The American Society for Bioethics has chosen Dr. Joseph Fins as its president for the 2011 term, a choice that will likely bring needed attention to the ethical issues surrounding the implementation of deep brain stimulators.
For much of his career at Weill Cornell Medical college, Fins has done what bio-ethecists do—fretted, advocated, encouraged, and debated about the proper treatment of patients. He's shown particular concern for people who recieve deep brain stimulation while in a state of vegetation and has written numerous papers about the potential benefits of this kind of therapy.
Patients who have been unresponsive for over about a year have traditionally been viewed as hopeless cases and are not typically considered as candidates for DBS. A 2007 paper by Fins in Nature challenged this dogma when it revealed therapeutic benefits for a patient who recieved DBS after having been in a minimally concious state for over six years. The work not only broadens the therapeutic spectrum for this kind of patient, but also complicates our standard diagram of conciousness, which we tend to view as a discrete state. The mind of a vegetative patient begins to look more like a banked fire scattered with embers and the potential to at least partially reignite.
But then comes the ethical part. With a device as new and sucessful and complicated as the deep brain stimulator, great care needs to be taken to ensure that the individuals who go under the knife and allow surgeons to wire up their thought boxes are treated more as patients than as research subjects. Fins has used many panel discussions and opinion articles to discuss the on going care of DBS patients, and urge surgeons to make the long term commitment to patients who have already been mined for data.
One of the main problems that Fins talks about, beyond a lack of long-term initiative, is the need to spread basic neurosurgical information beyond specialists. When a patient goes home to a small community after recieving a deep brain stimulator, it is not acceptable for them to have to return to a specialized facility every time they need a minor tune up or a new battery. Fins likens the situation to the relative ease of maintaining a heart pacemaker, and says we can do better.
Lest people like Fins come across as downers, it's important to point out that his suggestions serve not only to caution people in the field of DBS. Doing things like developing long-term relationships with DBS patients will ultimately benefit the technology as we gather complete records of its perormance. Hopefully will is part of his agenda as presdent next year.