Witt Karsten, Kuhn Jens, Timmermann Lars, Zurowski Mateusz, Woopen Christiane
Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Herderstraße 54, 50931 Cologne, Germany.
Neuroethics. 2013;6(3):499-511. doi: 10.1007/s12152-011-9100-1. Epub 2011 Feb 16.
Ethical evaluation of deep brain stimulation as a treatment for Parkinson's disease is complicated by results that can be described as involving changes in the patient's identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson's disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is meant by "becoming another person" from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of "individual identity" which centers on the idea of "core attitudes". Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a "foundational-function model" highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal.
将深部脑刺激作为帕金森病的一种治疗方法进行伦理评估，因结果可被描述为涉及患者身份的改变而变得复杂。术后变成另一个人的风险，对患者、护理人员和临床医生来说都是令人担忧的。这是目前帕金森病深部脑刺激面临的最紧迫的概念和伦理问题之一。在我们的论文中，我们从两个方面探讨了这个问题。首先，我们从概念的角度阐明“变成另一个人”是什么意思。在批判性地讨论了两种广泛的方法之后，我们专注于以“核心态度”概念为中心的“个人身份”概念。随后，我们讨论了几种确定核心态度与更外围态度区别的方法。我们主张一种“基础功能模型”，强调这些态度之间特定依赖关系的重要性。我们的第二个目标是评论实证测量个人身份变化的可能性，并认为目前在选择和监测深部脑刺激患者时常用的许多工具不适用于此目的。建议该领域未来的研究将概念方法和实证方法结合起来，作为合理伦理评估的基础。
