Advertisement

Ethical Guidance for the Use of Deep Brain Stimulation in Psychiatric Trials and Emerging Uses: Review and Reflections

  • Emily Bell
  • Eric Racine
Chapter

Abstract

Research has suggested novel promising opportunities for deep brain stimulation (DBS) to treat the disabling symptoms of some severe psychiatric patients. Accordingly, researchers and practitioners in the fields of neurosurgery, psychiatry, and bioethics have been attentive to the possible ethical challenges for research and care in this field. In fact, in addition to a range of scholarly work discussing the potential ethical concerns in psychiatric DBS, some of these articles provide explicit ethical guidance intended to direct ethical practice in research and care. This chapter reviews what is contained in the current international explicit ethical guidance on psychiatric DBS, identifying shared ethical themes of the guidance, and providing examples of how the guidance addresses these ethical challenges. On the basis of the content of the explicit ethical guidance, we reflect on the need for specific ethical guidance in psychiatric DBS, discuss whether there are issues that are overrepresented or underrepresented in the guidance, and suggest how current ethical guidance can be translated into practice by researchers and clinicians by providing a model for the cycle of generation and implementation of evidence-based ethics.

Keywords

Psychiatric Disorder Deep Brain Stimulation Ethical Challenge Current Guidance Ethical Guidance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Agid Y, Schupbach M, Gargiulo M, Mallet L, Houeto JL, Behar C, Maltete D, Mesnage V, Welter ML (2006) Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so? J Neural Transm Suppl 70:409–414PubMedCrossRefGoogle Scholar
  2. Bell E (under review) Ethical issues in psychiatric applications of deep brain stimulation: learning from Canadian healthcare providersGoogle Scholar
  3. Bell E, Mathieu G, Racine E (2009) Preparing the ethical future of deep brain stimulation. Surg Neurol 72:577–586PubMedCrossRefGoogle Scholar
  4. Bell E, Maxwell B, McAndrews MP, Sadikot A, Racine E (2011) Deep brain stimulation and ethics: perspectives from a multi-site qualitative study of Canadian neurosurgical centers. World Neurosurg 76:537–547PubMedCrossRefGoogle Scholar
  5. Carter A, Bell E, Racine E, Hall W (2011) Ethical issues raised by proposals to treat addiction using deep brain stimulation. Neuroethics 4:129–142CrossRefGoogle Scholar
  6. Dunn LB, Holtzheimer PE, Hoop JG, Mayberg HS, Roberts LW, Appelbaum PS (2011) Ethical issues in deep brain stimulation research for treatment-resistant depression: focus on risk and consent. Am J Bioeth Neurosci 2:29–36Google Scholar
  7. Fins JJ, Mayberg HS, Nuttin B, Kubu CS, Galert T, Sturm V, Stoppenbrink K, Merkel R, Schlaepfer TE (2011) Misuse of the FDA’s humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder. Health Aff (Millwood) 30:302–311CrossRefGoogle Scholar
  8. Glannon W (2008) Deep-brain stimulation for depression. HEC Forum 20:325–335PubMedCrossRefGoogle Scholar
  9. Haahr A, Kirkevold M, Hall EO, Ostergaard K (2010) From miracle to reconciliation: a hermeneutic phenomenological study exploring the experience of living with Parkinson’s disease following deep brain stimulation. Int J Nurs Stud 47:1228–1236Google Scholar
  10. Hildt E (2006) Electrodes in the brain: some anthropological and ethical aspects of deep brain stimulation. IRIE 5:33–39Google Scholar
  11. Kim SY (2004) Evidence-based ethics for neurology and psychiatry research. NeuroRx 1:372–377PubMedCrossRefGoogle Scholar
