IEEE Technology and Society Magazine - June 2015 - 70

that these discussions will be challenging for most, if not
all, patients and physicians.
The problem of a patient's readiness to discuss the
issues competently has parallels to other competency
questions that arise in more traditional informed consent.

The parts of individual identity that
are fundamental to the patient should
be identified by the patient prior to
implantation of DBS electrodes.

Ultimately, the evaluation of whether a change in personality constitutes an increase or a decrease in patient
autonomy, or whether it is inconsequential, rests on
the patient's conception of his or her identity and mind.
Therefore, one critical part of the answer to "What should
a patient know before he allows a physician to control
a part of his brain?" has very little to do with the actual
surgery. The patient should understand and share the
parts of his or her mind that are of critical importance to
maintaining his or her identity.

Author Information
Andrew Koivuniemi is with the Indiana University School
of Medicine. Email: akoivuni@iupui.edu.

Acknowledgment
As in those cases, it may be necessary to include in the
decision-making process a surrogate decision maker, or
at least a counselor who can assist the patient. Similarly, a
physician may want to enlist the help of a specialist during
the informed consent discussion to facilitate the dialog.
Finally, despite the challenging nature of these discussions,
it seems incumbent on physicians to deal with these questions as best they can before DBS applications. It is hoped
that the proposed model (or some future improvement) will
help patients and medical professionals to communicate
more effectively during these challenging discussions.

Patient Conception of Identity
Informed consent is a critical element for the ethical
practice of surgery. It seeks to help patients make rational decisions about whether or not they wish to undergo
a procedure by providing them with information regarding the procedure's risks and benefits. While several
experts have argued that psychiatric patients can ethically give informed consent for psychiatric applications
of DBS [9], [10] (including a recently published consensus guideline for the practice of psychiatric DBS [11]),
none have explicitly delineated the actual information
that patients need to understand in order to be considered adequately informed. This article argues that a
critical piece of information that must be understood by
both the patient and the treatment team is the patient's
conception of his or her identity. Such information could
be used to provide critical insight into interpretations of
off target effects of DBS on personality as exemplified by
the hypothetical patient Steven.
In order to facilitate and focus this discussion, a
non-authoritarian, four-part model of mind/identity/self
was presented. It is not intended to be a universally
applied tool. It is simply an option for neurosurgeons
that deem it is appropriate to broach this topic during
the informed consent process.

The author would like to thank Dr. Thomas Witt for sharing his approach to providing informed consent in DBS
as well as his comments on the introductory section.
Thanks also to Dr. Daniel Kelly for providing the initial
review and feedback during this project's inception.
Thank you to Dr. Paul Koivuniemi and Andi Corya for
their editorial review of the final manuscript. Finally,
thanks are due to Dr. Kevin Otto for supporting this project during four years of graduate engineering training.

References

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[7] J. Locke, "Of identity and diversity," in Essay Concerning Human
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[8] K. Witt, J. Kuhn, L. Timmermann, M. Zurowski, and C. Woopen, "Deep
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[9] T. Skuban, K. Hardenacke, C. Woopen, and J. Kuhn, "Informed consent
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