Transcranial direct current stimulation ethics and professional conduct

Abstract

Non-invasive neuromodulation, using low intensity transcranial direct current stimulation (tDCS), provides scientists and medical doctors with the ability to gain fundamental insight into brain functions and to treat several neurological and psychiatric conditions. Due to this circumstance, the use of tDCS, including the off-label applications, is rapidly expanding, without a full understanding of safety and efficacy implications. There is also a proliferation of over-the-counter (OTC) and do-it-yourself (DIY) device usage, raising severe ethical concerns. Therefore, this chapter aims to summarize and discuss the most relevant issues in the area of tDCS-ethics. In the first part, the international and national regulatory frameworks are briefly described. Different regulatory paths for tDCS devices in the USA and Europe have resulted in diverse availability of these devices around the world. In the second part, tDCS ethics are mentioned from the personnel point of view, including: professional conduct, training and responsibilities. The third part deals with ethical issues pertaining to tDCS recipients, comprising e.g. consent forms and reimbursement. The forth part of the chapter discusses ethical issues related to tDCS procedures, including protocols, monitoring and the safety of unsupervised use. Finally, in the last part, open questions are addressed, discussing the biological line between normal and better than normal functioning or treatment and enhancement. Ethical implications for involuntary or coercive uses of tDCS applied for the purpose of changing behavior or gaining compliance with socially accepted norms are also being discussed.