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Part of the Haer Family Symposium: Neuroscience Lecture Series, in conjuction with the Community Medical Ethics Project
Presenter: Dr. Emily Bell, Ph.D. Neuroethics Research
Associate Researcher, Institut de recherches cliniques de Montreal
Presentation: On Target? How Research And Guidance Are Informing The Ethical And Social Challenges In Deep Brain Stimulation For Movement Disorders And Psychiatric Indications.
Deep brain stimulation (DBS) is an approved neurosurgical intervention for Parkinson’s disease. Over the past years, there has been growing interest in examining DBS for new indications, including in refractory psychiatric patients suffering from depression or obsessive compulsive disorder. Encouraged by early clinical trials, the potential ethics issues for the use and research of DBS in psychiatric conditions have been the subject of discussion in the disciplines of neurosurgery and bioethics. In 2009, when we reviewed the key social and ethical issues in DBS for movement disorders and psychiatric disorders, we found that issues of patient selection, informed consent, resource allocation, transfer of knowledge and public perception, and personhood, narrative and identity dominated the academic literature (Bell et al., 2009). However recent research trials reveal new insights into some of these ethical debates and broaden the experience base from which ethical decisions are made. At the same time, researchers, practitioners, and bioethicists have been attuned to the possible ethical challenges for research and care, particularly in expanding psychiatric indications, and the results of this are demonstrated by a scholarly literature addressing a range of ethical concerns in the field. In movement disorders, for example decisions about patient selection, have gleaned important advances from recent clinical trials, but knowledge in other areas of ethical importance (for example informed consent and impact on personhood) has progressed less. Meanwhile, the explicit ethics guidance for research and care in psychiatric DBS highlights shared ethical themes such as responsibilities to promote the welfare of research participants, fostering a global perspective through multidisciplinary teams, conditions for informed consent and social considerations and impacts of DBS in psychiatric disorders which extend research ethics purview. I reflect on new developments in research related to key ethical and social issues in DBS for movement disorders and discuss the need for specific ethics guidance in psychiatric DBS.
Suggested reading: Bell E, Maxwell B, McAndrews MP, Sadikot A, Racine E. Hope and Patients’ Expectations in Deep Brain Stimulation: Healthcare Providers’ Perspectives and Approaches. Journal of Clinical Ethics, Summer 2010.
About the Haer Family Symposium: Neuroscience Lecture Series
This year’s symposium takes as its inspiration the lives of Thiel alums Fred and Jill Haer, whose various companies have advanced neuroscientific research and helped to develop new neurological and psychiatric therapies. And, true to the college’s missions, the Haers have created opportunities for Thiel College students to grow as learners and citizens.
About the Presenter, Dr. Emily Bell
As often is the case, science and engineering advance more rapidly than human’s ability to fully understand and appreciate the full implications, and importantly, control the consequences. Dr. Bell’s work explores the implications and how citizens, lay and professional, respond to these advances and helps to establish a rigorous and thoughtful approach to how ensure that science and technology benefits all.
Dr. Emily Bell completed a postdoctoral fellowship at the Neuroethics Research Unit, Institut de recherches cliniques de Montreal, Canada, in Spring 2010. Dr. Bell has since been an Associate Researcher at the Unit. Her MSc and PhD research in Psychiatry at the University of Alberta focused on investigating brain activity in mood disorders and anxiety disorders using functional magnetic resonance imaging (fMRI). Her postdoctoral work examined ethical and social challenges in deep brain stimulation (DBS) based on a Canadian multi-site investigation of neurosurgical units. She is a network investigator of the Neuroethics Core of NeuroDevNet, a Canadian Network of Centre of Excellence. In the past, Dr. Bell has been awarded support from the Social Sciences and Humanities Research Council (SSHRC), the Fonds de la recherche en santé du Quebec (FRSQ), and the Canadian Institutes of Health Research (CIHR). Some of her current active research areas include investigating the relationship of vulnerability to informed consent in invasive psychiatric research trials, ethical challenges in the development and application of biomarkers for neurodevelopmental disorders, and the role and contribution of deliberation and consultation in bioethics.