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

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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.