Preparing the ethical future of deep brain stimulation

Emily Bell PhD , Ghislaine Mathieu MA , Eric Racine PhD
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引用次数: 147

Abstract

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.

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为深部脑刺激的伦理未来做准备
脑深部刺激是一种被批准的有效的神经外科干预措施,用于治疗运动障碍,如PD和ET。脑深部刺激也可能有效治疗许多精神疾病,包括治疗难治性抑郁症和强迫症。尽管DBS是一种被广泛接受的运动障碍治疗方法,但它仍然是一种侵入性和昂贵的手术。DBS的伦理和社会挑战需要进一步研究,DBS在精神病学中的讨论和新兴应用也可能使DBS的伦理前景复杂化。方法为了识别和描述DBS应用中当前和新出现的问题,我们回顾了关于DBS的神经外科文献、跨学科医学伦理学以及相关的心理学和社会学文献。我们还查阅了USPTO数据库、FDA法规和报告决策以及主要DBS制造商的业务报告。结果DBS在当前和未来的实践中存在着重大的伦理和社会挑战,特别是在患者选择、知情同意、资源分配和公众理解方面。如果DBS在精神病学中的新应用获得批准,这些挑战可能会被放大。结论我们对星展银行相关伦理和社会问题的回顾强调了一些重大挑战,尽管并非不可克服,但需要更加密切地关注。将神经伦理学中以前使用的方法结合起来,例如建立伦理准则的专家共识研讨会和提高公众理解的公众参与,可能会有丰硕的探索成果。
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Surgical Neurology
Surgical Neurology 医学-临床神经学
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