CoChat
Sign Up
Cited by 104Neuroethics, Human Enhancement, Biomedical InnovationsNeurological disorders and treatmentsEthics and bioethics in healthcare

The ethics of deep brain stimulation for the treatment of anorexia nervosa

Open access
Maslen, Hannah, Pugh, Jonathan, Savulescu, Julian·2015·Neuroethics
DOI 10.1007/s12152-015-9240-9PMC PMC4643100
Open this paper in CoChat — free accountOpen PDF

Abstract

There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation (DBS) could be used to treat some patients with Anorexia Nervosa (AN). Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific literature, relating to desire, control, and emotion, respectively. We explain why the precise nature of the mechanism has important implications for the patient's autonomy and personal identity. In the second part of the paper, we consider practical dimensions of offering DBS to patients with AN in certain cases. We first discuss some limited circumstances where the mere offering of the intervention might be perceived as exerting a degree of coercive pressure that could serve to undermine the validity of the patient's consent. Finally, we consider the implications of potential effects of DBS for the authenticity of the patient's choice to continue using stimulation to ameliorate their condition.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1007/s12152-015-9240-9

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The extent to which we should be concerned about eBCIs affecting authenticity largely depends on our understanding of the "true self".

    “The extent to which we should be concerned about eBCIs affecting our authenticity largely depends on our understanding of the “true self” [57].”

    From Ethical considerations for the use of brain–computer interfaces for cognitive enhancement (2024) · cites this paper as [57]

    In “Reversibility, Authenticity and Shared Decision-Making” (page unavailable), the paper links concerns about DBS and authenticity to the question of which preferences represent an authentic self. But it discusses DBS for anorexia nervosa, not eBCIs generally, and explicitly recommends assessing preferences over time rather than assuming one self is the “true” self. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 47

