L.B. Likhterman, Doctor of Medical Scienсes, Professor, Chief Researcher
B.L. Lichterman, Doctor of Medical Sciences, Professor at the Department of the History
of Medicine, National History and Culturology
This study presents a brief excursion into the history of the question of ethics and morality in neurosurgery. The current contradictory situation is analyzed: a technological “explosion” in relation to methods of diagnosis and treatment of diseases of the nervous system and a crisis of medical ethics. The most important factors in the humanization of neurosurgery are highlighted: the approach to the criteria for an ideal method of diagnosis, treatment of previously surgically inaccessible lesions, the carrying out of minimally invasive procedures, the transition from neurodestruction to neurostimulation and neuromodulation, the development of reconstructive operations, adequate anesthesia, intraoperative neuromonitoring and the possibility of prolonged monitoring of vital functions. The main problems of dehumanization of neurosurgery are emphasized: estrangement (distancing) of the doctor from the patient, the possibility of adverse changes in the psyche as a result of neurosurgical intervention, increasing iatrogenic neurosurgical pathology, the high and growing cost of neurosurgical evaluation and treatment, and other problems. Contradictions in modern neurosurgery are noted. Particular attention is given to conflict of interest and conflict of obligations related to the commercialization of modern neurosurgery and their possible solutions, as well as mistakes caused by unwarranted surgery. The authors believe that the prioritizing of human values in all stages of neurosurgical education, training and work can prevent the dehumanization of neurosurgery in the era of high technology. The main condition for the humanization of neurosurgery is formulated: neurosurgeons must not only be homo sapiens, but also homo moralis.
Keywords: Medical ethics, deontology, neurosurgery, humanism, a conflict of interest