By Michael L.J. Apuzzo, Charles Y. Liu, Daniel Sullivan
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Extra info for Surgery of the Human Cerebrum
Someday armies and generals will be controlled by electric stimulation of the brain” (21, 26, 48, 49). Congressional Investigation In testimony before the Subcommittee on Health of the Senate Committee on Labor and Public Welfare, controversial psychiatrist Peter Breggin, an outspoken critic of not only psychosurgery, but also psychiatric medication, was quoted as saying, “[Psychosurgeons’ suspect consent practices] create for themselves an elitist power over the human mind and spirit. If America ever falls to totalitarianism, the dictator will be a behavioral scientist and the secret police will be armed with lobotomy and psychosurgery” (26, p 310).
Although 726 | VOLUME 59 | NUMBER 4 | OCTOBER 2006 the creation of destructive lesions in certain fiber tracts, nuclei, and cortical areas remains the basis for the four most common procedures currently in limited use, it may be better to consider a new vision of psychiatric surgery within the framework of neuromodulation (25, 26, 43). Neuromodulation is primarily defined as the regulation of brain function through the placement of stimulating electrodes and is an accepted means of treatment for a variety of movement disorders.
The main ethical consideration is then represented by informed consent, an integral part of the psychosurgery process. It should be stated that such consent obtained from a patient who may lack the mental faculties to properly provide it might be very questionable. The European Council Committee for Bioethics stated, “When a State approves the use of psychosurgery, the consent of the patient is the minimum requirement. ” The potential benefits and risks of the treatment, and of available alternative interventions, should be carefully reviewed and discussed with the patient and, where appropriate, the family.