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• W2000262071 abstract "Jared Pisapia and colleagues (2013) provide a sophisticated analysis of the ethical pitfalls of expanding deep brain stimulation (DBS) as a therapeutic option for addiction and overeating associated with obesity. We agree with their expectation that DBS is a promising treatment for these conditions. However, the authors’ assessment of ethical issues of this research field lacks the long-termperspective of turning (successful) clinical trials into routine clinical practice. We propose to assess such long-term consequences along twodimensions: The first one is the patient-related dimension, which involves, among others, information of patients, informed consent in normal treatment and research, shared decision making, criteria for patient selection, the assessment of outcome parameters, the psychosocial impact of the treatment, and follow-up strategies. The second dimension is the infrastructure-related dimension, which captures all aspects that are important for the development of a DBS infrastructure that can guarantee high-quality interventions. This includes issues like differences in technical and organizational procedures of centers, financing DBS interventions and research, long-term planning of center development, the information flow toward the public about chances and risks of DBS, and legislative issues of DBS (Abosch et al. 2012; Fins, Dorfman, and Pancrazio 2012). We recently performed two surveys amongDBS experts (n = 113) and DBS centers (n = 135) on the global practice of DBS (Christen et al. in preparation) that indeed indicate, as Pisapia and colleagues mention, that the indication spectrum of DBS is rapidly expanding. This trend includes even diseases for which many DBS experts think that the success probability of DBS is low (e.g., Alzheimer’s disease). This trend is, according to many experts, driven also by commercial interests. Of the centers in our survey, 16.3% plan to implement DBS research on addiction and 12.6% on obesity within the next 5 years; that is, it is indeed timely to start thinking on ethical consequences of this notably expansion. Some of our findings outline additional ethical aspects that need to be considered and that go beyondmere research ethics, which is the primary focus of Pisapia and colleagues. First, in the patient-related dimension, the information and the attitudes of the gatekeepers toDBS, namely, those physicians who are the key players with respect to patient information and patient referral, have to be considered. This is" @default.
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• W2000262071 date "2013-04-01" @default.
• W2000262071 modified "2023-10-03" @default.
• W2000262071 title "Expanding DBS Indications: Reminder of the Consequences of Establishing a Therapeutic Practice" @default.
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• W2000262071 doi "https://doi.org/10.1080/21507740.2013.782911" @default.
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