Self-Estrangement & Deep Brain Stimulation: Ethical Issues Related to Forced Explantation

Although being generally safe, the use of Deep Brain Stimulation (DBS) has been associated with a significant number of patients experiencing postoperative psychological and neurological harm within experimental trials (i.e. self-estrangement, hypersexuality, hypomania, suicidality, impulse control disorders, etc.). A proportion of these postoperative severe adverse effects have lead to the decision to medically prescribe device deactivation or removal. However, there is little debate in the literature as to what is in the patient’s best interest when device removal has been prescribed; in particular, what should be the conceptual approach to ethically guide the decision to remove or maintain implants. The purpose of this article is to examine the ethical issues raised when patients refuse brain device explantation despite medical prescription. In order to illustrate these issues, we report and discuss a clinical case involving a patient suffering from treatment resistant depression who experienced forms of postoperative self-estrangement, as well as suicidal attempts, but who resists giving consent to device explantation.