Schechtman Marya
University of Illinois at Chicago, USA.
J Clin Ethics. 2010 Summer;21(2):133-9.
Deep brain stimulation (DBS) has in some cases been associated with significant psychological effects and/or personality change. These effects occur sometimes as acute changes experienced intraoperatively or during the initial setting of the stimulator and sometimes as longer term progressive changes in the months following surgery. Sometimes they are the intended outcome of treatment, and in other cases they are an unintended side-effect. In all of these circumstances some patients and caregivers have described the psychological effects of DBS as frightening or disconcerting. I trace the source of these negative reactions to the fear that stimulation-related psychological and personality changes represent a threat to personal identity and agency. This issue has implications both for philosophical theories of personal identity and agency and for clinical concerns. A narrative account of personal identity is developed to illuminate the nature of the threat to identity and agency DBS potentially poses, and to suggest steps that might be taken to mitigate and avoid these threats.
在某些情况下，深部脑刺激（DBS）会产生显著的心理效应和/或人格变化。这些效应有时表现为术中或刺激器初始设置期间经历的急性变化，有时则表现为术后数月内的长期渐进性变化。有时它们是治疗的预期结果，而在其他情况下则是意外的副作用。在所有这些情况下，一些患者和护理人员都将DBS的心理效应描述为令人恐惧或不安。我将这些负面反应的根源追溯到这样一种恐惧，即与刺激相关的心理和人格变化对个人身份和能动性构成了威胁。这个问题对个人身份和能动性的哲学理论以及临床关注都有影响。本文构建了一个关于个人身份的叙事性描述，以阐明DBS可能对身份和能动性构成的威胁的本质，并提出可能采取的减轻和避免这些威胁的措施。
