Ethical considerations in deep brain stimulation for psychiatric illness.
Deep brain stimulation (DBS) is an efficacious surgical treatment for many conditions, including obsessive-compulsive disorder and treatment-resistant depression. DBS provides a unique opportunity to not only ameliorate disease but also to study mood, cognition, and behavioral effects in the brain. However, there are many ethical questions that must be fully addressed in designing clinical research trials. It is crucial to maintain sound ethical boundaries in this new era so as to permit the proper testing of the potential therapeutic role DBS may play in ameliorating these devastating and frequently treatment-refractory psychiatric disorders. In this review, we focus on the selection of patients for study, informed consent, clinical trial design, DBS in the pediatric population, concerns about intentionally or inadvertently altering an individual's personal identity, potential use of DBS for brain enhancement, direct modification of behavior through neuromodulation, and resource allocation.
Department of Neurosurgery, Yale, New Haven Medical Center, 60 Temple Street, New Haven, CT 06510, USA. Electronic address: ryan.grant@yale.edu.
Ryan A
RA
Grant
Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
Casey H
CH
Halpern
Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
Gordon H
GH
Baltuch
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA.
John P
JP
O'Reardon
Division of Bioethics, New York University, New York City, NY, USA.
Arthur
A
Caplan
D046690:Deep Brain Stimulation / Q000941:ethics*; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D001523:Mental Disorders / Q000628:therapy*; D012107:Research Design
Deep brain stimulation; Depression; Ethics; Mood; OCD; Psychiatric