Calum MacKellar: Complex world of medicine

The 2010 Edinburgh Film Festival on Medical Ethics takes place from November 26-28. This year the fesitval's focus is on psychiatry ethics.

The festival is concentrating on psychiatric neurosurgery, that is, brain surgery to correct psychiatric disorders. To some, it may seem like science fiction or a holdover from a less enlightened era. However, neurosurgery has made a resurgence in Scotland today. Indeed, the Dundee Advanced Interventions Service at Ninewells Hospital, specialises in neurosurgery for mental disorders.

Compared with other surgical procedures, psychiatric neurosurgery is rare. As Professor Keith Matthews of the University of Dundee explains: "Neurosurgical treatment is offered to a small number of patients severely disabled by an otherwise intractable mental disorder." These disorders are generally limited to chronic depression and obsessive- compulsive disorder.

The practice of psychiatric neurosurgery is implemented within the parameters of clear guidelines. In spite of these, it generates significant controversy. Many are concerned that the practice is under-explored and too risky for a non-life-threatening disease. Others argue that patients whose quality of life is severely diminished have the right to attempt every treatment possible. The uncertainty of the surgery's effectiveness leaves the quandary of how to establish effectiveness without experimentation? The complexity only deepens when considering the cases of vulnerable patients who cannot consent.

It is evident that psychiatric neurosurgery raises a mountain of ethical quandaries. It is vital that Scottish society is aware of these issues and them. The 2010 Film Festival on Psychiatry Ethics aims to aid in both regards by offering challenging films and engaging discussion.

Dr Calum MacKellar is director of research at the Scottish Council on Human Bioethics