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Aydin S, Darko K, Detchou D, Barrie U. Ethics of deep brain stimulation for neuropsychiatric disorders. Neurosurg Rev 2024; 47:479. [PMID: 39183197 DOI: 10.1007/s10143-024-02746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 08/27/2024]
Abstract
Deep Brain Stimulation (DBS) has emerged as a revolutionary neurosurgical technique with significant implications for the treatment of various neuropsychiatric disorders. Initially developed for movement disorders like Parkinson's disease, DBS has expanded to psychiatric conditions such as obsessive-compulsive disorder, depression, anorexia nervosa, dystonia, essential tremor, and Tourette's syndrome. This paper explores the clinical efficacy and ethical considerations of DBS in treating these disorders. While DBS has shown substantial promise in alleviating symptoms and improving quality of life, it raises ethical challenges, including issues of informed consent, patient selection, long-term management, and equitable access to treatment. The irreversible nature of DBS, potential adverse effects, and the high cost of the procedure necessitate a rigorous ethical framework to guide its application. The ongoing evolution of neuromodulation requires continuous ethical analysis and the development of guidelines to ensure that DBS is used responsibly and equitably across different patient populations. This paper underscores the need for a balanced approach that integrates clinical efficacy with ethical considerations to optimize patient outcomes and ensure sustainable practice.
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Affiliation(s)
- Serhat Aydin
- School of Medicine, Koc University, Istanbul, Turkey
| | - Kwadwo Darko
- Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Donald Detchou
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Umaru Barrie
- Department of Neurosurgery, New York University Grossman School of Medicine, New York City, NYC, USA
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2
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Sofronas M, Carnevale FA, Macdonald ME, Bitzas V, Wright DK. "We are not the person we will be when these things happen:" Reflections on personhood from an ethnography of neuropalliative care. Nurs Inq 2024; 31:e12646. [PMID: 38838221 DOI: 10.1111/nin.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Neuropalliative care developed to address the needs of patients living with life-limiting neurologic disease. One critical consideration is that disease-related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision-making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life.
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Affiliation(s)
- Marianne Sofronas
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
| | | | | | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, Canada
- CIUSSS Centre Ouest de l'Ile de Montreal, Montreal, Canada
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3
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Potthoff S, Hempeler C, Gather J, Gieselmann A, Vollmann J, Scholten M. Research ethics in practice: An analysis of ethical issues encountered in qualitative health research with mental health service users and relatives. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:517-527. [PMID: 37639076 PMCID: PMC10725844 DOI: 10.1007/s11019-023-10169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethics" and the identification and handling of ethical issues by researchers during the research process as "ethics in practice." While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors.
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Affiliation(s)
- Sarah Potthoff
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany.
| | - Christin Hempeler
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Astrid Gieselmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
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Bluhm R, Sipahi ED, Achtyes ED, McCright AM, Cabrera LY. Stakeholders' Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey. AJOB Empir Bioeth 2023; 15:11-21. [PMID: 37343219 PMCID: PMC10733552 DOI: 10.1080/23294515.2023.2224592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders' perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI). METHODS We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs. RESULTS Participants' ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies. CONCLUSIONS To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.
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Affiliation(s)
- R Bluhm
- Philosophy and Lyman Briggs College, Michigan State University, East Lansing, MI, USA
| | - E D Sipahi
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - E D Achtyes
- School of Human Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - A M McCright
- Sociology, Michigan State University, East Lansing, MI, USA
| | - L Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
- Rock Ethics Institute, The Pennsylvania State University, University Park, PA, USA
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Faissner M, Werning A, Winkelkötter M, Foullois H, Löhr M, Gather J. Situational vulnerability within mental healthcare - a qualitative analysis of ethical challenges during the COVID-19 pandemic. BMC Med Ethics 2023; 24:31. [PMID: 37189115 PMCID: PMC10184624 DOI: 10.1186/s12910-023-00910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability. METHODS We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability. RESULTS Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics. CONCLUSIONS Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability.
