Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Actio
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ORIGINAL PAPER
Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence Laura Klaming & Pim Haselager
Received: 29 April 2010 / Accepted: 7 September 2010 # The Author(s) 2010. This article is published with open access at Springerlink.com
Abstract Deep brain stimulation (DBS) is a wellaccepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop L. Klaming (*) Tilburg Institute for Law, Technology, and Society, Tilburg University, P. O. Box 90153, 5000 LE Tilburg, The Netherlands e-mail: [email protected] P. Haselager Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands e-mail: [email protected]
treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research. Keywords Deep brain stimulation . Personal identity . Psychological continuity . Responsibility for action . Mental competence
Introduction Deep brain stimulation (DBS) is a well-accepted treatment for movement disorders, including Parkinson’s disease (PD), Dystonia and Essential Tremor if symptoms are medically intractable and/or medical treatment has serious side effects. The application of DBS in patients with movement disorders was found to result in considerable alleviation of motor symptoms and reduced medication needs [1–5]. The finding that DBS affects neural activity in brain areas involved in cognitive and affective functions led to the extended use of DBS from motor disorders to psychiatric disorders including depression [6, 7] and obsessive-compulsive disorder [8–10]. Given the successfulness of the treatment and the continuing advancement of the technology, it seems likely that
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