Document Type : Letter to Editor


1 Center for Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia

2 Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India

3 Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh

4 Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh


The coronavirus disease (COVID-19) pandemic has affected the lives of a million people worldwide and has put healthcare workers, particularly neurosurgeons, under challenging situations.1 The medico-legal facts of the practice of neurosurgeons in COVID-19 prompted us to delve more into the ethical issues surrounding the neurosurgical practice during this pandemic. We would want to focus on the ethical concerns that neurosurgeons faced during COVID-19 and the urgency of neurosurgical procedures compared to other surgery.
Patients that require neurosurgical treatments are a particular group of patients whose diseases are time-sensitive, according to the patients’ optimum care. Unlike most other body cells and tissues, neurons exposed to insults are prone to irreparable damage over time.2 As a result, postponing most neurosurgical operations, especially elective ones, poses a difficult ethical burden.2 The pandemic COVID-19 outbreak had a significant impact on world healthcare, with Europe experiencing its worst. When the pandemic initially broke out, clinics were canceled, and elective procedures were halted. Some research looked at the actual variety of neurosurgical procedures throughout a vast area when the practice was most restricted owing to a COVID-19 through a multicenter survey.3 European Association for Neurosurgical Societies (EANS) introduces suggestions for elective neurosurgery and a neurosurgery triage system.4
A range for patients whose quality of life and impairment are in danger should be included in ethical considerations. In such circumstances, delaying neurosurgical intervention worsens the patient’s long-term outcome. Using functionality rather than selectivity to prioritize neurosurgical procedures during the COVID-19 pandemic is a great-proposed technique for selectingand prioritizing non-elective patients.5 To prevent any ethical concerns in urgent cases in all neurosurgery subspecialties should only be triaged and intervened.6 It is recommended that neurosurgical teams remark firsthand on the legal implications of their triaging policies. In this case, the neurosurgeon must explicitly articulate why they believe the patient requires emergency surgery under the accountability for reasonableness approach. In all challenging aspects, their decision-making process must be transparent. The pandemic will almost certainly have a long-term impact on health care. Therefore, neurosurgeons must devise a strategy for dealing with this and other global health crises that may happen in the future. Even in the face of fear and uncertainty, we should all adhere to the fundamental principles of probity in decision-making and ethical behavior.7