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Affiliation(s)
- Mirjam Faissner
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany.
| | - Anna Werning
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany
| | - Michael Winkelkötter
- Landschaftsverband Westfalen-Lippe (LWL), LWL-Dezernat für Krankenhäuser und Gesundheitswesen / LWL-PsychiatrieVerbund Westfalen, Münster, Germany
| | - Holger Foullois
- Landschaftsverband Westfalen-Lippe (LWL), LWL-Dezernat für Krankenhäuser und Gesundheitswesen / LWL-PsychiatrieVerbund Westfalen, Münster, Germany
| | - Michael Löhr
- Landschaftsverband Westfalen-Lippe (LWL), LWL-Klinikum Gütersloh, Gütersloh, Germany
- Fachhochschule der Diakonie, Bielefeld, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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6
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Bergeron D, Iorio-Morin C, Bonizzato M, Lajoie G, Orr Gaucher N, Racine É, Weil AG. Use of Invasive Brain-Computer Interfaces in Pediatric Neurosurgery: Technical and Ethical Considerations. J Child Neurol 2023; 38:223-238. [PMID: 37116888 PMCID: PMC10226009 DOI: 10.1177/08830738231167736] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/11/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
Invasive brain-computer interfaces hold promise to alleviate disabilities in individuals with neurologic injury, with fully implantable brain-computer interface systems expected to reach the clinic in the upcoming decade. Children with severe neurologic disabilities, like quadriplegic cerebral palsy or cervical spine trauma, could benefit from this technology. However, they have been excluded from clinical trials of intracortical brain-computer interface to date. In this manuscript, we discuss the ethical considerations related to the use of invasive brain-computer interface in children with severe neurologic disabilities. We first review the technical hardware and software considerations for the application of intracortical brain-computer interface in children. We then discuss ethical issues related to motor brain-computer interface use in pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel of experts in fields related to brain-computer interface (functional and restorative neurosurgery, pediatric neurosurgery, mathematics and artificial intelligence research, neuroengineering, pediatric ethics, and pragmatic ethics), we then formulate initial recommendations regarding the clinical use of invasive brain-computer interfaces in children.
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Affiliation(s)
- David Bergeron
- Division of Neurosurgery, Université de Montréal, Montreal, Québec, Canada
| | | | - Marco Bonizzato
- Electrical Engineering Department, Polytechnique Montréal, Montreal, Québec, Canada
- Neuroscience Department and Centre
interdisciplinaire de recherche sur le cerveau et l’apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Lajoie
- Mathematics and Statistics Department, Université de Montréal, Montreal, Québec, Canada
- Mila - Québec AI Institute, Montréal,
Québec, Canada
| | - Nathalie Orr Gaucher
- Department of Pediatric Emergency
Medicine, CHU Sainte-Justine, Montréal, Québec, Canada
- Bureau de l’Éthique clinique, Faculté
de médecine de l’Université de Montréal, Montreal, Québec, Canada
| | - Éric Racine
- Pragmatic Research Unit, Institute de
Recherche Clinique de Montréal (IRCM), Montreal, Québec, Canada
- Department of Medicine and Department
of Social and Preventative Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexander G. Weil
- Division of Neurosurgery, Department
of Surgery, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Département de
Pédiatrie, Université de Montréal, Montreal, Québec, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec, Canada
- Brain and Development Research Axis,
CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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7
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Sankary LR, Zelinsky M, Machado A, Rush T, White A, Ford PJ. Exit from Brain Device Research: A Modified Grounded Theory Study of Researcher Obligations and Participant Experiences. AJOB Neurosci 2022; 13:215-226. [PMID: 34255614 PMCID: PMC10570922 DOI: 10.1080/21507740.2021.1938293] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices.