  12. Kuhn J, Gaebel W, Klosterkoetter J, Woopen C (2009) Deep brain stimulation as a new therapeutic approach in therapy-resistant mental disorders: ethical aspects of investigational treatment. Eur Arch Psychiatry Clin Neurosci 259(Suppl 2):S135–S141PubMedCrossRefGoogle Scholar
  13. Lipsman N, Bernstein M, Lozano AM (2010) Criteria for the ethical conduct of psychiatric neurosurgery clinical trials. Neurosurg Focus 29:E9PubMedCrossRefGoogle Scholar
  14. Lipsman N, Mendelsohn D, Taira T, Bernstein M (2011) The contemporary practice of psychiatric surgery: results from a survey of North American functional neurosurgeons. Stereotact Funct Neurosurg 89:103–110PubMedCrossRefGoogle Scholar
  15. Mendelsohn D, Lipsman N, Bernstein M (2010) Neurosurgeons’ perspectives on psychosurgery and neuroenhancement: a qualitative study at one center. J Neurosurg 113:1212–1218PubMedCrossRefGoogle Scholar
  16. Mian MK, Campos M, Sheth SA, Eskandar EN (2010) Deep brain stimulation for obsessive-compulsive disorder: past, present, and future. Neurosurg Focus 29:E10PubMedCrossRefGoogle Scholar
  17. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1977) Report and recommendations: Psychosurgery. DHEW publication no. (OS)77-0001, WashingtonGoogle Scholar
  18. Nuttin B, Gybels J, Cosyns P, Gabriels L, Meyerson B, Andreewitch S, Rasmussen S, Greenberg B, Friehs G, Rezai A, Montgomery E, Malone D, Fins JJ (2002) Deep brain stimulation for psychiatric disorders. Neurosurgery 51:519Google Scholar
  19. Nuttin B, Gybels J, Cosyns P, Gabriels L, Meyerson B, Andreewitch S, Rasmussen SA, Greenberg B, Friehs G, Rezai AR, Montgomery E, Malone D and Fins JJ (2003) Deep brain stimulation for psychiatric disorders. Neurosurg Clin N Am 14:xv–xviGoogle Scholar
  20. Parens E, Johnston J (2007) Does it make sense to speak of neuroethics? Three problems with keying ethics to hot new science and technology. EMBO Rep 8 Spec No S61-4Google Scholar
  21. Rabins P, Appleby BS, Brandt J, DeLong MR, Dunn LB, Gabriels L, Greenberg BD, Haber SN, Holtzheimer PE 3rd, Mari Z, Mayberg HS, McCann E, Mink SP, Rasmussen S, Schlaepfer TE, Vawter DE, Vitek JL, Walkup J, Mathews DJ (2009) Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Arch Gen Psychiatry 66:931–937PubMedCrossRefGoogle Scholar
  22. Racine E (2010) Pragmatic neuroethics: improving understanding and treatment of the mind-brain. MIT Press, CambridgeGoogle Scholar
  23. Racine E, Bell E, Di Pietro NC, Wade L, Illes J (2011) Evidence-based neuroethics for neurodevelopmental disorders. Semin Pediatr Neurol 18:21–25PubMedCrossRefGoogle Scholar
  24. Schechtman M (2010) Philosophical reflections on narrative and deep brain stimulation. J Clin Ethics 21:133–139PubMedGoogle Scholar
  25. Schlaepfer TE, Fins JJ (2010) Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough. JAMA 303:775–776PubMedCrossRefGoogle Scholar
  26. Schupbach M, Gargiulo M, Welter ML, Mallet L, Behar C, Houeto JL, Maltete D, Mesnage V, Agid Y (2006) Neurosurgery in Parkinson disease: a distressed mind in a repaired body? Neurology 66:1811–1816PubMedCrossRefGoogle Scholar
  27. Synofzik M, Schlaepfer TE (2008) Stimulating personality: ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnol J 3:1511–1520PubMedCrossRefGoogle Scholar
  28. Synofzik M, Schlaepfer TE (2011) Electrodes in the brain–ethical criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders. Brain Stimul 4:7–16PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Neuroethics Research Unit, Institut de Recherches Cliniques de MontréalMontrealCanada
  2. 2.Université de MontréalMontrealCanada
  3. 3.McGill UniversityMontrealCanada

Personalised recommendations