The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics (...) that mention putative DBS-induced changes to patients’ postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probablyin lieuof robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS. (shrink)

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights (...) from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement. (shrink)

The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding (...) patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? (shrink)

Although being generally safe, the use of Deep Brain Stimulation has been associated with a significant number of patients experiencing postoperative psychological and neurological harm within experimental trials. A proportion of these postoperative severe adverse effects have lead to the decision to medically prescribe device deactivation or removal. However, there is little debate in the literature as to what is in the patient’s best interest when device removal has been prescribed; in particular, what should be the conceptual approach to ethically (...) guide the decision to remove or maintain implants. The purpose of this article is to examine the ethical issues raised when patients refuse brain device explantation despite medical prescription. In order to illustrate these issues, we report and discuss a clinical case involving a patient suffering from treatment resistant depression who experienced forms of postoperative self-estrangement, as well as suicidal attempts, but who resists giving consent to device explantation. (shrink)

Deep brain stimulation has been regarded as an efficient and safe treatment for Parkinson’s disease since being approved by the Food and Drug Administration in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase (...) life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced—harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers’ burden. (shrink)

Optogenetics is being optimistically presented in contemporary media for its unprecedented capacity to control cell behavior through the application of light to genetically modified target cells. As such, optogenetics holds obvious potential for application in a new generation of invasive medical devices by which to potentially provide treatment for neurological and psychiatric conditions such as Parkinson's disease, addiction, schizophrenia, autism and depression. Design of a first-in-human optogenetics experimental trial has already begun for the treatment of blindness. Optogenetics trials involve a (...) combination of highly invasive genetic and electronic interventions that results in irreversible and permanent modifications of an individual's nervous system. Given its novelty, its uncertain benefit to patients, and its unique risk profile of irreversible physiological alteration, optogenetics requires a reassessment of the ethical challenges for protecting human participants in clinical trials, particularly at formative stages of clinical evaluation. This study explores the evolving ethical issues surrounding optogenetics’ potential harm to participants within trial design, especially focusing on whether Phase 1 trials should incorporate efficacy as well as safety endpoints in ways that are fair and respectful to research trial participants. (shrink)

In this article, we explore the implications of a Rawlsian theory for intergenerational issues. First, we confront Rawls's way of locating his `just savings' principle in his Theory of Justice with an alternative way of doing so. We argue that both sides of his intergenerational principle, as they apply to the accumulation phase and the steady-state stage, can be dealt with on the bases, respectively, of the principle of equal liberty and of the difference principle. We then proceed by focusing (...) on the implications of applying maximin to his steady-state stage. One central claim is that, in principle, Rawlsians should consider not only generational dissavings, but also generational savings, as unfair. This principle suffers a series of exceptions on which we focus in the fourth section of the article. In some cases, growth can be maximin compatible. (shrink)

To conclude that there is enough or not enough evidence demonstrating that deep brain stimulation causes unintended postoperative personality changes is an epistemic problem that should be answered on the basis of established, replicable, and valid data. If prospective DBS recipients delay or refuse to be implanted because they are afraid of suffering from personality changes following DBS, and their fears are based on unsubstantiated claims made in the neuroethics literature, then researchers making these claims bear great responsibility for prospective (...) recipients' medical decisions and subsequent well-being. Our article “Deflating the ‘DBS causes personality’ bubble” reported an increase in theoretical neuroethics publications suggesting putative DBS-induced changes to personality, identity, agency, autonomy, authenticity and/or self and a critical lack of supporting primary empirical studies. This special issue of Neuroethics brings together responses to our initial publication, with our own counter-responses organized according to common themes. We provide a brief summary for each commentary and its main criticisms as well as a discussion of the way in which these responses can: 1) help clarify the meaning of PIAAAS, suggesting supplementary frameworks for understanding the impact of DBS on PIAAAS; 2) provide further empirical evidence of PIAAAS by presenting results from the researchers’ own work; and/or 3) offer a critique of our research approach and/or findings. Unintended postoperative putative changes to PIAAAS remain a critical ethical concern. It is beyond dispute that we need to develop reliable empirical and conceptual instruments able to measure complex cognitive, affective, and behavioural changes in order to investigate whether they are attributable to DBS alone. (shrink)

Owing to an oversight, we noted that the acknowledgement section was missing from the original published version of this paper.

