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South African legal and ethical guidelines direct health-care professionals to perform their duties in a manner that is acceptable within society. In South Africa, there is no minimum defined training or accreditation required to perform intraoperative neuromonitoring (IONM) nor is registration with the Health Professionals Council of South Africa (HPCSA) a prerequisite. It is therefore important to explore the ethical and legal aspects of this practice, particularly, since patients undergoing IONM are often vulnerable and need extra protection. We argue that the development of national guidelines sanctioned by a society or association with oversight from the HPCSA should be developed. In addition, independent providers of IONM should be governed as "health-care professionals" accountable to the HPCSA. This would ensure that the practice of IONM is better aligned with the ethical principles accepted by society.

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