ETHICAL ISSUES IN NON INVASIVE AND SURGICAL BRAIN STIMULATION
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1 ETHICAL ISSUES IN NON INVASIVE AND SURGICAL BRAIN STIMULATION Vittorio A. Sironi Professor of History of Medicine and Health Director of Research Center on the History of Biomedical Thougth University of Milano Bicocca Milan, November 22, 2016
2 ETHICAL ISSUES IN BRAIN STIMULATION 1. Basic aspects in cerebral neuromodulation 2. Non-invasive brain stimulation (NIBS) 3. Deep brain stimulation (DBS) 4. Conclusion
3 BASIC ASPECTS IN CEREBRAL NEUROMODULATION
4 HISTORICAL ASPECTS OF CEREBRAL STIMULATION NON-INVASIVE BRAIN STIMULATION Brain electrical stimulation of the ancient Electroshock Transcranial brain stimulation SURGICAL BRAIN NEUROMODULATION Stereotactic lesional neurosurgery Cortical brain stimulation Deep brain stimulation
5 NON-INVASIVE BRAIN STIMULATION
6 BRAIN ELECTRIC STIMULATION OF THE ANCIENT
7 ELECTROSHOCK OF UGO CERLETTI (1938)
8 MAGNETIC TRANSCRANIC STIMULATION
9 SURGICAL BRAIN NEUROSTIMULATION
10 STEREOTACTIC LESIONAL NEUROSURGERY (1950) (irreversible)
11 THE PROPETHS OF DEEP BRAIN STIMULATION: PHYSICAL CONTROL OF THE MIND? Josè M. Delgado 1963 N. P. Bechterava 1972 I. S. Cooper
12 DELGADO, M. R., H. HAMLIN and W. P. CHAPMAN. Technique of intracranial electrode implacement for recording and stimulation and its possible therapeutic value in psychotic patients. Conf. neurol., 12: , 1952.
13 JOSÉ M. DELGADO (1951) The implantation of chronic brain electrodes
14 JOSÉ M. DELGADO (1970) José Delgado, 'Matador' With a Radio Stops Wired Bull Modified Behavior in Animals Subject of Brain Study NYT, 1970
15 JOSÉ M. DELGADO (1968) DELGADO, J. M. R., V. MARK, W. SWEET, F. ERVIN, G. WEISS, G. BACH-Y-RITA, and R. HAGIWARA. Intracerebral radio stimulation and recording in completely free patients. J, nerv. ment. Dis., 147: , 1968.
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17 CEREBELLAR STIMULATION I.S. COOPER 1972
18 THE PROTAGONIST OF THE MODERN DEEP BRAIN STIMULATION: THERAPEUTIC NEUROMODULATION 1986 Jean Sigfried 1987 Alim L. Benabid
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21 CORTICAL BRAIN STIMULATION
22 DEEP BRAIN STIMULATION (reversible)
23 HISTORICAL ASPECTS OF CEREBRAL NEUROMODULATION BRAIN MANIPULATION grossly modify brain structures that are reshaped TO BRAIN NEUROMODULATION fine-tune the brain structures which are harmonized
24 NEUROBIOLOGICAL ASPECTS OF CEREBRAL NEUROMODULATION Modification of cortical excitability Influence on anatomical brain structures and functional cerebral network Changes in the neurochemistry and in the balance of the neuromediators
25 NON-INVASIVE BRAIN STIMULATION
26 NIBS TENS (tdcs, tms) USE HEALTHY SUBJECTS FOR NEUROENHANCEMENT enhancement of human performances and increase of some skills of the individual (Children and Adults) PATIENT WITH PATHOLOGICAL CONDITIONS FOR THERAPY for ex.: depression, pain, stroke, etc..
27 ETHICAL CRITERIA AUTONOMY (respect individual freedom) BENEFICIENCE (do well) NON-MALEFIENCE (do no ham) JUSTICE (treat like case alike)
28 ETHICAL ISSUES technical aspects (simple and easy use) - machine can be used at any time - unlike pharmaceutical (internal use), machine is not ingested into the body (external use) non pertynent and inadeguate use patient selection healty people or pathological patients only? children or adults only? list of diseases to be treated conscious and autonomous acceptance adeguate use
29 ETHICAL ISSUES Treatment - unrealistic aspectations - changes in personal identity - changes in moral choices unespected psychological and behavioral modifications
30 DEEP BRAIN STIMULATION
31 DBS EVOLUTION USE PATIENT WITH PATHOLOGICAL CONDITIONS FOR THERAPY Parkinson s disease dyskinesias psychiatric disorders (depression, OCD, etc) Tourette syndrome headache pain eating disorders states of altered consciousness? HEALTHY SUBJECTS FOR NEUROENHANCEMENT?
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35 CONCLUSIONS
36 ETHICAL ISSUES IN NEUROMODULATION RESPECT FOR PERSONAL IDENTITY ATTENTION TO PERSONAL AUTONOMY PROPORTION BETWEEN BENEFITS AND RISKS (do no harm, do well) USE ALWAYS ETHICS GUIDELINES IN THERAPY AND RESEARCH
37 THANKS FOR YOUR ATTENTION
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