Treatment Decisions for a Future Self: Ethical Obligations to Guide Truly Informed Choices

Treatment Decisions for a Future Self: Ethical Obligations to Guide Truly Informed Choices
Viewpoint
Claire J. Creutzfeldt, Robert G. Holloway
JAMA, 2 January 2020; 323(2) pp 115-116
Excerpt
It is estimated that every 3 minutes in the United States, a person dies after sustaining a severe acute brain injury, such as an ischemic stroke, intracranial hemorrhage, traumatic brain injury, or cardiac arrest.1 Almost half of deaths after severe acute brain injury, 100 000 per year, occur during the acute hospitalization, and approximately 90% of patients die after a decision to limit the intensity of treatment rather than from the direct effects of the brain injury.1,2

The decision to continue or withdraw life-sustaining treatment usually involves asking a surrogate decision maker to balance the uncertain possibility that a patient will return to some minimally acceptable quality of life against the burden of a prolonged hospital and rehabilitation course, which are options that are difficult to predict and difficult to fathom…

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