Threats to Neurosurgical Patients Posed by the Personal Identity Debate
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ORIGINAL PAPER
Threats to Neurosurgical Patients Posed by the Personal Identity Debate Sabine Müller & Merlin Bittlinger & Henrik Walter
Received: 13 September 2016 / Accepted: 16 January 2017 # Springer Science+Business Media Dordrecht 2017
Abstract Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative Bstandard view^ on personal identity is contentious. Second, diverse accounts of personal identity have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for Bdiagnosing^ the supposed changes in Bidentity^ are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism. We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the S. Müller (*) : M. Bittlinger : H. Walter Department for Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany e-mail: [email protected]
established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies. We recommend a pragmatic approach: (1) empirical research on personality changes arising from brain disorders or interventions, (2) comprehensive information about risks of personality changes, and (3) advance directives, particularly Ulysses contracts. Keywords Personal identity . Narrative identity . Personality change . Deep brain stimulation . Neuroethics . Advance directives
Introduction Deep brain stimulation (DBS) is used for an increasing number of patients with severe, treatment-refractory neurological and psychiatric diseases. With the rise of DBS, a new wave of ablative psychosurgery started in 1999 [1]. Regardless of whether one welcomes this potential expansion of therapeutic options or is alarmed by the increasing technological control over the patients’ minds, functional neurosurgery must stay high on the agenda of neuroethics. The increasing possibilities to intervene in the brain have raised the concern that patients’ personalities may be significantly changed. The debate has been fueled
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