TY - JOUR
T1 - Autonomy in depressive patients undergoing DBS-treatment
T2 - Informed consent, freedom of will and DBS’ potential to restore it
AU - Beeker, Timo
AU - Schlaepfer, Thomas E.
AU - Coenen, Volker A.
N1 - Funding Information:
Sensi, M., Eleopra, R., Cavallo, M. A., Sette, E., Milani, P., Quatrale, R., et al. (2004). Explosive-aggressive behavior related to bilateral subthalamic stimulation. Parkinsonism Relat. Disord. 10, 247–251. doi: 10.1016/j.parkreldis.2004. 01.007 Smeding, H. M. M., Goudriaan, A. E., Foncke, E. M. J., Schuurman, P. R., Speelman, J. D., and Schmand, B. (2007). Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease. J. Neurol. Neurosurg. Psychiatry 78, 517–519. doi: 10.1136/jnnp.2006. 102061 Temel, Y., Kessels, A., Tan, S., Topdag, A., Boon, P., and Visser-Vandewalle, V. (2006). Behavioural changes after bilateral subthalamic stimulation in advanced Parkinson disease: a systematic review. Parkinsonism Relat. Disord. 12, 265–272. doi: 10.1016/j.parkreldis.2006.01.004 Unterrainer, M., and Oduncu, F. S. (2015). The ethics of deep brain stimulation (DBS). Med. Health. Care Philos. 18, 475–485. doi: 10.1007/s11019-015-9622-0 van Staden, C. W., and Krüger, C. (2003). Incapacity to give informed consent owing to mental disorder. J. Med. Ethics 29, 41–43. doi: 10.1136/jme. 29.1.41 Voon, V., Mehta, A. R., and Hallett, M. (2011). Impulse control disorders in Parkinson’s disease: recent advances. Curr. Opin. Neurol. 24, 324–330. doi: 10.1097/WCO.0b013e3283489687 Watson, G. (1975). Free agency. J. Philos. 72, 205–220. doi: 10.2307/2024703 Conflict of Interest Statement: TB has no conflict of interest. TES was supported in the last five years in part by a grant from Medtronic, Inc., a manufacturer of DBS devices and the Hope for Depression Research Foundation and the Institute for Affective Neuroscience. VAC has occasionally received travel support and honoraria for lecturing and consulting from Medtronic (USA, Europe) and Boston Scientific (USA). VAC has ongoing IIT’s with Medtronic and Boston Scientific unrelated to this work.
PY - 2017/6/8
Y1 - 2017/6/8
N2 - 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.
AB - 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.
KW - Autonomy
KW - Decision making
KW - Deep brain stimulation
KW - Depression
KW - Informed consent
KW - Neuroethics
KW - Neuromodulation
UR - http://www.scopus.com/inward/record.url?scp=85032282051&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032282051&partnerID=8YFLogxK
U2 - 10.3389/fnint.2017.00011
DO - 10.3389/fnint.2017.00011
M3 - Article
C2 - 28642690
AN - SCOPUS:85032282051
VL - 11
JO - Frontiers in Integrative Neuroscience
JF - Frontiers in Integrative Neuroscience
SN - 1662-5145
M1 - 11
ER -