Ethics of the Choice of Invasive versus Non-invasive Neurosurgery: Different Stakeholders' Perspectives, Surgical Decision-making, and Impact on Patient Sense of Control

NIH RePORTER · NIH · RF1 · $1,665,044 · view on reporter.nih.gov ↗

Abstract

ABSTRACT A fundamental ethical tenet in medicine is bodily sovereignty, inherent in which is the concept of control. Over the past 10 years, there has been considerable discussion in the neuroethics literature concerning the loss of control attributed to neuromodulation devices, specifically deep brain stimulation (DBS), with a focus on reduced control related to undesired personality changes. Many of these concerns either explicitly or implicitly focus on the invasiveness of the DBS device. We have conducted prospective empirical studies examining the impact of DBS on different aspects of control that are personally meaningful to patients (i.e., global control, control of valued functional goals, and control of valued personality characteristics). Our data show that DBS significantly improves control of these personally meaningful variables. However, our findings are limited in that we did not assess directly the differential impact of invasive versus non-invasive surgery on control. The proposed study uses patients with essential tremor who undergo either an invasive (DBS) or non-invasive (MRI guided focused ultrasound) surgery to treat their tremor as a model to study the importance of surgical invasiveness by: 1) studying different stakeholders' (i.e., physicians, patients) understandings of invasiveness, how those understandings impact surgical decision-making, and how patients' decisions may change over time; and 2) the impact of invasiveness on patients' perceptions of control on individually meaningful metrics (i.e., control of valued functional goals, control of valued personality characteristics, and global control). Our proposed study directly addresses the RFA-MH-19-400 goal to “empirically consider different perspectives on the distinction between invasive versus noninvasive … neuromodulation; particularly as those views are similar or different between groups”.

Key facts

NIH application ID
10026287
Project number
1RF1MH123407-01
Recipient
CLEVELAND CLINIC LERNER COM-CWRU
Principal Investigator
Cynthia M. S. Kubu
Activity code
RF1
Funding institute
NIH
Fiscal year
2020
Award amount
$1,665,044
Award type
1
Project period
2020-07-20 → 2025-06-19