**15. Conclusion**

*Neuroethics in Principle and Praxis - Conceptual Foundations*

Professional decision-making cannot be overemphasized in medicine in general and neurosurgery in particular. The medical professional should be able to balance the principles of values-based medicine within the roles of the governing organization and hospital. This balance is very important to avoid conflicts of patient's

The most critical step in patient management is the decision made by the treating team. The correct decision for a particular patient at the right time is the most determinative factor for the outcome of management. Medical decisionmaking depends on empirical knowledge and rational and analytical thinking. Evidence-based medicine depends on knowledge and accumulated information over rational thinking and individual experiences and to a certain extent ignores the patient's own values. In brief, there are in general two ways of logical thinking in order to make medical decisions, deductive and inductive methods. However, the rapid development of science, discoveries, medical technology, understanding the roots of pathophysiological disorders, and introduction of new treatments should allow for a less tightly constructed and rigid clinical decision. With uncertainty, the increased probability of causing risk, unsure outcome, and treatment of specific problems in a field like neurosurgery, the patient's autonomy and values should be paramount. The concept of values-based medicine which focuses on patient's best care allows more flexibility to adapt any scientific method which may help the patient. Patient and patient values should be part of

The patient's family rights should be observed. The engagement of the patient and patient's family in making decisions created what is called "Patient-patient's family-doctor complex relationship." Such relationship is needed not only for the patient's comfort and well-being but also for the treating team to prevent any

The nature and pathophysiology of variable types of neurosurgical disorders may not help the neurosurgeons to ascertain an accurate predication of the prognostic outcome for a specific patient. Sometimes predictable answers can be hard to attain. This unfortunately is not rare which complicates the discussion, communication, and the relationship between a medical team and the patient and patient's family. Agonized and apprehensive extremely worried families are eager to hear answers to their painful questions. It is vital to reach the right diagnosis. Right diagnosis is always the fundamental base for management of the patient, however, in pediatric group may not give an accurate predication for long outcome. Usually the families regardless of their age, culture, religion, or race have many very similar nagging and worrying questions regarding the survival and well-being of their

Effective communication with patients and their families to discuss every step of the management and the prognostic information to the family is very important to create a good relationship and trust between the treating teams and patients and patients' families. The effective communication has profound influence on decisions regarding goals of care and clinical management of the patient, especially when prognostic information is clouded with a confusion of

**14. Ascertain the immediate outcome and long-term prognosis**

**13. Decision-making**

values or hospital policies.

any management equation.

misconduct and future unnecessary troubles.

**70**

loved one.

uncertainties [18].

Modern medicine may be based on EBM, which is a positive aspect of modern medicine; however, medicine since its inception, thousands of years ago, is based on values. The core of values-based medicine (VsBM) is creating a status to provide the patients the best possible available treatment within a frame of ethics and values which appreciate their culture and keep their dignity. Evidence-based medicine is, and should be, based on ethical and clinical principles which permit the best proven method of management. Values-based medicine and evidence-based medicine are and should be integrated, complementary to each other, not conflicting. The holistic approach to a human who has a disease needs to be treated, not just the disease should be treated. Humanity comes first, always.