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8
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Cabrera LY, Gilbert MMC, Achtyes ED, McCright AM, Bluhm R. Jumping through the hoops: Barriers and other ethical concerns regarding the use of psychiatric electroceutical interventions. Psychiatry Res 2022; 313:114612. [PMID: 35584563 PMCID: PMC10516532 DOI: 10.1016/j.psychres.2022.114612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022]
Abstract
Stakeholders' perceptions of barriers to and other ethical concerns about using psychiatric electroceutical interventions (PEIs), interventions that use electrical or magnetic stimuli to treat psychiatric conditions like treatment-resistant depression (TRD), may influence the uptake of these interventions. This study examined such perceptions among psychiatrists, patients with depression, and members of the public. We conducted semi-structured qualitative interviews with 16 members of each group to examine their views on practical barriers and ethical concerns. We used qualitative content analysis to identify relevant themes, and compared findings across stakeholder groups. Access limitations to the interventions, including cost and availability of the interventions, cut across all PEIs-including those that are still experimental, and were raised by all groups. Most participants across all groups raised concerns about informed consent, in terms of receiving adequate, appropriate, and understandable information. Our results suggest that these three stakeholder groups perceive similar structural and attitudinal barriers to, and have similar ethical concerns about, using PEIs for TRD. These results identify key issues that must be addressed for the full potential of PEIs to be realized. Future research with larger samples will help to better understand how to address these barriers to treatment for individuals with TRD.
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Affiliation(s)
- Laura Y Cabrera
- Center for Neural Engineering, Department of Science and Mechanics and Rock Ethics Institute, Pennsylvania State University, University Park, W-316 Millennium Science Complex, PA 16802, United States.
| | - Maryssa M C Gilbert
- College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Eric D Achtyes
- Division of Psychiatry & Behavioral Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States; Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Aaron M McCright
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI, United States
| | - Robyn Bluhm
- Department of Philosophy, College of Arts and Letters, and Lyman Briggs College, Michigan State University, East Lansing, MI, United States
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9
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Zagorac I, Stamenković Tadić B. Health within illness: The negativity of vulnerability revised. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:207-217. [PMID: 35133570 DOI: 10.1007/s11019-022-10072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
This paper attempts to philosophically articulate empirical evidence on the positive effects of illness within the wider context of a discussion of the positive aspects of vulnerability. The conventional understanding holds that to be vulnerable is to be open to harms and wrongs; it is to be fragile, defenseless, and of compromised autonomy. In this paper, we challenge the assumption that vulnerability consists of nothing but powerlessness and dependence on others. This paper attempts to: (1) outline the theoretical conceptualisation of the positive aspects of coping with illness, while simultaneously showing how these findings provide empirical support for some classical philosophical ideas; (2) influence a change in the manners in which the ill are usually perceived (as weak, dependent, robbed of a good life) and (3) point to the importance of modernising the prevalent biomedical conception of illness with the subjective dimension of health. Biomedical understanding of illness focuses on the vulnerable experience of the sufferer, suggesting the importance of philosophical additions.
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Affiliation(s)
- Ivana Zagorac
- Department of Philosophy, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000, Zagreb, Croatia.
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10
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Padoan CS, Garcia LF, Crespo KC, Longaray VK, Martini M, Contessa JC, Kapczinski F, de Oliveira FH, Goldim JR, Vs Magalhães P. A qualitative study exploring the process of postmortem brain tissue donation after suicide. Sci Rep 2022; 12:4710. [PMID: 35304551 PMCID: PMC8933424 DOI: 10.1038/s41598-022-08729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Access to postmortem brain tissue can be valuable in refining knowledge on the pathophysiology and genetics of neuropsychiatric disorders. Obtaining postmortem consent for the donation after death by suicide can be difficult, as families may be overwhelmed by a violent and unexpected death. Examining the process of brain donation can inform on how the request can best be conducted. This is a qualitative study with in-depth interviews with forty-one people that were asked to consider brain donation-32 who had consented to donation and 9 who refused it. Data collection and analyses were carried out according to grounded theory. Five key themes emerged from data analysis: the context of the families, the invitation to talk to the research team, the experience with the request protocol, the participants' assessment of the experience, and their participation in the study as an opportunity to heal. The participants indicated that a brain donation request that is respectful and tactful can be made without adding to the family distress brought on by suicide and pondering brain donation was seen as an opportunity to transform the meaning of the death and invest it with a modicum of solace for being able to contribute to research.
