Ethical Aspects of tDCS Use in Neuropsychiatry and the Risk of Misuse

Abstract

There is growing enthusiasm about the potential of tDCS to be of value to clinical treatment and cognitive enhancement in neuropsychiatry. Yet despite its promise, the use of tDCS in clinical and nonclinical contexts faces several scientific and ethical challenges, which must be considered to protect against unanticipated or even adverse effects on individuals and groups in society. Scientific challenges include the lack of precise understanding of tDCS mechanisms, the present unreliability of predictions for the magnitude and nature of an individual’s response to stimulation, the need for tDCS research to better capture dynamic effects in highly heterogeneous populations in whom comorbid diagnoses and the concurrent use of (multiple) medications may interact independently and interactively to affect tDCS response. Ethical challenges include issues of safety, character, justice, and autonomy. These considerations prompt a need to anticipate the trajectories of current and potential future use of tDCS both within and outside of clinical contexts, as there are likely to be evolving social and cultural consequences of tDCS use within neuropsychiatry. Likewise, neuroethical consequences from nonclinically oriented tDCS use are likely to have an impact on the way tDCS is used—and sought out—in clinical contexts. The accessibility of tDCS and its likelihood for broad use outside of medical contexts make it especially important to consider the promises, potential perils, and likely trajectories of tDCS use in multiple contexts from the outset. In this chapter, we reflect upon the way that the present degree of scientific understanding of tDCS motivates, justifies, and sometimes cautions against tDCS use.