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Deep Brain Stimulation Through the “Lens of Agency”: Clarifying Threats to Personal Identity from Neurological Intervention

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Abstract

This paper explores the impacts of neurological intervention on selfhood with reference to recipients’ claims about changes to their self-understanding following Deep Brain Stimulation (DBS) for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken and occludes what is ethically salient in changes from DBS. Rather, by adopting a relational narrative approach to identity and autonomy, I show that the ethically salient issue from DBS is impacts on autonomous agency—whether one’s actions and beliefs are one’s own, and how DBS may hinder, or foster, embodied, relational autonomy competences. This approach recognizes that if sufficiently significant, impacts on autonomy competences may pose a threat to one’s ability to contribute to the process of authoring one’s own life and so pose a threat to identity formation. I argue this approach resolves the confusion in the literature about whether and how DBS threatens identity and provides a complex picture of how DBS may affect selfhood by disrupting narrative identity formation and revision, distorting agency and/or undermining autonomy.

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Notes

  1. DBS is also used to treat psychiatric disorders associated with Treatment Resistant Depression (TRD) and Obsessive Compulsive Disorder (OCD) and treatment sites in the brain depend on the condition. I confine my analysis to DBS for the treatment of PD.

  2. For example, in personal videos, such as by Mike Robbins (https://www.youtube.com/watch?v=h8tWlYv1Ykc), as well as in personal testimonies such as on the Medtronics site (https://www.medtronicdbs.com/parkinsons/personal-stories/index.htm).

  3. Similar claims concerning changes in self-understanding have been made by recipients of pacemakers [12], and by recipients of organ transplants [13]. I do not claim that there is something unique about changes in self-understanding consequent on DBS. However, because DBS directly affects the brain, concerns about changes to identity and self-governance take on a special significance.

  4. Whilst there are other studies of patient’s first-person phenomenological reports of DBS implantation for PD, as well as for other conditions [14], the reports in Schüpbach and colleagues have been the most frequently cited examples. While I do not argue it here, it would be helpful if theorists were to draw on a wider range of case studies involving changes in self-understanding following DBS from which to draw generalizable claims about the impacts of DBS. By drawing on the patient reports I do not argue that all patient experience is the same or even that cohorts of patients have similar responses to DBS. Rather, I argue these first-person phenomenological accounts provided by Schüpbach and colleagues can inform our understanding of selfhood and personal identity.

  5. Levy [19] discusses and dismisses a similar concern, that neurotechnologies threaten identity because they directly manipulate the brain.

  6. For an outline of varying formulations of narrative approaches to identity constitution, see [21].

  7. DeGrazia argues that when there is concern about a threat to identity this is because there is static view of identity being mobilized (or a conflation of numerical and narrative senses of identity).

  8. Mackenzie and Walker set out a weakly substantial approach to relational autonomy. There are numerous approaches under the relational autonomy banner, which I cannot discuss in this paper. For further discussion, see [28].

  9. Baylis also critiques an individualist strand in DeGrazia’s narrative approach and argues his narrative approach is unable to sufficiently account for the conflict between first- and third- personal ascriptions, see [26].

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Acknowledgements

Research for this project was supported by the Australian Research Council Centre of Excellence Scheme (Project Number CE 140100012).

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  1. ARC Centre of Excellence for Electromaterials Science, School of Philosophy, University of Tasmania, Hobart, Australia

    Eliza Goddard

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Goddard, E. Deep Brain Stimulation Through the “Lens of Agency”: Clarifying Threats to Personal Identity from Neurological Intervention. Neuroethics 10, 325–335 (2017). https://doi.org/10.1007/s12152-016-9297-0

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