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Affiliation(s)
- Carolina Stopinski Padoan
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Lucas França Garcia
- Graduate Program in Health Promotion, Cesumar University, Maringá, Paraná, Brazil
| | - Kleber Cardoso Crespo
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Vanessa Kenne Longaray
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Murilo Martini
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Júlia Camargo Contessa
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Flávio Kapczinski
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
- St. Joseph's Healthcare Hamilton McMaster University, Hamilton, ON, Canada
| | - Francine Hehn de Oliveira
- Serviço de Patologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Roberto Goldim
- Bioethics Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Vs Magalhães
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil.
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11
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Trading Vulnerabilities: Living with Parkinson's Disease before and after Deep Brain Stimulation. Camb Q Healthc Ethics 2021; 30:623-630. [PMID: 34702406 DOI: 10.1017/s0963180121000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Implanted medical devices-for example, cardiac defibrillators, deep brain stimulators, and insulin pumps-offer users the possibility of regaining some control over an increasingly unruly body, the opportunity to become part "cyborg" in service of addressing pressing health needs. We recognize the value and effectiveness of such devices, but call attention to what may be less clear to potential users-that their vulnerabilities may not entirely disappear but instead shift. We explore the kinds of shifting vulnerabilities experienced by people with Parkinson's disease (PD) who receive therapeutic deep brain stimulators to help control their tremors and other symptoms of PD.
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12
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Retrograde Amnesia Associated With Intraoperative Neuromonitoring. J Neurosurg Anesthesiol 2021; 33:363-364. [PMID: 32028375 DOI: 10.1097/ana.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
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13
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Smilan LE. The Revised Common Rule and Mental Illness: Enduring Gaps in Protections. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:413-444. [PMID: 33413011 DOI: 10.1177/0098858820975532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa E Smilan
- Lisa E. Smilan, Visiting Scholar, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA; J.D., George Washington University Law School, Washington, D.C.; LL.M., specialization in health law, University of Maryland Francis King Carey School of Law, Baltimore, MD; Member, National Institutes of Health Intramural Institutional Review Board, Bethesda, MD. The opinions here expressed are those of the Author and completely independent of the National Institutes of Health. The Author thanks Ellen Wright Clayton for supporting this scholarship and for comments on earlier drafts. Thanks, also, to Leslie Meltzer Henry for her guidance and encouragement, and both Richard Bonnie and Xuemei Ding for their hospitality at the University of Virginia and for facilitating access to university libraries. Finally, thanks to the anonymous peer reviewers for their observations, probing questions, and helpful suggestions, and AJLM editors Jessa Boubker and Sharon Jaquez for their dedication and meticulous care in preparing this Article for publication
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14
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Lajoie C, Poleksic J, Bracken-Roche D, MacDonald ME, Racine E. The Concept of Vulnerability in Mental Health Research: A Mixed Methods Study on Researcher Perspectives. J Empir Res Hum Res Ethics 2020; 15:128-142. [DOI: 10.1177/1556264620902657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The concept of vulnerability plays a central role in research ethics in signaling that certain research participants warrant more careful consideration because their risk of harm is heightened due to their participation in research. Despite scholarly debates, the descriptive and normative meanings ascribed to the concept have remained disengaged from the perspective of users of the concept and those concerned by its use. In this study, we report a survey- and interview-based investigation of mental health researcher perspectives on vulnerability. We found that autonomy-based understandings of vulnerability were predominant but that other understandings coexisted, reflecting considerable pluralism. A wide range of challenges were associated with this concept, and further training was recommended by researchers.
