title: A patient revoking consent during awake craniotomy: an ethical challenge.
abstract: Purpose.  The ethical challenges posed when a patient requests the discontinuation of a procedure during awake neurosurgeries are seldom discussed. We present such a case with a very brief ethics discussion. Case.  A patient with idiopathic parkinsonism requested the discontinuation of a surgery in the middle of the implantation of bilateral deep brain stimulator electrodes. In consultation with a clinical bioethicist and the patient's family, the surgical team decided that the patient's current wishes needed to be respected. Subsequently, the surgical team performed the steps necessary to safely halt the surgery. Conclusion.  Even though the patient had the privilege of requesting a discontinuation, the surgeon had an obligation to keep the patient safe. Processes should be in place to assist decision-making about the continuation of awake surgery after such a patient request.
authors.affiliation: Department of Bioethics, and                                      Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, OH, USA; and                                      Department of Neurology and National Primate Research Center, University of Wisconsin-Madison Medical School, Madison, WI, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Ford
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Boulis
authors.forename: Erwin B
authors.initials: EB
authors.lastname: Montgomery
authors.forename: Ali R
authors.initials: AR
authors.lastname: Rezai