Severe Psychopathy May Deserve Special Consideration

The authors identify as a limit to the neurosurgical treatment (actually, neurophysiological treatment) of psychopaths two points: 1) the lack of a real medical benefit of neurophysiological treatments for these individuals; 2) the inability to provide a valid informed consent. The above considerations may hold only if one considers the benefit to the individual and not the gain for the whole social environment in which these persons live. Psychopaths, specifically because they are unable to act otherwise when not controlled, tend to enact persistent behaviors that are detrimental or harmful to others, causing serious crimes and inflicting a heavy burden of pain to other persons (the social environment). Their free will, when examined from this perspective, is virtually absent, which forces us to deeply reconsider the concept of retribution, as well as the hierarchy of values to consider when examining treatment possibilities. In the case of psychopaths, it is also doubtful that it is possible to apply a shared ethic, since the absence of empathy and reciprocity in this population does not give them any real chance to share a common moral universe with non-psychopathic individuals. Furthermore, a large amount of neuroanatomical and functional data indicates a different brain development and organization in this patient population. The issue that we wish to bring up is that, in this specific case, social considerations should have an equal rank as those of a personal nature. A second aspect must be taken into account: the reasons proposed by the Authors to claim the lack of ethical appropriateness for the neurophysiological treatments, would also apply to pharmacological treatments as well