Self-Estrangement & Deep Brain Stimulation: Ethical Issues Related to Forced Explantation
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Although being generally safe, the use of Deep Brain Stimulation (DBS) has been associated with a significant number of patients experiencing postoperative psychological and neurological harm within experimental trials (i.e. self-estrangement, hypersexuality, hypomania, suicidality, impulse control disorders, etc.). A proportion of these postoperative severe adverse effects have lead to the decision to medically prescribe device deactivation or removal. However, there is little debate in the literature as to what is in the patient’s best interest when device removal has been prescribed; in particular, what should be the conceptual approach to ethically guide the decision to remove or maintain implants. The purpose of this article is to examine the ethical issues raised when patients refuse brain device explantation despite medical prescription. In order to illustrate these issues, we report and discuss a clinical case involving a patient suffering from treatment resistant depression who experienced forms of postoperative self-estrangement, as well as suicidal attempts, but who resists giving consent to device explantation.
KeywordsConsent Deep brain stimulation Depression Forced explantation Forced removal Harms Self-estrangement
Fondation Brocher for its hospitality. Thaks to Eliza Goddard and Susan Dodds. ARC Centre of Excellence for Electromaterials Science (ACES), Project ID: CE140100012.
- 2.Oh, M.Y., et al. 2002. Long-term hardware-related complications of deep brain stimulation. Neurosurgery 50(6): 1268–1276.Google Scholar
- 3.http://www.medtronic.com/patients/parkinsons-disease/therapy/benefits-and-risks/ Last retrieved October 05 2014
- 4.Henderson, JM 2006, Permanent neurological deficit related to magnetic resonance Imaging in a patient with implanted deep brain stimulation electrodes for Parkinson’s disease: Case report, Neurosurgery, 57(5). DOI: 10.1227/01.NEU.0000180810.16964.3E.
- 5.Chang, CH et al., 2009, Hypomania with hypersexuality following bilateral anterior limb stimulation in obsessive-compulsive disorder, J Neurosurg, 112 DOI: 10.3171/2009.10.JNS09918.
- 8.Muller, S., and H. Walter. 2010. Reviewing autonomy: Implications of the neurosciences and the free will debate for the principle of respect for the patient’s autonomy. Cambridge Quarterly of Healthcare Ethics 19: 205–217.Google Scholar
- 9.Kraemer, F. 2013. Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 6: 483–497.Google Scholar
- 10.Baylis, F, 2013, “I am Who I Am”: On the perceived threats to personal identity from deep brain stimulation, 6: 513–526.Google Scholar
- 12.Gilbert, F. 2013. Deep brain stimulation and postoperative suicidability among treatment resistant depression patients: Should eligibility protocols exclude patients with history of suicide attempts and anger/impulsivity? American Journal of Bioethics: Neuroscience 4: 28–35. doi: 10.1080/21507740.2012.740143.
- 14.Daphne, S., M. Knutelska, N. Dorothy, et al. 2003. Feeling unreal: A depersonalization disorder update of 117 cases. Journal of Clinical Psychiatry 64: 990–997. doi: 10.4088/JCP.v64n0903.
- 15.de Oliveira, J.R.M., and M.F. de Oliveira. 2013. Depicting depersonalization disorder. The American Journal of Psychiatry 170: 263–264. doi: 10.1176/appi.ajp.2012.12111413.
- 16.Agid, Y., M. Schupbach, M. Gargiulo, et al. 2006. Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission. Supplementum 70: 400–414.Google Scholar
- 26.Bell E, Racine E, Ethical guidance for the use of deep brain stimulation in psychiatric trials and emerging uses: Review and reflections, in deep brain stimulation, A new Frontier in psychiatry, eds Damiann D, Feenstra M, Schuurman R, 2012; ch 25: 273–88.Google Scholar