Written by Elif Gulce Batgi
Neurotechnology, an unprecedented and new field of neuroscience blended with computer science and mathematics, has been extending its circle gradually. In the studies of this significant field, neurotechnology, electrodes are being used frequently. Deep brain stimulation, an elective surgery procedure in which electrodes are implanted into certain areas of the brain responsible for movements, is included in those studies (1, 2). The procedure aims to ease people’s life who have movement disabilities, caused by disorders such as Parkinson, dystonia, epilepsy, and essential tremor (3).
How Does Deep Brain Stimulation Work
To understand the concept of DBS and the ethical concerns behind it, the operation process needs to be defined clearly. The system has three features:
Leads: The lead electrode, in other words, is a thin, insulated wire that is inserted through a gap in the skull and implicated in the brain (3).
Implantable pulse generator (IPG): Then a battery-operated device is implanted in the chest or the abdomen as a separate procedure (5). Some say that the IPG device is similar to a peacemaker for the heart, and has been coined by some as a “pacemaker for the brain. (5)”
Extension: The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, to connect the lead to the IPG (3).
Image Credit: https://pdwise.com/wp-content/uploads/2021/09/2021-07-22-08.11.43-scaled-e1632258888836-680x460.jpg.
DBS is used to treat symptoms of dystonia, epilepsy, essential tremor, obsessive-compulsive disorder, and Parkinson’s disease such as involuntary muscle contractions occurring during specific actions, temporary confusion, tremors occurring in daily life aggressive thoughts toward someone, and stiffness respectively (1, 5). DBS is mostly used if medications are helping with your movements but don’t control them completely. Patients who will have an operation may question the side effects of this procedure since it invılves permanent changes in the brain. However, if it causes unwanted effects or more promising treatment models appear in the future, the DBS can be halted and the IPG can be removed (3). Moreover, if the statement of the patient changes, the IPG can easily adapt to the new situation, without further surgery.
Image Credit: https://www.deseret.com/2018/11/23/20659976/best-birthday-present-i-ve-had-advanced-surgery-zapping-parkinson-s-symptoms-comes-to-utah.
Ethical Concerns Behind the Deep Brain Stimulation
“A Crack in Creation,” a book by Jennifer Doudna, states the ethical concerns behind the technology of CRISPR gene editing. She is awarded a Nobel Prize in chemistry in the year 2020, because of her contributions to the realm of biology. However, her book involves the bioethical problems that CRISPR may cause in the future, rather than the scientific background of her studies. Similar to bioethics but extensive to form another field itself, neuroethics, has discussed technologies such as deep brain stimulation.
The first discussion of neuroethics on DBS is whether it is beneficial for patients or harmful. This discussion should be examined both at the group and individual levels, which means the available evidence regarding the effectiveness, risks, and side effects of DBS for various conditions, in various target areas, and for various patient populations must be assessed (6). Moreover, DBS is argued to be cost-effective in the longer run as compared to alternative treatment options but yet is an expensive treatment model. According to justice, the treatment should be given to the most seriously impaired and who will benefit the most.
To determine which patients will be selected to have a DBT, patients need to have a good chance to benefit from the procedure, have severe functional impairments, and be refractory to other, less invasive, or less burdensome, treatments (6). Additionally, patients are needed to be able to handle the process cognitively, emotionally, and physically.
A special and frequently mentioned side effect of DBS is the changes in an individual’s mood, emotions, and or cognition caused by DBS might result in changes in “personal identity. (6)” For example, a man who is kind, quiet, and calm in his life had a DBS, and when he was voluntarily in the study he attacked a woman in the laboratory. After the study ended he questioned himself with a huge shock and couldn’t believe what he did. The acute, rapid changes that DBS can bring about, can disrupt the normal, “narrative flow of life” and it may take time and effort for the patient to pick up and continue his life normally (6). Finally, when this personality change becomes hurtful to other people, it may cause a problem of responsibility.
Imagine a person’s arm is controlled by the thoughts of the individual. While playing volleyball a ball is thrown to a window. The individual says “It wasn’t me. I didn’t do that. I am not guilty, there must be an error with my implant.” How would you react? Is the individual right to say “It wasn’t me”? Or should we blame them for an electrical device that is implanted in them and said to be “under their control” of them? Firstly, it is clear that the patients voluntarily and fully informed consent to this procedure, just like for any other medical intervention. However, throughout the process, problematic results may occur, such as inducing a (hypo)manic state in patients. In such situations, it will significantly change the impact of treatment on an individual to control the situation.
In conclusion, DBS presents a hopeful treatment option for individuals with movement disorders and neurological conditions, but it also raises significant ethical concerns. The decision to undergo DBS must consider its potential benefits, risks, and side effects on both individual and group levels. Ethical dilemmas include the impact on personal identity due to mood and cognitive changes, as well as questions of responsibility and agency when the procedure may influence an individual's actions. Ensuring informed consent and equitable access to treatment is essential, and ongoing multidisciplinary discussions in neuroethics are necessary to navigate the ethical complexities surrounding DBS and other advancing neurotechnologies, ultimately aiming to prioritize the well-being and autonomy of patients.
References:
Deep brain stimulation – Advantages, risks, and conditions treated. (n.d.). American Association of Neurological Surgeons. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation.
Mayfield Brain & Spine. (n.d.). Deep brain stimulation (DBS) for Parkinson's & essential tremor | Mayfield brain & spine, Cincinnati. Mayfield Brain & Spine, Neurosurgery, Spine surgeons, Brain surgeons, Cincinnati, Ohio. https://mayfieldclinic.com/pe-dbs.htm.
Deep brain stimulation for movement disorders. (n.d.). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/deep-brain-stimulation-movement-disorders.
melissa. (2016, September 14). What is the process for DBS surgery? Neurology Solutions. https://www.neurologysolutions.com/process-for-dbs-surgery/.
Deep brain stimulation for Parkinson’s: Benefits and risks. (2021, September 1). Verywell Health. https://www.verywellhealth.com/deep-brain-stimulation-for-parkinsons-5193293.
Ethical issues in deep brain stimulation. (n.d.). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096836/.
Yorumlar