Stimulating brains, altering minds

Glannon, Walter

doi:10.1136/jme.2008.027789

Cited by 105 publications

(55 citation statements)

References 19 publications

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“…Taking antibiotics or having a tooth removed will not be personally transformative. Conversely, deep brain stimulation, having one's sight or hearing restored, chemotherapy, organ transplantation (especially facial allograft transplantation), having one's legs amputated, successful IVF, and antidepressants such as Prozac are likely to be personally transformative (Glannon 2009;Maguire and McGee 1999;Matthews 2011;Svenaeus 2012;Swindell 2007). 15 It is likely that undergoing these treatments will alter an important element of one's self and represent an experience that is epistemologically novel.…”

Section: Can a Patient's Regret Be Prevented?mentioning

confidence: 99%

The Role of Regret in Medical Decision-making

McQueen¹

2017

Ethic Theory Moral Prac

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In this paper, I explore the role that regret does and should play in medical decision-making. Specifically, I consider whether the possibility of a patient experiencing post-treatment regret is a good reason for a clinician to counsel against that treatment or to withhold it. Currently, the belief that a patient may experience post-treatment regret is sometimes taken as a sufficiently strong reason to withhold it, even when the patient makes an explicit, informed request. Relatedly, medical researchers and practitioners often understand a patient's post-treatment regret to be a significant problem, one that reveals a mistake or flaw in the decision-making process. Contrary to these views, I argue that the possibility of post-treatment regret is not necessarily a good reason for withholding the treatment. This claim is justified by appealing to respect for patient autonomy. Furthermore, there are occasions when the very reference to post-treatment regret during medical decision-making is inappropriate. This, I suggest, is the case when the decision concerns a Bpersonally transformative treatment^. This is a treatment that alters a person's identity. Because the treatment is transformative, neither clinicians nor the patient him/herself can ascertain whether post-treatment regret will occur. Consequently, I suggest, what matters in determining whether to offer a personally transformative treatment is whether the patient has sufficiently good reasons for wanting the treatment at the time the decision is made. What does not matter is how the patient may subsequently be changed by undergoing the treatment.

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Section: Can a Patient's Regret Be Prevented?mentioning

confidence: 99%

The Role of Regret in Medical Decision-making

McQueen¹

2017

Ethic Theory Moral Prac

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“…Given the quickly increasing interest in DBS research for neuropsychiatric disorders, investigators, investigational review boards, psychiatrists, patients, and caregivers are obviously in need of clear criteria that can easily be applied to both research and clinical decision-making. Although most current ethical perspectives provide a well-nuanced perspective on psychiatric DBS, 20,21 some of them still draw on references to early psychosurgery 22,23 or the risk to alter a patient's personality 20,24 to delineate limitations for ethically legitimate psychiatric DBS.…”

Section: Some Ethical Issuesmentioning

confidence: 99%

Separating Hope from Hype:Some Ethical Implications of the Development of Deep Brain Stimulation in Psychiatric Research and Treatment

Schläepfer

Lisanby

Pallanti³

2010

CNS Spectr.

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Major depression is the most common serious brain disorder with a lifetime prevalence of up to 17%. Despite numerous options currently available for the treatment of depression, ~2 million people in the United States may experience an inadequate response to treatment (treatment-resistant depression [TRD]) at some point in their lives. The definition of TRD is variable, ranging from a failure to respond to two or more trials of antidepressant monotherapy to a failure to respond to four or more trials of different antidepressant therapies, including augmentation, combination therapy, and electroconvulsive therapy. It has been reported that as many as one-third of patients experience only a partial response to initial therapy, while nearly one-fifth are considered nonresponders. In addition to the obvious quality of life issues for the patient with TRD, the economic cost of TRD is significant. Annual healthcare costs increase significantly for patients with TRD with each successive change in antidepressant medication. Early in treatment (two medication changes), the annual costs are <$7,000/Year. By the eighth medication change, annual costs double to nearly $14,000/year.There is a well-documented need for better long-term treatments for TRD, as witnessed by multiple efforts to establish treatment algorithms and best treatment steps when first and subsequent treatment measures prove inadequate. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which analyzed outcome following several standardized antidepressive treatment steps, reported that 33% of patients did not respond even after four evidence-based treatment steps. A substantial proportion of patients are inadequately treated and some of these will go on to suffer from chronic, debilitating, and life-threatening symptoms.

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“…Similarly, deep brain stimulation (DBS) threats have been investigated by Glannon [6], and Ford and Kubu [7]. DBS, despite modulating over-or under-active CNS areas for function improvement purposes, may, in selected cases as NPs, potentially change patient personality, thus benefits and harms should be carefully considered [6,7]. A choice based on careful assessment and the Evidence Based Medicine (EBM) paradigm may play a key role role in the decision-making process concerning particular patients' surgical candidacy.…”

Section: Introductionmentioning

confidence: 99%

“…Saha and Chhatbar described general problematic areas for implantable NPs as follows: manufacturing, animal experimentation, human trials, areas of application, individual issues, and societal issues [5]. Similarly, deep brain stimulation (DBS) threats have been investigated by Glannon [6], and Ford and Kubu [7]. DBS, despite modulating over-or under-active CNS areas for function improvement purposes, may, in selected cases as NPs, potentially change patient personality, thus benefits and harms should be carefully considered [6,7].…”

Section: Introductionmentioning

confidence: 99%

Ethical considerations in the use of brain-computer interfaces

Mikołajewska

Mikołajewski²

2013

Open Medicine

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AbstractNervous system disorders are among the most severe disorders. Significant breakthroughs in contemporary clinical practice may provide brain-computer interfaces (BCIs) and neuroprostheses (NPs). The aim of this article is to investigate the extent to which the ethical considerations in the clinical application of brain-computer interfaces and associated threats are being identified. Ethical considerations and implications may significantly influence further development of BCIs and NPs. Moreover, there is significant public interest in supervising this development. Awareness of BCIs’ and NPs’ threats and limitations allow for wise planning and management in further clinical practice, especially in the area of long-term neurorehabilitation and care.

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Stimulating brains, altering minds

Cited by 105 publications

References 19 publications

The Role of Regret in Medical Decision-making

The Role of Regret in Medical Decision-making

Separating Hope from Hype:Some Ethical Implications of the Development of Deep Brain Stimulation in Psychiatric Research and Treatment

Ethical considerations in the use of brain-computer interfaces

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