Ethics of the Choice of Invasive versus Non-invasive Neurosurgery: Different Stakeholders' Perspectives, Surgical Decision-making, and Impact on Patient Sense of Control

摘要 医学中的一个基本伦理原则是身体主权，其中固有的概念是 控制在过去的10年里，在神经伦理学中有相当多的讨论， 关于神经调节器械（特别是深部）导致失控的文献 脑刺激（DBS），重点是减少与不受欢迎的个性有关的控制 变化许多这些关注或明确或含蓄地集中在入侵的 DBS装置。我们进行了前瞻性的实证研究，研究DBS对 对患者个人有意义的控制的不同方面（即，全局控制，控制 有价值的功能目标，以及有价值的人格特征的控制）。我们的数据显示 DBS显著改善了对这些个人有意义的变量的控制。但我们的 研究结果是有限的，因为我们没有直接评估侵入性与 非侵入性手术这项拟议中的研究使用了特发性震颤患者， 接受侵入性（DBS）或非侵入性（MRI引导聚焦超声）手术， 将他们的震颤作为模型来研究手术侵入性的重要性：1）研究 不同的利益相关者（即，医生，患者）对侵入性的理解，这些 理解影响手术决策，以及患者的决定如何改变 时间;和2）侵入性对患者的控制感的影响， 有意义的度量（即，控制有价值的功能目标，控制有价值的人格 特性和全局控制）。我们提出的研究直接针对RFA-MH-19-400 目标是“从经验上考虑不同的观点， 非侵入性......神经调节;特别是当这些观点在 团体”。

ABSTRACT A fundamental ethical tenet in medicine is bodily sovereignty, inherent in which is the concept of control. Over the past 10 years, there has been considerable discussion in the neuroethics literature concerning the loss of control attributed to neuromodulation devices, specifically deep brain stimulation (DBS), with a focus on reduced control related to undesired personality changes. Many of these concerns either explicitly or implicitly focus on the invasiveness of the DBS device. We have conducted prospective empirical studies examining the impact of DBS on different aspects of control that are personally meaningful to patients (i.e., global control, control of valued functional goals, and control of valued personality characteristics). Our data show that DBS significantly improves control of these personally meaningful variables. However, our findings are limited in that we did not assess directly the differential impact of invasive versus non-invasive surgery on control. The proposed study uses patients with essential tremor who undergo either an invasive (DBS) or non-invasive (MRI guided focused ultrasound) surgery to treat their tremor as a model to study the importance of surgical invasiveness by: 1) studying different stakeholders' (i.e., physicians, patients) understandings of invasiveness, how those understandings impact surgical decision-making, and how patients' decisions may change over time; and 2) the impact of invasiveness on patients' perceptions of control on individually meaningful metrics (i.e., control of valued functional goals, control of valued personality characteristics, and global control). Our proposed study directly addresses the RFA-MH-19-400 goal to “empirically consider different perspectives on the distinction between invasive versus noninvasive … neuromodulation; particularly as those views are similar or different between groups”.