Ethical objections to deep brain stimulation for neuropsychiatric disorders and enhancement a critical review

Abstract

Over the last decades, deep brain stimulation has become an established treatment for movement disorder. However, the recent clinical research investigating the application of the technique for neuropsychiatric disorders as well as the potential to use DBS in a wider range of conditions has brought ethical controversy. This chapter examines some of the ethical objections against extending the use of DBS beyond the treatment of movement disorders. The first part of this chapter focuses on the objections related to the past uses of psychosurgery and examines the ethical weight of invasiveness and reversibility, two commonly used concepts in ethical discussions about DBS. The second part examines objections related to freedom and autonomy, including the slippery slope arguments related to “mind control,” as well as the issue of control over the parameters of the stimulation in the context of cognitive liberty. The third part briefly discusses the objection to the enhancement uses of DBS, highlighting different contexts in which DBS can be used for enhancement while arguing for a systematic consideration of ethically relevant factors instead of the reliance on the treatment/enhancement distinction. The final part addresses the objection to DBS related to threats to identity. First, the ethical weight of discontinuity under psychological continuity approaches to identity is discussed. Next, the focus turns to the narrative approach to identity and Schechtman’s objection to the use of DBS, and it is argued that although the narrative approach brings valuable insights, the normative conclusions we can draw from it are limited.