Skip to main content

Does Closed-Loop DBS for Treatment of Psychiatric Disorders Raise Salient Authenticity Concerns?

  • 262 Accesses

Part of the Advances in Neuroethics book series (AIN)

Abstract

Despite the success of deep brain stimulation (DBS) for treatment of neurological disorders, future success depends on creating improved systems that rely on artificial intelligence. Where the current deep brain stimulation systems are open-loop—applying a constant or intermittent electrical current to the brain—the new generation of DBS devices will utilize artificial intelligence technologies, such as machine learning algorithms, to facilitate closed-loop implants that are adaptive and continuously modified by neural feedback. Closed-loop DBS devices read neural data, interpret the signals to make a clinical decision, and stimulate the brain dynamically. This process occurs continuously and without active input from users or clinicians, allowing for far fewer adjustments and improving treatment specificity. This raises concerns about whether these devices threaten a user’s ability to live an authentic life. While some of these concerns have been raised in the context of open-loop DBS, we argue that closed-loop devices introduce new worries that need to be examined. Failure to develop ethical guidance for this unique setting may lead to user harm and a lack of acceptance of new devices.

Keywords

  • Deep brain stimulation
  • Authenticity
  • Psychiatric disorders
  • Neurological disorders
  • Agency
  • Closed-loop
  • Artificial intelligence
  • Machine learning
  • Identity
  • Bioethics
  • Neuroethics

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-74188-4_14
  • Chapter length: 15 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   119.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-74188-4
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   159.99
Price excludes VAT (USA)

References

  1. Lozano AM, Lipsman N, Bergman H, Brown P, Chabardes S, Chang JW, et al. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol. 2019;15:148–60.

    CrossRef  Google Scholar 

  2. Widge AS, Malone DA, Dougherty DD. Closing the loop on deep brain stimulation for treatment-resistant depression. Front Neurosci. 2018;12:175.

    CrossRef  Google Scholar 

  3. Klein E, Goering S, Gagne J, Shea CV, Franklin R, Zorowitz S, et al. Brain-computer interface-based control of closed-loop brain stimulation: attitudes and ethical considerations. Brain Comput Interfaces. 2016;3:140–8.

    CrossRef  Google Scholar 

  4. de Haan S, Rietveld E, Stokhof M, Denys D. Effects of deep brain stimulation on the lived experience of obsessive-compulsive disorder patients. PLoS One. 2015;10(8):e0135524. [cited 2015 Dec 10]; http://philpapers.org/rec/DEHEOD.

    CrossRef  Google Scholar 

  5. Schüpbach M, Gargiulo M, Welter ML, Mallet L, Behar C, Houeto JL, et al. Neurosurgery in Parkinson disease a distressed mind in a repaired body? Neurology. 2006;66:1811–6.

    CrossRef  Google Scholar 

  6. Kraemer F. Me, myself and my brain implant: deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics. 2013;6:483–97.

    CrossRef  Google Scholar 

  7. Mackenzie C, Walker M. Neurotechnologies, personal identity, and the ethics of authenticity. In: Clausen J, Levy N, editors. Handbook of neuroethics [Internet]. Dordrecht: Springer; 2015. p. 373–92. https://doi.org/10.1007/978-94-007-4707-4_10.

    CrossRef  Google Scholar 

  8. Elliott C. Enhancement technologies and the modern self. J Med Philos. 2011;36:364–74.

    CrossRef  Google Scholar 

  9. Pugh J, Maslen H, Savulescu J. Deep brain stimulation, authenticity and value. Camb Q Healthc Ethics. 2017;26:640–57.

    CrossRef  Google Scholar 

  10. Goering S, Klein E, Dougherty DD, Widge AS. Staying in the loop: relational agency and identity in next-generation DBS for psychiatry. AJOB Neurosci. 2017;8:59–70.

    CrossRef  Google Scholar 

  11. de Haan S, Rietveld E, Stokhof M, Denys D. Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: experiences of OCD patients and general considerations. PLoS One. 2017;12:e0175748.

    CrossRef  Google Scholar 

  12. Gardner J. A history of deep brain stimulation: technological innovation and the role of clinical assessment tools. Soc Stud Sci. 2013;43:707–28.

    CrossRef  Google Scholar 

  13. Schechtman M. Philosophical reflections on narrative and deep brain stimulation. J Clin Ethics. 2009;21:133–9.

    Google Scholar 

  14. Dougherty DD, Rezai AR, Carpenter LL, Howland RH, Bhati MT, O’Reardon JP, et al. A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biol Psychiatry. 2015;78:240–8.

    CrossRef  Google Scholar 

  15. Meidahl AC, Tinkhauser G, Herz DM, Cagnan H, Debarros J, Brown P. Adaptive deep brain stimulation for movement disorders: the long road to clinical therapy. Mov Disord. 2017;32:810–9.

    CrossRef  Google Scholar 

  16. Malone DA, Dougherty DD, Rezai AR, Carpenter LL, Friehs GM, Eskandar EN, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009;65:267–75.

    CrossRef  Google Scholar 

  17. Widge AS, Ellard KK, Paulk AC, Basu I, Yousefi A, Zorowitz S, et al. Treating refractory mental illness with closed-loop brain stimulation: progress towards a patient-specific transdiagnostic approach. Exp Neurol. 2017;287:461–72.

