Rewiring criminal minds via Brain Stimulation: Balancing Rehabilitation effects and Ethics

Written by: Sabrina Xu

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The use of Deep Brain Stimulation (DBS) to modify personality traits in criminal rehabilitation presents a unique intersection of neuroscientific intervention and ethics. Originally developed for treating neurological disorders, DBS offers a potentially transformative method for reducing recidivism rates among criminal offenders by targeting brain regions associated with aggression and impulsivity. Below, We focus on the positive and negative effects of DBS (especially of the prefrontal cortex) on patients affected with antisocial personality disorder (ASPD) and psychopathy. This essay explores the ethical implications of deploying DBS within the criminal justice system, aiming to balance the therapeutic benefits of DBS against ethical concerns such as consent, patient benefit, and personal identity.

The Emergence of DBS and How It Works

In the last 50 years, there has been rapid development in the safety and efficacy of Deep Brain Stimulation (DBS), an invasive and reversible technique that has emerged as a viable option for the treatment of neurological and psychiatric disorders. During the procedure, electrodes are inserted deep into the brain at targeted regions, connected via wire extensions to a small electrical generator under the collarbone, which continuously passes electric pulses into the brain. Stimulation parameters such as frequency, pulse width, and voltage need to be altered to achieve maximum efficacy.

Despite the growing awareness in neuroscience to explain and predict antisocial and illegal conducts, the extent to which such knowledge is used to advance research in criminology remains limited. The most prevalent mental disorders across offenders are antisocial personality disorder(ASPD), borderline personality disorder (BPD), and major depressive disorder (MDD). Currently, criminal rehabilitation techniques in the UK involve educational, psychological and vocational therapies to help them learn skills for use outside prison. In terms of its effectiveness, the reoffending rate in the UK is 56% (after <1 year of rehabilitation), which could conceivably be reduced by the use of DBS and other neurointerventions.

According to a number of influential views in penal theory, one of the primary goals of the criminal justice system is to rehabilitate offenders. Whilst DBS could potentially provide powerful new means of facilitating criminal rehabilitation, it also raises several ethical problems (although more traditional criminal justice interventions do not), and it is these problems that provide the impetus for this essay, which explores the hypothesis that using DBS could rehabilitate criminals more efficiently.

Need for DBS vs Ethical Concerns

A link between frontal lobe and criminal behavior is supported by the research on empathy, moral decision-making and reasoning . A prototypical example of contempt for social rules and legality with a strong neurobiological characterization is offered by ASPD, a clinical condition characterized by behaviour potentially harmful to themselves or others . An estimated 1% of males meet the criteria for psychopathy, which roughly equals 1,150,000 adult psychopathic males in the United States. Almost 93% of that population, are in prison, jail or on probation . It has been shown through studies that reduced connections in the prefrontal cortex holds accountability for the severity of ASPD.

Currently, there is no pharmacological treatment for ASPD. Regardless of past efforts, therapies proved to be ineffective and those who underwent treatment were often more aggressive and showed higher rates of recidivism following their incarceration. So this is where DBS steps in, and what makes it so compelling is its reversibility and minimization of infection. The electric impulses to be sent into targeted brain areas, stimulating and inhibiting neural activity to regulate emotions, aggression, and impulsivity.

One of the main problems is that DBS constitutes a form of medical intervention, and it is a standard tenet of medical ethics that it is permissible to perform a medical intervention on a competent individual only if that individual has given his/her informed consent to that intervention. However, it is not clear whether the consent obtained from an incarcerated individual, is valid.

In terms of the extent of consent, offenders should be given the choice to either undergo DBS treatment and serve less time in prison, or serve their full sentence without treatment. In the UK, individuals have a legal right to refuse medical interventions, this highlights the view that moral reasons to respect individual autonomy prevail over reasons to protect the offenders’ interests.

Another consideration is patient benefit: in these cases where “the doctor is happy, the patient less so,” some have hypothesized that it is a difficulty in self-perception after surgery that dampens patients’ estimates of the success of the procedure. For example, patients may struggle to reconcile their pre-surgery identity with the changes induced by the procedure, leading to a sense of disconnection and dissatisfaction. Additionally, the emotional toll of undergoing a such a significant medical procedure should not be underestimated. It is essential for doctors to consider these factors when evaluating rehabilitation success and to offer care and compassion for their patients.

Conclusion

Although the use of DBS (and other neuro-correctives) is currently rare, there are good reasons to trust the possibility of them becoming more prevalent in the future. However, the revolutionary technology that makes effective rehabilitation possible, also poses several ethical problems that requires ongoing collaboration between researchers, neuroscientists, and psychologists. I believe that with the correct efforts made, it is plausible to ethically implement DBS not only in criminal rehabilitation but also in various other areas of medicine and therapy.