On/Off-Discrepancies in medical decision-making: utilising the reversibility of deep brain stimulation to strengthen patient autonomy

Definition of the problem Some medical interventions have the potential to interfere with patients’ future healthcare decision-making. We identify two types of such influences: affecting whether a patient has decision-making capacity in the first place; and influencing which treatment option a patient ends up selecting. Argument Using the example of deep brain stimulation, we argue that one should utilise this effect to obtain more authentic treatment preferences. In patients with implanted deep brain stimulators who do not meet the capacity threshold, the device state should be reverted as there is a chance that doing so has a positive effect on their capacity. In patients who are already deemed decision-competent, the same approach can reveal on/off-discrepancies in the selection of treatment choices. Conclusion We propose five cross-checking strategies to deal with such discrepancies and call for a revision of current procedures for obtaining consent following any interventions whose psychotropic influences can be reversed within clinically reasonable time frames.