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

7.项目摘要/摘要 精神健康障碍造成巨大的个人痛苦，是一种重大的社会负担。近期 研究强调精神电干预(PEI)的潜力--生物电子治疗 使用电刺激来影响和改变大脑功能--以有效地治疗这种疾病。小说 然而，Peis也引发了重大的伦理问题。并不罕见的是，它们与 历史上有争议的干预措施，如电休克治疗和脑叶切除术。此外，虽然他们的 目标是改变疾病的潜在病理生理学，这些干预措施也可能产生意想不到的影响 在认知、行为和情感上。这些影响反过来又引发了对自治的伦理担忧， 个人身份和知情同意的能力。PEI有时也被认为更有害 而不是有帮助。大量学术文献阐述了对药物精神病学的伦理关注 干预措施，但关于PEI的伦理关切和相关信仰和态度的研究有限 在临床医生、患者和更广泛的公众中。随着贝的小说获得了关注，这 建议的研究通过以下方式解决这一重大差距：(A)检查伦理关切、信念和态度 在相关利益攸关方中使用PEI，以及(B)制定一份指南，以预测未来的政策挑战 关于PEI的创新和使用。使用务实的神经伦理学框架和负责任的 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 创新和利用。为了实现这一目标，我们建立了跨学科的研究团队，在 杰出的科学咨询委员会将回答三个问题：(1)相关利益攸关方团体如何 不同的PEI治疗抑郁症吗？也就是说，他们的伦理关切和相关的 对PEI的使用的信念和态度？(2)PEI的特征和疾病严重程度如何形成伦理 对PEI的关注和相关的信念和态度？(3)PEI的特征和态度如何影响 疾病的严重程度在利益相关者群体中有所不同？为了回答这些问题，我们将分析来自 假设驱动的全国性调查，包含嵌入的析因实验(目标1-3)。我们将研究 形成对PEIS的伦理关切和相关信念和态度的关键因素在三个相关的 利益相关者群体：医疗专业人员(目标1)、被诊断为抑郁症的患者(目标2)和 更广泛的公众(目标3)。这些结果将为制定道德挑战的分析地图提供信息 以及伦理关切、信念和态度可能为PEI创新和使用(AIM)带来的政策选择 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 在塑造利益相关者的道德关切、信念、 以及对贝的态度。响应大脑倡议的要求，我们的循证地图将 预测和指导与围绕PEI创新和使用的关注和态度相关的选择。

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.