DBS, Enhancement & Ethics

Placement of an electrode into the brain. The ...

Placement of an electrode into the brain. The head is stabilised in a frame for stereotactic surgery. (Photo credit: Wikipedia)

Deep Brain Stimulation (DBS) involves the surgical implantation of electrodes into a patient’s brain that, as the name indicates, stimulate the brain. Currently the procedure is used to treat movement disorders (such as Parkinson’s disease, dystonia and essential tremor) and Tourette’s syndrome. Research is currently underway for using the procedure to treat neuropsychiatric disorders (such as PTSD) and there is some indications that it can help with the memory loss inflicted by Alzheimers.

From a moral standpoint, the use of DBS in treating such conditions seems no more problematic than using surgery to repair a broken bone. If these were the only applications for DBS, then there would be no real moral concerns about the process. However, as is sometimes the case in medicine, there are potential applications that do raise moral concerns.

One matter for concern has actually been a philosophical problem for some time. To be specific, DBS can be used to stimulate the nucleus accumbens (a part of the brain associated with pleasure). While this can be used to treat depression, it can also (obviously) be used to create pleasure directly—the infamous pleasure machine scenario of so many Ethics 101 classes (the older version of which is the classic pig objection most famously considered by J.S. Mill in his work on Utilitarianism). Thanks to these stock discussions, the ethical ground of pleasure implants is well covered (although, as always, there are no truly decisive arguments).

While the sci-fi/philosophy scenario of people in pleasure comas is interesting, what is rather more interesting is the ethics of DBS as a life-enhancer. That is, getting the implant not to use to excess or in place of “real” pleasure, but to just make life a bit better. To use the obvious analogy, the excessive scenario is like drinking oneself into a stupor, while the life-upgrade would be like having a drink with dinner. On the face of it, it would be hard to object if the effect was simply to make a person feel a bit better about life—and it could even be argued that this would be preventative medicine. Just as person might be on medication to keep from developing high blood pressure or exercise to ward off diabetes, a person might get a brain boost to ward off potential depression. That said, there is the obvious concern of abusing the technology (and the iron law of technology states that any technology that can be abused, will be abused).

Another area of concern is the use of DBS for other enhancements. To use a specific example, if DBS can improve memory in Alzheimer’s patients, then it could do the same for healthy people. It is not difficult to imagine some people seeking to boost their memory or other abilities through this technology. This, of course, is part of the general topic of brain enhancements (which is part of the even more general topic of enhancements). As David Noonan has noted, DBS could become analogous to cosmetic/plastic surgery: what was once intended to treat serious injuries has become an elective enhancement surgery. Just as people seek to enhance their appearance by surgery, it seems reasonable to believe that they will do so to enhance their mental abilities. As long as there is money to be made here, many doctors will happily perform the surgeries—so it is probably a question of when rather than if DBS will be used for enhancement rather than for treatment.

From a moral standpoint, there is the same concern that has long held regarding cosmetic surgery, namely the risk of harm for the sake of enhancement. However, if enhancing one’s looks via surgery is morally acceptable, then enhancing one’s mood, memory and so on should certainly be acceptable as well. In fact, it could be argued that such substantial improvements are more laudable than merely improving appearance.

There is also the stock moral concern with fairness: those who can afford such enhancements will have yet another advantage over those less well off, thus widening the gap even more. This is, of course, a legitimate concern. But, aside from the nature of the specific advantage, nothing new morally. If it is acceptable for the wealthy to buy advantages in other ways, this should not seem to be any special exception.

There is, of course, two practical matters to consider. The first is whether or not DBS will prove effective in enhancement. The answer seems likely to be “yes.” The second is whether or not DBS will be tarnished by a disaster (or disasters). If something goes horribly wrong in a DBS procedure and this grabs media attention, this could slow the acceptance of DBS. That said, horrific tales involving cosmetic surgery did little to slow down its spread. So, someday soon people will go in to get a facelift, a memory lift and a mood lift. Better living through surgery.

 

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  1. Where there is an anomaly DBS would be justified, it would not be justified for everyone. It should be available to all who have psychic anomalies, not just for the wealthy. Used merely as a life enhancer it could be abused. If painful memories that the mind has kept at bay surfaced all at once it could be disastrous.

    It has been said that happiness is not the absence of problems, but the ability to keep things in perspective and deal with them. A good mood earned through striving is owned. A good mood through a DBS procedure would give autonomy to an outside source creating dependence, which is never a good thing.

    As physical evolution involved struggle, psychic evolution also involves struggle. A person who strives to be happy acts in such a way so as to invite happiness, a person who is surgically enhanced to be happy, whose happiness is artificially created, would have no such incentive.

    There is no panacea without consequences; the law of relativity dictates that for every boon there is a bane. That is how the duality of relativity works, there is no escaping it. The bane associated with DBS for regular people free from anomalies, could be, in addition to loss of autonomy, a neutralization of psychic life similar to taking a drug. The ability to evolve by meeting challenges through natural ability would be stymied.

  2. A very thought-provoking article.

    I recently wrote a blogpost about my concerns related to the rolling-out of DBS to treatment of distress. I’d be grateful to hear what you think if you have time to take a look.

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