1
|
Smith JN, Dorfman N, Hurley M, Cenolli I, Kostick-Quenet K, Storch EA, Lázaro-Muñoz G, Blumenthal-Barby J. Adolescent OCD Patient and Caregiver Perspectives on Identity, Authenticity, and Normalcy in Potential Deep Brain Stimulation Treatment. Camb Q Healthc Ethics 2024:1-14. [PMID: 38602092 DOI: 10.1017/s0963180124000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients' views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and "normalcy" in the context of OCD.
Collapse
Affiliation(s)
- Jared N Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Natalie Dorfman
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Meghan Hurley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Ilona Cenolli
- Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | | |
Collapse
|
2
|
Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
Collapse
|
3
|
Klein E, Montes Daza N, Dasgupta I, MacDuffie K, Schönau A, Flynn G, Song D, Goering S. Views of stakeholders at risk for dementia about deep brain stimulation for cognition. Brain Stimul 2023; 16:742-747. [PMID: 37076043 PMCID: PMC10576447 DOI: 10.1016/j.brs.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, United States; Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States.
| | - Natalia Montes Daza
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
| | - Ishan Dasgupta
- The Dana Foundation, 1270 Avenue of the Americas, 12th Floor, New York, NY, 10020, United States
| | - Kate MacDuffie
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 Ninth Ave. Seattle, WA, 98101, United States; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, PO Box 5371, Seattle, WA, 98105, United States
| | - Andreas Schönau
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
| | - Garrett Flynn
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Denney Research Center (DRB) 140, Los Angeles, CA, 90089-1111, United States
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Denney Research Center (DRB) 140, Los Angeles, CA, 90089-1111, United States
| | - Sara Goering
- Department of Philosophy, University of Washington, Savery Hall, Room 361, Box 353350, Seattle, WA, 98195, United States
| |
Collapse
|
4
|
Gilbert F, Lancelot M. Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a 'new form of the disease'. JOURNAL OF MEDICAL ETHICS 2021; 47:20-25. [PMID: 32409626 DOI: 10.1136/medethics-2019-106052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Deep brain stimulation (DBS) has been regarded as an efficient and safe treatment for Parkinson's disease (PD) since being approved by the Food and Drug Administration (FDA) in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced-harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago (at the time of writing) and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers' burden.
Collapse
Affiliation(s)
- Frederic Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
- Center for Neurotechnology, University of Washington, Seattle, U.S.A
| | - Mathilde Lancelot
- SPHERE, Paris Diderot University / University of Paris, Paris, France
| |
Collapse
|
5
|
Deflating the Deep Brain Stimulation Causes Personality Changes Bubble: the Authors Reply. NEUROETHICS-NETH 2020. [DOI: 10.1007/s12152-020-09437-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
6
|
Pugh J. Clarifying the Normative Significance of 'Personality Changes' Following Deep Brain Stimulation. SCIENCE AND ENGINEERING ETHICS 2020; 26:1655-1680. [PMID: 32189235 PMCID: PMC7286862 DOI: 10.1007/s11948-020-00207-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/29/2020] [Indexed: 05/11/2023]
Abstract
There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self (PIAAAS). For example, some patients undergoing DBS for Parkinson's Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient's dispositional, emotional and behavioural states, in so far as dysfunctions in these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment.
Collapse
Affiliation(s)
- Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK.
| |
Collapse
|
7
|
Gilbert F, Brown, Dasgupta, Martens, Klein, Goering. An Instrument to Capture the Phenomenology of Implantable Brain Device Use. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|