Is the Treatment Perceived to be Worse than the Disease?: Ethical Concerns and Attitudes towards Psychiatric Electroceutical Interventions

治疗被认为比疾病更糟糕吗？：对精神病电干预的伦理关注和态度

• 批准号: 9608514
• 负责人: Laura Yenisa Cabrera Trujillo
• 金额: $ 78.06万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9608514
• 关键词: Address; Adoption; Affect; Attention; Attitude; BRAIN initiative; Behavior; Belief; Brain; Caregivers; Characteristics; Cognition; Data; Data Collection; Deep Brain Stimulation; Development; Diagnosis; Disease; Electric Stimulation; Electroconvulsive Therapy; Emotions; Ethics; Family Caregiver; Frequencies; Functional disorder; Future; Gatekeeping; General Population; Goals; Individual; Influentials; Informed Consent; Intervention; Knowledge; Literature; Lobotomies; Maps; Medical; Mental Depression; Mental disorders; Modernization; Nature; Participant; Patients; Perception; Pharmacologic Substance; Pharmacology; Physicians; Policies; Process; Psychiatrist; Research; Sampling; Severity of illness; Shapes; Social Policies; Surveys; Weight; Work; beneficiary; caregiving; clinical Diagnosis; clinical application; clinical translation; comparative; development policy; evidence base; experience; experimental study; innovation; neuroethics; neurotechnology; novel; policy implication; social implication; therapy development; uptake

7. PROJECT SUMMARY/ABSTRACT Mental health disorders cause immense personal suffering and represent a significant societal burden. Recent research emphasizes the potential of psychiatric electroceutical interventions (PEIs) – bioelectronic treatments that employ electrical stimulation to affect and modify brain function – to effectively treat such disorders. Novel PEIs, however, also raise significant ethical concerns. Not uncommonly, they are negatively associated with historically controversial interventions such as electroconvulsive therapy and lobotomy. Moreover, while their goal is to alter the underlying pathophysiology of disease, these interventions can also have unintended effects on cognition, behavior, and emotions. Those effects, in turn, raise ethical concerns regarding autonomy, personal identity, and capacity for informed consent. PEIs also are sometimes perceived to be more harmful than helpful. A large body of scholarly literature addresses ethical concerns about pharmacological psychiatric interventions, yet there is limited research on ethical concerns and related beliefs and attitudes about PEIs among the clinicians, patients, and the broader public. With the attention novel PEIs have garnered, this proposed study addresses that significant gap by (a) examining ethical concerns, beliefs, and attitudes about the use of PEIs among relevant stakeholders, and (b) developing a guide to anticipate future policy challenges regarding PEI innovation and use. Using a pragmatic neuroethics framework together with a responsible research and innovation framework, our goal is to develop a strategy to support responsible and ethical PEI innovation and use. To achieve this goal, our established, transdisciplinary research team, guided by a distinguished Scientific Advisory Board, will answer three questions: (1) How do relevant stakeholder groups perceive different PEIs for the treatment of depression? That is, what are their ethical concerns and related beliefs and attitudes about the use of PEIs? (2) How do PEI characteristics and disease severity shape ethical concerns and related beliefs and attitudes about PEIs? (3) How does the influence of PEI characteristics and disease severity vary across stakeholder groups? To answer these questions, we will analyze data from hypothesis-driven, national surveys containing an embedded factorial experiment (Aims 1-3). We will examine the key factors shaping ethical concerns and related beliefs and attitudes about PEIs among three relevant stakeholder groups: medical professionals (Aim 1), patients diagnosed with depression (Aim 2), and the broader public (Aim 3). These results will inform the development of an analytical map of the ethical challenges and policy choices that ethical concerns, beliefs and attitudes might generate for PEI innovation and use (Aim 4). The significance of this work lies in the in-depth new knowledge it will generate regarding specific PEI characteristics and relevant vantage points most influential in shaping stakeholders’ ethical concerns, beliefs, and attitudes toward PEIs. Responding to the BRAIN Initiative imperatives, our evidence-based map will anticipate and guide choices related to concerns and attitudes surrounding PEI innovation and use.

7.项目总结/摘要 心理健康障碍造成巨大的个人痛苦，是一个重大的社会负担。最近 研究强调了精神病学电介入（PEI）的潜力-生物电子治疗 利用电刺激来影响和改变大脑功能-有效地治疗这种疾病。小说 然而，PEI也引起了重大的伦理问题。并不罕见，它们与 历史上有争议的干预措施，如电休克治疗和额叶切除术。此外，虽然他们 虽然这些干预的目的是改变疾病的潜在病理生理学，但也可能产生意想不到的效果 对认知行为和情感的影响这些影响反过来又引起了关于自主权的伦理问题， 个人身份和知情同意的能力。PEI有时也被认为是更有害的 而不是帮助。大量的学术文献涉及药物精神病学的伦理问题， 干预措施，但有有限的研究伦理问题和相关的信念和态度，对PEI 在临床医生、患者和更广泛的公众中。随着关注小说PEI已经获得，这 拟议的研究通过以下方式解决了这一重大差距：（a）检查以下方面的伦理问题、信念和态度： 在相关利益攸关方中使用贫穷人口影响指标，以及（B）制定预测未来政策挑战的指南 关于PEI的创新和使用。使用一个务实的神经伦理学框架， 研究和创新框架，我们的目标是制定一项战略，以支持负责任和道德的PEI 创新和使用。为了实现这一目标，我们建立了跨学科的研究团队，由一个 一位杰出的科学咨询委员会成员将回答三个问题：（1）相关利益攸关方群体如何 如何看待治疗抑郁症的不同PEI？也就是说，他们的道德关切和相关的 关于使用PEI的信念和态度？(2)PEI特征和疾病严重程度如何塑造伦理 对PEI的关注和相关的信念和态度？(3)PEI的特性和 不同利益相关者群体的疾病严重程度不同？为了回答这些问题，我们将分析来自 假设驱动的全国调查，其中包含一个嵌入式析因实验（目标1-3）。我们将研究 在三个相关领域中，形成对PEI的伦理关注和相关信念和态度的关键因素 利益相关者群体：医疗专业人员（目标1），抑郁症患者（目标2）， 更广泛的公众（目标3）。这些结果将为制定道德挑战分析图提供信息 伦理问题、信念和态度可能为PEI创新和使用产生的政策选择（Aim 4）。这项工作的意义在于它将产生关于特定PEI的深入的新知识 在塑造持份者的道德关注，信念， 和对PEI的态度。为了响应BRAIN倡议的要求，我们的循证地图将 预测和指导与PEI创新和使用相关的问题和态度的选择。