Sunday, 8 March 2015

Guest Editorial on the Ethics of How to Balance Risks and Chances of Benefits in Neurosurgery with High Stakes

When you're a medical ethics or bioethics researcher, it is always an important proof of the value of what you do when policy makers and professionals in the fields you relate to find your ideas relevant to consider in their decision-making. Therefore, I'm pretty happy and proud about this recent publication:  On kind invitation by the editor in chief, I have written a guest editorial for the European neurosurgery journal, Acta Neurochirurgica, and yesterday it went online. The title is 'The ethics of “primo non nocere”, professional responsibility and shared decision making in high-stakes neurosurgery', and so far the journal management has chosen to make it freely accessible for download:

 Should that generosity ever go away, I have uploaded my own submitted version (not including corrections made in copy-editing and proofreading) here.

In the article, I analyse a debate between to neurosurgical teams (of Jannick Brennum and Hugues Duffau, respectively) on whether or not it would be  ethically acceptable to offer an option to people with fatal brain disease (e.g., cancer), to offer an option of going for more radical surgery to boost the chance of longer survival, which at the same time brings increased risks of major functional disability (such as loss of eyesight or ability to walk). I show that this seemingly straightforward issue actualises a cluster of rather different ethical questions, and that both sides of the debate may have been lured astray or getting lost in this situation. I end by suggesting a "diagnosis" of what the question is at heart about, and offer a thought experiment to hopefully help the medical professionals to further their debate on this particular issue. I don't have any pretension of solving the issue, but as my thought experiment suggests, I do harbour suspicions that some of the reasoning going on this far among the discussants may have been influenced by an irrational temporal bias.