“The Ethics of Novel Therapeutic Applications of Deep Brain Stimulation”
Deep brain stimulation (DBS) is a neurosurgical procedure that has been used to ameliorate motor symptoms associated with neurological conditions such as Parkinson’s disease. Following its success in this regard, DBS has been increasingly considered as a treatment for psychiatric disorders including obsessive-compulsive-disorder,depression, anorexia nervosa, schizophrenia, and addiction. As well as promising beneficial treatment outcomes, the use of DBS in psychiatry might also provide researchers with insights into the neurological mechanisms underlying psychiatric disorders. Although this is an important development, the use of DBS in psychiatry raises ethical issues that are distinct from those raised by its use in the treatment of non-psychiatric neurological conditions, due to the diminished decision-making competence amongst many psychiatric patients, and the effects that psychiatric disorders often have on the patient’s self-conception and values, effects that DBS may exacerbate. The disturbing historical abuses of neurosurgery in psychiatry also suggest that it is imperative to develop adequate ethical guidelines for the use of DBS in this context.
In this Wellcome Trust funded project, I aim to provide a comprehensive study of the ethics of novel therapeutic applications of DBS, and to develop policy recommendations and ethical guidelines for its use. I seek to address the ethical issues alluded to above by focusing on questions pertaining to the following interrelated four core themes:
- Authenticity and Personal Identity
- The Significance Of Consent and Weighing Risks
- The Research Ethics Paradigm
- Distributive Justice and Resource Allocation
Interventions that act directly on the brain, or ‘neurointerventions’, are increasingly being used or advocated for crime prevention. For instance, drugs that attenuate sexual desire are sometimes used to prevent recidivism in sex offenders, while drug-based treatments for substance abuse have been used to reduce addiction-related offending.
Recent scientific developments suggest that the range of neurointerventions capable of preventing criminal offending may eventually expand to include, for example, drugs capable of reducing aggression or enhancing empathy.
In this Wellcome Trust-funded project, we are investigating ethical questions raised by the use of such interventions to prevent criminal offending, focusing particularly on cases where they are imposed on convicted offenders as part of a criminal sentence or as a condition of parole. On the one hand, there seems to be at least some reason to support the use of neurointerventions in this way, since there is a clear need for new means of preventing crime. Traditional means of crime prevention, such as incarceration, are frequently ineffective and can have serious negative side-effects; neurointervention may increasingly seem, and sometimes be, a more effective and humane alternative. On the other hand, neurointerventions can be highly intrusive and may threaten fundamental human values, such as bodily integrity and freedom of thought. In addition, humanity has a track record of misguided and unwarrantedly coercive use of psychosurgery and other neurotechnological ‘solutions’ to criminality.
We are deploying philosophical methods and recent thinking on autonomy, coercion, mental integrity and moral liability to answer two over-arching questions
- When, if ever, may the state force neurointerventions on criminal offenders?
- When, if ever, may the state offer neurointerventions to criminal offenders?
We plan also to examine how our answers to these questions bear on the use of neurointerventions to prevent offending in individuals who have not previously offended, but are thought to be at high risk of doing so.
A recent publication from this project: Pugh J, Maslen H, “‘Drugs That Make You Feel Bad’? Remorse-Based Mitigation and Neurointerventions”, Criminal Law and Philosophy, Online First.