D5) Discussion post – Feb 10

Case: For several years, you have been working with a patient who has advanced Parkinson’s disease. The patient has been suffering from lack of motor control since becoming your patient. A year ago, you and the patient decided to try experimental deep brain stimulation (DBS) treatments (see main article under “Personal Identity” for a bit more context for this case) to treat the motor symptoms of his Parkinson’s. The DBS treatments have almost completely alleviated the motor control issues, but the patient suffers from catastrophic mood swings and violent outbursts when the DBS is active. After the first DBS treatment, the patient requested that you stop the DBS treatment because he couldn’t handle the mood swings and outbursts (though, there doesn’t seem to be any threat of harm from these outbursts, but they are scary for the patient and those close to him). However, just a few days after removing the DBS kit, the motor control issues returned and the patient requested that you try the DBS again, but this time with different electrode placement. You agree and perform the risky procedure again. Once again, the patient’s motor control issues all but vanish and the patient becomes emotionally unstable, often ranting and rambling nonsensically. Once again, he asks you to cease the DBS treatment. You can be fairly certain that the motor control issues will return after you cease the DBS treatment. You also know that the motor issues are debilitating to the patient, essentially destroying his quality of life due to their severity. You can also be fairly certain that the patient will, once the DBS is ceased, ask you to reactivate or even replace the DBS kit once again, and ask that you ignore him if he asks you to cease the DBS treatment again. Other experts have looked into this case with you and there doesn’t seem to be any alternative treatments available. You can either leave the DBS in and alleviate the the motor control issues and try to treat the psychological side effects, or you can remove the DBS and refuse to perform the risky procedure a third time, leaving the patient with debilitating motor control issues. In either case, you can be sure that the patient will request the opposite of whatever state you decide he should be left in.

TASK 1: Identify and explain the issues with autonomy and consent in this case. Make sure you offer some discussion about how using DBS, a proven but still emerging neurotechnology, uniquely affects your considerations about autonomy and consent. It may help to compare DBS to a treatment that does not directly affect cytoarchitecture.

TASK 2: Argue FOR continuing DBS or AGAINST continuing DBS in this case. Make sure you give supporting reasons for your argument, which should, at least, involve a further discussion of autonomy and consent. (Hint: Feel free to discuss “who” you are talking to in each state).