International Legal Approaches to Neurosurgery for Psychiatric Disorders

Abstract

Neurosurgery for psychiatric disorders (NPD), also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law (what should be regulated), what types of regulations are required (eligibility criteria, approval procedures, data collection, and oversight mechanisms), and how to approach international harmonization given the potential migration of researchers and patients.

Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation

“…Mental health legislation in multiple countries, specifically addressing neurosurgery for psychiatric disorders, includes psychiatric applications of DBS within the scope of the laws ( Nadler and Chandler, 2019 ; Chandler et al, 2021 ). Many of these laws are quite recent ( Mental Health Act, Scotland, 2003 ; Mental Health Act, Australia, 2014 ; Mental Healthcare Act, India, 2017 ), revealing continued social and legal attention to neurosurgical treatments especially to address psychiatric conditions.…”

“…Many of these laws are quite recent ( Mental Health Act, Scotland, 2003 ; Mental Health Act, Australia, 2014 ; Mental Healthcare Act, India, 2017 ), revealing continued social and legal attention to neurosurgical treatments especially to address psychiatric conditions. These laws often address the following general issues: restricted eligibility of particular populations for psychiatric neurosurgery (particularly incapable patients, children, prisoners and involuntarily hospitalized patients), independent pre-surgical approval processes sometimes including courts or mental health tribunals, and record-keeping and post-surgical reporting requirements ( Chandler et al, 2021 ). The 1977 report on psychosurgery by a US National Commission made recommendations in each of these areas.…”

Interventional Psychiatry and Neurotechnologies: Education and Ethics Training

“…38 From a medicolegal perspective, existing legal frameworks regarding the use of psychiatric neurosurgery have been identified to be inconsistent both within or across countries and are based on a concept of strict dualism between the mind and brain that does not reflect the current scientific understanding of the primacy of the nervous system in the genesis and expression of emotional disorders. 39 It has been proposed that attending to these and other neuroethical issues can complement and advance neuroscience by providing a critical lens on identifying and addressing the implications of discoveries in the basic and clinical neurosciences and their implementation, such as the new technologies and interventional approaches outlined in this paper. 40 Indeed, all major nationally endorsed neuroscience initiatives, including the Canadian Brain Research Strategy, 41 have prioritized funding for exploration of neuroethical issues.…”

Influencing Human Behavior with Noninvasive Brain Stimulation: Direct Human Brain Manipulation Revisited

“…For instance, the US Food and Drug Administration (FDA) has approved devices for deep brain stimulation of different subcortical brain targets for the treatment of Parkinson’s disease (subthalamic nucleus or globus pallidus internus), dystonia (globus pallidus internus), essential tremor (ventral intermediate nucleus of the thalamus), and severe obsessive-compulsive disorder (anterior limb of the internal capsule). In addition, an active research field continues to explore deep brain stimulation for other indications, including epilepsy, major depression, Alzheimer’s disease, obesity, or substance use disorders, although current regulations remain unclear ( Chandler and others 2021 ). However, the early research efforts of the 1950s also revealed the risks of this line of investigation.…”