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Justice and Equity in Trials of Deep Brain Stimulation for the Treatment of Addiction and Overeating

are themselves manipulated by DBS, since DBS arguably alters not only first-order emotions, but all emotions— even those interconnected with deeply held beliefs and values. If a patient’s feelings about food, drugs, playing with children, and even DBS are manipulated, then so are the patient’s beliefs—since beliefs and emotions are intimately and inextricably connected. Therefore, post-DBS, the patient is not without controlling influence over her or his beliefs and evaluative judgments, and cannot grant autonomous authorization to the effects of that procedure. The patient fails to meet all of Faden and Beauchamp’s (1986) criteria for informed consent. Even when a patient has the decisional capacity to provide informed consent to undergo DBS for treatment of addiction and substance abuse, the patient will lack the capacity thereafter to consent to the global changes in personality and emotional experience that result. There is an important follow-up question, though: Does the presence of a controlling influence invalidate consent granted post DBS to continue stimulation? Faden and Beauchamp state, “There may be compelling policy or moral justifications in some contexts for adopting consent requirements that establish a threshold below the level of substantial autonomy, in effect treating less than substantially autonomous consents as valid or, more precisely, effective consents” (1986, 241). Increased well-being, better family life and more fulfilling relationships, job security, and other perks of substance-abuse-free living may be compelling enough reasons to continue DBS when the patient consents to even radical changes in personality. However, we should be reluctant to call this informed consent as it is traditionally understood as “autonomous authorization,” since DBS is, arguably, a controlling influence over the patient’s emotions and, therefore, even deeply held beliefs.