Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice

Int Rev Psychiatry. 2011 Oct;23(5):476-85. doi: 10.3109/09540261.2011.616189.

Abstract

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.

Publication types

  • Review

MeSH terms

  • Cognition
  • Deep Brain Stimulation* / adverse effects
  • Deep Brain Stimulation* / ethics
  • Deep Brain Stimulation* / methods
  • Humans
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Motor Activity
  • Nervous System Diseases / psychology
  • Nervous System Diseases / therapy*
  • Neurophysiology / ethics*
  • Neurophysiology / methods
  • Personal Autonomy
  • Personality* / drug effects
  • Personality* / radiation effects
  • Psychophysiology / ethics*
  • Psychophysiology / methods
  • Psychotropic Drugs / adverse effects
  • Self Concept
  • Therapies, Investigational / ethics
  • Therapies, Investigational / methods
  • Transcranial Magnetic Stimulation* / adverse effects
  • Transcranial Magnetic Stimulation* / ethics
  • Transcranial Magnetic Stimulation* / methods

Substances

  • Psychotropic Drugs