Ethical Challenges of Deep Brain Stimulation
An Islamic Perspective
DOI:
https://doi.org/10.55613/jeet.v34i2.155Keywords:
Deep Brain Stimulation, cognitive enhancement, Islamic bioethics, moral responsibility, medical necessity, personality changeAbstract
Arriving in the era of neurotechnology, different methods for brain stimulation are becoming increasingly recognized as viable ways for the treatment of neurological diseases, such as Parkinson’s disease. However, many of the brain stimulation methods are now available readily on the market directly for non-medical consumer use without any medical supervision. Among the non-medical uses for the brain stimulation technology is cognitive enhancement, which is to augment a person’s cognitive capabilities beyond what they are normally capable of. One brain stimulation technology that has not yet been made publicly available is deep brain stimulation (DBS), because of its invasiveness and need for expert surgical intervention to implant the electrodes and the pacemaker. Nevertheless, some studies have tested its effects on cognitive enhancement, which predicts its potential usability in the future for cognitive enhancement purposes. In this paper, we provided definitions and analysis of cognitive enhancement and DBS after which DBS was examined from an Islamic view of biomedical ethics taking into perspective the Islamic principles of taklīf (responsibility before God) and ḍarūra (necessity). As literature on Islamic scholarly views of DBS is virtually non-existent, we have also interviewed two Islamic scholars from prominent religious institutions to provide Islamic legal insights into the therapeutic and enhancement uses of DBS. This paper serves as a foundation based on which further research into religious views of brain stimulation and cognitive enhancement can be made.
References
Abu Dawud, S. I. (n.d.). Sunan Abu Dawud, Book 29, Hadith 20. Retrieved November 27, 2024, from https://sunnah.com/abudawud:3874
Arabi, Oussama (2000), "The Interdiction of the Spendthrift (Al-Safīh). A Human Rights Debate in Classical Fiqh“, in: Islamic Law and Society 7(3):300–324.
Asendorpf, Jens (2018), Persönlichkeit. Was uns ausmacht und warum, Berlin: Springer.
Al-Bayhaqi (2003) Shuab ul Iman. Vol 6 p. 401. Hadith 8298. Al-Rushd. Library for Publishing and Distribution in Riyadh in cooperation with the Salafi House in Bombay, India. Retrieved November 29, 2024, from: https://shamela.ws/book/10660/5621
Al-Bukhari, M. I. (n.d.). Sahih al-Bukhari, Book 76, Hadith 22. Retrieved November 27, 2024, from https://sunnah.com/bukhari:5702
Al-Bukhari, M. I. (n.d.). Sahih al-Bukhari. Book 8, Hadith 70. Retrieved November 27, 2024, from https://sunnah.com/bukhari:420
Bajwa, Jawad, personal correspondence, October 01, 2024.
Blomstedt P, Sjöberg RL, Hansson M, Bodlund O, Hariz MI. Deep brain stimulation in the treatment of obsessive-compulsive disorder. World Neurosurg. 2013 Dec;80(6):e245-53. doi: 10.1016/j.wneu.2012.10.006. Epub 2012 Oct 5. PMID: 23044000.
Brem A. K., Fried P. J., Horvath J. C., Robertson E. M., Pascual-Leone A. (2014). Is neuroenhancement by noninvasive brain stimulation a net zero-sum proposition? Neuroimage 85, 1058–1068. 10.1016/j.neuroimage.2013.07.038
Brittain JS, Sharott A, Brown P. The highs and lows of beta activity in cortico-basal ganglia loops. Eur J Neurosci. 2014 Jun;39(11):1951-9. doi: 10.1111/ejn.12574. Epub 2014 Apr 3. PMID: 24890470; PMCID: PMC4285950.
Brunyé, T.T., Brou, R., Doty, T.J. et al. A Review of US Army Research Contributing to Cognitive Enhancement in Military Contexts. J Cogn Enhanc 4, 453–468 (2020). https://doi.org/10.1007/s41465-020-00167-3
Buch ER, Santarnecchi E, Antal A, Born J, Celnik PA, Classen J, Gerloff C, Hallett M, Hummel FC, Nitsche MA, Pascual-Leone A, Paulus WJ, Reis J, Robertson EM, Rothwell JC, Sandrini M, Schambra HM, Wassermann EM, Ziemann U, Cohen LG. Effects of tDCS on motor learning and memory formation: A consensus and critical position paper. Clin Neurophysiol. 2017 Apr;128(4):589-603. doi: 10.1016/j.clinph.2017.01.004. Epub 2017 Jan 29. PMID: 28231477.