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Affiliation(s)
- Corinne Lajoie
- Institut de recherches cliniques de Montréal, Québec, Canada
- The Pennsylvania State University, University Park, USA
| | - Jelena Poleksic
- Institut de recherches cliniques de Montréal, Québec, Canada
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Western University, London, Ontario, Canada
| | | | - Mary Ellen MacDonald
- McGill University, Montréal, Québec, Canada
- McGill University Health Centre, Montréal, Québec, Canada
| | - Eric Racine
- Institut de recherches cliniques de Montréal, Québec, Canada
- McGill University, Montréal, Québec, Canada
- Université de Montréal, Québec, Canada
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15
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Racine E, Cascio MA, Montreuil M, Bogossian A. Instrumentalist analyses of the functions of ethics concept-principles: a proposal for synergetic empirical and conceptual enrichment. THEORETICAL MEDICINE AND BIOETHICS 2019; 40:253-278. [PMID: 31587142 DOI: 10.1007/s11017-019-09502-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics-and the specific role(s) it can or should play-remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: (1) function identification, (2) function enrichment, and (3) function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing (eudaimonia). We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts.
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Affiliation(s)
- Eric Racine
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada.
- Université de Montréal, Montréal, QC, Canada.
- McGill University, Montréal, QC, Canada.
| | - M Ariel Cascio
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- Central Michigan University, Mount Pleasant, MI, USA
| | - Marjorie Montreuil
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Aline Bogossian
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
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16
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Cascio MA, Racine E. Person-oriented research ethics: integrating relational and everyday ethics in research. Account Res 2018; 25:170-197. [PMID: 29451025 DOI: 10.1080/08989621.2018.1442218] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Research ethics is often understood by researchers primarily through the regulatory framework reflected in the research ethics review process. This regulatory understanding does not encompass the range of ethical considerations in research, notably those associated with the relational and everyday aspects of human subject research. In order to support researchers in their effort to adopt a broader lens, this article presents a "person-oriented research ethics" approach. Five practical guideposts of person-oriented research ethics are identified, as follows: (1) respect for holistic personhood; (2) acknowledgement of lived world; (3) individualization; (4) focus on researcher-participant relationships; and (5) empowerment in decision-making. These guideposts are defined and illustrated with respect to different aspects of the research process (e.g., research design, recruitment, data collection). The person-oriented research ethics approach provides a toolkit to individual researchers, research groups, and research institutions in both biomedical and social science research wishing to expand their commitment to ethics in research.
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Affiliation(s)
- M Ariel Cascio
- a Neuroethics Research Unit , Institut de recherches cliniques de Montréal (IRCM) , Montréal , Québec , Canada.,b Neurology and Neurosurgery and Division of Experimental Medicine (Biomedical Ethics Unit) , McGill University, Montréal, Québec , Canada
| | - Eric Racine
- a Neuroethics Research Unit , Institut de recherches cliniques de Montréal (IRCM) , Montréal , Québec , Canada.,b Neurology and Neurosurgery and Division of Experimental Medicine (Biomedical Ethics Unit) , McGill University, Montréal, Québec , Canada.,c Department of Medicine and Department of Social and Preventive Medicine , Université de Montréal, Montréal , Québec , Canada
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The Therapeutic “Mis”conception: An Examination of its Normative Assumptions and a Call for its Revision. Camb Q Healthc Ethics 2017; 27:154-162. [DOI: 10.1017/s0963180117000482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss a suitable topic, contact Tuija Takala at tuija.takala@helsinki.fi.
