Neuroethics

, Volume 6, Issue 3, pp 447–455 | Cite as

Deep Brain Stimulation in Children: Parental Authority Versus Shared Decision-Making

Original Paper

Abstract

This paper discusses the use of deep brain stimulation for the treatment of neurological and psychiatric disorders in children. At present, deep brain stimulation is used to treat movement disorders in children and a few cases of deep brain stimulation for psychiatric disorders in adolescents have been reported. Ethical guidelines on the use of deep brain stimulation in children are therefore urgently needed. This paper focuses on the decision-making process, and provides an ethical framework for (future) treatment decisions in pediatric deep brain stimulation. I defend a shared decision-making model in case of deep brain stimulation for neurological and psychiatric disorders in children. To protect the vulnerable child patient, a dual consent process is needed where parents or parental guardians give their consent, and the child gives his/her assent.

Keywords

Deep brain stimulation Shared decision-making Informed consent Assent Dissent Psychiatric disorders Children 

References

  1. 1.
    Hardesty, D.E., and H.A. Sackeim. 2007. Deep brain stimulation in movement and psychiatric disorders. Biological Psychiatry 61: 831–835.CrossRefGoogle Scholar
  2. 2.
    Merkel, R., G. Boer, J. Fegert, T. Galert, D. Hartmann, B. Nuttin, and S. Rosahl. 2007. Intervening in the brain. Changing psyche and society. Berlin: Springer.Google Scholar
  3. 3.
    Bussone, G., A. Franzini, A.P. Cecchini, E. Mea, M. Curone, V. Tullo, G. Broggi, G. Casucci, V. Bonavita, and M. Leone. 2007. Deep brain stimulation in craniofacial pain: seven year’s experience. Neurological Sciences 28: S146–S149.CrossRefGoogle Scholar
  4. 4.
    Greenberg, B.D., D.A. Malone, G.M. Friehs, A.R. Rezai, C.S. Kubu, P.F. Malloy, S.P. Salloway, M.S. Okun, W.K. Goodman, and S.A. Rasmussen. 2006. Three-year outcomes in deep brain stimulation for highly resistant obsessive compulsive disorder. Neuropsychopharmacology 31: 2384–2393.CrossRefGoogle Scholar
  5. 5.
    Mayberg, H.S., A.M. Lozano, V. Voon, H.E. McNeely, D. Seminowicz, C. Hamani, J.M. Schwalb, and S.H. Kennedy. 2005. Deep brain stimulation for treatment-resistant depression. Neuron 45: 651–660.CrossRefGoogle Scholar
  6. 6.
    Wichmann, T., and M.R. DeLong. 2003. Pathophysiology of Parkinson’s disease: the MPTP primate model of the human disorder. New York Academy of Sciences 991: 199–213.CrossRefGoogle Scholar
  7. 7.
    Kupsch, A., R. Benecke, J. Mueller, T. Trottenberg, G. Schneider, W. Poewe, et al. 2006. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. New England Journal of Medicine 355: 1978–1990.CrossRefGoogle Scholar
  8. 8.
    Roubertie, A., B. Echenne, L. Cif, N. Vayssiere, S. Hemm, and P. Coubes. 2000. Treatment of early-onset dystonia: update and a new perspective. Childs Nervous System 16: 334–340.CrossRefGoogle Scholar
  9. 9.
    Parr, J.R., A.L. Green, C. Joint, M. Andrew, R.P. Gregory, R.B. Scott, A. McShane, and T.Z. Aziz. 2007. Deep brain stimulation in childhood: an effective treatment for early onset idiopathic generalized dystonia. Archives of Disease in Childhood 92: 708–711.CrossRefGoogle Scholar
  10. 10.
    Borggraefe, I., J.H. Mehrkens, M. Telegravciska, S. Berweck, K. Bötzel, and F. Heinen. 2010. Bilateral pallidal stimulation in children and adolescents with primary generalized dystonia—report of six patients and literature-based analysis of predictive outcome variables. Brain & Development 32: 223–228.CrossRefGoogle Scholar
  11. 11.
    Isaias, I.U., R.L. Alterman, and M. Tagliati. 2008. Outcome predictors of pallidal stimulation in patients with primary dystonia: the role of disease duration. Brain 131: 1895–1902.CrossRefGoogle Scholar
  12. 12.
    Mehrkens, J.H., K. Boetzel, U. Steude, K. Zeitler, A. Schnitzler, V. Sturm, and J. Voges. 2009. Long-term efficacy and safety of chronic globus pallidus internus stimulation in different types of primary dystonia. Stereotactic and Functional Neurosurgery 87: 8–17.CrossRefGoogle Scholar
  13. 13.
