Schermer Maartje
Medical Ethics and Philosophy of Medicine, ErasmusMC, Room AE 340, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Neuroethics. 2013;6(3):435-445. doi: 10.1007/s12152-011-9097-5. Epub 2011 Jan 27.
Deep Brain Stimulation (DBS) is a treatment involving the implantation of electrodes into the brain. Presently, it is used for neurological disorders like Parkinson's disease, but indications are expanding to psychiatric disorders such as depression, addiction and Obsessive Compulsive Disorder (OCD). Theoretically, it may be possible to use DBS for the enhancement of various mental functions. This article discusses a case of an OCD patient who felt very happy with the DBS treatment, even though her symptoms were not reduced. First, it is explored if the argument that 'doctors are not in the business of trading happiness', as used by her psychiatrist to justify his discontinuation of the DBS treatment, holds. The relationship between enhancement and the goals of medicine is discussed and it is concluded that even though the goals of medicine do not set strict limits and may even include certain types of enhancement, there are some good reasons for limiting the kind of things doctors are required or allowed to do. Next, the case is discussed from the perspective of beneficence and autonomy. It is argued that making people feel good is not the same as enhancing their well-being and that it is unlikely-though not absolutely impossible-that the well-being of the happy OCD patient is really improved. Finally, some concerns regarding the autonomy of a request made under the influence of DBS treatment are considered.
深部脑刺激（DBS）是一种将电极植入大脑的治疗方法。目前，它被用于治疗帕金森病等神经疾病，但适应症正在扩展到抑郁症、成瘾和强迫症（OCD）等精神疾病。从理论上讲，使用DBS增强各种心理功能是有可能的。本文讨论了一名强迫症患者的案例，尽管她的症状没有减轻，但她对DBS治疗感到非常满意。首先，探讨她的精神科医生用来为停止DBS治疗辩护的“医生不是从事交易幸福的行业”这一论点是否成立。讨论了增强与医学目标之间的关系，并得出结论，尽管医学目标没有设定严格限制，甚至可能包括某些类型的增强，但有一些充分的理由限制医生被要求或允许做的事情。接下来，从行善和自主的角度讨论该案例。有人认为，让人感觉良好与增进他们的福祉并不相同，而且这位快乐的强迫症患者的福祉真正得到改善的可能性不大，尽管并非绝对不可能。最后，考虑了一些关于在DBS治疗影响下提出的请求的自主性的问题。