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18
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Racine E, Cascio MA, Bogossian A. Instrumentalist Analyses of the Functions of Health Ethics Concepts and Principles: Methodological Guideposts. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:16-18. [PMID: 29148946 DOI: 10.1080/15265161.2017.1388869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Eric Racine
- a Institut de recherches cliniques de Montréal, Université de Montréal, and McGill University
| | - M Ariel Cascio
- b Institut de recherches cliniques de Montréal and McGill University
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Bell E, Leger P, Sankar T, Racine E. Deep Brain Stimulation as Clinical Innovation: An Ethical and Organizational Framework to Sustain Deliberations About Psychiatric Deep Brain Stimulation. Neurosurgery 2017; 79:3-10. [PMID: 26909704 DOI: 10.1227/neu.0000000000001207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Deep brain stimulation (DBS) for psychiatric disorders needs to be investigated in proper research trials. However, there are rare circumstances in which DBS could be offered to psychiatric patients as a form of surgical innovation, therefore potentially blurring the lines between these research trials and health care. In this article, we discuss the conditions under which surgical innovation may be accepted as a practice falling at the frontiers of standard clinical care and research per se. However, recognizing this distinction does not settle all ethical issues. Our article offers ethical guideposts to allow clinicians, surgical teams, institutions, and institutional review boards to deliberate about some of the fundamental issues that should be considered before surgical innovation with psychiatric DBS is undertaken. We provide key guiding questions to sustain this deliberation. Then we review the normative and empirical literature that exists to guide reflection about the ethics of surgical innovation and psychiatric DBS with respect to general ethical questions pertinent to psychiatric DBS, multidisciplinary team perspectives in psychiatric DBS, mechanisms for oversight in psychiatric DBS, and capacity and consent in psychiatric DBS. The considerations presented here are to recognize the very specific nature of surgical innovation and to ensure that surgical innovation in the context of psychiatric DBS remains a limited, special category of activity that does not replace appropriate surgical research or become the standard of care based on limited evidence. ABBREVIATIONS DBS, deep brain stimulationIRB, institutional review boardOCD, obsessive-compulsive disorder.
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Affiliation(s)
- Emily Bell
- *Neuroethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), Montréal, Quebec, Canada; ‡Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; §Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada; ¶Departments of Neurology and Neurosurgery, Experimental Medicine & Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
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20
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Beeker T, Schlaepfer TE, Coenen VA. Autonomy in Depressive Patients Undergoing DBS-Treatment: Informed Consent, Freedom of Will and DBS' Potential to Restore It. Front Integr Neurosci 2017; 11:11. [PMID: 28642690 PMCID: PMC5462943 DOI: 10.3389/fnint.2017.00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/22/2017] [Indexed: 12/17/2022] Open
Abstract
According to the World Health Organization, depression is one of the most common and most disabling psychiatric disorders, affecting at any given time approximately 325 million people worldwide. As there is strong evidence that depressive disorders are associated with a dynamic dysregulation of neural circuits involved in emotional processing, recently several attempts have been made to intervene directly in these circuits via deep brain stimulation (DBS) in patients with treatment-resistant major depressive disorder (MDD). Given the promising results of most of these studies, the rising medical interest in this new treatment correlates with a growing sensitivity to ethical questions. One of the most crucial concerns is that DBS might interfere with patients' ability to make autonomous decisions. Thus, the goal of this article is to evaluate the impact DBS presumably has on the capacity to decide and act autonomously in patients with MDD in the light of the autonomy-undermining effects depression has itself. Following the chronological order of the procedure, special attention will first be paid to depression's effects on patients' capacity to make use of their free will in giving valid Informed Consent. We suggest that while the majority of patients with MDD appear capable of autonomous choices, as it is required for Informed Consent, they might still be unable to effectively act according to their own will whenever acting includes significant personal effort. In reducing disabling depressive symptoms like anhedonia and decrease of energy, DBS for treatment resistant MDD thus rather seems to be an opportunity to substantially increase autonomy than a threat to it.
