Legal and ethical considerations

Neurosurgery is not an available option by law in many countries (e.g. Germany) and in some American states (e.g. Oregon). Special legislation applies to many countries including the United Kingdom, where, however, the provisions in Scotland are different from those in England and Wales. In countries where there is no special legislation the selection of patients is regulated by a panel of experts which sits in the hospitals providing the surgery.

In England and Wales, under Section 57 of the Mental Health Act, patients must be assessed by a panel of three representatives appointed by the Mental Health Commission. The panel certifies that the patients have given their free and informed consent and are likely to benefit from the procedure. This process can be cumbersome, at times resulting in fatal delays in providing the service.(20) The procedure is different in Scotland, in that Section 97 only applies to patients who are detained.

The main ethical issue to be considered is the balance between adequate consent, adequate previous therapeutic attempts, and allowing treatment. This is dealt with differently in different societies, some of which have produced algorithms for the definition of a treatment-resistant population. (8.,U)

This balance would be affected by the conduct of appropriately controlled studies, especially in affective disorders where the chances of spontaneous remission are much higher than in obsessive- compulsive disorder. Such studies could be carried out either using sham techniques (now possible for some procedures that can be carried out with a cobalt gamma knife) or by comparing with aggressive and prolonged pharmacological treatment.

Adult Dyslexia

Adult Dyslexia

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