Intervening in the Brain: Ethics and Neurosurgery

The wonder evoked by the term “brain surgery” is well-deserved. Neurosurgeons can clip an aneurysm and save a life; deep brain stimulation can alleviate disabling muscle tone disorders, control the tremors of Parkinson, and relieve intractable psychiatric symptoms. At the frontiers of neurosurgery lie interventions for treatment of cognitive and behavioral disorders and technological advances that will expand the scope and reach of neurosurgery and challenge the line between treatment and enhancement. Contributors to the January issue explore current and possible neurosurgical interventions and offer guidance for decision making under conditions of clinical and ethical uncertainty.

Volume 17, Number 1: 1-104 Full Issue PDF
  • From the Editor
    Jan 2015

    Neurosurgery Ethics: Perspectives from the Field, Circa 2015

    Jordan P. Amadio, MD, MBA
    Rather than a scholarly exercise, we have sought to create a living showcase of the most important ethical issues in neurosurgery circa 2015.
    Virtual Mentor. 2015;17(1):3-5. doi: 10.1001/virtualmentor.2015.17.1.fred1-1501.
  • Case and Commentary
    Jan 2015

    Applying Guidelines to Individual Patients: Deep Brain Stimulation for Early-Stage Parkinson Disease, Commentary 2

    Kara Beasley, DO, MBe
    When deciding whether to offer deep brain stimulation earlier than usual for Parkinson disease, it is important to consider not only the patient’s autonomy but also the validity of the evidence and concepts of harm that are being used to form practice policies.
    Virtual Mentor. 2015;17(1):18-22. doi: 10.1001/virtualmentor.2015.17.1.ecas2-1501.
  • Case and Commentary
    Jan 2015

    Duty-Hour Exceptions for Neurosurgery Residency Programs, Commentary 1

    Nathan R. Selden, MD, PhD
    Approval of requests for exceptions to duty-hour restrictions from the Accreditation Council for Graduate Medical Education (ACGME) may require increasing the complement of midlevel practitioners, implementing innovative resident scheduling, and using social learning techniques to increase efficiency.
    Virtual Mentor. 2015;17(1):23-28. doi: 10.1001/virtualmentor.2015.17.1.ecas3-1501.
  • Case and Commentary
    Jan 2015

    Duty-Hour Exceptions for Neurosurgery Residency Programs, Commentary 2

    Michael M. Haglund, MD, PhD
    Approval of requests for exceptions to duty-hour restrictions from the Accreditation Council for Graduate Medical Education (ACGME) may require increasing the complement of midlevel practitioners, implementing innovative resident scheduling, and using social learning techniques to increase efficiency.
    Virtual Mentor. 2015;17(1):28-32. doi: 10.1001/virtualmentor.2015.17.1.ecas3-1501.
  • Medical Education
    Jan 2015

    Evaluating Simulation as a Teaching Tool in Neurosurgery

    Brian D. Rothstein, MD, MS and Warren R. Selman, MD
    With the advancement of simulation technology and more accurate assessment of competency, simulators will prove beneficial for training neurosurgeons.
    Virtual Mentor. 2015;17(1):33-36. doi: 10.1001/virtualmentor.2015.17.1.medu1-1501.
  • In the Literature
    Jan 2015

    Integrating Ethics into Science Education and Research: Report of the Presidential Commission for the Study of Bioethical Issues

    Jonathan Riley, MD and Jessica Emery
    The 2013 BRAIN Research Initiative calls for the integration of ethics into medical education and all levels of research, from hypothesis generation to evaluation, which promises to provide an ethical foundation for all future biomedical research.
    Virtual Mentor. 2015;17(1):37-40. doi: 10.1001/virtualmentor.2015.17.1.jdsc1-1501.
  • State of the Art and Science
    Jan 2015

    Innovation in Surgery and Evidence Development: Can We Have Both at Once?

    Brett E. Youngerman, MD and Guy M. McKhann II, MD
    Surgery’s unique characteristics, including difficulties in standardizing, blinding, and recruiting participants for clinical trials, render problematic the application of evidence-based standards to surgery.
    Virtual Mentor. 2015;17(1):41-48. doi: 10.1001/virtualmentor.2015.17.1.stas1-1501.
  • Policy Forum
    Jan 2015

    Models of Neurosurgery International Aid and their Potential Ethical Pitfalls

    George M. Ibrahim, MD, PhD and Mark Bernstein, MD, MHSc
    Four models of international aid in neurosurgery can be categorized by the level of the commitment and the breadth of applications, each giving rise to a different set of ethical problems that may involve challenges to access, sustainability, equity, or informed consent processes in health care.
    Virtual Mentor. 2015;17(1):49-55. doi: 10.1001/virtualmentor.2015.17.1.pfor1-1501.
  • Medicine and Society
    Jan 2015

    A Preparatory Neuroethical Approach to Assessing Developments in Neurotechnology

    James Giordano, PhD, MPhil
    The pace at which neurotechnological developments are being translated into clinical applications calls for a preparatory neuroethical model that can plot the benefits, burdens, and risks of neurosurgery as a step toward minimizing risks and maximizing benefits.
    Virtual Mentor. 2015;17(1):56-61. doi: 10.1001/virtualmentor.2015.17.1.msoc1-1501.
  • History of Medicine
    Jan 2015

    Technological Innovation and Ethical Response in Neurosurgery

    Jayant Menon, MD, MEng and Daniel J. Riskin, MD, MBA
    The authors describe a historical pattern in which a set of enabling technologies facilitates rapid advances in medical practice, resulting in recognition of new ethical challenges and a decades-long struggle to resolve them.
    Virtual Mentor. 2015;17(1):62-68. doi: 10.1001/virtualmentor.2015.17.1.mhst1-1501.
  • Viewpoint
    Jan 2015

    Disclosure of Experience as a Risk Factor in Informed Consent for Neurosurgery: The Case of Johnson v. Kokemoor

    John D. Banja, PhD
    The case of Johnson v Kokemoor illuminates the conflict between patients’ right to informed consent and clinicians’ need to learn through practice, a conflict that possibly could be resolved through greater transparency about clinicians’ experience or experience-dependent medical fees.
    Virtual Mentor. 2015;17(1):69-73. doi: 10.1001/virtualmentor.2015.17.1.oped1-1501.
  • Viewpoint
    Jan 2015

    The New Era of Neuromodulation

    Marwan Hariz, MD, PhD and Jordan P. Amadio, MD, MBA
    Deep brain stimulation (DBS) for enhancements of non-disease states is ethically indefensible given our incomplete knowledge of this technology. Attention should instead be focused on increasing access to DBS for patients with illnesses potentially treatable by the procedure.
    Virtual Mentor. 2015;17(1):74-81. doi: 10.1001/virtualmentor.2015.17.1.oped2-1501.
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    Podcast
    Jan 2015

    Ethics Talk: Emerging Ethical Issues in Neurosurgery

    This month, Virtual Mentor theme editor Jordan P. Amadio, MD, MBA, a senior neurosurgery resident at Emory University School of Medicine in Atlanta, Georgia, interviewed Paul Root Wolpe, PhD, about the ethical import of new technologies and the practical import of the White House Brain Initiative for neurosurgeons and neurosurgeons in training.