Building Intricate Partnerships with Neurotechnology: Deep Brain Stimulation and Relational Agency
Publication: IJFAB: International Journal of Feminist Approaches to Bioethics
Volume 13, Number 1
Abstract
Deep Brain Stimulation (DBS) is an FDA-approved treatment for symptoms of motor disorders—with experimental use for psychiatric disorders. DBS, however, causes a variety of side effects. Moral philosophers question DBS’s influence on users’ experiences of authenticity, identity, and/or autonomy. These characterizations of DBS, however, may not make sense of how DBS complicates, rather than simply impedes or bolsters, users’ abilities to exercise agency. Empirical work exploring DBS users’ lived-experiences and feminist accounts of relational autonomy demonstrate that the issues users face are better characterized in terms of the user’s relationship to their stimulator, that is, in terms of “relational agency.”
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References
Agid, Y., M. Schüpbach, M. Gargiulo, et al. 2006. “Neurosurgery in Parkinson’s Disease: The Doctor Is Happy, the Patient Less So?” Journal of Neural Transmission 70: 409–14. https://doi.org/10.1007/978-3-211-45295-0_61. Medline: 17017560
Alonso, Pino, Daniel Cuadras, Loes Gabriëls, et al. 2015. “Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.” PLoS ONE 10 (7): e0133591. https://doi.org/10.1371/journal.pone.0133591. Medline: 26208305
Baylis, Françoise. 2012. “The Self in Situ: A Relational Account of Personal Identity.” In Being Relational, ed. Jocelyn Downie and Jennifer J. Llewellyn, 109–31. Vancouver: UBC Press.
Baylis, Françoise. 2013. “‘I Am Who I Am’: On the Perceived Threats to Personal Identity from Deep Brain Stimulation.” Neuroethics 6 (3): 513–26. https://doi.org/10.1007/s12152-011-9137-1. Medline: 24273621
Belser, Julia Watts. 2016. “Vital Wheels: Disability, Relationality, and the Queer Animacy of Vibrant Things.” Hypatia 31 (1): 5–21. https://doi.org/10.1111/hypa.12217
Bierria, Alisa. 2014. “Missing in Action: Violence, Power, and Discerning Agency.” Hypatia 29 (1): 129–45. https://doi.org/10.1111/hypa.12074
Brown, Timothy, Margaret C. Thompson, Jeffrey Herron, et al. 2016. “Controlling Our Brains a Case Study on the Implications of Brain-Computer Interface-Triggered Deep Brain Stimulation for Essential Tremor.” Brain-Computer Interfaces 3 (4): 165–70. https://doi.org/10.1080/2326263X.2016.1207494
Clark, Andy. 2008. Supersizing the Mind: Embodiment, Action, and Cognitive Extension. Oxford: Oxford University Press.
Clark, Andy, and David Chalmers. 1998. “The Extended Mind.” Analysis 58 (1): 7–19. https://doi.org/10.1093/analys/58.1.7
Dos Santos, Joao Flores Alves, Sophie Tezenas du Montcel, et al. 2017. “Tackling Psychosocial Maladjustment in Parkinson’s Disease Patients Following Subthalamic Deep-Brain Stimulation: A Randomised Clinical Trial.” PLoS ONE 12 (4): e0174512. https://doi.org/10.1371/journal.pone.0174512. Medline: 28399152
Dubiel, Helmut. 2009. Deep within the Brain: Living with Parkinson’s Disease. New York: Penguin.
Fins, Joseph J. 2018. “Mosaic Decisionmaking and Reemergent Agency after Severe Brain Injury.” Cambridge Quarterly of Healthcare Ethics 27 (1): 163–74. https://doi.org/10.1017/S0963180117000329. Medline: 28918755
Gallagher, Shaun. 2000. “Philosophical Conceptions of the Self: Implications for Cognitive Science.” Trends in Cognitive Sciences 4 (1): 14–21. https://doi.org/10.1016/S1364-6613(99)01417-5
Gallagher, Shaun. 2018. “Deep Brain Stimulation, Self and Relational Autonomy.” Neuroethics, March: 1–13.
