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Neurosurgical procedures are often performed on patients with brain diseases, making them mentally dysfunctional. These patients may be unconscious, and the surgery is emergency and life-saving then. Its execution from a legal point of view is performed with implied consent. Another problem, both ethically and legally, are the conscious patients who, however, has mental limitations and disturbed criticism, are fully conscious and who do not agree to pronounced treatment. Judgment approval is necessary in these cases. A certain dilemma is the implementation of treatment during the consistently emphasized refusal of treatment. It is difficult for physician, especially since he has contact with this patient every day. We present our own experience in the treatment of such patients. We share our comments and observations. We describe cases of patients treated for brain tumors, hydrocephalus and chronic subdural hematomas. We present the daily ethical, legal and organizational aspects of treating such patients. We suggest that empathy and conversation with such patients is of key importance.
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