Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes

Abstract

Within the recent development of brain-machine-interfaces deep brain stimulation (DBS) has become one of the most promising approaches for neuromodulation. After its introduction more than 20 years ago, it has in clinical routine become a successful tool for treating neurological disorders like Parkinson's disease, essential tremor and dystonia. Recent evidence also demonstrates efficacy in improving emotional and cognitive processing in obsessive-compulsive disorder and major depression, thus allowing new treatment options for treatment refractory psychiatric diseases, and even indicating future potential to enhance functioning in healthy subjects. We demonstrate here that DBS is neither intrinsically unethical for psychiatric indications nor for enhancement purposes. To gain normative orientation, the concept of "personality" is not useful--even if a naturalistic notion is employed. As an alternative, the common and widely accepted bioethical criteria of beneficence, non-maleficence, and autonomy allow a clinically applicable, highly differentiated context- and case-sensitive approach. Based on these criteria, an ethical analysis of empirical evidence from both DBS in movement disorders and DBS in psychiatric disease reveals that wide-spread use of DBS for psychiatric indications is currently not legitimated and that the basis for enhancement purposes is even more questionable. Nevertheless, both applications might serve as ethically legitimate, promising purposes in the future.

Anticipating possible policy uses of addiction neuroscience research

“…DBS involves inserting microelectrodes into specific regions of the brain and modulating neural activity by applying an electrical current. It was first used to treat movement disorders in Parkinson's disease (Benabid et al, 1993), but is now being investigated to treat intractable psychiatric disorders, such as Tourette's syndrome (Servello, Porta, Sassi, Brambilla, & Robertson, 2008), obsessive compulsive disorder (FDA, 2009;Lipsman, Neimat, & Lozano, 2007), and depression (Schlaepfer et al, 2008).…”

“…We and others have criticized the evidence base for trials in addiction (Carter, Bell, Racine, & Hall, 2011;Synofzik & Schlaepfer, 2008). DBS is an invasive intervention that carries significant short-and long-term risks in 1-2% of patients.…”

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

“…The reference to psychosurgery is misleading as psychiatric DBS does not stand in a continuous line with early psychosurgery (it was adopted from the field of pain therapy and movement disorders treatment) and as it differs from psychosurgery in almost all important ethical variables. 25 The potential risk of DBS-induced personality changes cannot be taken as an ethical criterion to mark ethical limitations of psychiatric DBS. Modification of mood and cognitive behavior-and thus important elements of personality-is not an unwanted, coincidental side effect, but rather the main intended outcome of this intervention.…”

The Routledge Handbook of Neuroethics

“…These suggestions range from the exogenous administration of neurohormones such as oxytocin (in combination with appropriate psychological therapy or social modification) to potentially increase "pro-social attitudes, like trust, sympathy and generosity" (Savulescu and Persson, 2012, 402; see also Donaldson and Young, 2008; but see Bartz et al, 2011;Lane et al, 2015Lane et al, , 2016Nave et al, 2015;Wudarczyk et al, 2013) to the alteration of serotonin or testosterone levels to mitigate undue aggression while at the same time ostensibly enhancing fair-mindedness, willingness to cooperate, and aversion to harming others (e.g., Crockett, 2014;Montoya et al, 2012;Savulescu and Persson, 2012; but see Wiseman, 2014, re: serotonin) to the application of newly developed brain modulation techniques, such as noninvasive (but see Davis and Koningsbruggen, 2013) transcranial electric or magnetic stimulation or even deep brain stimulation via implanted electrodes (for scientific overviews, see, e.g., Fregni and Pascual-Leone, 2007;Perlmutter and Mink, 2005; for ethical overviews, see, e.g., Clausen, 2010;Hamilton et al, 2011;Maslen et al, 2014;Rabin et al, 2009;Synofzik and Schlaepfer, 2008).…”