Modern Psychosurgery: Ethical Implications of Deep Brain Stimulation in Psychiatric Disorders
Introduction
Deep brain stimulation (DBS) is the most common form of electrical brain stimulation in use today. It involves surgical implantation of electrodes into the brain tissue. These electrodes are attached to an impulse generator that is placed under the skin of the upper chest. Over the past twenty years, DBS has been used successfully to reduce the symptoms associated with movement disorders such as Parkinson’s disease, essential tremor, and dystonia. Because of the successful implementation of DBS in patients with movement disorders, research has now turned to studying the effects on psychiatric disorders such as major depression, obsessive-compulsive disorder (OCD), and substance abuse. Although the Food and Drug Administration has approved DBS for treatment of movement disorders, it is considered an experimental treatment for psychiatric patients; thus, it is reserved for the most severe cases. The experimental nature of the procedure along with the controversial history of psychosurgery brings many ethical concerns to light regarding DBS treatment for psychiatric disorders.
The purpose of this paper is to outline the bioethical issues surrounding DBS. The author will give a brief background into the history of psychosurgical treatments, as well as outline the risks and benefits of the new surgical treatment of DBS. Ethical dimensions related to DBS use will be discussed. Kant’s deontological theory will be used to provide moral reasoning, and the ethical principles of beneficence and non-maleficence, justice, and autonomy will be applied. Two provisions from the Code of Ethics for Nurses will also be compared to the issue. The role of nursing will be demonstrated through the use of Parse’s theory The Humanbecoming School of Thought. A faith-based approach will also be presented. The author will conclude with her own opinions and a summary of all major points.
Background
Psychosurgery can be traced back as early as 6500 BC. (Mashour, Walker, and Martuza, 2005) Archeologists have uncovered evidence of a procedure known as trepanning. This was a technique in which a hole was created in the skull to allow evil spirits to leave the body. Many of the recovered skulls showed evidence of bone healing, indicating that there were some survivors of this procedure.
Psychosurgery, as people think of it today, did not significantly develop until the 1930s. Portuguese neurologist Egas Moniz was the first scientist to introduce the theory that mental illness was the result of faulty synapses in the brain. In 1935, he invented the procedure known as the leucotomy. This method involved drilling holes into the sides of patients’ heads to disrupt these faulty synapses. (Mashour et al., 2005) Moniz and his colleague Almeida Lima conducted over one hundred procedures; however, their postoperative evaluations were subjective, and they kept sparse records of follow-ups. Nevertheless, Moniz published multiple books and articles about the success of his procedure.
In the United States of America, neurologist Walter Freeman and his neurosurgical partner James Watts expanded on Moniz procedure. They believed that severing the connections between the prefrontal lobes and the deeper structures of the brain would provide better results. These two physicians created their own procedure called the lobotomy. (Feldman & Goodrich, 2001) Initially, the lobotomy was performed by making a sweeping cut through burr holes on either side of the brain. Freeman eventually developed a technique, which did not require the assistance of a neurosurgeon. He created an ice pick like device that he would hammer through the eye socket and sweep through the frontal lobe of the brain. The transorbital lobotomy was initially received with much favor from the medical community. However, reports soon were documented in the scientific literature that the
