Values-based Medicine: Ethical Issues in Hydrocephalus

Abstract

Modern medicine is based on what is known “evidence-based medicine.” The term value-based medicine (VBM) may be newly introduced in recent medical literature (Neurosurgical ethics in practice: value based medicine, Springer, New York, 2014). However, the concept of value-based medicine is as old as medicine practiced in any form anywhere. Since the early history, those who took the responsibility to help to relieve pain and deal with different health problems were highly respected and either connected to temples or religious institutes or the governor’s palaces or philosophers or scholars. They always observed values of their societies in addition to the cultures and traditions of the patients they have to deal with. Management of hydrocephalus, the decision making, and dealing with the patients and their parents may illustrate the true meaning and highlight the concept of “value-based medicine.” Hydrocephalus could be a unique illustrative sample of how bioethics (values) are deeply engaged in any decision making in every step of the progress in managing the disease from intrauterine diagnosis to follow-ups and long-term outcome.

The scopes of managing hydrocephalus include:

• 1. The patient, who in most cases cannot express his autonomy right, cannot choose the best method of treatment, and sometimes cannot even choose the right to survive.

• 2. The family specially the mother has the absolute right to deal with her fetus. However, the question has been raised: Does the fetus have rights too? I believe so!

• 3. The parents’s participation in making decisions for their baby after birth.

• 4. The society and its social and economic status including education and continuous health care.

• 5. Choosing the type of shunt or type of endoscope.

• 6. The treating medical team, which could not be consistent for some patient as the majority of neurosurgeons consider shunt as a simple operation and should be left for young trainees to perform.

The true consequences of wrong insertion of the shunts have not been properly studied. Usually, patients are treated by different treating teams. As the child grows (from fetus-to-neonate; infant-to-child; adolescence-to-adult) and the disease progresses, the new treating team has limited to no full knowledge or awareness on the management and plansof the previous treating team.