[Biology and psychiatry: ethical aspects of the prevention of antisocial behaviour in children]. / Biologie en psychiatrie: ethische aspecten van de preventie van antisociaal gedrag bij kinderen.

BACKGROUND: Genetic and neurobiological research into the causes of antisocial behaviour is playing an increasingly important role in forensic psychiatry. AIM: To contribute some ethical and societal reflections on the possible consequences of this kind of research for the prevention of antisocial behaviour. METHOD: In this ethical analysis, which gives attention to the concepts of 'informed consent' and 'best interests', we investigate which persons and which interests need to be taken into account when new preventive measures are implemented. RESULTS: It is important to differentiate between distinct target groups. From an ethical point of view it makes a difference whether measures are related to the early identification of a-symptomatic high-risk children and appropriate preventive interventions, or whether they are directed towards the (sub)typing and preventive treatment of children who already have behavioural problems or whether they are concerned with the treatment of children with conduct disorders whose parents have asked the child psychiatrist for assistance. CONCLUSION: From an ethical point of view it is not really important whether prevention measures are based on genetic and neurobiological research or on societal and psychological research. What is more important is that these measures target particular groups of children and that prevention is implemented in an appropriate manner.

[Mental competence in the context of deep brain stimulation]. / Wilsbekwaamheid in de context van elektrostimulatie van de hersenen.

In a case of Parkinson's disease, the patient was treated with deep brain stimulation of the subthalamic nucleus (STN-DBS). STN-DBS affected the mental competence of the patient and ethical questions were raised about the decision as to the direction of further treatment. The patient was asked for his opinion on the therapeutic options during a phase of non-stimulation and chose to be stimulated and admitted to a psychiatric hospital because of mental incompetence rather than remaining unstimulated, mentally competent but bedridden. Developments in the neurosciences (including STN-DBS) raise a number of different fundamental (theoretical and philosophical) as well as practical questions. STN-DBS can have various unintended (behavioural) effects. In the case presented, more weight was rightly given to the mental competence of the unstimulated patient, although comments can be made with regard to his decision making, as his choice was made in a phase of serious distress. Attention is paid to the relevance of a so-called self-binding directive. STN-DBS is not morally neutral and the case involves a tragic dilemma: a conflict between irreconcilable duties for the physician. The further development and proliferation of STN-DBS requires caution and moral deliberation. It remains important to search for alternative treatment strategies with less undesirable side effects.