Preparing the ethical future of deep brain stimulation

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.

Abbreviations: CAPSIT-PD, Core Assessment Program for Surgical Intervention Therapies in PD, DBS, deep brain stimulation, ECT, electroconvulsive therapy, ET, essential tremor, FDA, Food and Drug Administration, IPG, implanted pulse generator, IRB, institutional review board, MRI, magnetic resonance imaging, NIH, National Institutes of Health, OCD, obsessive-compulsive disorder, PD, Parkinson disease, TMS, transcranial magnetic stimulation, TS, Tourette syndrome, USPTO, United States Patent and Trademark Office, VNS, vagus nerve stimulation, WHO, World Health Organization

Keywords: Deep brain stimulation, Parkinson disease, Psychiatry, Depression, Ethics, Patient selection, Neuroethics, Resource allocation, Informed consent, Knowledge translation