• Marleen Eijkholt, Laura Y Cabrera, Adolfo Ramirez-Zamora, and Julie G Pilitsis.
• Center for Ethics & Humanities in the Life Sciences, Michigan State University, Grand Rapids, MI, USA.
• Neuromodulation. 2017 Jul 1; 20 (5): 411-416.

ObjectivesDeep brain stimulation (DBS) is a well-established treatment for the management of severe motor fluctuations in advanced Parkinson's disease (PD). Until recently, device regulation, medical, and insurance practices limited DBS to patients with advanced stages of PD. In February 2016 this changed, however, when the US Food and Drug Administration (FDA) granted formal approval for the use of brain stimulator in mid-stage PD patients. In this article, we examine whether DBS in mid-stage PD can be ethically justified beyond the FDA approval.Materials And MethodsWe scrutinize the current risk-benefit profile, the costs-benefit profile, and the capacity for informed consent requirement, to ask if use of subthalamic nucleus (STN) in mid-stage DBS is ethically appropriate.ResultsWe propose that mid-stage DBS decisions could be appropriate under a shared decision-making model, which embraces a broad quality of life perspective.ConclusionAlthough it might be too premature to know how the FDA decision will affect medical and insurance practices, we conclude by arguing that revisions to persisting guidelines seems justified both on scientific and ethical grounds.© 2017 International Neuromodulation Society.

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