    Clausen, J. 2010. Ethical brain stimulation: neuroethics of deep brain stimulation in research and clinical practice. European Journal of Neuroscience 32: 1152–1162.CrossRefGoogle Scholar
  14. 14.
    Kupsch, A., J. Mehrkens, and A.A. Kuhn. 2009. Deep brain stimulation in dystonia: when and where? Survey summer 2008. Aktuelle Neurologie 36: S32–S40.CrossRefGoogle Scholar
  15. 15.
    Sato, K., E. Nakagawa, Y. Saito, H. Komaki, H. Sakuma, K. Sugai, M. Sasaki, T. Kaido, H. Nakama, and T. Otskuki. 2009. Hyperkinetic movement disorder in a child treated by globus pallidus stimulation. Brain & Development 31: 452–455.CrossRefGoogle Scholar
  16. 16.
    Dueck, A., A. Wolters, K. Wunsch, S. Bohne-Suraj, J.-U. Mueller, F. Haessler, R. Benecke, and J. Buchmann. 2009. Deep brain stimulation of globus pallidus internus in a 16-year-old boy with severe Tourette syndrome and mental retardation. Neuropediatrics 40: 239–242.CrossRefGoogle Scholar
  17. 17.
    Servello, D., Porta, M., Sassi, M., Brambilla, A., and Robertson, M.M. 2008. Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation.Google Scholar
  18. 18.
    Shaded, J., C. Poysky, C. Kenney, R. Simpson, and J. Jankovic. 2007. GPi deep brain stimulation for Tourette improves tics and psychiatric comorbidities. Neurology 68: 159–162.CrossRefGoogle Scholar
  19. 19.
    Rabins, P., B.S. Appleby, J. Brandt, M.R. DeLong, L.B. Dunn, L. Gabriëls, et al. 2009. Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Archives of General Psychiatry 66: 931–937.CrossRefGoogle Scholar
  20. 20.
    Lipsman, N., M. Ellis, and A.M. Lozano. 2010. Current and future indications for deep brain stimulation in pediatric populations. Neurosurgical Focus 29: 1–7.Google Scholar
  21. 21.
    Chou, Y.-C., S.-Z. Lin, W.A. Hsieh, S.H. Lin, C.C. Lee, Y.L. Hsin, P.S. Yen, C.W. Lee, W.-T. Chiu, and S.-Y. Chen. 2007. Surgical and hardware complications in subthalamic nucleus deep brain stimulation. Journal of Clinical Neuroscience 14: 634–649.CrossRefGoogle Scholar
  22. 22.
    Buchanan, A.E., and D.W. Brock. 1989. Deciding for others. The ethics of surrogate decision-making. Cambridge: Cambridge University Press.Google Scholar
  23. 23.
    Cummings, C.L., and M.R. Mercurio. 2010. Ethics for the pediatrician: autonomy, beneficence, and rights. Pediatrics in Review 31: 252–255.CrossRefGoogle Scholar
  24. 24.
    Ladd, R.E., and E.N. Forman. 2010. Ethics for the pediatrician: pediatrician/patient/parent relationships. Pediatrics in Review 31: e65–e67.CrossRefGoogle Scholar
  25. 25.
    Ross, L.F. 1998. Children, families and health care decision making. Oxford: Clarendon.Google Scholar
  26. 26.
    Dare, T. 2009. Parental rights and medical decisions. Pediatric Anesthesia 19: 947–952.CrossRefGoogle Scholar
  27. 27.
    Archard, D.W. 2006. Children’s rights. The Stanford Encyclopedia of Philosophy [http://plato.stanford.edu]
  28. 28.
    Doyal, L., L. Doyal, and D. Sokol. 2009. Balancing protection and respect in paediatrics. Postgraduate Medical Journal 85: 169–170.CrossRefGoogle Scholar
  29. 29.
    Hagger, L. 2009. The child as vulnerable patient. Protection and empowerment. Farnham: Ashgate.Google Scholar
  30. 30.
    Alderson, P., K. Sutcliffe, and K. Curtis. 2006. Children’s competence to consent to medical treatment. Hastings Center Report 6: 25–34.CrossRefGoogle Scholar
  31. 31.
    Archard, D., and M. Skivenes. 2009. Balancing a child’s best interests and a child’s views. International Journal of Children’s Rights 17: 1–21.CrossRefGoogle Scholar
  32. 32.
    Anderson, P. 2007. Competent children? Minors’ consent to health care treatment and research. Social Science & Medicine 65: 2272–2283.CrossRefGoogle Scholar
  33. 33.
    Ross, L.F. 2009. Arguments against respecting a minor’s refusal of efficacious life-saving treatment redux, part II. Cambridge Quarterly of Healthcare Ethics 18: 432–442.CrossRefGoogle Scholar
  34. 34.
    Ross, L.F. 2004. Informed consent in pediatric research. Cambridge Quarterly of Healthcare Ethics 13: 346–358.CrossRefGoogle Scholar
  35. 35.
    Tates, K., E. Elbers, L. Meeuwesen, and J. Bensing. 2002. Doctor-parent-child relationships: a ‘pas de trois’. Patient Education and Counseling 48: 5–14.CrossRefGoogle Scholar
