Deep brain stimulation: a principled and pragmatic approach to understanding the ethical and clinical challenges of...

DBS has emerged in the past few decades as a powerful clinical tool in the treatment of movement disorders such as dystonia and Parkinson's disease. As a result of its striking effects, the therapeutic utility of DBS has been investigated in a number of different neurological and neuropsychiatric conditions. Ethical discussion has accompanied this evolution of DBS and has led to the identification of a number of important ethical challenges. In this chapter, we review these challenges based on three of the key principles of biomedical ethics (autonomy, justice, and non-maleficence). Specifically, we adopt a pragmatic perspective by reviewing the ethical issues as they emerge within the context of Parkinson's disease, as this can serve to guide further ethical thinking on the future of DBS. Through this contextualization, we enrich the meaning of the Ethical principles and increase their specificity. We hope that this contribution will inform readers and also stimulate discussion related to areas where important questions remain unanswered and where further research would need to be undertaken to understand and enact ethical principles.