title: When benefitting a patient increases the risk for harm for third persons - the case of treating pedophilic Parkinsonian patients with deep brain stimulation.
abstract: This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation - given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: Mueller.sabine@charite.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Müller
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Walter
authors.affiliation: Institute of Biomedical Ethics, Pestalozzistrasse 24, 8032 Zurich, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Christen
mesh_terms: D002650:Child Abuse, Sexual; D002675:Child, Preschool; D046690:Deep Brain Stimulation / Q000941:ethics* / Q000523:psychology; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D010378:Pedophilia; D018570:Risk Assessment; D012725:Sexual Behavior
keywords: Child sexual abuse; Deep brain stimulation; Ethics of principles; Neuroethics; Parkinson's disease; Pedophilia