For patients suffering from epilepsy that does not respond to medication, temporal lobe resection is the most commonly utilized treatment alternative. In temporal lobectomies, surgeons remove either part or all of the temporal lobe that has been shown through depth electrodes to be the source of the patient’s debilitating seizures.

Temporal lobe resection is problematic within a utilitarian framework. While WebMD reports that temporal lobe resection successfully reduces seizure symptoms in 60-90% of patients, what can one make of the cases where the surgery is unsuccessful?[1] One may argue that for these particular patients who experience only the losses associated with the treatment, the surgery was not only unsuccessful but also unethical. Essentially, for the 30-40% of patients who do not see any improvement to their seizure activity, the procedure only results in the discomforts of recovery and potentially long-term harms of the surgery. A simple utilitarian evaluation of the outcome of surgery for these individuals would deem the procedure ethically impermissible. Due to the statistical problems that arise within a utilitarian framework, I will instead attempt to evaluate temporal lobe resection to determine its ethical qualities categorically. I will do so on the basis of maintaining the integrity of the patient’s personality, identity and autonomy.

To be sure, temporal lobectomy would not be such a widely used procedure if it were entirely devoid of benefits. In fact, it is essential to recognize that the brain areas that are partially or wholly removed in this procedure are diseased in the status quo. As a result, removing these malfunctioning portions of the brain often results in a higher quality of  life. For instance, one study by Dr. Daniel Drane of the American Epilepsy Society finds, “Working memory improved after anterior temporal lobe resection, particularly following left-sided resections” (Drane, 2014).[2] Since working memory determines much of one’s moment-to-moment functioning, improved WM may do much to enhance individual autonomy.

However, the primary ethical concern with any neurological surgery pertains to its effects on an individual’s identity. Thomas Fuchs of the University of Heidelberg notes, “technical interventions in the brain raise particular concerns regarding the identity, agency and inviolability of the person” (Fuchs, 2006).[3] The brain constitutes and creates personality and other aspects of personal identity in complex and poorly understood ways. Thus, any type of neural surgery that affects the structural composition of the brain and its intricate web of synaptic connections has the potential to disrupt identity. In fact, deep brain stimulation, a surgical therapy for Parkinson’s disease has been shown to cause personality and mood abnormalities.[4][5] One particular study published in the Journal of Neurology, Neurosurgery and Psychiatry reports the “appearance of personality disorders” in patients treated with DBS (Houeto, 2002).[6] Another related study reported in Neurology focuses more on the impacts of this form of neurosurgery to mood. The study, conducted at McGill University, finds, “In six patients (25%), mood state worsened significantly, and three were transiently suicidal despite clear motor improvement. Caregivers and patients should be educated about [this] potential impact”(Berney, 2002).[7] More relevantly, temporal lobe resection has been shown to result in behavioral abnormalities such as hypersexuality (Baird, 2002).[8]

In observing the deleterious effects of DBS and temporal lobe resections, it becomes clear that brain surgery can have significant effects on an individual’s mood, personality and identity. Considering that neural resection affects the brain much more substantially and permanently than DBS, the potential for harm to patients’ identity becomes self-evident. If we are to treat the individual with dignity, we must recognize that preserving personal identity is an end within itself. We must respect the moral integrity of personhood and attempt to avoid any circumstance that might detract from the individual’s sense of self. We must not presume that the presence of illness precludes someone from this basic moral protection.

Also of concern is that much remains unknown about the brain. Given that the temporal lobe is associated with the integral functions of sensation, perception and memory, the temporal lobe can clearly be understood as a vital segment of an individual’s identity framework. However, the mechanisms by which the temporal lobe creates and modifies identity are yet to be fully elucidated. In discussing the development and application of surgical innovations, a review in Seizure magazine observes, “Clinicians must therefore weigh deficiencies in knowledge against the limited evidence supporting the utility of [certain innovations] and make ethical decisions for the treatment of individual patients” (Ibrahim, 2012).[9] Certainly, the known harms of temporal lobectomies and related innovations must be carefully considered and balanced in light of the limited knowledge and understanding of the potential benefits. In this way, uncertainty mediates the ethical conversation to suggest a more conservative approach to these types of neurological interventions.

 

[1] Temporal Lobe Resection Surgery: Risks, Recovery, What to Expect. (n.d.). Retrieved February 27, 2016, from http://www.webmd.com/epilepsy/guide/temporal-lobe-resection

[2]  Drane, D. L. (2015). Understanding Working Memory Recovery Following Anterior Temporal Lobe Resection. Epilepsy Currents, 15(1), 17-19.

[3]  Fuchs, T. (2006). Ethical issues in neuroscience. Current Opinion in Psychiatry, 19(6), 600-607.

[4] Houeto, J. L. (2002). Behavioural disorders, Parkinson’s disease and subthalamic stimulation. Journal of Neurology, Neurosurgery & Psychiatry, 72(6), 701-707.

[5]  Berney, A., Vingerhoets, F., Perrin, A., Guex, P., Villemure, J., Burkhard, P. R., . . . Ghika, J. (2002). Effect on mood of subthalamic DBS for Parkinson’s disease A consecutive series of 24 patients. Neurology, 59(9), 1427-1429.

[6] Ibid 4.

[7] Ibid 5.

[8]  Baird, A. D., Wilson, S. J., Bladin, P. F., Saling, M. M., & Reutens, D. C. (2002). Hypersexuality after Temporal Lobe Resection. Epilepsy & Behavior, 3(2), 173-181.

[9]  Ibrahim, G. M., Fallah, A., Snead, O. C., Drake, J. M., Rutka, J. T., & Bernstein, M. (2012). The use of high frequency oscillations to guide neocortical resections in children with medically-intractable epilepsy: How do we ethically apply surgical innovations to patient care? Seizure, 21(10), 743-747.