  1. [1]Israël M Steiger H Kolivakis T McGregor L Sadikot AF Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder Biological Psychiatry 2010 67 9 e53 e54 10.1016/j.biopsych.2009.11.016 20044072 · DOI
  2. [2]Lipsman N Woodside DB Giacobbe P Hamani C Carter JC Norwood SJ Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial The Lancet 2013 381 9875 1361 1370 10.1016/S0140-6736(12)62188-6 23473846 · DOI
  3. [3]McLaughlin NC Didie ER Machado AG Haber SN Eskandar EN Greenberg BD Improvements inanorexia symptoms after deep brain stimulation for intractable obsessive-compulsive disorder Biological Psychiatry 2013 73 9 e29 e31 10.1016/j.biopsych.2012.09.015 23128051 · DOI
  4. [4]Wu H Van Dyck-Lippens PJ Santegoeds R van Kuyck K Gabriëls L Lin G Deep-brain stimulation for anorexia nervosa World Neurosurgery 2013 80 3–4 S29.e1 10 22743198
  5. [5]Cabrera LY Evans EL Hamilton RH Ethics of the electrified mind: defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care Brain Topography 2014 27 1 33 45 10.1007/s10548-013-0296-8 23733209 PMC3806889 · DOI
  6. [6]Widdows KC, Davis NJ. Ethical Considerations in Using Brain Stimulation to Treat Eating Disorders. Front Behav Neurosci [Internet]. 2014 Oct 9 [cited 2015 Jul 16];8. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191207/ PMC4191207 25346667
  7. [7]Harris EC Barraclough B Excess mortality of mental disorder British Journal of Psychiatry 1998 173 1 11 53 10.1192/bjp.173.1.11 9850203 · DOI · Paper page
  8. [8]Park RJ Godier LR Cowdrey FA Hungry for reward: how can neuroscience inform the development of treatment for anorexia nervosa? Behaviour Research and Therapy 2014 62 47 59 10.1016/j.brat.2014.07.007 25151600 · DOI
  9. [9]Levy N. 2007. Neuroethics. Cambridge: Cambridge University Press. Xiii + 346 p.
  10. [10]Focquaert F Schermer M Moral enhancement: do means matter morally? Neuroethics 2015 8 2 139 151 10.1007/s12152-015-9230-y PMC5569135 28890740 · DOI
  11. [11]Greely HT Neuroscience and criminal justice: not responsibility but treatment University of Kansas Law and Review 2008 56 5 1103 1138
  12. [12]Tan J Stewart A Fitzpatrick R Hope RA Competence to make treatment decisions in anorexia nervosa: thinking processes and values Philosophy, Psychiatry, & Psychology 2007 13 4 267 282 10.1353/ppp.2007.0032 PMC2121578 18066393 · DOI
  13. [13]Kendall S Anorexia nervosa: the diagnosis Journal of Bioethical Inquiry 2014 11 1 31 40 10.1007/s11673-013-9496-x 24366443 · DOI
  14. [14]Kocabicak E Temel Y Höllig A Falkenburger B Tan SK Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders Neuropsychiatric Disease and Treatment 2015 11 1051 25914538 PMC4399519
  15. [15]McClelland J Bozhilova N Campbell I Schmidt U A systematic review of the effects of neuromodulation on eating and body weight: evidence from human and animal studies European Eating Disorders Review Journal Eating Disorders Association 2013 21 6 436 455 10.1002/erv.2256 24155246 · DOI
  16. [16]Nestler EJ Treating the brain deep down: brain surgery for anorexia nervosa? Nature Medicine 2013 19 6 678 679 10.1038/nm.3223 PMC3734853 23744148 · DOI
  17. [17]Wagenbreth C Zaehle T Galazky I Voges J Guitart-Masip M Heinze H-J Deep brain stimulation of the subthalamic nucleus modulates reward processing and action selection in Parkinson patients Journal of Neurology 2015 262 6 1541 1547 10.1007/s00415-015-7749-9 25929662 · DOI
  18. [18]Treasure J Schmidt U DBS for treatment-refractory anorexia nervosa The Lancet 2013 381 9875 1338 1339 10.1016/S0140-6736(13)60057-4 23473848 · DOI
  19. [19]Berridge KC “Liking” and “wanting” food rewards: brain substrates and roles in eating disorders Physiology and Behavior 2009 97 5 537 550 10.1016/j.physbeh.2009.02.044 19336238 PMC2717031 · DOI · Paper page
  20. [20]Cowdrey FA Finlayson G Park RJ Liking compared with wanting for high-and low-calorie foods in anorexia nervosa: aberrant food reward even after weight restoration American Journal of Clinical Nutrition 2013 97 3 463 470 10.3945/ajcn.112.046011 23364019 · DOI
  21. [21]Cowdrey FA Park RJ Harmer CJ McCabe C Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa Biological Psychiatry 2011 70 8 736 743 10.1016/j.biopsych.2011.05.028 21714958 · DOI · Paper page
  22. [22]Frankfurt HG Freedom of the will and the concept of a person Journal of Philosophy 1971 68 1 5 20 10.2307/2024717 · DOI · Paper page
  23. [23]Craigie J Competence, practical rationality and what a patient values Bioethics 2011 25 6 326 333 10.1111/j.1467-8519.2009.01793.x 20047588 · DOI
  24. [24]Walker RL Respect for rational autonomy Kennedy Institute of Ethics Journal 2009 19 4 339 366 10.1353/ken.0.0301 20191948 · DOI
  25. [25]Savulescu J Momeyer RW Should informed consent be based on rational beliefs? Journal of Medical Ethics 1997 23 5 282 288 10.1136/jme.23.5.282 9358347 PMC1377366 · DOI
  26. [26]Watson G Free agency Journal of Philosophy 1975 72 8 205 220 10.2307/2024703 · DOI
  27. [27]Sinnott-Armstrong W, Pickard H. 2013. What is Addiction? In: Oxford Handbook of Philosophy of Psychiatry. p. 851–864.
