[Deep brain stimulation and neuroethics].
The use of deep brain stimulation (DBS) for mental disorders has been discussed in Japan from the viewpoint of ethical problems. Trials of experimental therapies require a basis of sound scientific rationale. New standard therapy emerges from such trials through detailed analysis of the outcome and side effects. Long-suffering patients with intractable symptoms may desperately seek an experimental therapy even though it has not yet been accepted as standard therapy. The ethical committee of each institution evaluates the level of scientific rationale and the expected level of benefits on the bias of the reported data, and decides whether the patients can receive the experimental therapy. However, the use of DBS for mental disorders is not based on sound scientific rational, since the disease mechanisms involved are far from understood. The data reported from the previous trials are insufficient for assuring the satisfactory results for mental disoder patients. Most institutions in Japan do not accept such levels of scientific rationale and expected benefits. Furthermore, from the cultural perspective, strong skepticism exists in Japan with regard to surgical interventions for mental disorders. Such an attitude is unexpectedly in harmony with many of the subjects currently discussed in the field of neuroethics. For example, who has the right to control DBS? How does someone decide the level of control of mental function by DBS? These questions are related to the discussion on how human society is formed and how the ethics are decided by considering both scientific rationale and human society.
Katayama
Yoichi
Y
Divisions of Neurosurgery and Applied System Neuroscience, Nihon University School of Medicine, Oyaguchi-kamimachi 30, Itabashi-ku, Tokyo 173-8610, Japan.
Fukaya
Chikashi
C
D001675:Bioethics; D046690:Deep Brain Stimulation / Q000941:ethics*; D006801:Humans; D007564:Japan; D001523:Mental Disorders / Q000628:therapy*; D009488:Neurosciences / Q000941:ethics*