Reflections on 40 years of IVF.

The past For many practitioners of in vitro fertilisation (IVF) today, it must be hard to comprehend the disdain and disgust with which the introduction of IVF as therapy for infertility was greeted. The ethical and legal wrangling about human reproductive cloning and the current debate over trans-generational (germline) genome editing gives a small flavour of how IVF was seen then. What was regarded as an irrelevant, disruptive and unethical practice is now effectively mainstream treatment in most countries of the world

Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence

Contains fulltext : 99253.pdf (publisher's version ) (Open Access)Deep brain stimulation (DBS) is a wellaccepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research.13 p