al 2012). Finally, a set of concerns relates to whether the wider use of these technologies may eventually introduce either explicit or implicit coercive pressure for individuals to undergo brain stimulation to treat real or perceived cognitive or psychological impairments (Hamilton et al 2011).…”

Section: Autonomy: Searching For Self In the Stimulated Brainmentioning

confidence: 99%

“…A separate, but related concept is mental competence, which is a legal status that must be demonstrated in order to start, continue, or stop any clinical or experimental manipulation that entails intervening on an individual’s body or mind. 2 With these definitions in mind, clinicians and investigators employing brain stimulation techniques must be cognizant that for individuals with certain conditions, particularly psychiatric disorders, the determination of medical decision-making capacity may be quite complicated (Bell et al 2009; Cabrera 2011; Schmitz-Luhn et al 2012; Synofzik and Schlaepfer 2011). One reason for this is that individuals’ treatment preferences 3 (Synofzik and Schlaepfer 2011) and decision-making capacities (Cabrera 2011) are strongly influenced by mood and affect, which are in turn affected in these types of conditions.…”

Section: Autonomy: Searching For Self In the Stimulated Brainmentioning

confidence: 99%

“…Importantly, it has been argued that neural interventions have the capacity to alter these experiences so profoundly that they may impact the experience of personhood (Farah and Wolpe 2004). This has been a major topic in the discussion of ethical issues surrounding DBS in particular (Heinrichs 2012; Jotterand and Giordano 2011; Klaming and Haselager 2010; Lipsman and Glannon 2012; Mathews 2011; Schmitz-Luhn et al 2012; Witt et al 2011), and is also a theoretical concern for other brain stimulation techniques.…”

Section: Autonomy: Searching For Self In the Stimulated Brainmentioning

confidence: 99%

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

2013

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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.

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“…The IRB of the local ethics committee was informed about the undertaking of a so-called individual treatment attempt (“individueller Heilversuch”) in each case. The decision to perform an individual treatment attempt was made in compliance with German law (Schmitz-Luhn et al, 2012). …”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome

Neudorfer

Majdoub

Hunsche

et al. 2017

Front. Hum. Neurosci.

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The current rationale for target selection in Tourette syndrome revolves around the notion of cortico-basal ganglia circuit involvement in the pathophysiology of the disease. However, despite extensive research, the ideal target for deep brain stimulation (DBS) is still under debate, with many structures being neglected and underexplored. Based on clinical observations and taking into account the prevailing hypotheses of network processing in Tourette syndrome, we chose the fields of Forel, namely field H1, as a target for DBS. The fields of Forel constitute the main link between the striatopallidal system and the thalamocortical network, relaying pallidothalamic projections from core anatomical structures to the thalamic ventral nuclear group. In a retrospective study we investigated two patients suffering from chronic, medically intractable Tourette syndrome who underwent bilateral lead implantation in field H1 of Forel. Clinical scales revealed significant alleviation of tics and comorbid symptoms, namely depression and anxiety, in the postoperative course in both patients.

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Law and ethics of deep brain stimulation

Cited by 25 publications

References 0 publications

Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework

Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework

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

Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome

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