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[Full disclosure--I have not had a chance to read this article. Does anyone know where I can get access to the article even though I am no longer affiliated with an academic institution? I graduated several years ago from a school where I could access these articles for free.]

I wonder if DBS is really that much more dangerous than taking multiple meds for years (or life). It's very targeted, avoiding the widespread effects of medications on multiple organ systems. Also, I can't imagine any patient in their right mind (esp. when they have tried all traditional therapies and they have failed) refusing this treatment -- it would be like someone choosing to live their life in something worse than a vegetative state. Can we assume some type of "reasonable person" standard or consent?

On a different note, I dislike the title of this article. When the alternative to DBS is a devastating, excruciatingly painful depression that has failed to respond to meds, therapy, or ECT, calling for "modesty" sounds flippant. I trust that Morse appreciates the seriousness of the disorder and is referring just as much to taking a modest approach intellectually as clinically, but the title is insensitive. In a situation where the alternative is most likely death or enduring an existence that can barely be called a life, an aggressive approach is warranted--even where informed consent is an issue. Intellectually, I realize than an academic debate about informed consent is vitally important, but as someone who has dealt with these issues in a clinical setting, the title leaves the impression that academics are out of touch with those of us fighting in the trenches. The REAL "modest" approach is to give gravely ill people lifesaving treatment until we are SURE there is some compelling legal or medical reason not to -- especially where the preliminary evidence indicates that the treatment benefit outweighs the medical risks. Why should there have to be any more disclosure than with other new but potentially lifesaving procedures offered in such serious situations?

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