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Ethics of the Electrified Mind: Defining Issues and Perspectives on the Principled Use of Brain Stimulation in Medical Research and Clinical Care

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Abstract

In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation, transcranial magnetic stimulation and transcranial direct current stimulation. We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice.

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Notes

  1. Even though TMS has FDA approval, its “clinical effect sizes are modest and the ultimate clinical significance remains unclear and is still controversial” (George et al. 2009).

  2. The foundational document of research ethics, the Nuremberg Code, begins the first of its ten requirements with: “the voluntary consent of the human subject is absolutely essential”.

  3. For instance, treatment-resistant patients might feel desperate to find a cure.

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Authors and Affiliations

  1. National Core for Neuroethics, The University of British Columbia, Vancouver, BC, Canada

    Laura Y. Cabrera

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Emily L. Evans & Roy H. Hamilton

  3. Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, 518 Goddard Building, 3710 Hamilton Walk, Philadelphia, PA, 19104, USA

    Roy H. Hamilton

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  1. Laura Y. Cabrera
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  2. Emily L. Evans
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  3. Roy H. Hamilton
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Correspondence to Roy H. Hamilton.

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This is one of several papers published together in Brain Topography on the ‘‘Special Topic: Clinical and Ethical Implications of Neuromodulation Techniques”.

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Cabrera, L.Y., Evans, E.L. & Hamilton, R.H. Ethics of the Electrified Mind: Defining Issues and Perspectives on the Principled Use of Brain Stimulation in Medical Research and Clinical Care. Brain Topogr 27, 33–45 (2014). https://doi.org/10.1007/s10548-013-0296-8

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