Clinical and ethical dimensions of an innovative approach for treating mental illness: a qualitative study of health care trainee perspectives on deep brain stimulation.

BACKGROUND: The acquisition of knowledge and application of critical thinking skills are required to tackle the clinical and ethical dimensions of new approaches and technologies. Health care trainees rely partly on their training to manage, reason and reflect on the ethical uncertainties of innovations and new technologies. Deep brain stimulation (DBS) is neurosurgery involving the implantation of electrodes into deep brain nuclei and is approved for Parkinson's disease and other motor disorders. Experimental uses of DBS are emerging in refractory obsessive compulsive disorder and depression.

METHODS: We conducted a qualitative interview-based study to gather the perspectives of health care trainees from different disciplines on the clinical and ethical issues associated with DBS in psychiatric disorders.

RESULTS: First impressions about the use of DBS in mental illness were mixed. We identified factors influencing impressions about DBS and information missing that compounded uncertainty about long-term outcomes and effects on other physical or psychological systems. Participants revealed nascent exploration of the ethical issues of DBS. They emphasized the obligations of health care providers to manage ethical problems and supported patient autonomy in guiding choice, even when choosing innovative approaches.

DISCUSSION: We discuss trainee expectations about evidence in decision making and the role of ethics education.