scholarly journals Deep Brain Stimulation in Persistent Vegetative States: Ethical Issues Governing Decision Making

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sara Patuzzo ◽  
Paolo Manganotti
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Ethical Issues ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Future Perspectives ◽  
Methodological Issues ◽  
Deep Brain

The aim of the present paper was to investigate the fundamental ethical issues of Deep Brain Stimulation (DBS) on patients remaining in Persistent Vegetative State (PVS). First, the purpose of this analysis was to discuss the nature of this intervention in order to classify it such as an ordinary clinical practice, or otherwise as an extraordinary clinical practice or as experimental research. Second, ethical issues, criticisms, and methodological issues of this intervention, also in the future perspectives, are discussed, attempting to identify who could give informed consent for a patient in PVS.

Deep brain stimulation for prolonged disorders of consciousness

2016 ◽  
Vol 11 (4) ◽  
pp. 105-111
Author(s):  
Gilberto KK Leung
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Functional Neuroimaging ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Minimal Conscious State ◽  
Wide Range ◽  
Deep Brain

Deep brain stimulation has emerged as a “last resort” therapy for patients with prolonged disorders of consciousness. The latter encompasses a range of conditions including minimal conscious state and persistent vegetative state. Functional neuroimaging studies have shown that minimal conscious state and persistent vegetative state have different patterns of residual brain function and may therefore respond differently to deep brain stimulation. The failure to distinguish between the two conditions in this context can give rise to false expectation, misunderstanding and ill-guided treatment. As a halfway technology for prolonged disorders of consciousness, deep brain stimulation could also produce improvement in awareness that is in fact harm, and its impact may involve a wide range of public interests. This paper will discuss related ethical and legal issues with an emphasis on the distinction between minimal conscious state and persistent vegetative state in the application of deep brain stimulation.

scholarly journals Indications and Effects of Deep-brain Stimulation Therapy in a Persistent Vegetative State : Evaluation Using Pain-related P250

1994 ◽  
Vol 3 (5) ◽  
pp. 398-403
Author(s):  
Chikashi Fukaya ◽  
Takashi Moriya ◽  
Takamitsu Yamamoto ◽  
Yoichi Katayama ◽  
Takashi Tsubokawa
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
State Evaluation ◽  
Deep Brain

Deep-brain stimulation in a persistent vegetative state: Follow-up results and criteria for selection of candidates

Brain Injury ◽  
1990 ◽  
Vol 4 (4) ◽  
pp. 315-327 ◽  
Author(s):  
Takashi Tsubokawa ◽  
Takamitsu Yamamoto ◽  
Yoichi Katayama ◽  
Teruyasu Hirayama ◽  
Sadahio Maejima ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Criteria For Selection ◽  
Selection Of ◽  
Deep Brain

Pathologies of Decision-Making

2020 ◽  
pp. 127-132
Author(s):  
Thomas Boraud
Keyword(s):  
Neural Network ◽  
Decision Making ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Obsessive Compulsive ◽  
The Neural Network ◽  
Decision Making System ◽  
Obsessive Compulsive Disorders ◽  
Compulsive Disorders ◽  
Deep Brain

This chapter explores the pathophysiology of neural conditions related to the neural network of decision-making. If humans are not fully rational, they manage to pretend to be most of the time. Some individuals are distinguished by traits that influence their decision-making, such as impulsiveness, procrastination, and stubbornness. These behaviours are so common that they are not considered pathological. There are, however, cases in which the decision-making system is dysfunctional enough for this irrationality to go beyond socially acceptable norms. This is the field of neurological and psychiatric syndromes of decision-making. The chapter then examines in detail obsessive-compulsive disorders (OCDs), Tourette’s syndrome, Parkinson's disease, and hyperdopaminergic syndromes. It also describes the deep brain stimulation paradox.

Neuroethics

2021 ◽  
pp. 405-420
Author(s):  
Georg Northoff
Keyword(s):  
Deep Brain Stimulation ◽  
Psychiatric Disorders ◽  
Brain Stimulation ◽  
Empirical Data ◽  
Moral Agency ◽  
Ethical Issues ◽  
Spatio Temporal ◽  
The Brain ◽  
Deep Brain

Neuroethics, located at the interface of conceptual and empirical dimensions, carries major implications for psychiatry, such as the neuroscientific basis of ethical concepts as moral agency. Drawing on data in neuroscience, this chapter highlights issues central to psychiatric ethics. First, it addresses a reductionistic model of the brain, often conceived as purely neuronal, and then it discusses empirical data suggesting that the brain’s activity is strongly aligned to its respective social (e.g., relation to others) and ecological (e.g., relation to the environment and nature) contexts; this implies a relational rather than reductionist model. Second, it suggests that self (e.g., the experience or sense of a self) and personhood (e.g., the person as existent independent of experience) must also be understood in such a social and ecological and, therefore, relational and spatio-temporal sense. Ethical concepts like agency, therefore, cannot be limited solely to the person and brain, but must rather be understood in a relational and neuro-ecological/social way. Third, it discusses deep brain stimulation as a treatment that promotes enhancement. In sum, this chapter presents findings in neuroscience that carry major implications for our view of brain, mental features, psychiatric disorders, and ethical issues like agency, responsibility, and enhancement.

Ethical issues in neurology

2019 ◽  
pp. 41-52
Author(s):  
Jan J. Heimans
Keyword(s):  
Decision Making ◽  
Cognitive Functioning ◽  
Ethical Issues ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Brain Dysfunction ◽  
Emotional Disturbances ◽  
Neurologic Diseases ◽  
Surrogate Decision

Neurologic diseases may lead to brain dysfunction and consequently to impairment of consciousness, cognitive decline, and emotional disturbances. These conditions may give rise to a wide array of ethical issues. Cerebral dysfunction can be temporary but many conditions are chronic and/or progressive, and the impact of such long-lasting brain dysfunction on decision-making processes is substantial. In this chapter, disturbances of consciousness and the decision-making process, with focus on communication during the various stages of coma, persistent vegetative state, and permanent vegetative state, are discussed. Special attention is paid to the role of proxies, who often have to act as surrogate decision-makers. Further, some aspects of brain death and organ donation are reviewed and the role of the neurologist as a specialist with respect to brain functioning, but also as an advocate acting in the interest of the patient and the patients’ relatives is depicted. Subsequently, consequences of impaired decision-making capacity in dementia and other diseases leading to diminished cognitive functioning are discussed and a short reflection is dedicated to driving ability. Ultimately, ethical issues in connection with decisions on withdrawing and withholding life-sustaining treatment including end-of-life decisions are discussed, both in neurologic diseases with diminished cognitive functioning but also in neurologic disorders, like motor neuron disease, where cognitive functions are preserved.

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