Introduction: Neuropsychiatric manifestations of central nervous system tumors are common. Although tumor removal can resolve this symptomatology, offering treatment may be impossible when there’s lack of insight, such as when psychotic symptoms are present.
Objectives: To develop an ethical reflexion about a clinical case. 
Methods : Review of the clinical case and literature. 
Results : A 40-year-old female with no previous psychiatric history was taken to the emergency department due to psychomotor agitation. In the initial evaluation, persecutory delusions and 2 previous episodes  of seizures were detected. CT-scan revealed an expansive bilateral frontal lesion suggestive of meningioma, confirmed in MRI. Psychotic symptomatology responded inconspicuously to risperidone. Due to lesion characteristics and the chronological relationship with psychotic symptoms, surgery was proposed, which she refused as part of her persecutory delusion, denying the tumor presence. Due to the absence of insight for the disease or need of treatment, and following the beneficence principle, surgery was pondered. The ethics committee was consulted, as the autonomy principle was compromised since psychotic symptoms distorted the apreciation of the disease and the autonomy of thought when making her decisions. Due to increasing psychotic symptoms and agitation, compulsive admission on a psychiatric ward was considered prior to the surgery. When informed of this hypothesis, the patient agreed to the neurosurgical treatment. 
Conclusions : Although the dilemma was spontaneously solved, it’s worthwile to review this case and the ethical principles within in the light of the relevance to the clinical practice.

MENINGIOMA RELATED PSYCHOSIS - AN ETHICAL REFLECTION ON THERAPEUTIC DECISION