When Time Is Critical, Is Informed Consent Less So? A Discussion of Patient Autonomy in Emergency Neurosurgery
When Time Is Critical, Is Informed Consent Less So? A Discussion of Patient Autonomy in Emergency Neurosurgery
复制标题
DOI：
10.1016/j.wneu.2019.01.074
复制
发表时间：
2019-05-01
影响因子：
2
通讯作者：
Broekman, Marike L. D.
中科院分区：
文献类型：
--
作者：
Muskens, Ivo S.;Gupta, Saksham;Broekman, Marike L. D.
神经外科干预经常发生在紧急情况下。在这种情况下，患者往往意识受损，无法直接表达他们对治疗的价值观和愿望。有限的时间用于临床决策有很大的伦理影响，因为知情同意程序可能会受到损害。患者、家属和神经外科医生之间的不同观点可能会进一步挑战伦理状况；预先指示的存在；创新程序的使用；或者这个过程是研究项目的一部分。这篇道德观点文章提出了在紧急神经外科情况下，时间限制和患者自主决策能力缺乏的影响。提出了应对这些挑战的潜在解决方案，这些解决方案可能有助于在紧急情况下改善合乎道德的患者管理。急诊神经外科挑战了对病人自主权的尊重。在大多数情况下，结果将依赖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。
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.