Preparing the ethical future of deep brain stimulation.
BACKGROUND
Deep brain stimulation is an approved and effective neurosurgical intervention for motor disorders such as PD and ET. Deep brain stimulation may also be effective in treating a number of psychiatric disorders, including treatment refractory depression and OCD. Although DBS is a widely accepted therapy in motor disorders, it remains an invasive and expensive procedure. The ethical and social challenges of DBS need further examination, and discussion and emerging applications of DBS in psychiatry may also complicate the ethical landscape of DBS.


METHODS
To identify and characterize current and emerging issues in the use of DBS, we reviewed the neurosurgical literature on DBS as well as the interdisciplinary medical ethics and relevant psychological and sociological literatures. We also consulted the USPTO database, FDA regulations and report decisions, and the business reports of key DBS manufacturers.


RESULTS
Important ethical and social challenges exist in the current and extending practice of DBS, notably in patient selection, informed consent, resource allocation, and in public understanding. These challenges are likely to be amplified if emerging uses of DBS in psychiatry are approved.


CONCLUSIONS
Our review of ethical and social issues related to DBS highlights that several significant challenges, although not insurmountable, need much closer attention. A combination of approaches previously used in neuroethics, such as expert consensus workshops to establish ethical guidelines and public engagement to improve public understanding, may be fruitful to explore.
Bell
Emily
E
Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
Mathieu
Ghislaine
G
Racine
Eric
E
D046690:Deep Brain Stimulation / Q000941:ethics*; D020329:Essential Tremor / Q000628:therapy*; D004992:Ethics, Medical; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D010300:Parkinson Disease / Q000628:therapy*; D018579:Patient Selection / Q000941:ethics; D011639:Public Opinion; D040841:Resource Allocation / Q000941:ethics