IEEE Technology and Society Magazine - June 2015 - 66

and the severity of the risks suggest that neurosurgeons (or someone they designate for the task) should
take great pains to explain these risks to patients and
to address their questions in a thoughtful and compassionate manner appropriate for the patient's intelligence, curiosity, concerns, level of education, and
cultural background.
So what is missing? What other information should a
patient being offered DBS have in order to make a sound
decision about whether DBS is the right option for him
or her? I argue that the one item missing is a discussion
about the patient's theory of mind. What does the patient
mean by the words "mind," "self," or "identity" and how
do they see their "mind" as relating to their "brain"? Is
the mind something immutable or permanent, more akin
to an immortal soul, or is it the product of the activity of
the brain, or is it something else entirely?
It is understandable that neurosurgeons would tend
to shy away from these questions because they risk
creating confusion without providing insight. Indeed,

Currently, neurosurgeons are left
to use their judgment as to what
information they believe is necessary
for the patient to make an informed
decision on whether to treat or not.

contentious philosophical debate has surrounded
the "mind" for centuries with little apparent progress
towards a resolved answer. Why ask when there is no
objective answer? Here I will argue that although there
is no agreed upon universal answer, there is a correct
answer. It is a subjective answer, the patient's answer of
what defines his mind and identity, and that definition
must be known in order to appropriately tailor therapy to
the specific patient.
In order to demonstrate this point, I will present a
hypothetical case of a patient receiving DBS for a psychiatric illness who has an unexpected outcome. I will then
argue that the confusion experienced in this case might
have been avoided if a clearer definition of the patient's
sense of self had been known in advance. Finally, I will
present a simple but complete model of the human
mind that can be used to frame and facilitate the discussion so it could be accomplished in an effective and
timely manner.

The first item of the IEEE Code of Ethics urges its
membership "to accept responsibility in making decisions consistent with the safety, health, and welfare of the
public, and to disclose promptly factors that might endanger the public or the environment" [6]. As an engineer
who works to develop brain-implantable microelectrode
systems that directly interface with the human brain, I
believe that I have a duty to help others ensure the technology is employed in the most ethical way possible by
offering my thoughts for consideration. This intuition motivates the following work.

Hypothetical Case
Imagine an individual, called Steven, who receives DBS
for the treatment of obsessive compulsive disorder (OCD).
Steven is a 32 year old man who has struggled for years
to maintain stable employment because of his compulsive behaviors. These include counting items out loud and
repeating simple actions, like placing items in his pocket
and removing them again and again. Despite years of
psychiatric therapy, he remains unable to correct these
behaviors and has grown increasingly frustrated and
depressed with his inability to achieve his goal of meaningful employment.
Nevertheless, Steven maintains a network of friends,
is involved in his local church, and has been married to
his wife, Becky, for the last six years. Becky is a loving
and patient spouse. She understands his difficulty and
supports him as the major breadwinner for the household. They have delayed having children because neither is sure how the changes in lifestyle attendant with
children would be handled by Steven, who is dependent
on his routines and a rigid schedule.
Word reaches Steven and Becky that there is a new
treatment for people with OCD who are significantly
debilitated and have not seen a benefit from therapy or
medication. They learn that it is called DBS. Steven discusses DBS with Becky, and they decide that he should
look into it further. They both want to have children and
feel that this is their best option for making that dream
a reality.
Steven meets with the DBS team, and they describe
the procedure. They explain how it will happen, and the
risks of blood loss, infection, device failure, or functional neurological deficit (e.g., paralysis, loss of sensory function, pain, or loss of speech). Steven listens
patiently, asks thoughtful questions, and agrees to proceed. The surgery is scheduled and performed without
complication.
Two months later the neurosurgeon receives a tearful call from Becky. "Something is wrong with Steven."
She says, "He's changed so much! He won't return his
friends' calls; he refuses to go to church. And lately, he
says he wants to leave me and move to a different state

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june 2015

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