Ethics of psychosurgery.
The ethics of psychosurgery involve questions of moral philosophy and pragmatism in alleviating human suffering. The weighing of scientific data along with philosophical oughts and shoulds is required. The medical literature indicates definite efficacy for some kinds of limbic surgery, mainly cingulotomy and capsulotomy, in some kinds of conditions, namely major depression, pain and anxiety. The relative utility of these procedures given the severity of the illnesses and the safety of the procedures described is significant. Ethical and moral conflicts over altruism, autonomy and suffering require recognition before their due considerations (Kleinig 1985). The following recommendations emerge from these considerations: 1. No consideration of ethics in psychosurgery is complete without consideration of both the scientific data and moral conflicts. 2. The considerable efficacy and safety of cingulotomy and capsulotomy must be acknowledged. 3. Indications and contraindications do exist for selecting patients. Major psychiatric Axis I diagnoses of depression and anxiety are the indications. Personality disorders are not indications. 4. Peer review, unfettered consent and knowledge of the psychodynamics of severe illness are three ingredients necessary for wise decisions about performing limbic surgery. 5. The liberal advocation of autonomy without responsibility is an amoral, not liberating, point of view. 6. Politics should be denounced as the most serious ethical problem in medical decision making. Political intrusion into the scientific matters and the doctor-patient relationship has created ethical problems with psychosurgery and continues to do so today.
Bouckoms
A J
AJ
Harvard Medical School, Massachusetts General Hospital, Boston.
D002421:Caudate Nucleus / Q000601:surgery; D004992:Ethics, Medical; D005625:Frontal Lobe / Q000601:surgery; D006179:Gyrus Cinguli / Q000601:surgery; D006801:Humans; D001523:Mental Disorders / Q000601:surgery*; D010554:Personality Disorders / Q000523:psychology; D011183:Postoperative Complications / Q000523:psychology; D011612:Psychosurgery; D012307:Risk Factors; D013788:Thalamus / Q000601:surgery