Preparing the ethical future of deep brain stimulation
Preparing the ethical future of deep brain stimulation
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DOI：
10.1016/j.surneu.2009.03.029
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Racine, Eric
中科院分区：
文献类型：
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作者：
Bell, Emily;Mathieu, Ghislaine;Racine, Eric
背景：脑深部电刺激是一种获批且有效的神经外科干预方法，用于治疗运动障碍，如PD和ET。脑深部电刺激也可以有效治疗许多精神疾病，包括难治性抑郁症和强迫症。虽然DBS是一种广泛接受的运动障碍疗法，但它仍然是一种侵入性和昂贵的手术。DBS的伦理和社会的挑战需要进一步检查，讨论和新兴的应用DBS在精神病学也可能复杂的伦理景观的DBS.Methods：要确定和表征当前和新出现的问题，在使用DBS，我们回顾了神经外科文献DBS以及跨学科的医学伦理学和相关的心理和社会学文献。我们还咨询了美国专利商标局数据库，FDA法规和报告的决定，以及业务报告的关键DBS manufacturers.Results：重要的伦理和社会的挑战存在于当前和扩展实践的DBS，特别是在病人的选择，知情同意，资源分配，并在公众的理解。这些挑战很可能会被放大，如果新兴用途的DBS在精神病学approved.Conclusions：我们的审查DBS相关的伦理和社会问题强调，一些重大的挑战，虽然不是不可逾越的，需要更加密切的关注。结合以前在神经伦理学中使用的方法，如专家共识研讨会，以建立道德准则和公众参与，以提高公众的理解，可能是富有成效的探索。(C)2009爱思唯尔公司All rights reserved.
Background: Deep brain stimulation is an approved and effective neurosurgical intervention for motor disorders such as PD and ET. Deep brain stimulation may also be effective in treating a number of psychiatric disorders, including treatment refractory depression and OCD. Although DBS is a widely accepted therapy in motor disorders, it remains an invasive and expensive procedure. The ethical and social challenges of DBS need further examination, and discussion and emerging applications of DBS in psychiatry may also complicate the ethical landscape of DBS.Methods: To identify and characterize current and emerging issues in the use of DBS, we reviewed the neurosurgical literature on DBS as well as the interdisciplinary medical ethics and relevant psychological and sociological literatures. We also consulted the USPTO database, FDA regulations and report decisions, and the business reports of key DBS manufacturers.Results: Important ethical and social challenges exist in the current and extending practice of DBS, notably in patient selection, informed consent, resource allocation, and in public understanding. These challenges are likely to be amplified if emerging uses of DBS in psychiatry are approved.Conclusions: Our review of ethical and social issues related to DBS highlights that several significant challenges, although not insurmountable, need much closer attention. A combination of approaches previously used in neuroethics, such as expert consensus workshops to establish ethical guidelines and public engagement to improve public understanding, may be fruitful to explore. (C) 2009 Elsevier Inc. All rights reserved.