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Affiliation(s)
- Timo Beeker
- Department of Psychiatry and Psychotherapy, Medical School Brandenburg Theodor FontaneRüdersdorf, Germany
| | - Thomas E. Schlaepfer
- Department of Interventional Biological Psychiatry, Freiburg University Medical CenterFreiburg, Germany
- Medical Faculty, Freiburg UniversityFreiburg, Germany
| | - Volker A. Coenen
- Medical Faculty, Freiburg UniversityFreiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical CenterFreiburg, Germany
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21
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Bracken-Roche D, Bell E, Macdonald ME, Racine E. The concept of 'vulnerability' in research ethics: an in-depth analysis of policies and guidelines. Health Res Policy Syst 2017; 15:8. [PMID: 28173859 PMCID: PMC5297186 DOI: 10.1186/s12961-016-0164-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of vulnerability has held a central place in research ethics guidance since its introduction in the United States Belmont Report in 1979. It signals mindfulness for researchers and research ethics boards to the possibility that some participants may be at higher risk of harm or wrong. Despite its important intended purpose and widespread use, there is considerable disagreement in the scholarly literature about the meaning and delineation of vulnerability, stemming from a perceived lack of guidance within research ethics standards. The aim of this study was to assess the concept of vulnerability as it is employed in major national and international research ethics policies and guidelines. METHODS We conducted an in-depth analysis of 11 (five national and six international) research ethics policies and guidelines, exploring their discussions of the definition, application, normative justification and implications of vulnerability. RESULTS Few policies and guidelines explicitly defined vulnerability, instead relying on implicit assumptions and the delineation of vulnerable groups and sources of vulnerability. On the whole, we found considerable richness in the content on vulnerability across policies, but note that this relies heavily on the structure imposed on the data through our analysis. CONCLUSIONS Our results underscore a need for policymakers to revisit the guidance on vulnerability in research ethics, and we propose that a process of stakeholder engagement would well-support this effort.
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Affiliation(s)
- Dearbhail Bracken-Roche
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, QC Canada
| | - Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC H2W 1R7 Canada
| | - Mary Ellen Macdonald
- Faculty of Dentistry, Oral Health and Society Research Unit, McGill University, 2001 McGill College, Suite 500, Montréal, QC H3A 1G1 Canada
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, QC Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC Canada
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Wardrope A, Reuber M. Diagnosis by Documentary: Professional Responsibilities in Informal Encounters. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:40-50. [PMID: 27749168 DOI: 10.1080/15265161.2016.1222008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional-patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such "informal" encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the "social contract" model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large.
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23
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Klein E. Informed Consent in Implantable BCI Research: Identifying Risks and Exploring Meaning. SCIENCE AND ENGINEERING ETHICS 2016; 22:1299-1317. [PMID: 26497727 DOI: 10.1007/s11948-015-9712-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Implantable brain-computer interface (BCI) technology is an expanding area of engineering research now moving into clinical application. Ensuring meaningful informed consent in implantable BCI research is an ethical imperative. The emerging and rapidly evolving nature of implantable BCI research makes identification of risks, a critical component of informed consent, a challenge. In this paper, 6 core risk domains relevant to implantable BCI research are identified-short and long term safety, cognitive and communicative impairment, inappropriate expectations, involuntariness, affective impairment, and privacy and security. Work in deep brain stimulation provides a useful starting point for understanding this core set of risks in implantable BCI. Three further risk domains-risks pertaining to identity, agency, and stigma-are identified. These risks are not typically part of formalized consent processes. It is important as informed consent practices are further developed for implantable BCI research that attention be paid not just to disclosing core research risks but exploring the meaning of BCI research with potential participants.
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Affiliation(s)
- Eran Klein
- Department of Philosophy and Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA.
- Department of Neurology, Oregon Health and Sciences University, Portland, OR, USA.
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Bracken-Roche D, Bell E, Racine E. The "Vulnerability" of Psychiatric Research Participants: Why This Research Ethics Concept Needs to Be Revisited. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:335-9. [PMID: 27254842 PMCID: PMC4872238 DOI: 10.1177/0706743716633422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dearbhail Bracken-Roche
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec Biomedical Ethics Unit, McGill University, Montréal, Québec
| | - Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec Biomedical Ethics Unit, McGill University, Montréal, Québec Département de Médecine, Université de Montréal, Montréal, Québec
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25
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Trujols J, Manresa MJ, Batlle F, Duran-Sindreu S, Pérez de Los Cobos J. Deep Brain Stimulation for Addiction Treatment: Further Considerations on Scientific and Ethical Issues. Brain Stimul 2016; 9:788-789. [PMID: 27267859 DOI: 10.1016/j.brs.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain.