Glannon, W. 2009. “Stimulating Brains, Altering Minds.” Journal of Medical Ethics 35 (5): 289–92. https://doi.org/10.1136/jme.2008.027789. Medline: 19407032
Goddard, Eliza. 2017. “Deep Brain Stimulation through the ‘Lens of Agency’: Clarifying Threats to Personal Identity from Neurological Intervention.” Neuroethics 10 (3): 325–35. https://doi.org/10.1007/s12152-016-9297-0
Goering, Sara, Eran Klein, Darin D. Dougherty, et al. 2017. “Staying in the Loop: Relational Agency and Identity in Next-Generation DBS for Psychiatry.” AJOB Neuroscience 8 (2): 59–70. https://doi.org/10.1080/21507740.2017.1320320
Haan, Sanneke de, Erik Rietveld, Martin Stokhof, et al. 2013. “The Phenomenology of Deep Brain Stimulation-Induced Changes in OCD: An Enactive Affordance-Based Model.” Frontiers in Human Neuroscience 7 (October): 653. https://doi.org/10.3389/fnhum.2013.00653
Haan, Sanneke de, Erik Rietveld, Martin Stokhof, et al. 2017. “Becoming More Oneself? Changes in Personality Following DBS Treatment for Psychiatric Disorders: Experiences of OCD Patients and General Considerations.” PLoS ONE 12 (4): e0175748. https://doi.org/10.1371/journal.pone.0175748. Medline: 28426824
Hariz, Marwan I., Stig Rehncrona, Niall P. Quinn, et al. 2008. “Multicenter Study on Deep Brain Stimulation in Parkinson’s disease: An Independent Assessment of Reported Adverse Events at 4 Years.” Movement Disorders 23 (3): 416–21. https://doi.org/10.1002/mds.21888. Medline: 18067188
Hebb, Adam O., Jun Jason Zhang, Mohammad H. Mahoor, et al. 2014. “Creating the Feedback Loop.” Neurosurgery Clinics of North America 25 (1): 187–204. https://doi.org/10.1016/j.nec.2013.08.006. Medline: 24262909
Kellmeyer, Philipp, Thomas Cochrane, Oliver Müller, et al. 2016. “The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems.” Cambridge Quarterly of Healthcare Ethics 25 (4): 623–33. https://doi.org/10.1017/S0963180116000359. Medline: 27634714
Klaming, Laura, and Pim Haselager. 2013. “Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence.” Neuroethics 6 (3): 527–39. https://doi.org/10.1007/s12152-010-9093-1. Medline: 24273622
Klein, Eran, and C. S. Nam. 2016. “Neuroethics and Brain-Computer Interfaces (BCIs).” Brain-Computer Interfaces 3 (3): 123–25. https://doi.org/10.1080/2326263X.2016.1210989
Klein, Eran, Sara Goering, Josh Gagne, et al. 2016. “Brain-Computer Interface-Based Control of Closed-Loop Brain Stimulation: Attitudes and Ethical Considerations.” Brain-Computer Interfaces 3 (3): 140–48. https://doi.org/10.1080/2326263X.2016.1207497
Kraemer, Felicitas. 2011a. “Authenticity Anyone? The Enhancement of Emotions via Neuro-Psychopharmacology.” Neuroethics 4 (1): 51–64. https://doi.org/10.1007/s12152-010-9075-3. Medline: 21475717
Kraemer, Felicitas. 2011b. “Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation.” Neuroethics 6 (3): 483–97. https://doi.org/10.1007/s12152-011-9115-7. Medline: 24273619
Kraemer, Felicitas. 2013. “Authenticity or Autonomy? When Deep Brain Stimulation Causes a Dilemma.” Journal of Medical Ethics 39 (12): 757–60. https://doi.org/10.1136/medethics-2011-100427. Medline: 23355227
Kuncel, Alexis M., Scott E. Cooper, Barbara R. Wolgamuth, et al. 2006. “Clinical Response to Varying the Stimulus Parameters in Deep Brain Stimulation for Essential Tremor.” Movement Disorders 21 (11): 1920–28. https://doi.org/10.1002/mds.21087. Medline: 16972236
Lindemann, Hilde. 2009. “Holding One Another (Well, Wrongly, Clumsily) in a Time of Dementia.” Metaphilosophy 40 (3–4): 416–24. https://doi.org/10.1111/j.1467-9973.2009.01592.x
Lindemann, Hilde. 2014. Holding and Letting Go: The Social Practice of Personal Identities. Oxford: Oxford University Press.
Lipsman, Nir, and Walter Glannon. 2013. “Brain, Mind and Machine: What Are the Implications of Deep Brain Stimulation for Perceptions of Personal Identity, Agency and Free Will?” Bioethics 27 (9): 465–70. https://doi.org/10.1111/j.1467-8519.2012.01978.x. Medline: 22681593
Mackenzie, Catriona, and Mary Walker. 2015. “Neurotechnologies, Personal Identity, and the Ethics of Authenticity.” In Handbook of Neuroethics, ed. Jens Clausen and Neil Levy, 373–92. Dordrecht: Springer Netherlands.