Haeusermann et al. (Citation2023) draw three overall conclusions from their study on closed loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. The first is that closed-loop neuromodulation devices did not substantially change epileptic patient’s personalities or self-perception postoperatively. The second is that some patients and caregivers attributed observed changes in personality and self-perception to the epilepsy itself and not to the DBS treatments. The third is that the devices provided participants with novel ways to make sense of their (...) illness. These findings further demonstrate a misalignment between some neuroethicists’ concerns about putative postoperative changes to personality, and the empirical evidence for such changes. Haeusermann et al. nonetheless concede that “neurotechnology directed at persisting rather than episodic clinical phenomena could have greater implications for personality or self-perception, either because they operate more continuously or are directed at clinical phenomena that are more stably integrated into patients’ self-concepts” (41). We acknowledge that the hypothesis that participants did not report changes because they were only episodically and not continually stimulated offers an interesting line for future investigation. Nonetheless, we would like to propose that potential postoperative personality changes might be correlated with the pathophysiology itself, rather than the stimulation effects of the technology. Generally, we advance the view that unintended effects solely induced by the technology cannot be excluded per se. Regardless, this comment aims to highlight that ethicists’ starting premise should be that patients suffering from diverse pathophysiology, or patients who are treated with stimulation in different brain regions and with differing parameters, would likely not react in the same way to treatment. (shrink)

One important concern regarding implantable Brain Computer Interfaces is the fear that the intervention will negatively change a patient’s sense of identity or agency. In particular, there is concern that the user will be psychologically worse-off following treatment despite postoperative functional improvements. Clinical observations from similar implantable brain technologies, such as deep brain stimulation, show a small but significant proportion of patients report feelings of strangeness or difficulty adjusting to a new concept of themselves characterized by a maladaptive je ne (...) sais quoi despite clear motor improvement. Despite the growing number of cases in the DBS literature, there is currently no accepted or standardized tool in neuroethics specifically designed to capture the phenomenological postoperative experience of patients implanted with DBS or BCI devices. Given potential risks of postoperative maladaptation, it is important for the field of neuroethics to develop a qualitative instrument that can serve as a shared method for capturing postoperative variations in patient experience of identity and agency. The goal of this article is to introduce an instrument we have developed for this purpose and call for further neuroethical efforts to assess the phenomenology of implantable brain device use. (shrink)

Philosophical ability, so that the principles chosen for formalization are not trivial or absurd.

In her article, Pascale Hess raises the issue of whether her proposed model may be extrapolated and applied to clinical research fields other than stem cell-based interventions in the brain (SCBI-B) (Hess 2012). Broadly summarized, Hess’s model suggests prioritizing efficacy over safety in phase 1 trials involving irreversible interventions in the brain, when clinical criteria meet the appropriate population suffering from “degenerative brain diseases” (Hess 2012). Although there is a need to reconsider the traditional phase 1 model, especially with respect (...) to first-in-human clinical trials involving novel technologies, the question arises as to whether it is appropriate to advocate for a new model that prioritizes efficacy over safety across all phase 1 clinical research trials involving irreversible interventions in the brain. -/- . (shrink)

Deep brain stimulation (DBS) is optimistically portrayed in contemporary media. This already happened with psychosurgery during the first half of the twentieth century. The tendency of popular media to hype the benefits of DBS therapies, without equally highlighting risks, fosters public expectations also due to the lack of ethical analysis in the scientific literature. Media are not expected (and often not prepared) to raise the ethical issues which remain unaddressed by the scientific community. To obtain a more objective portrayal of (...) DBS in the media, a deeper collaboration between the science community and journalists, and particularly specialized ones, must be promoted. Access to databases and articles, directly or through science media centers, has also been proven effective in increasing the quality of reporting. This article has three main objectives. Firstly, to explore the past media coverage of leukotomy, and to examine its widespread acceptance and the neglect of ethical issues in its depiction. Secondly, to describe how current enthusiastic coverage of DBS causes excessive optimism and neglect of ethical issues in patients. Thirdly, to discuss communication models and strategies to enhance media and science responsibility. (shrink)

In their article, Herrera-Ferra et al. (2023) highlight how the progress and implementation of neurotechnology, especially in conjunction with artificial intelligence, have revealed potential impli...

The idea of creation as the free, spontaneous, and joyous play (līlā) of the gods has been a pervasive motif in Indian thought since Vedic times. In the tradition of Advaita Vedānta, however, where the sole Reality is Brahman alone, divine playfulness is given an illusionistic interpretation and līlā becomes an expression of the deceptive power of māyā.

