Ethico — Legal aspects of high risk neurosurgery

Conclusions

The greatest impediment to Courts understanding the realities of high risk Neurosurgery lies in the advice of neurosurgical experts who themselves are prepared to overlook those realities in support of a Plaintiff's case in an adversarial legal system. If such advice is taken to extremes, and Judges are unable to consider reality rather than perfection in formulating judgements, Neurosurgeons may be inhibited from performing some operations for which there are clear indications. Neurosurgeons in some Western Countries carry very high indemnity insurance, which follows from the high risk nature of Neurosurgery, patient's expectations, and, to some extent, from the activities of Lawyers. However if all parties behaved reasonably, developments could continue which will in time lead to the “high risk’ to today becoming the normal or low risk of tomorrow. Furthermore, given responsible behaviour by those who seek and who administer the Law, the Law could prove overall to be of benefit to the practice of Neurosurgery.

Within the practice and organisation of Neurosurgery, it is the tradition of the Prima Donna which does most harm. The Prima Donna may find it very difficult to accept the “lesser” Donna for reasons which may be complex, and include personality, pride and financial gain. Such a situation may hinder the development of skills in high risk Neurosurgery. The solution lies in the design of training programmes and the appropriate delegation under supervision of Neurosurgery, which in the past was considered to be the province of the blessed, but really blinkered, few.