The ethics of research on deep brain stimulation for depression: decisional capacity and therapeutic misconception

被引:33
作者
Fisher, Carl Erik [1 ,2 ]
Dunn, Laura B. [3 ]
Christopher, Paul P. [4 ]
Holtzheimer, Paul E. [5 ]
Leykin, Yan [3 ]
Mayberg, Helen S. [6 ]
Lisanby, Sarah H. [7 ]
Appelbaum, Paul S. [1 ,2 ]
机构
[1] New York State Psychiat Inst & Hosp, New York, NY 10032 USA
[2] Columbia Univ Coll Phys & Surg, Dept Psychiat, New York, NY 10032 USA
[3] Univ Calif San Francisco, Dept Psychiat, San Francisco, CA USA
[4] Univ Massachusetts, Sch Med, Dept Psychiat, Worcester, MA 01655 USA
[5] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Dept Psychiat, Hanover, NH 03756 USA
[6] Emory Univ, Sch Med, Dept Psychiat & Behav Sci, Atlanta, GA USA
[7] Duke Univ, Sch Med, Dept Psychiat, Durham, NC USA
来源
BRAIN STIMULATION IN NEUROLOGY AND PSYCHIATRY | 2012年 / 1265卷
关键词
research ethics; deep brain stimulation; decisional capacity; therapeutic misconception; TREATMENT-RESISTANT; INFORMED-CONSENT; COMPETENCE; RISKS; HOPE;
D O I
10.1111/j.1749-6632.2012.06596.x
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Research on deep brain stimulation (DBS) for treatment-resistant depression appears promising, but concerns have been raised about the decisional capacity of severely depressed patients and their potential misconceptions about the research. We assessed 31 DBS research participants with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), a well-validated capacity measure, and with a scale to measure therapeutic misconception, which occurs when subjects do not recognize key differences between treatment and clinical research. Correlations with baseline depressive symptoms were explored. Subjects' performance on the MacCAT-CR was excellent, but therapeutic misconception was still apparent. A trend toward significance was found in the correlation between baseline depression ratings and total therapeutic misconception score. Responses to open-ended prompts revealed both reassuring and concerning statements related to expectations of risk, benefit, and individualization. Even severely depressed patients did not manifest impairments in their capacity to consent to DBS research. Therapeutic misconception, however, remained prevalent.
引用
收藏
页码:69 / 79
页数:11
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