Wheeler Natalie C, Murali Sadhana, Sattin Justin A
Department of Neurology, University of Wisconsin, Madison, Wisconsin.
Semin Neurol. 2018 Oct;38(5):515-521. doi: 10.1055/s-0038-1667383. Epub 2018 Oct 15.
There are ethical aspects to each of the three phases of cerebrovascular disease: hyperacute management, acute prognostication and management of early complications, and long-term recovery and reintegration with the community. This article addresses ethical concerns pertinent to each phase. First, we discuss ethical issues regarding consent for thrombolysis and endovascular treatment for acute ischemic stroke, including a review of considerations regarding the provision of acute stroke treatment advice over the telephone. Next, we discuss capacity for consent and prognostication after ischemic stroke and intracranial hemorrhage, with a focus on the problems of the self-fulfilling prophecy. Finally, we discuss residual disability and patients' return to driving. Consideration of these ethical dimensions of cerebrovascular disease will assist neurologists in caring for patients and families suffering from this complex condition.
超急性期管理、急性预后及早期并发症的处理，以及长期康复和重新融入社区。本文探讨了与每个阶段相关的伦理问题。首先，我们讨论急性缺血性卒中溶栓及血管内治疗的同意相关伦理问题，包括对通过电话提供急性卒中治疗建议的相关考量的综述。其次，我们讨论缺血性卒中和颅内出血后的同意能力及预后，重点关注自我实现预言的问题。最后，我们讨论残留残疾及患者恢复驾驶的问题。对脑血管疾病这些伦理层面的考量将有助于神经科医生照料患有这种复杂疾病的患者及其家庭。
