Problems With Seeing DBS Recipients Primarily as Research Subjects

摘要

Pisapia and colleagues, in their 2013 paper “Ethical Considerations in Deep Brain Stimulation for the Treatment of Addiction and Overeating Associated With Obesity,” present an argument in favor of regarding the recipients of experimental interventions, specifically, deep brain stimulation (DBS) for addiction and obesity, primarily as research subjects. In general, they argue that more research is needed in this area, and for particular ethical concerns that must be considered when designing and implementing clinical trials. That is, there is an underlying assumption that clinical research is the appropriate paradigm for progress in applying DBS as a treatment for obesity and addiction, because uncertainty about how stimulation works and for whom it works best remains. This comment presents a counterargument, that this same uncertainty justifies prioritizing a paradigm of individualized care or practice, instead of generalizable knowledge or research, when assessing whether obesity and addiction are appropriate indications for DBS.