# Ethics of the Choice of Invasive versus Non-invasive Neurosurgery: DifferentStakeholders' Perspectives, Surgical Decision-making, and Impact on Patient Sense ofControl

> **NIH NIH RF1** · CLEVELAND CLINIC LERNER COM-CWRU · 2022 · $81,305

## 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:** 10598171
- **Project number:** 3RF1MH123407-01S1
- **Recipient organization:** CLEVELAND CLINIC LERNER COM-CWRU
- **Principal Investigator:** Cynthia M. S. Kubu
- **Activity code:** RF1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $81,305
- **Award type:** 3
- **Project period:** 2020-07-21 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10598171

## Citation

> US National Institutes of Health, RePORTER application 10598171, Ethics of the Choice of Invasive versus Non-invasive Neurosurgery: DifferentStakeholders' Perspectives, Surgical Decision-making, and Impact on Patient Sense ofControl (3RF1MH123407-01S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10598171. Licensed CC0.

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