  36. 36.
    Rosenbaum, P. 2008. Children’s quality of life: separating the person from the disorder. Archives of Disease in Childhood 93: 100–101.CrossRefGoogle Scholar
  37. 37.
    Hart, C., and R. Chesson. 1998. Children as consumers. British Medical Journal 316: 1600–1603.CrossRefGoogle Scholar
  38. 38.
    Upton, P., J. Lawford, and C. Eiser. 2008. Parent-child agreement across health-related quality of life instruments: a review of the literature. Quality of Life Research 17: 895–913.CrossRefGoogle Scholar
  39. 39.
    Gilbert, R., C.S. Widom, K. Browne, D. Fergusson, E. Webb, and S. Janson. 2009. Burden and consequences of child maltreatment in high-income countries. The Lancet 373: 68–81.CrossRefGoogle Scholar
  40. 40.
    Kohrman, A., E.W. Clayton, J.E. Frader, M.A. Grodin, K.L. Moseley, I.H. Porter, and V.M. Wagner. 1995. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 95: 314–317.Google Scholar
  41. 41.
    Ross, L.F. 1997. Health care decisionmaking by children. Is it in their best interest? Hastings Center Report 27: 41–45.Google Scholar
  42. 42.
    Cauffman, E., and L. Steinberg. 2000. (Im)maturity of judgment in adolescence: why adolescents may be less culpable than adults. Behavioral Sciences and the Law 18: 741–760.CrossRefGoogle Scholar
  43. 43.
    Steinberg, L., E. Cauffman, J. Woolard, S. Graham, and M. Banich. 2009. Are adolescents less mature than adults? Minors’ access to abortion, the juvenile death penalty and the alleged APA “flip-flop”. American Psychologist 64: 583–594.CrossRefGoogle Scholar
  44. 44.
    McCabe, M.A. 1996. Involving children and adolescents in medical decision-making: developmental and clinical considerations. Journal of Pediatric Psychology 21: 505–516.CrossRefGoogle Scholar
  45. 45.
    Porta, M., M. Sassi, F. Ali, A.E. Cavanna, and D. Servello. 2009. Neurosurgical treatment for Gilles de la Tourette syndrome: the Italian perspective. Journal of Psychosomatic Research 67: 585–590.CrossRefGoogle Scholar
  46. 46.
    Woodgate, R.L. 2006. The importance of being there: perspectives of social support by adolescents with cancer. Journal of Pediatric Oncology Nursing 23: 122–134.CrossRefGoogle Scholar
  47. 47.
    Moumjid, N., A. Gafni, A. Bremond, and M.O. Carrere. 2007. Shared decision making in the medical encounter: are we all talking about the same thing? Medical Decision Making 27: 539–546.CrossRefGoogle Scholar
  48. 48.
    Moulton, B., and J.S. King. 2006. Rethinking informed consent: the case for shared medical decision-making. American Journal of Law & Medicine 32: 429–501.Google Scholar
  49. 49.
    Bloch, M.H., and J.F. Leckman. 2009. Clinical course of Tourette syndrome. Journal of Psychosomatic Research 67: 497–501.CrossRefGoogle Scholar
  50. 50.
    Mink, J.W., J. Walkup, K.A. Frey, P. Como, D. Cath, M.R. DeLong, et al. 2006. Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Movement Disorders 21: 1831–1838.CrossRefGoogle Scholar
  51. 51.
    Focquaert, F. in press. Pediatric deep brain stimulation: a cautionary approach. Frontiers in Integrative Neuroscience.Google Scholar
  52. 52.
    Bloch, M.H., B.G. Craiglow, A. Landeros-Weisenberger, P.A. Dombrowski, K.E. Panza, B.S. Peterson, and J.F. Leckman. 2009. Predictors of early adult outcomes in pediatric-onset obsessive-compulsive disorder. Pediatrics 124: 1085–1093.CrossRefGoogle Scholar
  53. 53.
    Stewart, S.E., D.A. Geller, M. Jenike, D. Pauls, D. Shaw, B. Mullin, and S.V. Faraone. 2004. Long-term outcome of pediatric obsessive compulsive disorder: a meta-analysis and qualitative review of the literature. Acta Psychiatrica Scandinavica 110: 4–13.CrossRefGoogle Scholar
  54. 54.
    Micali, N., I. Heyman, M. Perez, K. Hilton, E. Nakatani, C. Turner, and D. Mataix-Cols. 2010. Long-term outcomes of obsessive compulsive disorder: follow-up of 142 children and adolescents. The British Journal of Psychiatry 197: 128–134.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Bioethics Institute Ghent, Department of Philosophy and Moral SciencesGhent UniversityGhentBelgium

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