2004
Volume 110, Issue 3
  • ISSN: 0002-5275
  • E-ISSN: 2352-1244

Abstract

Abstract

In this paper, I discuss the impact of psychological and relational changes after neuromodulation for movement- and psychiatric disorders and the need to adequately address the possibility of such changes in clinical contexts. Based on Focquaert and Schermer (2015), Goddard (2017) and Baylis (2013), I outline a relational narrative identity perspective that can inform and support medical-ethical decisions. The narrative identity theory by Marya Schechtman in combination with a focus on the relational aspects that impact and constitute our identity, highlights the need to identify post-interventional identity changes both from the perspective of the patient, his or her family and loved ones and the medical team. I argue that a thorough informed consent process pre- and post-intervention and adequate psychological counseling allows for such identification and a step by step monitoring and guiding of the patient in this process. From a relational narrative perspective, neuromodulation does not by default pose a threat to our identity. However, this perspective highlights the need to take the relational autonomy of patients seriously and provide a substantial informed consent procedure and adequate psychological counseling.

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2018-09-01
2021-11-29
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References

  1. Air, E.L., Ostrem, J.L., Sauger, T.D. en Starr, P.A.(2011)Deep brain stimulation in children: experience and technical pearls. Journal of Neurosurgery: Pediatrics8(6), pp. 566-574
    [Google Scholar]
  2. Baylis, F.(2013)“I am who I am”: On the perceived threats to personal identity from deep brain stimulation. Neuroethics6(3), pp. 513-526.
    [Google Scholar]
  3. Bell, E., Maxwell, B., McAndrews, M.P., Sadikot, A.F. en Racine, A.(2011)A review of social and relational aspects of deep brain stimulation in parkinson's disease informed by healthcare provider experiences. Parkinson’s Disease, vol. 2011, Article ID 871874.
    [Google Scholar]
  4. Broen, M., Duits, A., Visser-Vandewalle, V., Temel, Y. en Winogrodzka, A.(2011)Impulse control and related disorders in Parkinson’s disease treated with bilateral subthalamic nucleus stimulation: A review. Parkinsonism and Related Disorders17, pp. 413-417.
    [Google Scholar]
  5. Bublitz, J.C. en Merkel, R.(2014)Crimes against minds: On mental manipulations, harms and a human right to mental self-determination. Criminal Law and Philosophy8(1), pp. 51-77.
    [Google Scholar]
  6. DeGrazia, D.(2005)Enhancement technologies and human identity. Journal of Medicine and Philosophy30, pp. 261-283.
    [Google Scholar]
  7. Delft, S. van(2011)Diepe hersenstimulatie. Ontwaken uit depressie. ec.europa.eu/health-eu/journalist_prize/2011/docs/article_netherlands_nl.pdf
    [Google Scholar]
  8. DiFrancesco, M.F., Halpern, C.H., Hurtig, H.H., Baltuch, G.H. en Heuer, G.G.(2012)Paediatric indications for DBS. Child’s Nervous System28, pp. 1701-1714.
    [Google Scholar]
  9. Dings, R. en de Bruin, L.(2016)Situating the self: Understanding the effects of deep brain stimulation. Phenomenology and the Cognitive Sciences15, pp. 151-165.
    [Google Scholar]
  10. Fins, J.J., Mayberg, H.S., Nuttin, B., Kubu, C.S., Galert, T., Sturm, V., Stoppenbrink, K., Merkel, R. en Schlaepfer, T.E.(2011)Misuse of the FDA’s humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder. Health Affairs30(2), pp. 302-311.
