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首页> 外文期刊>Current opinion in anaesthesiology >Informed consent for special procedures: Electroconvulsive therapy and psychosurgery
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Informed consent for special procedures: Electroconvulsive therapy and psychosurgery

机译：特殊程序知情同意：电抽搐治疗和心理外科

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Purpose of Review: Informed consent has become the cornerstone of the expression of patient's autonomy for ethical and sound patient-physician relationships. However, some severe psychiatric diseases markedly hinder the ability of selected patients to ensure a proper consent. Confronted with mentally disabled individuals whose condition may lead to violence or inflicting it on others, society must carry out its duty of protecting those who are particularly vulnerable, while respecting and protecting these disabled individuals. Recent Findings: The recent update in the indications and more detailed understanding of electroconvulsive therapy, and the technical ability of obtaining less invasive or reversible techniques of psychosurgery, has renewed interest in these impressive and efficient techniques. Specifically, the emergence of new and promising cerebral neurostimulation techniques for treating Parkinson's disease have led to considering their extension to severe psychiatric disorders. This method can mimic the effects of 'conventional' psychosurgery, but in a potentially reversible and adaptable way, thus avoiding many undesirable side-effects of lesional surgery. Ensuring an ethical decision-making process and the appropriateness of consent becomes of paramount importance. Summary: Consent can be relatively easy to secure in selected patients who are often fully aware of their torments (such as those suffering from severe refractory depression of obsessive-compulsive disorders) whose suffering may be such that they are ready to accept, or for that matter demand, such actions. However, the duty of physicians is to realize that pains should always be taken to do as much good (and as little harm) as possible, while respecting the freedom of decision of those who seek to help. ? 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
机译：审查目的：知情同意已成为表达患者自律与良好医患关系的基础。但是，一些严重的精神疾病明显阻碍了某些患者确保获得适当同意的能力。面对可能导致暴力或对他人施加暴力的弱智人士，社会必须履行保护特别弱势者的义务，同时尊重和保护这些弱智人士。最新发现：对电惊厥疗法的适应症和更详细的了解的最新更新，以及获得创伤较小或可逆的心理外科技术的技术能力，使人们对这些令人印象深刻且有效的技术重新产生了兴趣。具体地，用于治疗帕金森氏病的新的和有希望的脑神经刺激技术的出现已经导致考虑将其扩展到严重的精神疾病。该方法可以模仿“常规”心理手术的效果，但是以潜在的可逆和适应性方式，从而避免了病变手术的许多不良副作用。确保道德决策过程和同意的适当性变得至关重要。摘要：在通常完全意识到自己的折磨（例如患有强迫症的严重难治性抑郁症的患者）的选定患者中，同意可能相对容易获得，而这些患者的痛苦可能使他们愿意接受，或者为此物质需求，这种行动。但是，医师的职责是认识到，在尊重寻求帮助的人的决定自由的同时，应始终尽最大的努力去做（尽可能少的伤害）。 ？ 2013威科集团健康|利平科特·威廉姆斯和威尔金斯。

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