Ethische overwegingen bij transcraniële magnetische stimulatie in de behandeling van depressie

BACKGROUND: Transcranial magnetic stimulation (TMS) has proved effective in the treatment of depression. However, the step that was needed to progress from positive research results to the actual use of TMS to treat patients has raised a number of ethical concerns. The concerns extend beyond matters such as the safety of the technique, the patient's right of access to therapy and the patient's informed consent; ethics are involved because the new treatment can be mind-bending and can interfere with the patient's autonomy and decision-making capacity. AIM: To discuss ethical issues raised by the use of TMS in the treatment of depression. METHOD: We reviewed the relevant scientific literature RESULTS: The effects of the treatment on the patient's genuine wishes and on his or her views on the efficacy of the treatment are technique-related ethical issues that have not yet been adequately addressed. Furthermore, the effects of TMS on the patient's autonomy and mental capacity and the'last resort' argument in relation to the effectiveness of the therapy are context-related considerations that warrant further discussion. CONCLUSION: There will have to be more research and discussion among researchers and clinicians about specific ethical questions before TMS can take its rightful place in clinical practice.