A view inherited from Max Weber states that purposive rational action, value rational action and affective action are three distinct types of social action that can compete, oppose, complement or substitute each other in social explanations. Contrary to this statement, I will defend the view that these do not constitute three different types of social actions, but that social actions always seem to concurrently involve rationality, normativity and affectivity. I show this by discussing the links between rational actions and consequentialism (...) and non-consequentialism, and by elaborating on certain major relationships between rationality, normativity and emotions. (shrink)

Some writers have noted that valuation is often focused on foreseen changes. They say that we often don't value situations in terms of what we would have in them only but also in terms of the gains or losses that they offer us — that we then focus on departures from our status quo. They argue that such thinking conflicts with basic economic analysis, and also that it violates logic: they say that it is irrational. I agree that it seems (...) to be common. But is such a way of setting one's values a challenge to economics? And does it conflict with being rational? (shrink)

Han Fei (around 280 to 233 B.C.) advocates a strong and orderly state based on the absolute authority of the state and the law. Han Fei is usually not associated with human rights. His philosophy is difficult to reconcile with civil and political human rights, even if some of his political concepts support the realization of certain human rights. However, Han Fei’s ideas help us to gain a better understanding of the People’s Republic of China’s official human rights narrative. The (...) PRC emphasizes collective social and economic human rights, views the authority of the Communist Party as a prerequisite for the realization of human rights, and advocates rule by law, i.e. using the law as a tool of governance. This largely conforms to Han Fei‘s views on the role of the authority of the state and the law, and the relationship between the government and its citizens. (shrink)

Mathematical continuity, in the technical sense, is a precisely definable mathematical notion which refers to certain properties of numbers and number sequences. The continuity of the physical world, on the other hand, is rather different from mathematical continuity, since it is a directly experienced attribute of nature and does not require, for being understood, any mathematical theory of properties of numbers.

The question of whether Deep Brain Stimulation (DBS), as open-loop, closed-loop or adaptative technology, induces unwanted effects on patients’ personality is still an ongoing multidisciplinary deb...

Buddhism was not really known in the West until a little more than 150 years ago. Although since the thirteenth century there had been numerous contacts with local Buddhist traditions, the travellers and missionaries of the Middle Ages and the Renaissance had not yet brought to light the history of Buddhism and its unity across this immense diversity of worship and doctrine, disseminated through most of the countries of Asia. Of course, since the seventeenth century some Europeans had guessed at (...) the Indian origin of the Buddha and they succeeded in pinning down his historical existence after a fashion. In 1691 and 1693 Simon de la Loubère, Louis XIV's envoy at the court of the king of Siam, published remarkable research which established the possibility of a link between the different regions of Siam, Ceylon, Japan and China and conjured up the possible existence of a single founder long before Christ. But this far too isolated knowledge had scarcely any impact in Europe. It was only with the foundation of the Asiatic Society of Bengal in 1784 that orientalism was to enjoy a rapid and decisive expansion. The word ‘Buddhism’ appeared from the 1820s onwards, and with it the first conceptualization of a tree with many branchings. But it was not until the publication, in 1844, of Eugène Burnouf's magisterial Introduction l'histoire du buddhisme indien, that more detailed knowledge became available, thanks to a critical scrutiny of the most varied sources. The works of the French scholar and of other pioneers in Buddhist studies - mainly Alexander Csoma de Koros and Edmond Foucaux on Tibet, Jean-Pierre Abel-Remusat and Stanislas Julien on China, Christian Lassen and Spence Hardy on Ceylon - were to give rise to a tremendous craze for Buddhism in Europe. Since then there has been no break in the successive waves disseminating it right up to the present day, when the majority of Western countries appear to be so receptive to the message of the Buddha that for some years the media have been insistently questioning the reasons for this ‘Buddhist wave’. (shrink)

We resolve a useful formulation of the question how a statistician can coherently incorporate the information in a consulted expert’s probability assessment for an event into a personal posterior probability assertion. Using a framework that recognises the total information available as composed of units available only to each of them along with units available to both, we show: that a sufficient statistic for all the information available to both the expert and the statistician is the product of their odds ratios (...) in favour of the event; that the geometric mean of their two probabilities specifies a contour of pairs of assertions in the unit-square that yield the same posterior probability; that the information-combining function is parameterised by an unknown probability for the event conditioned only on the unspecified information common to both the statistician and the expert; and that an assessable mixing distribution over this unspecified probability allows an integrable mixture distribution to represent a computable posterior probability. The exact results allow the identification of the subclass of coherent probabilities that are externally Bayesian operators. This subclass is equivalent to the class of combining functions that honour the principles of uniformity and compromise. (shrink)

La politesse n’est pas seulement chez Hume une dissimulation sociale de l’orgueil et une vertu artificielle exigée par la vie en société, elle permet une intensification de la sympathie entre les hommes. Bien qu’elle repose sur une convention, comme la vertu de justice, son exercice est si manifestement désirable que l’artifice prend ici le caractère de la spontanéité et de l’agrément. Ainsi, même si la pensée de Hume échappe à l’idéalisation humaniste d’une sociabilité à la fois vertueuse et naturelle, elle (...) se démarque également de la tradition augustinienne et mandevillienne par le rôle donné à la sympathie et par la valeur éthique accordée à l’orgueil justifié, à la pratique de la conversation, et à la facilité dans l’exercice de la sociabilité. (shrink)