Bublitz Christoph, Sjors Ligthart, The new regulation of non-medical neurotechnologies in the European Union: overview and reflection, Journal of Law and the Biosciences, Volume 11, Issue 2, July-December 2024, lsae021, https://doi.org/10.1093/jlb/lsae021
Chang R, Peng J, Chen Y, Liao H, Zhao S, Zou J, Tan S. Deep Brain Stimulation in Drug Addiction
Treatment: Research Progress and Perspective. Front Psychiatry. 2022 Apr 7;13:858638. doi: 10.3389/fpsyt.2022.858638. PMID: 35463506; PMCID: PMC9022905.
Clark KB, Naritoku DK, Smith DC, Browning RA, Jensen RA. Enhanced recognition memory following vagus nerve stimulation in human subjects. Nat Neurosci. 1999 Jan;2(1):94-8. doi: 10.1038/4600. PMID: 10195186.
Colzato, L.S. Responsible Cognitive Enhancement: Neuroethical Considerations. J Cogn Enhanc 2, 331–334 (2018). https://doi.org/10.1007/s41465-018-0090-3
Dols, Michael W. (1992), Majnūn. The Madman in Medieval Islamic Society, Oxford: Clarendon Press.
Dresler M, Shirer WR, Konrad BN, Müller NCJ, Wagner IC, Fernández G, Czisch M, Greicius MD. Mnemonic Training Reshapes Brain Networks to Support Superior Memory. Neuron. 2017 Mar 8;93(5):1227-1235.e6. doi: 10.1016/j.neuron.2017.02.003. PMID: 28279356; PMCID: PMC5439266.
Eldomy, Mohammed, personal correspondence, October 30, 2024.
Esposito, Massimiliano, Giuseppe Cocimano, Federica Ministrieri, Giuseppe Li Rosi, Nunzio Di Nunno, Giovanni Messina, Francesco Sessa, Monica Salerno. Smart drugs and neuroenhancement: what do we know?. Front. Biosci. (Landmark Ed) 2021, 26(8), 347–359.
Fan H, Zheng Z, Yin Z, Zhang J, Lu G. Deep Brain Stimulation Treating Dystonia: A Systematic Review of Targets, Body Distributions and Etiology Classifications. Front Hum Neurosci. 2021 Nov 26;15:757579. doi: 10.3389/fnhum.2021.757579. PMID: 34899219; PMCID: PMC8663760.
Faridzadeh, Ghazaleh (2016), Vom Mensch-Sein zum Person-Sein. Eine historische Analyse des (Rechts-)Personengedankens im Islam, Baden-Baden: Nomos.
Ford PJ. Advancing from Treatment to Enhancement in Deep Brain Stimulation: A Question of Research Ethics. The Pluralist 1 July 2006; 1 (2): 35–44. doi: https://doi.org/10.2307/20708862
Grossman N, Bono D, Dedic N, Kodandaramaiah SB, Rudenko A, Suk HJ, Cassara AM, Neufeld E, Kuster N, Tsai LH, Pascual-Leone A, Boyden ES. Noninvasive Deep Brain Stimulation via Temporally Interfering Electric Fields. Cell. 2017 Jun 1;169(6):1029-1041.e16. doi: 10.1016/j.cell.2017.05.024. PMID: 28575667; PMCID: PMC5520675.
Hamani C, McAndrews MP, Cohn M, Oh M, Zumsteg D, Shapiro CM, Wennberg RA, Lozano AM. Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Ann Neurol. 2008 Jan;63(1):119-23. doi: 10.1002/ana.21295. PMID: 18232017.
Hamani C, Pilitsis J, Rughani AI, Rosenow JM, Patil PG, Slavin KS, Abosch A, Eskandar E, Mitchell LS, Kalkanis S; American Society for Stereotactic and Functional Neurosurgery; Congress of Neurological Surgeons; CNS and American Association of Neurological Surgeons. Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons. Neurosurgery. 2014 Oct;75(4):327-33; quiz 333. doi: 10.1227/NEU.0000000000000499. PMID: 25050579.
Harari, Yuval N. author. Sapiens: A Brief History of Humankind. New York: Harper, 2015.
Heemskerk, Margaretha Tijsiena (2000): Suffering in the Muʿtazilite Theology. ʿAbd al-Jabbārʼs Teaching on Pain and Divine Justice, Leiden: Brill.
Ibn Mājah (1918), Sunan Ibn Mājah, ed. Muḥammad Fuʾād ʿAbd al-Bāqī, 2 vols., Cairo: Dār al-Iḥyāʾ al-Kutub al-ʿArabīya.
Ilkilic, Ilhan (2002). Der muslimische Patient. Medizinethische Aspekte des muslimischen Krankheitsverständnisses in einer wertpluralen Gesellschaft, Münster: LIT.
Jung IH, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Complications After Deep Brain Stimulation: A 21-Year Experience in 426 Patients. Front Aging Neurosci. 2022 Apr 7;14:819730. doi: 10.3389/fnagi.2022.819730. PMID: 35462695; PMCID: PMC9022472.