    CrossRef  Google Scholar 

  18. Lo M-C, Widge AS. Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness. Int Rev Psychiatry. 2017;29:191–204.

    CrossRef  Google Scholar 

  19. Posternak MA, Zimmerman M. Is there a delay in the antidepressant effect? A meta-analysis. J Clin Psychiatry. 2005;66(2):148–58.

    CAS  CrossRef  Google Scholar 

  20. Brudney D, Lantos J. Agency and authenticity: which value grounds patient choice? Theor Med Bioeth. 2011;32:217–27.

    CrossRef  Google Scholar 

  21. Mackenzie R. Authenticity versus autonomy in choosing the new me: beyond IEC and NIEC in DBS. AJOB Neurosci. 2014;5:51–3.

    CrossRef  Google Scholar 

  22. Kraemer F. Authenticity or autonomy? When deep brain stimulation causes a dilemma. J Med Ethics. 2013;39:757–60.

    CrossRef  Google Scholar 

  23. Sharp D, Wasserman D. Deep brain stimulation, historicism, and moral responsibility. Neuroethics. 2016;9:173–85.

    CrossRef  Google Scholar 

  24. Berg JW. Constructing competence: formulating standards of legal competence to make medical decisions. Rutgers Law Rev: 53.

    Google Scholar 

  25. Bublitz JC, Merkel R. Autonomy and authenticity of enhanced personality traits. Bioethics. 2009;23:360–74.

    CrossRef  Google Scholar 

  26. Baylis F. “I am who I am”: on the perceived threats to personal identity from deep brain stimulation. Neuroethics. 2011:1–14.

    Google Scholar 

  27. Ahlin J. What justifies judgments of inauthenticity? HEC Forum. 2018;30:361–77.

    CrossRef  Google Scholar 

  28. Erler A, Hope T. Mental disorder and the concept of authenticity. Philos Psychiatry Psychol. 2014;21:219–32.

    CrossRef  Google Scholar 

  29. Sjöstrand M, Juth N. Authenticity and psychiatric disorder: does autonomy of personal preferences matter? Med Health Care Philos. 2014;17:115–22.

    CrossRef  Google Scholar 

  30. Choi KS, Riva-Posse P, Gross RE, Mayberg HS. Mapping the “depression switch” during intraoperative testing of Subcallosal cingulate deep brain stimulation. JAMA Neurol. 2015;72:1252–60.

    CrossRef  Google Scholar 

  31. Klein E, Brown T, Sample M, Truitt AR, Goering S. Engineering the brain: ethical issues and the introduction of neural devices. Hastings Cent Rep. 2015;45:26–35.

    CrossRef  Google Scholar 

  32. Ienca M, Haselager P. Hacking the brain: brain–computer interfacing technology and the ethics of neurosecurity. Ethics Inf Technol. 2016;18:117–29.

    CrossRef  Google Scholar 

  33. Pycroft L, Boccard SG, Owen SLF, Stein JF, Fitzgerald JJ, Green AL, et al. Brainjacking: implant security issues in invasive Neuromodulation. World Neurosurg. 2016;92:454–62.

    CrossRef  Google Scholar 

  34. Denning T, Matsuoka Y, Kohno T. Neurosecurity: security and privacy for neural devices. Neurosurg Focus. 2009;27:E7.

    CrossRef  Google Scholar 

  35. Glannon W, Ineichen C. Philosophical aspects of closed-loop neuroscience. In: El Hady A, editor. Closed loop neuroscience [Internet]. San Diego: Academic Press; 2016. p. 259–70. https://books.google.com/books?hl=en&lr=&id=0ZTBCQAAQBAJ&oi=fnd&pg=PP1&dq=glannon+philosophical+aspects+of+closed-loop+neuroscience&ots=74dkrS5k9z&sig=bOJfqUkD-6FU0tJYOEdy5bQbyFw. Accessed 17 May 2017.

    CrossRef  Google Scholar 

  36. Char DS, Shah NH, Magnus D. Implementing machine learning in health care—addressing ethical challenges. N Engl J Med. 2018;378:981–3.

    CrossRef  Google Scholar 

  37. Gilbert F. The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment. J Med Ethics. 2012;38:408–12.

    CrossRef  Google Scholar 

  38. O’Brolchain F, Gordijn B. Brain–computer interfaces and user responsibility. In: Grübler G, Hildt E, editors. Brain-computer-interfaces in their ethical, social and cultural contexts [Internet]. Dordrecht: Springer; 2014. p. 163–82. Accessed 24 May 2019. https://doi.org/10.1007/978-94-017-8996-7_14.

    CrossRef  Google Scholar 

  39. Klein E. Models of the patient-machine-clinician relationship in closed-loop machine Neuromodulation. In: van Rysewyk SP, Pontier M, editors. Machine medical ethics [Internet]. Cham: Springer International; 2015. p. 273–90. Accessed 4 Nov 2019. https://doi.org/10.1007/978-3-319-08108-3_17.

    CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ishan Dasgupta .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Dasgupta, I., Schönau, A., Brown, T., Klein, E., Goering, S. (2021). Does Closed-Loop DBS for Treatment of Psychiatric Disorders Raise Salient Authenticity Concerns?. In: Jotterand, F., Ienca, M. (eds) Artificial Intelligence in Brain and Mental Health: Philosophical, Ethical & Policy Issues. Advances in Neuroethics. Springer, Cham. https://doi.org/10.1007/978-3-030-74188-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74188-4_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74187-7

  • Online ISBN: 978-3-030-74188-4

  • eBook Packages: MedicineMedicine (R0)