Ethical issues in neurology

Thos I Cochrane MD MBA (Dr. Cochrane of Brigham and Women’s Hospital has no relevant financial relationships to disclose.)
Benjamin D Tolchin MD (Dr. Tolchin of Brigham and Women’s Hospital has no relevant financial relationships to disclose.)
James G Greene MD PhD, editor. (Dr. Greene of Emory University School of Medicine has no relevant financial relationships to disclose.)
Originally released June 7, 2015; expires June 7, 2018

This article includes discussion of ethical issues in neurology, neuroethics, and neurologic ethics. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Ethical issues in neurology (neuroethics) is a rapidly expanding field of medical ethics involving the ethical dilemmas commonly faced by neurologists and other clinicians treating patients with neurologic diseases. This field includes difficult questions about whether to initiate or continue life-sustaining therapies for neurologically compromised patients. These questions are complicated because neurologically ill patients are often unable to decide for themselves and because the prognosis for recovery is often uncertain. This article includes frameworks for approaching these difficult questions.

Key points

 

• Ethical issues in neurology can be analyzed using a framework of 4 principles: autonomy, beneficence, nonmaleficence, and justice.

 

• Informed consent requires that a patient (or her surrogate) not only consent to treatment, but also have decision-making capacity, be provided the relevant information, and demonstrate understanding of the decision.

 

• To have capacity to make a decision, a patient (or her surrogate) must be able to 1) appreciate her current situation, 2) understand the treatment options and their expected outcomes, 3) reason about treatment options, and 4) communicate a choice.

 

• When a patient does not have capacity to make medical decisions, healthcare surrogates or clinicians may assist in making medical decisions using the standards of substituted judgment or best interests.

 

Brain death is a state of irreversible loss of all clinical functions of the brain and is recognized in all 50 states as legally equivalent to death determined by other means, after which there is no legal obligation to continue interventions to sustain respiration or circulation.

 

• Vital organs can only be procured from patients who meet brain death criteria or from patients who meet criteria for donation after cardiac death.

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