Abstract
The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation (DBS) on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (1), I argue that the pattern theory of self (PTS) can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves.
Highlights
Deep brain stimulation (DBS) is an invasive treatment involving the implantation of electrodes and electrical stimulation of specific areas of the brain (Hemm & Wårdell, 2010; Herrington et al, 2016)
How we define the self will have implications for how we think about authenticity, and how we define authenticity will have implications for how we think about autonomy, and for how we think about responsibility
I would like to emphasize that, from an ethical standpoint, assessments of moral responsibility should necessarily take into account cognitive, behavioral, and narrative aspects associated with autonomy, and—in some influential accounts, such as Frankfurt’s approach or HSRV—aspects associated with authenticity
Summary
Deep brain stimulation (DBS) is an invasive treatment involving the implantation of electrodes and electrical stimulation of specific areas of the brain (Hemm & Wårdell, 2010; Herrington et al, 2016). Many neuroethicists have expressed concerns over the potential danger to patients’ selves posed by DBS.1 These concerns were initially raised by individual case reports; various qualitative studies, as well as a recent semiquantitative study (Eich et al, 2019) have proved their relevance.. These concerns were initially raised by individual case reports; various qualitative studies, as well as a recent semiquantitative study (Eich et al, 2019) have proved their relevance.4 These results have stimulated ongoing neuroethical debate concerning DBS’s impact on the self. Conclude (section 7—Summary) by pointing out more general theoretical gains from the inclusion of moral aspects within the PTS framework
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