, Volume 6, Issue 1, pp 115–128 | Cite as

Involuntary & Voluntary Invasive Brain Surgery: Ethical Issues Related to Acquired Aggressiveness

Original Paper


Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents a rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour.


Acquired aggressiveness Cognitive impairment Decision-making capacity Frontal lobe surgery Involuntary treatment Personality changes 



Thanks to Eliza Goddard and Susan Dodds. Thanks to the anonymous reviewers for their helpful comments and suggestions. This research was funded by the Australian Centre of Excellence for Electromaterials Science (ACES). CE0561616.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Ethics & Bionics/Nanomedicine, Australian Centre of Excellence for Electromaterials Science (ACES)University of TasmaniaTasmaniaAustralia
  2. 2.Department of NeurosurgeryUniversity Medical Centre LjubljanaLjubljanaSlovenia
  3. 3.Institute for Biomedical EthicsGeneva 4Switzerland

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