    [Google Scholar]
  11. Focquaert, F.(2003)Philosophical thought experiments: Personal identity and its boundaries. Philosophica72, pp. 131-152.
    [Google Scholar]
  12. Focquaert, F.(2013)Neuromodulatie en identiteit: Komt ons zelf in het gedrang? in: M.Schermer, M.Boenink en G.Meyen, Komt een filosoof bij de dokter. Amsterdam: Boom, pp. 89-104.
    [Google Scholar]
  13. Focquaert, F. en Ridder, D. de(2009)Direct intervention in the brain: Questions concerning personal identity. Journal of Ethics in Mental Health4, pp. 1-7.
    [Google Scholar]
  14. Focquaert, F. en Schermer, M.(2015)Moral enhancement: Do means matter morally?Neuroethics8, pp. 139-151.
    [Google Scholar]
  15. Gallagher, S. (2018, online first) Deep brain stimulation, self and relational autonomy. Neuroethics. doi:https://doi.org/10.1007/s12152-018-9355-x
    [Google Scholar]
  16. Glannon, W.(2009)Stimulating brains, altering minds. Journal of Medical Ethics35, pp. 289-292.
    [Google Scholar]
  17. Gilbert, F.(2012)The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment. Journal of Medical Ethics38(7), pp. 408-412.
    [Google Scholar]
  18. Gisquet, E.(2008)Cerebral implants and Parkinson’s disease: A unique form of biographical disruption?Social Science & Medicine67, pp. 1847-1851.
    [Google Scholar]
  19. Goddard, E.(2017)Deep brain stimulation through the “Lens of agency”: Clarifying threats to personal identity from neurological intervention. Neuroethics10, pp. 325-335.
    [Google Scholar]
  20. Haan, S. de, Rietveld, E., Stokhof, M en Denys, D.(2017)Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations. PLoS ONE12(4), e0175748.
    [Google Scholar]
  21. Houeto, J. L., Mesnage, V., Mallet, L., Pillon, B., Gargiulo, M., du Montcel, S. T.et al.(2002)Behavioural disorders, Parkinson's disease and subthalamic stimulation. Journal of Neurology, Neurosurgery, and Psychiatry72(6), pp. 7017-20.
    [Google Scholar]
  22. Inwagen, P. van(1990)Material beings. Ithaca: Cornell University Press.
    [Google Scholar]
  23. Klein, S., Rozendal, K. en Cosmides, L.(2002)A social-cognitive neuroscience analysis of the self. Social Cognition20(2), pp. 105-135.
    [Google Scholar]
  24. Leentjens, A.F.G., Visser-Vandewalle, V., Temel, V. en Verhey, F.R.J.(2004)Manipuleerbare wilsbekwaamheid: een ethisch probleem bij elektrostimulatie van de nucleus subthalamicus voor ernstige ziekte van Parkinson. Nederlands Tijdschrift voor Geneeskunde148(28), pp. 1394-1398.
    [Google Scholar]
  25. Locke, J.(1975) [1694]An essay concerning human understanding. P.Nidditch (red.). Oxford: Clarendon Press.
    [Google Scholar]
  26. Merkel, R., Boer, G., Fegert, J., Galert, T., Hartmann, D., Nuttin, B. en Rosahl, S.(2007)Intervening in the brain. Changing psyche and society. Berlin: Springer.
    [Google Scholar]
  27. Müller, S., Walter, H. en Christen, M.(2014)When benefitting a patient increases the risk for harm for third persons – The case of treating pedophilic Parkinsonian patients with deep brain stimulation. International Journal of Law and Psychiatry37, pp. 295-303.
    [Google Scholar]
  28. Müller, S., Bittlinger, M., Walter, H.(2017)Threats to neurosurgical patients posed by the personal identity debate. Neuroethics10, pp. 299-310.
    [Google Scholar]
  29. Nozick, R.(1981)Philosophical Explanations. Harvard University Press.
    [Google Scholar]
  30. Olson, E.(1997)The human animal: Personal identity without psychology. Oxford University Press.
