title: Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS.
  
  
  METHODS
  Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted.
  
  
  RESULTS
  Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care.
  
  
  CONCLUSIONS
  This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.
authors.affiliation: Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Bell
authors.forename: Bruce
authors.initials: B
authors.lastname: Maxwell
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: McAndrews
authors.forename: Abbas
authors.initials: A
authors.lastname: Sadikot
authors.forename: Eric
authors.initials: E
authors.lastname: Racine
mesh_terms: D002170:Canada / Q000453:epidemiology; D046690:Deep Brain Stimulation / Q000941:ethics* / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000941:ethics / Q000706:statistics & numerical data; D004868:Equipment Failure; D032984:Ethics, Research; D019317:Evidence-Based Medicine; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000941:ethics; D009069:Movement Disorders / Q000601:surgery / Q000628:therapy; D009493:Neurosurgery / Q000941:ethics* / Q000706:statistics & numerical data*; D010348:Patient Care Team; D018579:Patient Selection / Q000941:ethics; D040841:Resource Allocation / Q000941:ethics; D012959:Socioeconomic Factors