| | - María José Manresa
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Francesca Batlle
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Santiago Duran-Sindreu
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - José Pérez de Los Cobos
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
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Ineichen C, Christen M. Analyzing 7000 texts on deep brain stimulation: what do they tell us? Front Integr Neurosci 2015; 9:52. [PMID: 26578908 PMCID: PMC4620160 DOI: 10.3389/fnint.2015.00052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/27/2015] [Indexed: 01/15/2023] Open
Abstract
The enormous increase in numbers of scientific publications in the last decades requires quantitative methods for obtaining a better understanding of topics and developments in various fields. In this exploratory study, we investigate the emergence, trends, and connections of topics within the whole text corpus of the deep brain stimulation (DBS) literature based on more than 7000 papers (title and abstracts) published between 1991 to 2014 using a network approach. Taking the co-occurrence of basic terms that represent important topics within DBS as starting point, we outline the statistics of interconnections between DBS indications, anatomical targets, positive, and negative effects, as well as methodological, technological, and economic issues. This quantitative approach confirms known trends within the literature (e.g., regarding the emergence of psychiatric indications). The data also reflect an increased discussion about complex issues such as personality connected tightly to the ethical context, as well as an apparent focus on depression as important DBS indication, where the co-occurrence of terms related to negative effects is low both for the indication as well as the related anatomical targets. We also discuss consequences of the analysis from a bioethical perspective, i.e., how such a quantitative analysis could uncover hidden subject matters that have ethical relevance. For example, we find that hardware-related issues in DBS are far more robustly connected to an ethical context compared to impulsivity, concrete side-effects or death/suicide. Our contribution also outlines the methodology of quantitative text analysis that combines statistical approaches with expert knowledge. It thus serves as an example how innovative quantitative tools can be made useful for gaining a better understanding in the field of DBS.
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Affiliation(s)
- Christian Ineichen
- Institute of Biomedical Ethics and History of Medicine, University of Zurich Zurich, Switzerland ; Preclinical Laboratory for Translational Research into Affective Disorders, Clinic for Affective Disorders and General Psychiatry, Psychiatric University Hospital Zurich Zurich, Switzerland
| | - Markus Christen
- Institute of Biomedical Ethics and History of Medicine, University of Zurich Zurich, Switzerland ; University Research Priority Program Ethics, University of Zurich Zurich, Switzerland
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Does the new EU Regulation on clinical trials adequately protect vulnerable research participants? Health Policy 2015; 119:925-31. [PMID: 25951954 DOI: 10.1016/j.healthpol.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 11/20/2022]
Abstract
Vulnerable research participants deserve special protection because of their increased risks of being wronged. Yet, paradoxically, the conduct of trials involving vulnerable groups is sometimes inescapable to develop safe and efficient therapies suitable to these groups. The key question is therefore how to protect vulnerable research participants from harm and exploitation without excluding the populations they belong to from the benefits of research. The European Union faced this challenge in April 2014 when adopting the new Regulation on clinical trials, which will replace the currently applicable 2001 Clinical Trials Directive in 2016. In order to assess the protection of vulnerable persons in the new Regulation, this paper makes four suggestions: first, the need to adopt a risk-based approach to vulnerability in biomedical research; second, to better distinguish between decisional vulnerabilities and health-related vulnerabilities; third, to emphasise the need to preserve the freedom of consent of subjects with decisional vulnerability, who are more susceptible to undue influence; and finally to assert the need of actively promoting specific clinical trials involving people with physical or psychological vulnerabilities. In conclusion, this paper claims that the protection of vulnerable subjects still needs to be improved in the new EU Regulation.
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Bell E. Young Persons in Research: A Call for the Engagement of Youth in Mental Health Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:28-30. [PMID: 26575810 DOI: 10.1080/15265161.2015.1088977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Emily Bell
- a Neuroethics Research Unit, Institut de recherches cliniques de Montréal
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