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End-of-Life Care

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Neurosurgical Ethics in Practice: Value-based Medicine

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Abstract

Ethical challenges at the end of life (EOL) affect a large number of hospitalized patients, and neurosurgical cases may be overrepresented due to the nature of our patients. EOL decisions can take many forms: (1) a decision to not perform an intervention for a patient who is terminally ill or has a grave prognosis; (2) a decision to limit the escalation or addition of certain life-sustaining treatments (also known as withholding life-sustaining treatments (WHLS)); (3) a decision to stop certain life-sustaining treatments (also known as withdrawing life-sustaining treatments (WDLS)); (4) a decision to actively assist or cause the death of the patient (also known as active euthanasia or physician-assisted death (PAD), which is illegal in most countries); and (5) a decision to continue to offer all available treatments with no limitations until the point of death.

In this chapter, these thorny issues are discussed in the context of the four bioethics principles. This topic is so important because it potentially affects every single patient, so two commentators were invited to supply chapters on this subject (the other is Chap. 9).

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Author information

Authors and Affiliations

  1. Division of Respirology/Critical Care, Toronto General Hospital, 200 Elizabeth Street 9N-926, Toronto, ON, M5G 2C4, Canada

    James Downar MD, MHSc, FRCPC

  2. Divisions of Critical Care and Palliative Care, University of Toronto, 200 Elizabeth Street 9N-926, Toronto, ON, M5G 2C4, Canada

    James Downar MD, MHSc, FRCPC

  3. Division of Neurosugery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    Mark Bernstein MD, MHSc, FRCSC

Authors
  1. James Downar MD, MHSc, FRCPC
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  2. Mark Bernstein MD, MHSc, FRCSC
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Corresponding author

Correspondence to James Downar MD, MHSc, FRCPC .

Editor information

Editors and Affiliations

  1. Dept. of Neurosurgery, King Fahd University Hospital, Dammam University, Al Khobar, Saudi Arabia

    Ahmed Ammar

  2. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada

    Mark Bernstein

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© 2014 Springer-Verlag Berlin Heidelberg

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Downar, J., Bernstein, M. (2014). End-of-Life Care. In: Ammar, A., Bernstein, M. (eds) Neurosurgical Ethics in Practice: Value-based Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54980-9_8

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  • DOI: https://doi.org/10.1007/978-3-642-54980-9_8

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54979-3

  • Online ISBN: 978-3-642-54980-9

  • eBook Packages: MedicineMedicine (R0)

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