Kam, Hureyre (2023): New Bottles for Old Wine? On Playing God: Post- and Transhumanism from the Perspective of Kalām. in: Journal of Posthuman Studies, 7(1), 24‒50. https://doi.org/10.5325/jpoststud.7.1.0024
Kellner, Martin (2020), “Tun oder Lassen am Lebensende? Muslimische Seelsorge in der Palliativbetreuung”, in: ed. Badawia, Tarek/Erdem, Gülbahar/Abdallah, Mahmoud: Grundlagen muslimischer Seelsorge. Die muslimische Seele begreifen und versorgen, Wiesbaden: Springer VS, 317–332.
Kongkeaw C, Dilokthornsakul P, Thanarangsarit P, Limpeanchob N, Norman Scholfield C. Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. J Ethnopharmacol. 2014;151(1):528-35. doi: 10.1016/j.jep.2013.11.008. Epub 2013 Nov 16. PMID: 24252493.
Kostick-Quenet K, Kalwani L, Koenig B, Torgerson L, Sanchez C, Munoz K, Hsu RL, Sierra-Mercado D, Robinson JO, Outram S, Pereira S, McGuire A, Zuk P, Lazaro-Munoz G. Researchers' Ethical Concerns About Using Adaptive Deep Brain Stimulation for Enhancement.
Koubeissi MZ, Kahriman E, Syed TU, Miller J, Durand DM. Low-frequency electrical stimulation of a fiber tract in temporal lobe epilepsy. Ann Neurol. 2013 Aug;74(2):223-31. doi: 10.1002/ana.23915. Epub 2013 Sep 4. PMID: 23613463.
Kurnaz, Serdar/Ben-Abdeljelil, Jameleddine (2014), Maqāṣid aš-šarīʿa. Die Maximen des islamischen Rechts, Berlin: EB.
Lipsman N, Lozano AM. Cosmetic neurosurgery, ethics, and enhancement. Lancet Psychiatry. 2015 Jul;2(7):585-6. doi: 10.1016/S2215-0366(15)00206-0. Epub 2015 Jun 30. PMID: 26303544.
Luber B. (2014). Neuroenhancement by noninvasive brain stimulation is not a net zero-sum proposition. Front. Syst. Neurosci. 8:127. 10.3389/fnsys.2014.00127
Maia TV, Cooney RE, Peterson BS. The neural bases of obsessive-compulsive disorder in children and adults. Dev Psychopathol. 2008 Fall;20(4):1251-83. doi: 10.1017/S0954579408000606. PMID: 18838041; PMCID: PMC3079445.
Marazziti D, Avella MT, Ivaldi T, Palermo S, Massa L, Vecchia AD, Basile L, Mucci F. Neuroenhancement: State of the Art and Future Perspectives. Clin Neuropsychiatry. 2021 Jun;18(3):137-169. doi: 10.36131/cnfioritieditore20210303. PMID: 34909030; PMCID: PMC8629054.
Mar-Barrutia L, Ibarrondo O, Mar J, Real E, Segalàs C, Bertolín S, Aparicio MA, Plans G, Menchón JM, Alonso P. Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder. Brain Stimul. 2022 Sep-Oct;15(5):1128-1138. doi: 10.1016/j.brs.2022.07.050. Epub 2022 Aug 1. PMID: 35926783.
Mayo Clinic. (n.d.). Deep brain stimulation: Overview. Retrieved November 27, 2024, from https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562
Mocking RJT, Graat I, Denys D. Why Has Deep Brain Stimulation Had So Little Impact in Psychiatry? Front Neurol. 2021 Dec 14;12:757142. doi: 10.3389/fneur.2021.757142. PMID: 34970208; PMCID: PMC8712949.
Muslim, I. A. (n.d.). Sahih Muslim. Book 46, Hadith 52. Retrieved November 27, 2024, from https://sunnah.com/muslim:2664
National Institute of Mental Health. (n.d.). Obsessive-compulsive disorder (OCD). Retrieved November 27, 2024, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
Olson MC, Shill H, Ponce F, Aslam S. Deep brain stimulation in PD: risk of complications, morbidity, and hospitalizations: a systematic review. Front Aging Neurosci. 2023 Nov 17;15:1258190. doi: 10.3389/fnagi.2023.1258190. PMID: 38046469; PMCID: PMC10690827.
Padela, Aasim I (2021), “An Introduction to Islamic Bioethics” in: Medicine and Shariah. A Dialogue in Islamic Bioethics, ed. Aasim I. Padela, Notre Dame: University of Notre Dame Press, 1‒37.
Pelluchon, Corine (2019). Ethik der Wertschätzung, Darmstadt: wbg.
