Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2019 May;125:e336-e340. doi: 10.1016/j.wneu.2019.01.074. Epub 2019 Jan 26.
Neurosurgical interventions frequently occur in an emergency setting. In this setting, patients often have impaired consciousness and are unable to directly express their values and wishes regarding their treatment. The limited time available for clinical decision making has great ethical implications, as the informed consent procedure may become compromised. The ethical situation may be further challenged by different views between the patient, family members, and the neurosurgeon; the presence of advance directives; the use of an innovative procedure; or if the procedure is part of a research project. This moral opinion piece presents the implications of time constraints and a lack of patient capacity for autonomous decision making in emergency neurosurgical situations. Potential solutions to these challenges are presented that may help to improve ethical patient management in emergency settings. Emergency neurosurgery challenges the respect of autonomy of the patient. The outcome in most scenarios will rely on the neurosurgeon acting in a professional way to manage each unique situation in an ethically sound manner.
神经外科干预经常在紧急情况下进行。在这种情况下，患者通常意识受损，无法直接表达他们对治疗的价值观和意愿。由于知情同意程序可能受到影响，临床决策的可用时间非常有限，这具有重大的伦理意义。患者、家属和神经外科医生之间的不同观点、预先指示的存在、创新程序的使用，或者如果该程序是研究项目的一部分，都会进一步挑战伦理状况。这篇道德观点文章阐述了紧急神经外科情况下时间限制和患者自主决策能力不足对患者的影响。提出了一些潜在的解决方案，可能有助于改善紧急情况下的伦理患者管理。紧急神经外科手术挑战了对患者自主权的尊重。在大多数情况下，结果将取决于神经外科医生以专业的方式以合乎道德的方式处理每个独特的情况。
