Neurosurgery for psychiatric disorders, 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 types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Major depression is among the most common, challenging and disabling conditions. It is highly heterogeneous, affects patients throughout the lifespan and, in up to one-third of people affected, res...

Abstract:Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal surgery, raises (...) a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus. (shrink)

: Understanding Helmholtz's philosophy of science requires attention to his experimental practice. I sketch out such a project by showing how experiment shapes his theory of perception in three ways. One, the theory emerged out of empirical and experimental research. Two, the concept of experiment fills a critical conceptual gap in his theory of perception. Experiment functions not merely as a scientific technique, but also as a general epistemological strategy. Three, Helmholtz's experimental practice provides essential clues to the interpretation of (...) his theory of perception. A case study from experimental investigation of hearing shows how he designed such studies in accordance with the epistemological commitments of the theory of perception. Yet, while the theory was important to his experiments, the soundness of the experimental strategy was epistemically independent of those commitments. Secondly, the case study illustrates how Helmholtz consistently held that causal inferences underwrite reference to a real, but indirectly experienced external world. (shrink)

Ethical issues in physician-industry and academia-industry relationships have focused largely on the financial nature of these relationships. It took very little time after solutions to transparenc...

While it was not a main focus of his work, Ernan McMullin contributed to reflection on being human in the context of human evolutionary history. His work developed multiple strands for the formation of a systematic Christian evolutionary theism regarding human beings. The first theme concerns St. Augustine’sexplorations of “seed-like” principles in developing the idea that God brought forth humans in part through a natural process. Secondly, the paper discussesMcMullin’s response to the claim that evolutionary theory suggests humans to be (...) the result of radical contingency, calling into question the Providential natureof human evolution. McMullin invokes Augustinian sensibilities about God’s eternality in his reply. Next, Fr. Ernan reflected on the concept of matter and howit can inform a response to dualistic conceptions of human being. Finally, in a characteristically even-handed tone, he defended emergentism as a viable optionto dualism, recognizing there to be serious philosophical and theological concerns about the emergentist picture. While McMullin did not solve the problems thatchallenge a synthesis of evolutionary theory and Christian anthropology, he offered a number of very helpful clues. (shrink)

Electroencephalographic monitoring provides critical diagnostic and management information about patients with epilepsy and seizure mimics. Admission to an epilepsy monitoring unit (EMU) is the gold standard for such monitoring in major medical facilities worldwide. In many countries, access can be challenged by limited resources compared to need. Today, triaging admission to such units is generally approached by unwritten protocols that vary by institution. In the absence of explicit guidance, decisions can be ethically taxing and are easy to challenge. In an (...) effort to address this gap, we propose a two-component approach to EMU triage that takes into account the unique landscape of epilepsy monitoring informed by triage literature from other areas of medicine. Through the strategic component, we focus on the EMU wait list management infrastructure at the institutional level. Through the principled component, we apply a combination of the ethical principles of prioritarianism, utilitarianism and justice to triage; and we use individual case examples to illustrate how they apply. The effective implementation of this approach to specific epilepsy centres will need to be customised to the nuances of different settings, including diverse practice patterns, patient populations and constraints on resource distribution, but the conceptual consolidation of its components can alleviate some of the pressures imposed by the complex decisions involved in EMU triage. (shrink)