Rohe, Mathias (2011), Das islamische Recht. Geschichte und Gegenwart, third edition, München: C. H. Beck.
Sala G, Gobet F. Cognitive Training Does Not Enhance General Cognition. Trends Cogn Sci. 2019 Jan;23(1):9-20. doi: 10.1016/j.tics.2018.10.004. Epub 2018 Nov 21. PMID: 30471868.
Salanova V, Witt T, Worth R, Henry TR, Gross RE, Nazzaro JM, Labar D, Sperling MR, Sharan A, Sandok E, Handforth A, Stern JM, Chung S, Henderson JM, French J, Baltuch G, Rosenfeld WE, Garcia P, Barbaro NM, Fountain NB, Elias WJ, Goodman RR, Pollard JR, Tröster AI, Irwin CP, Lambrecht K, Graves N, Fisher R; SANTE Study Group. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology. 2015 Mar 10;84(10):1017-25. doi: 10.1212/WNL.0000000000001334. Epub 2015 Feb 6. PMID: 25663221; PMCID: PMC4352097.
Schermer M. Ethical issues in deep brain stimulation. Front Integr Neurosci. 2011 May 9;5:17. doi: 10.3389/fnint.2011.00017. PMID: 21625629; PMCID: PMC3096836.
Segal, A., Parkes, L., Aquino, K. et al. Regional, circuit and network heterogeneity of brain abnormalities in psychiatric disorders. Nat Neurosci 26, 1613–1629 (2023). https://doi.org/10.1038/s41593-023-01404-6
Sherman SM, Buckley TP, Baena E, Ryan L. Caffeine Enhances Memory Performance in Young Adults during Their Non-optimal Time of Day. Front Psychol. 2016 Nov 14;7:1764. doi: 10.3389/fpsyg.2016.01764. PMID: 27895607; PMCID: PMC5107567.
Sironi VA. Origin and evolution of deep brain stimulation. Front Integr Neurosci. 2011 Aug 18;5:42. doi: 10.3389/fnint.2011.00042. PMID: 21887135; PMCID: PMC3157831.
Snoek, A., de Haan, S., Schermer, M. et al. On the Significance of the Identity Debate in DBS and the Need of an Inclusive Research Agenda. A Reply to Gilbert, Viana and Ineichen. Neuroethics 14 (Suppl 1), 65–74 (2021). https://doi.org/10.1007/s12152-019-09411-w
Suthana N, Haneef Z, Stern J, Mukamel R, Behnke E, Knowlton B, Fried I. Memory enhancement and deep-brain stimulation of the entorhinal area. N Engl J Med. 2012 Feb 9;366(6):502-10. doi: 10.1056/NEJMoa1107212. PMID: 22316444; PMCID: PMC3447081.
Suthana N, Fried I. Deep brain stimulation for enhancement of learning and memory. Neuroimage. 2014 Jan 15;85 Pt 3(0 3):996-1002. doi: 10.1016/j.neuroimage.2013.07.066. Epub 2013 Aug 3. PMID: 23921099; PMCID: PMC4445933.
Sterling P (2022) A Neuroscientist Evaluates the Standard Biological Model of Depression madinamerica.com/2022/10/neuroscientist-evaluates-depression/
Sterling P (2023) Causality in mental disturbance. https://www.madinamerica.com/2023/07/causality-mental-disturbance/
Thabet, Mostafa Ahmed, personal correspondence, November 19, 2024.
Thomson, C. J., Segrave, R. A., Fitzgerald, P. B., Richardson, K. E., Racine, E., & Carter, A. (2023). Personal and relational changes following deep brain stimulation for treatment-resistant depression: A prospective qualitative study with patients and caregivers. Plos one, 18(4), e0284160.
Thomson, C.J., Segrave, R.A. & Carter, A. Changes in Personality Associated with Deep Brain Stimulation: a Qualitative Evaluation of Clinician Perspectives. Neuroethics 14 (Suppl 1), 109–124 (2021). https://doi.org/10.1007/s12152-019-09419-2
Al-Tirmidhi, M. I. (n.d.). Jami’ at-Tirmidhi. Book 22, Hadith 19. Retrieved November 27, 2024, from https://sunnah.com/tirmidhi:1637
Weaver FM, Follett KA, Stern M, Luo P, Harris CL, Hur K, Marks WJ Jr, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ; CSP 468 Study Group. Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology. 2012 Jul 3;79(1):55-65. doi: 10.1212/WNL.0b013e31825dcdc1. Epub 2012 Jun 20. PMID: 22722632; PMCID: PMC3385495.
Zeineddine, Nora (2019), Die Methodik der islamischen Jurisprudenz Uṣūl al-Fiqh, Baden-Baden: Nomos.
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