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Neurosurgery and Neuroinnovation in the Surgical Suite: The Ethics of Neurostimulation for Severe Obesity

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Ethics and Clinical Neuroinnovation

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Abstract

Innovation has been fundamental to neurosurgical advancements. Neurostimulation as treatment for severe obesity is one such innovation that has garnered much attention and implores several ethical considerations. The first ethical consideration relates to the establishment of trust in the surgeon–patient relationship. As part of this trust-building process, informed consent must be obtained from the patient before any surgical procedure is performed. The patient, however, must have mental capacity. In addition, respect for autonomy makes provisions for circumstances in which a patient may not have capacity to make his or her own medical decisions. Other moral considerations regarding neurostimulation for severe obesity include nonmaleficence, justice, and beneficence. Although the use of surgical instruments inherently causes physical “harm” to patients, religious and cultural considerations may also contribute to a patient’s perception of “harm.” In effort to maximize benefits and minimize harm, distribution of medical resources must be done equitably. Patients with severe obesity who are most in need of neurostimulation oftentimes rely on public or private health insurance to cover their costs. However, most health insurance plans offer coverage to only U.S. Food and Drug Administration-approved indications for neurostimulation. This financial limitation challenges a neurosurgeon’s desire to render care to patients who may benefit most from the therapy. This chapter presents additional ethical considerations pertaining to the use of neurostimulation as treatment for severe obesity—namely, conflict of interest, clinical trial design, implantation of neurostimulation devices in vulnerable populations, preoperative assessments, postoperative tracking, and registries.

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Further Reading

  • Halpern CH, Wolf JA, Bale TL, Stunkard AJ, Danish SF, Grossman M, et al. Deep brain stimulation in the treatment of obesity. J Neurosurg. 2008;109(4):625–34.

    Google Scholar 

  • Ho AL, Sussman ES, Pendharkar AV, Azagury DE, Bohon C, Halpern CH. Deep brain stimulation for obesity: Rationale and approach to trial design. Neurosurg Focus. 2015;38(6):E8.

    Google Scholar 

  • Khan FR, Henderson JM. Deep brain stimulation surgical techniques. Handb Clin Neurol. 2013;116:27–37.

    Article  Google Scholar 

  • Lennerz B, Lennerz JK. Food addiction, high-glycemic-index carbohydrates, and obesity. Clin Chem. 2018;64(1):64–71.

    Article  CAS  Google Scholar 

  • Wu H, Adler S, Azagury DE, Bohon C, Safer DL, Barbosa DAN, et al. Brain-responsive neurostimulation for loss of control eating: Early feasibility study. Neurosurgery. 2020;87(6):1277–88.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

    Disep I. Ojukwu

  2. Department of Neurosurgery, Perelman School of Medicine, Richards Medical Research Laboratories, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, USA

    Daniel A. N. Barbosa & Casey H. Halpern

  3. Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA

    Arthur L. Caplan

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  1. Disep I. Ojukwu
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  4. Casey H. Halpern
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Correspondence to Casey H. Halpern .

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  1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA

    Laura Weiss Roberts

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Ojukwu, D.I., Barbosa, D.A.N., Caplan, A.L., Halpern, C.H. (2023). Neurosurgery and Neuroinnovation in the Surgical Suite: The Ethics of Neurostimulation for Severe Obesity. In: Roberts, L.W. (eds) Ethics and Clinical Neuroinnovation. Springer, Cham. https://doi.org/10.1007/978-3-031-14339-7_7

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