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[与用于精神疾病的深部脑刺激相关的伦理问题]

[Ethical issues relating to deep brain stimulation for psychiatric disorders].

作者信息

Leentjens A F G, Horstkötter D, de Wert G

出版信息

Tijdschr Psychiatr. 2017;59(10):662-666.

Abstract

Deep brain stimulation (dbs) can improve the quality of life of patients with therapy-resistant obsessive compulsive disorder (ocd). For other psychiatric indications, dbs should still be regarded as an experimental treatment.
AIM: To discuss potential ethical issues associated with the use of dbs in the treatment of psychiatric disorders.
METHOD: Ethical discourse.
RESULTS: The ethical issues associated with the use of dbs to treat psychiatric disorders are no different from those that may arise during psychotherapeutic or pharmacological treatments. However, in view of the intensive and invasive nature of dbs, special attention should be given to establishing the indication for dbs treatment and discussions about the continuation or cessation of dbs in case of side-effects or lack of effect. Except in the case of ocd, dbs in psychiatry is provided mainly in a research context in which ethical questions, such as those relating to competence, need to be carefully considered.
CONCLUSION: The basic ethical principles in medicine generally provide an adequate basis for guiding clinical decisions relating to the use of dbs in the treatment of psychiatric disorders. However, as dbs treatment for psychiatric disorders continues to develop, proactive reflection on ethical issues is warranted.

摘要

深部脑刺激(DBS)可改善难治性强迫症(OCD)患者的生活质量。对于其他精神科适应症,DBS仍应被视为一种实验性治疗方法。

目的

探讨DBS用于治疗精神疾病相关的潜在伦理问题。

方法

伦理讨论。

结果

与使用DBS治疗精神疾病相关的伦理问题与心理治疗或药物治疗期间可能出现的问题并无不同。然而,鉴于DBS的强化性和侵入性,应特别注意确定DBS治疗的适应症,并在出现副作用或无效时讨论DBS的继续或停止使用。除强迫症外,精神科的DBS主要在研究背景下进行,其中与能力等相关的伦理问题需要仔细考虑。

结论

医学中的基本伦理原则通常为指导与使用DBS治疗精神疾病相关的临床决策提供了充分依据。然而,随着精神疾病的DBS治疗不断发展,有必要对伦理问题进行前瞻性思考。

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