Informed consent and the history of modern neurosurgery

Abstract

The concept of consent has a long history, being defined and understood in different ways over time. Specific historical events and debates, both internal and external to the medical profession, have shaped the manner in which experimentation on humans has been conducted and regulated. The adoption of laboratory approaches and an alliance with experimental science in the nineteenth century transformed the medical profession. Despite early attempts to articulate an ethics of experimentation, invasive and dangerous therapeutic procedures, including on the brain, were often tried on patients without their consent. The Nuremberg Code set important criteria, but egregious experimentation continued after the war. It was in the 1960s and 1970s, during the rights movement, and in the wake of public outrage over a number of revelations that a modern notion of informed consent began to take shape and that medical practices became subject to some external safeguards and regulations. The history of neurosurgery mirrors this more general story. After two decades of bold attempts to open the skull for a variety of afflictions, the development of neurosurgery as a medical specialty in the early twentieth century brought with it an initial conservatism both in technique and in the range of conditions for which brain surgery was attempted. Starting in the 1930s, a radical interventionist ethos paved the way for the wide adoption of procedures such as lobotomy. A thorough scrutiny of these procedures came only in the 1970s, when review boards and other safeguards were put into place.