Psychosurgery

In this chapter we review the history of psychosurgery and why it is so much under the microscope and conjures so much ethical ambivalence. We then discuss ablative and neuromodulatory psychosurgery in the context of three of the fundamental ethical principles of patient autonomy, beneficence, and justice. Major concerns involve vulnerable populations and informed consent, conflicts of interest with clinician-researchers providing care, industry funders, and non-abandonment after studies are completed. Equitable access to care across geographic and socioeconomic levels, medical tourism, and long-term care and reporting are additional important issues. What to do about cosmetic neurosurgery or deep brain stimulation for memory enhancement is an emerging concern which will likely require regulation in the future. We present ethical approaches for the future of psychiatric neurosurgery.