Limitation of life sustaining therapy in disorders of consciousness: ethics and practice.
| Autor: | Lissak IA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA., Young MJ; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Brain : a journal of neurology [Brain] 2024 Jul 05; Vol. 147 (7), pp. 2274-2288. |
| DOI: | 10.1093/brain/awae060 |
| Abstrakt: | Clinical conversations surrounding the continuation or limitation of life-sustaining therapies (LLST) are both challenging and tragically necessary for patients with disorders of consciousness (DoC) following severe brain injury. Divergent cultural, philosophical and religious perspectives contribute to vast heterogeneity in clinical approaches to LLST-as reflected in regional differences and inter-clinician variability. Here we provide an ethical analysis of factors that inform LLST decisions among patients with DoC. We begin by introducing the clinical and ethical challenge and clarifying the distinction between withdrawing and withholding life-sustaining therapy. We then describe relevant factors that influence LLST decision-making including diagnostic and prognostic uncertainty, perception of pain, defining a 'good' outcome, and the role of clinicians. In concluding sections, we explore global variation in LLST practices as they pertain to patients with DoC and examine the impact of cultural and religious perspectives on approaches to LLST. Understanding and respecting the cultural and religious perspectives of patients and surrogates is essential to protecting patient autonomy and advancing goal-concordant care during critical moments of medical decision-making involving patients with DoC. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Databáze: | MEDLINE |
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