    [Google Scholar]
  31. Nyholm, S.(2018)Is the personal identity debate a ‘threat’ to neurosurgical patients? A reply to Müller et al. Neuroethics11, pp. 229-235.
    [Google Scholar]
  32. Nyholm, S. & O’Neill, E.(2016)Deep brain stimulation, continuity over time, and the true self. Cambridge Quarterly of Healthcare Ethics25(4), pp. 647-658.
    [Google Scholar]
  33. Parfit, D.(1984)Reasons and persons. Oxford: Oxford University Press.
    [Google Scholar]
  34. Perozzo, P., Rizzone, M., Bergamasco, B., Castelli, L., Lanotte, M., Tavella, A., Torre, E. en Lopiano, L.(2001)Deep brain stimulation of subthalamic nucleus: behavioural modifications and familiar relations. Neurological Sciences22, pp. 81-82.
    [Google Scholar]
  35. Pugh, J., Maslen, H. en Savulescu, J.2017. Deep brain stimulation, authenticity and value. Cambridge Quarterly of Healthcare Ethics26, pp. 640-657.
    [Google Scholar]
  36. Saleh, C. en Fontaine, D.(2015)Deep brain stimulation for psychiatric diseases: What are the risks. Current Psychiatry Reports17(5), p. 33.
    [Google Scholar]
  37. Schechtman, M.(1996)The constitution of selves. New York: Cornell University Press.
    [Google Scholar]
  38. Schechtman, M.(2007)Stories, lives and basic survival: A refinement and defense of the narrative view. Royal Institute of Philosophy Supplement60, pp. 155-178.
    [Google Scholar]
  39. Schechtman, M.(2010)Philosophical reflections on narrative and deep brain stimulation. The Journal of Clinical Ethics21(2), pp. 133-139.
    [Google Scholar]
  40. Schecthman, M.(2014)Staying alive: Personal identity, practical concerns, and the unity of a life. Oxford, UK: Oxford University Press.
    [Google Scholar]
  41. Schermer, M.(2009)Changes in the self: The need for conceptual research next to empirical research. The American Journal of Bioethics9(5), pp. 45-47.
    [Google Scholar]
  42. Schüpbach, M., Gargiolo, M., Welter, M. L., Mallet, L., Béhar, C., Houeto, J. L.et al.(2006)Neurosurgery in Parkinson Disease: A distressed mind in a repaired body?Neurology66, pp. 1811-1816.
    [Google Scholar]
  43. Shoemaker, S.(1984)Personal identity: A materialist's account, in: S.Shoemaker en S.Swinburne (red.), Personal identity. Great debates in philosophy. Oxford: Blackwell.
    [Google Scholar]
  44. Slob, M. (2007, 28juli) Uitschakelbare dwang. NRC.nl. vorige.nrc.nl/wetenschap/article1822814.ece/Uitschakelbare_dwang
    [Google Scholar]
  45. Strawson, G.(2004)Against narrativity. Ratio17(4), pp. 428-452.
    [Google Scholar]
  46. Synofzik, M. en Schlaepfer, T.E.(2008)Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal3, pp. 1511-1520.
    [Google Scholar]
  47. Temel, Y., Kessels, A., Tan, S., Topdag, A., Boon, P. en Visser-Vandewalle, V.(2006)Behavioural changes after bilateral subthalamic stimulation in advanced Parkinson disease. A systematic review. Parkinsonism and Related Disorders12, pp. 265-272.
    [Google Scholar]
  48. Unterrainer, M. en Oduncu, F.S.(2015)The ethics of deep brain stimulation (DBS). Medicine, Health Care and Philosophy. Online first, DOI10.1007/s11019‑015‑9622‑0.
    [Google Scholar]
  49. Williams, B.(1970)The self and the future. The Psychological Review78, pp. 161-180.
    [Google Scholar]
  50. Woopen, C., Pauls, K.A.M., Koy, A., Moro, E. en Timmerman, L.(2013)Early application of deep brain stimulation: Clinical and ethical aspects. Progress in Neurobiology110, pp. 74-88.
    [Google Scholar]
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