Authenticity Versus Autonomy in Choosing the New Me: Beyond IEC and NIEC in DBS

摘要

Johansson and colleagues' (2014) distinction between Inherent Ethical Concerns (IEC) and Noninherent Ethical Concerns (NIEC) is put forward as a common analytic tool for ethical evaluation of neuromodulation technologies, including DBS. I evaluate their claim by applying their model to a deeper consideration of authenticity, drawing upon factors they do not mention. These include whether the pretreatment or post-treatment state of someone treated with DBS should be considered as authentic, how much control over the settings of the DBS device the patient should have, the impact on the family/ carers of personality changes posttreatment, issues with the authenticity of consent procedures and the implications of preferences for post-treatment states by patients where these are viewed as problematic by families/carers and/or by clinicians. I conclude that the IEC/NIEC model holds promise, but that complex ethical issues which fall outside it.