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Deep Brain Stimulation, Continuity over Time, and the True Self

Published online by Cambridge University Press:  16 September 2016

SVEN NYHOLM  and
ELIZABETH O’NEILL
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Abstract:

One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a threat to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a threat to continuity over time is too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g., a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self.” We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self.

Keywords

deep brain stimulation (DBS)personal identityselfanorexia nervosa
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 647 - 658
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

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35. See note 33, Tan et al. 2007, at 20.

36. See note 33, Tan et al. 2007.

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40. See note 37, Maslen et al. 2015, at 227.

41. See note 37, Maslen et al. 2015, at 227.

42. See note 37, Maslen et al. 2015, at 228.

43. We are assuming here that we should mainly consider cases in which there is at least one mind-set in which the patient him- or herself thinks in terms of values that incline him or her to want to consent to the DBS. We are not discussing the possible case in which the patient is so set on the values associated with AN that there is no mind-set in which the patient is inclined to agree that he or she needs healthcare.

44. The authors wish to thank Frederic Gilbert, the editors and anonymous reviewers of CQ, and our departmental colleagues at Eindhoven University of Technology for their helpful feedback on this material.