Mayberg, Helen S. 2008. “Deep Brain Stimulation for Treatment-Resistant Depression.” Journal of Affective Disorders 107 (March): S23. https://doi.org/10.1016/j.jad.2007.12.153
Mayberg, Helen S., Andres M. Lozano, Valerie Voon, et al. 2005. “Deep Brain Stimulation for Treatment-Resistant Depression.” Neuron 45 (5): 651–60. https://doi.org/10.1016/j.neuron.2005.02.014. Medline: 15748841
Mayberg, Helen S., Patricio Riva-Posse, and Andrea L. Crowell. 2016. “Deep Brain Stimulation for Depression: Keeping an Eye on a Moving Target.” JAMA Psychiatry 73 (5): 439–40. https://doi.org/10.1001/jamapsychiatry.2016.0173. Medline: 27049731
Mecacci, Giulio, and W. F. G. Pim Haselager. 2014. “Stimulating the Self: The Influence of Conceptual Frameworks on Reactions to Deep Brain Stimulation.” AJOB Neuroscience 5 (4): 30–39. https://doi.org/10.1080/21507740.2014.951776
Meyers, Diana T. 1989. Self, Society, and Personal Choice. New York: Columbia University Press.
Meyers, Diana T. 2000. “Intersectional Identity and the Authentic Self?” In Relational Autonomy, edited by Catriona Mackenzie and Natalie Stoljar, 151–180. Oxford: Oxford University Press.
Pham, Uyen, Anne-Kristin Solbakk, Inger-Marie Skogseid, et al. 2015. “Personality Changes after Deep Brain Stimulation in Parkinson’s Disease.” Parkinson’s Disease 2015 (13): 1–7. https://doi.org/10.1155/2015/490507, https://doi.org/10.1155/2015/461453. Medline: 25705545
Schechtman, Marya. 2010. “Philosophical Reflections on Narrative and Deep Brain Stimulation.” The Journal of Clinical Ethics 21 (2): 133–39. Medline: 20866019
Schlosser, Markus. 2015. “Agency.” In Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta. Stanford, CA: Stanford Center for the Study of Language and Information. https://plato.stanford.edu/entries/agency/
Schüpbach, M., M. Gargiulo, M. L. Welter, and L. Mallet. 2006. “Neurosurgery in Parkinson Disease: A Distressed Mind in a Repaired Body?” Neurology 66 (12): 1811–16. https://doi.org/10.1212/01.wnl.0000234880.51322.16. Medline: 16801642
Scully, Jackie Leach. 2010. “Hidden Labor: Disabled/Nondisabled Encounters, Agency, and Autonomy.” IJFAB 3 (2): 25–42. https://doi.org/10.3138/ijfab.3.2.25
Sharp, Daniel, and David Wasserman. 2016. “Deep Brain Stimulation, Historicism, and Moral Responsibility.” Neuroethics 9 (2): 173–85. https://doi.org/10.1007/s12152-016-9260-0
Smeding, H. M. M., A. E. Goudriaan, E. M. J. Foncke, et al. 2007. “Pathological Gambling after Bilateral Subthalamic Nucleus Stimulation in Parkinson Disease.” Journal of Neurology, Neurosurgery & Psychiatry 78 (5): 517–19. https://doi.org/10.1136/jnnp.2006.102061. Medline: 17210626
Specker Sullivan, Laura. 2019. “Insight and the No-Self in Deep Brain Stimulation.” Bioethics 33 (4): 487–94. https://doi.org/10.1111/bioe.12539. Medline: 30474139
Voon, Valerie, Cynthia Kubu, Paul Krack, et al. 2006. “Deep Brain Stimulation: Neuropsychological and Neuropsychiatric Issues.” Movement Disorders 21 (S14): S305–27. https://doi.org/10.1002/mds.20963. Medline: 16810676
Wendell, Susan. 1989. “Toward a Feminist Theory of Disability.” Hypatia 4 (2): 104–24. https://doi.org/10.1111/j.1527-2001.1989.tb00576.x. Medline: 11787505
Widge, Alik S., Amanda R. Arulpragasam, Thilo Deckersbach, et al. 2015. Deep Brain Stimulation for Psychiatric Disorders. Vol. 57. An Interdisciplinary, Searchable, and Linkable Resource. Hoboken, NJ, USA: American Cancer Society.
Yuste, Rafael, Sara Goering, Blaise Agüera y Arcas, et al. 2017. “Four Ethical Priorities for Neurotechnologies and AI.” Nature News 551 (7679): 159–63. https://doi.org/ 10.1038/551159a. Medline: 29120438
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IJFAB: International Journal of Feminist Approaches to Bioethics
Volume 13 • Number 1 • Spring 2020
Pages: 134 - 154
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© IJFAB: International Journal of Feminist Approaches to Bioethics 2019.
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Published in print: Spring 2020
Published online: 4 March 2020
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International Journal of Feminist Approaches to Bioethics 2020 13:1, 134-154
International Journal of Feminist Approaches to Bioethics 2020 13:1, 134-154