  28. [28]Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Bischoff-Grethe A. Nothing Tastes as Good as Skinny Feels: The Neurobiology of Anorexia Nervosa. Trends Neurosci [Internet]. 2013 Feb [cited 2015 Jul 20];36(2). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880159/ PMC3880159 23333342
  29. [29]Godier LR, Park RJ. Compulsivity in anorexia nervosa: a transdiagnostic concept. Front Psychol [Internet]. 2014 Jul 17 [cited 2015 Jul 20];5. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101893/ PMC4101893 25101036
  30. [30]Parfit D On what matters 2011 Oxford Oxford University Press 2
  31. [31]Hope T Tan J Stewart A McMillan J Agency, ambivalence and authenticity: the many ways in which anorexia nervosa can affect autonomy The International Journal of Law in Context 2013 9 01 20 36 10.1017/S1744552312000456 · DOI
  32. [32]Fineberg NA Potenza MN Chamberlain SR Berlin HA Menzies L Bechara A Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review Neuropsychopharmacology 2010 35 3 591 604 10.1038/npp.2009.185 19940844 PMC3055606 · DOI · Paper page
  33. [33]Meunier D Ersche KD Craig KJ Fornito A Merlo-Pich E Fineberg NA Brain functional connectivity in stimulant drug dependence and obsessive–compulsive disorder NeuroImage 2012 59 2 1461 1468 10.1016/j.neuroimage.2011.08.003 21871569 · DOI · Paper page
  34. [34]Lipsman N Lozano AM Targeting emotion circuits with deep brain stimulation in refractory anorexia nervosa Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 2014 39 1 250 251 10.1038/npp.2013.244 24317325 PMC3857669 · DOI
  35. [35]Schechtman M The constitution of selves 1996 Ithaca Cornell University Press 169
  36. [37]Tan J, Richards L. Legal and Ethical Issues in the Treatment of Really Sick Patients with Anorexia Nervosa. In: Robinson PH, Nicholls D, editors. Critical Care for Anorexia Nervosa [Internet]. Springer International Publishing; 2015 [cited 2015 Sep 2]. p. 113–50. Available from: http://link.springer.com/chapter/10.1007/978-3-319-08174-8_6 · DOI
  37. [38]Beumont P Carney T Conceptual issues in theorising anorexia nervosa: Mere matters of semantics? International Journal of Law and Psychiatry 2003 26 6 585 598 10.1016/j.ijlp.2003.09.001 14637203 · DOI
  38. [39]Savulescu J Rational desires and the limitation of life sustaining treatment Bioethics 1994 8 3 191 222 10.1111/j.1467-8519.1994.tb00255.x 11652346 · DOI
  39. [40]Charland LC Anorexia and the MacCAT-T test for mental competence: validity, value, and emotion Philos Psychiatry Psychol 2007 13 4 283 287 10.1353/ppp.2007.0027 · DOI
  40. [41]Giordano S Anorexia and refusal of life-saving treatment: the moral place of competence, suffering, and the family Philos Psychiatry Psychol 2010 17 2 143 154 10.1353/ppp.0.0286 · DOI
  41. [42]Draper H Anorexia nervosa and respecting a refusal of life‐prolonging therapy: a limited justification Bioethics 2000 14 2 120 133 10.1111/1467-8519.00185 11765761 · DOI
  42. [43]Carney T The incredible complexity of being? Degrees of influence, coercion, and control of the “autonomy” of severe and enduring anorexia nervosa patients. Commentary on “Anorexia nervosa: the diagnosis: a postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa” by Sacha Kendall J Bioethical Inq 2014 11 1 41 42 10.1007/s11673-013-9506-z 24390618 · DOI
  43. [44]Ryan CJ Callaghan S Treatment refusal in anorexia nervosa: the hardest of cases J Bioethical Inq 2014 11 1 43 45 10.1007/s11673-013-9498-8 24415127 · DOI
  44. [45]Feinberg J The moral limits of the criminal Law volume 3: harm to self [electronic resource] 1989 New York Oxford University Press 444
  45. [46]Beauchamp TL Childress JF Principles of biomedical ethics 2009 6 New York Oxford University Press 417
  46. [48]Carney T Tait D Wakefield A Ingvarson M Touyz S Coercion in the treatment of anorexia nervosa: clinical, ethical and legal implications Medicine and Law 2005 24 1 21 40 15887611
  47. [49]Carney T Crim D Wakefield A Tait D Touyz S Reflections on coercion in the treatment of severe anorexia nervosa Israel Journal of Psychiatry and Related Sciences 2006 43 3 159 165 17294981

Cited by

Sorted by citations

Authors
Maslen, H., Pugh, J., & Savulescu, J.
Affiliations
University of Oxford (GB)
Corresponding author
Maslen, Hannah
ORCID
Venue
Neuroethics
Publisher
Springer Science and Business Media LLC
Published
2015-09-24
Volume
8
Issue
3
Pages
215-230
ISSN
  • 1874-5490 (ISSN-L)
  • 1874-5504
DOI
10.1007/s12152-015-9240-9
PMC
PMC4643100
OpenAlex
W1780541361
Cited by
104
References
1
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 21 · 2022: 5 · 2021: 4 · 2020: 21 · 2019: 5 · 2018: 23 · 2017: 10 · 2016: 4 · 2015: 1
FWCI
7.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuroethics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Wellcome Trust (104848/Z/14/Z, 104848, 086041/Z/08/Z, 086041)
  • Uehiro Foundation on Ethics and Education
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
deep brain stimulation, anorexia nervosa, patient autonomy, personal identity, desire, control, emotions, informed consent, coercion, therapeutic mechanisms

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review