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Background: The development of artificial intelligence (AI) raises ethical concerns about its side effects on the attitudes and behaviors of clinicians and medical practitioners. The authors aim to understand the medical ethics of AI-based chatbots and to suggest coping strategies for an emerging landscape of increased access and potential ambiguity using AI., Methods: This study examines the medical ethics of AI-based chatbots (Chat generative pretrained transformer [GPT], Bing Chat, and Google's Bard) using multiple-choice questions. ChatGPT and Bard correctly answered all questions (5/5), while Bing Chat correctly answered only 3 of 5 questions. ChatGPT explained answers simply. Bing Chat explained answers with references, and Bard provided additional explanations with details., Results: AI has the potential to revolutionize medical fields by improving diagnosis accuracy, surgical planning, and treatment outcomes. By analyzing large amounts of data, AI can identify patterns and make predictions, aiding neurosurgeons in making informed decisions for increased patient wellbeing. As AI usage increases, the number of cases involving AI-entrusted judgments will rise, leading to the gradual emergence of ethical issues across interdisciplinary fields. The medical field will be no exception., Conclusions: This study suggests the need for safety measures to regulate medical ethics in the context of advancing AI. A system should be developed to verify and predict pertinent issues., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Dr. William Beecher Scoville, an eminent American neurosurgeon of the 1940s, offered to treat Mr Molaison for his intractable epilepsy. During the operation, he removed large portions of both of Mr. Molaison's temporal lobes. Such an operation had never been performed earlier as the function of these parts of the brain was not clearly understood and neurosurgeons such as Dr. Wilder Penfield of Canada feared they could cause grave damage to the patient. Mr. Molaison developed severe loss of memory to the extent that a few minutes after meeting someone, he had no recollection of the meeting and he could not find his way to his own home. Mr. Dittrich, grandson of Dr. Scoville, has analysed the operation on Mr. Molaison's brain against the background of neurosurgery in the 1940s. This essay discusses the ethical aspects of Dr. Scoville's operation in the light of current understanding and practice.

Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child's condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents' religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future.

Bioethics is a new discipline which developed as modern medical and scientific breakthroughs surpassed the ability of traditional medical ethics to contend with unique ethical dilemmas. It evolved into an interdisciplinary discourse regarding the ethical and societal implications of medicine and the biomedical sciences. Wilder Penfield (1891-1976), celebrated neurosurgeon and neuroscientist, is rarely thought of as a "bioethicist," and his mention in texts on the history of bioethics is little more than a footnote. However, he appears to have contributed to the field of bioethics in a number of ways: through his solutions to the ethical problems posed by the unique form of surgery he developed; through his recognition of the limitations of traditional medical ethics; through his involvement of the public and other disciplines in ethical discussions; and through the impact that his work still has today in the area of bioethics termed "neuroethics."

Background: Although the randomized controlled trial (RCT) is a major methodological breakthrough extending the limits of objectivity in clinical medical science, clinical trials of surgery have seldom included placebo surgery as a control, for ethical reasons. Especially in clinical studies intended eventually to establish a new intervention for developmental conditions, it has been recognized that there is huge examiner bias. In addition, the many miraculous cases that have been reported in nonsurgical open trials for developmental conditions and have eventually been evaluated as nonspecific positive outcomes in RCTs suggest that empirically promising interventions must be subjected to scientific scrutiny as soon as possible in the field of developmental conditions., Application to Pediatric Neurosurgery: Therefore, in childhood neurosurgery, clinical studies to establish a new therapeutic measure for developmental conditions should be designed as rigorously as possible using optimized scientific methods. The worldwide ethical guideline, the Declaration of Helsinki issued by the World Medical Association, can provide principles for the establishment of a new intervention in the treatment of a patient when proven therapeutic methods do not exist or methods used thus far have been ineffective. Physicians' discretion to use unproven or new therapeutic measures for such patients is approved in the presence of efforts of an ethical and scientific approach. Even if the measure is a very promising intervention, the research aspects must completely be demonstrated for informed consent and review by the ethical committee and the trial must be regarded as a clinical research. Especially when an RCT is not possible for ethical reasons, appropriate epidemiological data or animal experiments should suggest that the new measure is effective before a clinical trial. In a clinical setting, where neither epidemiological studies nor animal experimentation can be introduced, if necessary the researcher should collaborate with experts to obtain multidisciplinary justification for clinical testing.