In England in 1980 lawyer Larry Gostin called for psychosurgery to be subject to "the strictest legal and ethical scrutiny". He identified a number of problems with the newer forms of psychosurgery: the lack of any reliable theoretical position relating to psychosurgery, with different forms of surgery used in similar cases, and similar surgery used for a wide range of psychiatric conditions; the absence of controlled trials; the difficulty in assessing changes in character caused by the surgery; and the irreversible nature of surgery on brain tissue that appeared to be structurally normal. In spite of these ethical concerns, he noted, there had never been in the UK any "guidelines, controls, regulations or monitoring arrangements relating to its use". Gostin argued that psychosurgery should only be given with the consent of the patient and approval of an independent body comprising a multi-disciplinary legal and lay element. His proposals were largely incorporated into the Mental Health Act 1983, and led to a significant fall in the use of psychosurgery in England and Wales.
