Neurosurgeons' perspectives on psychosurgery and neuroenhancement: a qualitative study at one center

Clinical article

Daniel Mendelsohn M.Sc., Nir Lipsman M.D., and Mark Bernstein M.D., M.H.Sc., F.R.C.S.C.
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  • Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
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Object

Advances in the neurosciences are stirring debate regarding the ethical issues surrounding novel neurosurgical interventions. The application of deep brain stimulation (DBS) for treating refractory psychiatric disease, for instance, has introduced the prospect of altering disorders of mind and behavior and the potential for neuroenhancement. The attitudes of current and future providers of this technology and their position regarding its possible future applications are unknown. The authors sought to gauge the opinions of neurosurgical staff and trainees toward various uses of neuromodulation technology including psychosurgery and neuroenhancement.

Methods

The authors conducted a qualitative study involving in-depth interviews with 47 neurosurgery staff, trainees, and other neuroclinicians at a quaternary care center.

Results

Several general themes emerged from the interviews. These included universal support for psychosurgery given adequate informed consent and rigorous scientific methodology, as well as a relative consensus regarding the priority given to patient autonomy and the preservation of personal identity. Participants' attitudes toward the future use of DBS and other means of neuromodulation for cognitive enhancement and personality alteration revealed less agreement, although most participants felt that alteration of nonpathological traits is objectionable.

Conclusions

There is support in the neurosurgical community for the surgical management of refractory psychiatric disease. The use of neuromodulation for the alteration of nonpathological traits is morally and ethically dubious when it is out of sync with the values of society at large. Both DBS and neuromodulation will have far-reaching and profound public health implications.

Abbreviations used in this paper: DBS = deep brain stimulation; GKS = Gamma Knife surgery; OCD = obsessive-compulsive disorder; PTSD = posttraumatic stress disorder.

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Contributor Notes

Address correspondence to: Mark Bernstein, M.D., Division of Neurosurgery, Toronto Western Hospital, West Wing, Room 4W451, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8. email: mark.bernstein@uhn.on.ca.

Please include this information when citing this paper: published online June 4, 2010; DOI: 10.3171/2010.5.JNS091896.

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