Focquaert, F. (2013). Rethinking vulnerability. American Journal of Bioethics Neuroscience, 4, 44-45.

The aim of deep brain stimulation (DBS) for treatment-resistant depression (TRD) is to provide reflief for individuals who due to the very nature of their disease may be faced with (a history of) suicidal ideation and suicide attempts. It is not unlikely that DBS for TRD, which is currently experimental in nature, will become standard treatment sometime in the (near) future for patients who have failed conventional treatments (i.e., psychotherapy, medication, and electroconvulsive therapy). If such a scenario will indeed present itself, it is of the utmost importance that the procedure is safe for all the individuals in this patient group. Provided that the necessary safeguards are put in place (e.g., an informed consent process that gives specific and sufficient attention to the elevated suicide risk; pre- and postoperative monitoring and treatment), is it ethical to exclude TRD patients with a history of suicidal ideation and suicide attempts from having safe access to DBS treatment? It can be argued that "under the assumption that DBS would be an efficacious treatment, one might do harm to patients not only by performing DBS, but also by not performing it" (Synofzik and Schlaepfer 2011, 10-11; also see Focquaert 2011).

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