Reconsidering "Psychosurgery": Issues of Informed Consent and Physician Responsibility

Abstract

...Cingulotomy, a specific surgical intervention, is a treatment option for patients suffering from various psychiatric disorders that resist medical, behavioral, and psychotherapeutic treatments. In this article we will use the example of the patient with obsessive-compulsive disorder (OCD) whose condition does not respond to treatment and who is an appropriate candidate for cingulotomy as a paradigm. We will explore the capacity of patients with severe and chronic mental illness to make decisions, and the responsibility of physicians to these patients. The following questions will guide the discussion: Are such patients capable of giving an informed consent or refusal to treatments? What criteria or standards should be used to assess their capacity? Who is qualified to perform the assessment? And finally, should physicians include the option of surgery?