Different Perspectives on Deep Brain Stimulation

In today’s society, we have come to accept the thought of a surgical procedure that can fix complications with our organs, bones, vessels and even the most important muscle in our body, the heart. We, as consumers, understand the common medical treatments, however, having a procedure done on our brain to regenerate the current in our brain to correct a neurological condition causes us to have a different perspective.

A specter of ancient practices of lobotomies in the 1940s has created an uneasy sense of deep brain stimulation. Regardless of those memories, there is a new kind of technology that is benefiting for its acceptance over the years, however, deep brain stimulation is not the way to go. Deep brain stimulation means the world to some people, but only for a short time.

“Deep brain stimulation is a surgical implant within the cerebral cortex of the brain” (Jimenez, 2009). Deep brain stimulation is used to treat certain diseases that are caused by out of control and uncontrollable electrical impulses inside the brain that are sent throughout the body. Some of these diseases include Tourette’s, Parkinson’s, and Dementia. Scientists have done the unthinkable and have performed open brain surgery while the patient is awake and coherent. Electrodes are taken and inserted into the cerebral cortex of the brain and then the doctors eject small shocks of electricity into certain cells. While the patient is awake, the doctors can ask questions and have the patient move to see if the experimental procedure is working.

First created in 1987, deep brain stimulation was used to treat patients with tremors and distress in Grenoble, France. Early voltage mechanisms were created by looking at the pacemakers that were inserted into the heart and providing stimulations that could take an abnormal heartbeat and steady it. Soon after the cardiac pacemakers were invented, deep brain stimulation was created to increase the electrical current in the brain by inserting different locations of electrodes in the brain and configuring the brain. The future of deep brain stimulation could lead to a brain pacemaker that could be shut off at night and could stimulate the brain during the day and provide feedback to the rest of the body to help limit the diseases. The goal of the experiment is not the same as a heart pacemaker- the goal of the brain would be to increase the activity in a region of the brain or some cases disrupt activity. As technology advances, we may even be able to wake people from a coma.

“Since DBS involves a brain surgery and modulation of brain-states, it may invoke reminiscences of unethical neurosurgical practices from the past”. The past of lobotomies that were operated on by Moniz and Freeman or the electrical stimulation program may cause people to believe that these advanced interventions of the brain may be used to manipulate or misuse people. Such memories may create the pubic to have a different view of Deep brain stimulation and the ongoing ethical issues related to DBS. However, there are vast differences from the past forms of deep brain stimulation to the current versions. “The most important operation techniques such as MRI-guided stereotactic surgery have improved and the intervention is much safer” (Synofzik & Schlaepfer, 2008). Furthermore, the side effect of deep brain stimulation is reversible and can be turned off.

Nevertheless, deep brain stimulation raises ethical concerns, both in treatment and in the background research. Some of the ethical concerns with deep brain stimulation is structured around the four principles of medicine. These morals and ethics include non-maleficence, beneficence, justice and the respect of autonomy. The most crucial ethical question that is asked is if deep brain stimulation has favorable results or if there is any maleficence present. With non-maleficence meaning “do no harm”, the big question is “ are the expected risks and side-effects proportional to the expected benefits?” (Schermer, 2011b). These questions must be answered by using an individual and group level of patients. At the level that affects the group, there is evidence that shows effectiveness, however, there are a lot of risks and complications. The effects of deep brain stimulation must be assessed based on the condition that the brain is in and the targeted areas.

For diseases like Parkinson’s Disease, muscle contractions and tremors, deep brain stimulation has demonstrated to be effective. However, the risks and complications outweigh the effectiveness of the procedure. These include, but aren’t limited to hemorrhage, infection, embolisms, nausea and vomiting, misplacement or shift in the leads, and possibly death. “Side effects also depend on the stimulation target and include effects on cognition, behavior, and psyche, including speech disturbances, memory loss, aggression, manic attitude, depression, and an increased suicide risk” (Schermer, 2011a).

There are also the ethical issues related to beneficence “do well”, justice “treat all cases alike” and the respect of autonomy “the respect for patients’ choices”. The reason that beneficence is violated is due to the effectiveness of the surgery and due to the fact that deep brain stimulation will not cure the disease, it will only lessen the symptoms. When beneficence is violated, autonomy is also violated. The respect for the patient’s choices are violated when there is a set age limit to who can be in the study, as well as what is told to the patients. The patients are misled and told that deep brain stimulation will fix the problem. However, what doctors fail to tell patients is that the symptoms are not long-lasting. This leads to disappointment in the patient since they set high expectations for the surgery and that they were told this was a fix for their disease. From the perspective of “treat all cases alike”, priority is usually given to the people who have the most serious condition or to those who will benefit from the operation. “Priority setting becomes more difficult when “chance to benefit” and “seriousness of impairment” do not go together”. Doctors must look at each patient and determine who gets the opportunity to get into the program, however, not all cases are identical. There are new indications for deep brain stimulation that is being investigated with addiction and psychiatric disorders. For each clinical research project that involves human individuals, the ethical challenge is to advocate for a scientific analysis for patients in the future as well as protecting the rights of each patient. However, the doctors have to be careful not to leave out patients who may gain from the operation.

My stance on this is that it is a very beneficial thing, however, I believe that it needs to see some improvements before more patients are exposed to the brain stimulations. Right now, there are so many complications and risks and not enough benefits for the 'brain pacemaker.' If this was permanente and not temporary, this could be such a big piece of technology. If technology continues to advance, this could help so many people and change their lives.