Electrodes in the brain—Ethical criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders
Received 27 July 2009; received in revised form 12 January 2010; accepted 14 January 2010. published online 15 February 2010. Uncorrected Proof
Background
Deep brain stimulation (DBS) has been used for neuropsychiatric disorders in clinical and research settings for almost 50 years now. Recent evidence demonstrates some efficacy in treating obsessive-compulsive disorder and major depression in patients refractory to other treatment modalities beyond single case reports. This has led to a considerable surge of clinical and commercial interest in DBS for psychiatric indications. Because of the high vulnerability of psychiatric patients, the lack of extensive short- and long-term data about effectiveness and adverse effects and the haunting history of psychosurgery, this new field in psychiatry raises important and specific ethical issues that have only rarely been systematically addressed so far.
Objective and Methods
We here review an evidence-based systematic ethical analysis of psychiatric DBS using the criteria of beneficence, nonmaleficence, and autonomy.
Conclusions
These criteria can easily be applied to research and future clinical application of DBS in neuropsychiatric disorders. This will prepare the ground for ethically justified, empirically comprehensive DBS in this highly vulnerable population and allow stringent future societal discussions about its legitimation.
aDepartment for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
bDepartment of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
cDepartments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland
Correspondence: Thomas E. Schlaepfer, MD, Department of Psychiatry / University Hospital, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Dr. Schlaepfer received limited support for an Investigator Initiated Study on DBS in resistant major depression from Medtronic Inc., a manufacturer of DBS equipment between 2004 and 2007.
ABSTRACT