eCite Digital Repository

Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a ‘new form of the disease’

Citation

Gilbert, F and Lancelot, M, Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a new form of the disease', Journal of Medical Ethics, 47 pp. 20-25. ISSN 1473-4257 (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Author(s) (or their employer(s))

DOI: doi:10.1136/medethics-2019-106052

Abstract

Deep brain stimulation (DBS) has been regarded as an efficient and safe treatment for Parkinson’s disease (PD) since being approved by the Food and Drug Administration (FDA) in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced—harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago (at the time of writing) and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers’ burden.

Item Details

Item Type:Refereed Article
Keywords:autonomy, deep brain stimulation, side effects, end-of-life, consent, dementia
Research Division:Philosophy and Religious Studies
Research Group:Applied ethics
Research Field:Ethical use of new technology
Objective Division:Culture and Society
Objective Group:Ethics
Objective Field:Bioethics
UTAS Author:Gilbert, F (Dr Frederic Gilbert)
ID Code:139003
Year Published:2020
Funding Support:Australian Research Council (DE150101390)
Web of Science® Times Cited:1
Deposited By:Office of the School of Humanities
Deposited On:2020-05-19
Last Modified:2021-04-28
Downloads:0

Repository Staff Only: item control page