Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-30T15:40:19.918Z Has data issue: false hasContentIssue false
  • English
  • Français

Commentary: The Value of Patient Benefit: Consideration of Framing Contingencies to Guide the Ethical Use of DBS—a Case Analysis

Published online by Cambridge University Press:  16 September 2016

James Giordano
Get access Rights & Permissions [Opens in a new window]

Extract

Here we have a case in which (1) the outcome(s) for the patient do not comport with the projected—or initially defined—outcomes of the research study, and (2) these outcomes represent cognitive and behavioral effects that are positively interpreted by the patient, but not by the patient’s immediate family. The 6Cs approach, which frames the technique or technology—and its effects—within defined considerations of domains and dimensions, can be used as part of a multistep approach to addressing issues arising from the use of neurotechnology.1 The approach recommends that the medical team consider the following domains and dimensions when engaging neuroethical analyses:

  • • The capacities and limitations of current neuroscience and technology (neuroS/T), and the capacity of the patient

  • • The consequences incurred by neuroS/T on recipients, families, and society in the short, intermediate, and long term

  • • The character of the recipient (e.g., patterns of cognition, emotion, and behavior) affected by neuroS/T

  • • The continuity of research and clinical care

  • • The contexts of need and value that influence the use or nonuse of neuroS/T

  • • Consent through provision of the most information possible 2

Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 755 - 758
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Giordano, J. A preparatory neuroethical approach to assessing developments in neurotechnology. AMA Journal of Ethics 2015;17(1):56–61.Google ScholarPubMed

2. Adapted from Giordano 2015 (see note 1).

3. Jotterand, F, Giordano, J. Transcranial magnetic stimulation, deep brain stimulation and personal identity: Ethical questions and neuroethical approaches for medical practice. International Review of Psychiatry 2011;23(5):476–85.CrossRefGoogle ScholarPubMed

4. Lewis, CJ, Maier, F, Horstkötter, N, Zywczok, A, Witt, K, Eggers, C, et al. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson’s disease. Psychological Medicine 2015;45(1):73–85.CrossRefGoogle ScholarPubMed

5. Pham U, Solbakk AK, Skogseid IM, Toft M, Pripp AH, Konglund AE, et al. Personality changes after deep brain stimulation in Parkinson’s disease. Parkinson’s Disease 2015.

6. Pellegrino, ED, Thomasma, DC. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press; 1988.Google Scholar

7. Rossi, PJ, Okun, M, Giordano, J. Translational imperatives in deep brain stimulation research: Addressing neuroethical issues of consequences and continuity of clinical care. AJOB-Neuroscience 2014;5(1):46–8.CrossRefGoogle Scholar

8. Rossi PJ, Giordano J, Okun M. Uncertain coverage for off-label deep brain stimulation: Neuroethical challenges—and possible inroads—to research and the provision of care. AJOB-Neuroscience 2016.

9. Appelbaum, PS, Roth, LH, Lidz, CW, Benson, P, Winslade, W. False hopes and best data: Consent to research and the therapeutic misconception. Hastings Center Report 1987;17(2):20–4.CrossRefGoogle ScholarPubMed

10. Horng, S, Grady, C. Misunderstanding in clinical research: Distinguishing therapeutic misconception, therapeutic misestimation, and therapeutic optimism. IRB 2003;25(1):11–16.CrossRefGoogle ScholarPubMed

11. Gilbert, F. A threat to autonomy? The intrusion of predictive brain implants. AJOB-Neuroscience 2015;6(4):1–4.CrossRefGoogle ScholarPubMed

12. Giordano, J. Conditions for consent to the use of neurotechnology: A preparatory neuroethical approach to risk assessment and reduction. AJOB-Neuroscience 2015;6(4):12–14.CrossRefGoogle Scholar